Clinical Resources
Assessments
PHQ-9 - Patient Health Questionnaire, screens for Depression
PCL-5 - PTSD assessment
COVID Tx - Self-Assessment for Covid
C-SSRS - Columbia Suicide Severity Rating Scale - SI assessment
AUDIT - Alcohol Use Disorders Identification Test
ASSIST - Alcohol, Smoking, and Substance Involvement Screening Test
CRAFFT - substance use screening tool for adolescents aged 12-21
Must Review w Client
Psychotropic medication guide (currently being edited - google doc)
Modalities
EMDR (Eye Movement Desensitization Reprocessing)
CBT (Cognitive Behavioral Therapy)
Tf-CBT (Trauma Focused CBT for children and adolescents)
CBT-ED (CBT for Eating Disorders)
Insight-Oriented (analyze and understand events in our lives)
Gestalt (individual awareness, freedom and self-direction)
IFS (Internal Family Systems, “parts of ourselves”)
ACT (Acceptance and Commitment Therapy)
DBT (Dialectical Behavioral Therapy)
AEDP (Accelerated Experiential-Dynamic Psychotherapy)
MI (harm-reduction)
Somatic Mindfulness (Mind/Body Treatment for PTSD)
Play Therapy (Directive / Non-Directive)
IPP (Infant-Parent Psychotherapy)
Medical Model Framework vs Environmental/Feminist Theory approach
Training Resources
The articles below are recommended reading resources on dedicated topics:
Termination
Best Practices
HERE is an article from GoodTherapy.org with some helpful guidance on how best to terminate work with a client
How To Terminate a Client (Therapy Notes, and other files)
If you terminate with a client, you must complete a Termination Note.
If a client doesn’t respond to outreach and an initial session hasn’t been completed, document that you notified the client of case closure and how to reach out again if they are interested in a contact note. No termination note is necessary as clinical work was not initiated.
Safety Planning
Complaints
How to handle Client Complaints
1) It is of great importance of check-in with clients on how things are going, especially if something is off
2) clients should know who your supervisor is – please clearly communicate it.
3) clients can reach out to Executive Director (Sarah Strole) with complaints. However, preference is always for clients to talk with therapist about issues.
Ethical complaints: Executive Director (Sarah Strole) will address (NASW Code of Ethics)
Therapist Satisfaction:
-Clinician should open up this conversation and invite feedback. talk about how to do this
Treatment Planning
Templates / Resources CONTENT HERE
Giving and Receiving Gifts
Droste policy is that therapists should not give client gifts. If there is a unique circumstance with a client where you believe it is in the best interest of the client and the clinical work to give a gift, discuss the situation with your supervisor and the Executive Director.
Droste also recommends that therapists do not accept gifts. This is because giving and receiving gifts can complicate the professional boundaries we are required to uphold by the Code of Ethics. That being said, there are times when accepting a gift from a client is warranted. Droste’s policy, if you do accept a gift from a client, is that the gift should not have significant financial value (think anything over $20) and there should always be a discussion about the gift with the client reiterating professional boundaries.
When you are making your ethical judgment call around deciding if you are going to accept a gift from a client, HERE is a framework to utilize as well as an additional discussion of ethical decision making HERE. Focus on the potential benefits and risks, ask yourself if accepting the gift is inline with our beneficent responsibility, and consider if there could be any harm in accepting the gift. Bottom line: Ask yourself, who benefits?
NASW Code of Ethics
CEUs
HERE is a site where people can sign up Earn CE Certificates for Viewing Live or Recorded edWebinars.
Adolescent Client Games
Adolescent Client GAMES
HANGMAN: https://www.hangmanwords.com/create
Would You Rather: https://www.youtube.com/watch?v=_8OkE0YJi1s
Adolescent Client GAMES
MORE HERE
Best Practices: Articles / Case Studies for Ongoing Considerations for Evaluations & Treatments
Literature Review
Soliman, H.H. (1999). Post-traumatic stress disorder: Treatment outcomes for a Kuwaiti child. International Social Work, 42(2), 163-175. doi: 10.1177/002087289904200205
This is an incredible case study of an 11-yr-old little boy named Hamad with PTSD (caused by war). By using SSD as a research technique, Hamad and his therapist were able to bring him to a reduction of his acute symptoms.
Goal for Hamad: improve social, and behavioral functioning; reduce tension.
Objectives for Hamad:
Reduce stress
Reduce nightmares / improve sleep
Increase social support
Activities engagement to increase self esteem and social skills
Express feelings of fear, guilt, and anxiety
First Treatment Phase / Intervention (B1)
Art therapy for feelings expression
Analytic and Cathartic technique for nightmares. Describing the event and the feelings, then describing dreams — sw helped attach meanings to the parts of the dreams. Dream journal.
Group Counseling: activities group for discussion, games, soccer, and art projects.
Family Involvement: daily discussions and encouraging him to oick movie night and decide where to go on vacation. They monitored his behavior at home. Dad went to school and spoke with teachers. Brother helped with school work.
Phase 2 (A2/B2) Symptoms were assessed again using the same technique as Phase 1: Family Observation & CPTSD-RI … And in the second baseline, A2 intervention was withdrawn for a period of three weeks during which Hamad and his father attended clinic. During this time Hammad continued to meet with group, but no structured activities, just talking about different subjects.
The second intervention phase B2 continued for 4 weeks Hamad received the same interventions as were applied in B1 plus:
The Story-Line Alteration Procedure for treatment of nightmares. This intervention focuses on diffusing the energy of the nightmare by creating new insights; guided visualization techniques.
Effective reduction of symptoms but not elimination.
McNeill, T., & Nicholas, D. B. (2019). Creating and applying knowledge for critical social work practice: Reflections on epistemology, research, and evidence-based practice. Journal of Ethnic & Cultural Diversity in Social Work, 28(4), 351-369.
This article explores 3 distinct areas in order to advance critical practice in social work: 1. the application of critical realism as a complementary epistemology for research and practice with diverse (and oppressed) populations, 2. the way that case-specific knowledge can inform and strengthen critical practice, and 3. what it means to be an advocate and yet still hold space for critical commentary on evidence based practices and where further exploration of gaps of knowledge may be needed.
Ellis, T. E., Rufino, K. A., Allen, J. G., Fowler, J. C., & Jobes, D. A. (2015). Impact of a Suicide-Specific Intervention within Inpatient Psychiatric Care: The Collaborative Assessment and Management of Suicidality. Suicide and Life-Threatening Behavior, 45(5), 556–566. https://doi.org/10.1111/sltb.12151
Studies have demonstrated the effectiveness in reducing suicidality with dialectical behavioral therapy and cognitive behavioral therapy. The Collaborative Assessment and Management of Suicidality (CAMS) is a framework for working with suicidal patients independent of therapeutic orientation, for suicide-specific assessment and treatment of a patient’s suicidal risk. CAMS was also significantly linked to decreases in primary care and emergency department utilization room settings. It is a flexible approach that can be used across theoretical orientations and disciplines for a wide range of suicidal patients across treatment settings and different treatment modalities.
The clinician and patient engage in a highly interactive assessment process and the patient is actively involved in the development of their own treatment plan. Every session of CAMS intentionally utilizes the patient’s input about what is and is not working. All assessment work in CAMS is collaborative; seeking to have the patient be a “co-author” of their own treatment plan.
Feldhaus, C. G., Jacobs, R. H., Watkins, E. R., Peters, A. T., Bessette, K. L., & Langenecker, S. A. (2020). Rumination-Focused Cognitive Behavioral Therapy Decreases Anxiety and Increases Behavioral Activation Among Remitted Adolescents. Journal of Child and Family Studies, 29(7), 1982–1991. https://doi.org/10.1007/s10826-020-01711-7
This study examines whether rumination-focused cognitive behavior therapy (RF-CBT) alleviates symptoms of anxiety, increases behavioral activation, or increases global functioning among adolescents with a history of Major Depressive Disorder (MDD). RF-CBT directly teaches adolescents to recognize rumination or “when you get stuck in your head” and to notice the influence this has on their mood. This psychoeducation component includes noticing personal triggers to ruminate, as well as opportunities to shift/change any situations that tend to increase rumination, to reduce the habit. Adolescents were taught to be Active, Specific, and Kind (ASK) when thinking about oneself, rather than ruminative, which tends to be passive, abstract, and a critical form of thinking.
Adolescents learn about their cycle of emotions and that the habit of rumination gets them stuck at thinking and feeling, which can make it harder to take action and has consequences. At each session, adolescents participated in a mindfulness exercise to show how to use your attention to shift into a different way of being. Mindfulness exercises included three-part breath, the body scan, progressive muscle relaxation, lovingkindness, the wave exercise, and others as appropriate. Another key skill taught is to change “Why?” questions to “How?” questions because abstract “Why?” questions lead to impaired problem solving, greater negative overgeneralization, and greater emotional reactivity.
Group Therapy Case Studies
Literature Review
Ross, L. E., Doctor, F., Dimito, A., Kuehl, D., & Armstrong, M. S. (2007). Can talking about oppression reduce depression? Modified CBT group treatment for LGBT people with depression. Journal of Gay & Lesbian Social Services, 19(1), 1-15.
Research has demonstrated that rates of depression are elevated among lesbian, gay, bisexual and transsexual (LGBT) people as a result of social stigmatization. This study tested a cognitive behavioral therapy-based group intervention for LGBT people living with depression, which was delivered based on anti-oppression principles and included sessions on coming out and internalized homophobia.
Each session reviewed an educational component of the CBT model. In the first session, clients were introduced to the model and taught how thoughts, moods, physical reactions, and behaviors all interact within their environment or within a particular situation to create and maintain symptoms of depression. Group members actively participated in each session by completing the exercises, drawing upon their own lived experiences. Homework was assigned at the end of each session. During sessions, group members reviewed their homework from previous sessions, shared their experiences, gave each other feedback, and furthered their understanding about the relationship between their thoughts and their moods.
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Supervision Evaluation
(what is going well and where are we struggling / challenged?)
Literature Review
Orme J.G. and Combs-Orme, T (2012). Ch2. Problem List
Key facet of assessment (and evaluation) is the ‘problems list’. Collaboratively listing problems can organize and bring clarity around issues that were disorganized and vague before. It’s also useful to have a problems list for monitoring progress. The creation of a Problems List can be valuable for tracking triggers that can lead to problem-behavior. By referencing the list, we can better address with appropriate intervention(s).
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Self Evaluation
List of factors involved, questions to ask, things to consider
Literature Review
McDowell, T (2000) Practice evaluation as a collaborative process: A client's and a clinician's perceptions of helpful and unhelpful moments in a clinical interview. Smith College Studies in Social Work, 70(2), 375-387. DOI: 10.1080/00377310009517598
Process recordings are helpful to the practitioner but tell us nothing about the clients experience. This is a case for client participation in Practitioner evaluation... “clients and clinicians are encouraged to work together to identify problems, form treatment goals, and resolve problems”
This is a study of soliciting the client’s feedback and the dissection and learnings from how that went…. Where the practitioner and client were aligned, and where they were not. It articulates the success of bringing the client into the evaluation process.
Stronger connections were felt by the client when the practitioner showed more of their own humanness and struggle – the collaboration of problem-solving together strengthened the bond in the client/practitioner relationship. Judgments, assumptions and premature conclusions were all markedly unwelcome and unhelpful to the client by their own assessment. Client takes the ‘next steps’ and assigns the meaning they wish and draws the conclusion they wish.
Kinman, G., & Grant, L. (2017). Building resilience in early-career social workers: Evaluating a multi-modal intervention. British Journal of Social Work, 47(7), 1979-1998.
The complexity and emotional demands inherent in social work often come with physical and mental ill health, sickness, absence and attrition, and a range of other negative side effects such as burnout, emotional exhaustion, compassion, fatigue, and secondary trauma.
This article emphasizes the benefits of emotional resilience among social workers. Social work requires strong, coping, adapting, and personal development. The importance of optimism, effective coping skills and self-care has been emphasized. Factors that mediate between the self and the practice include support from supervisors and colleagues, coping and problem-solving skills, effective boundary setting and developmental learning. Reflective ability is also a fundamental aspect of emotional literacy that has been found to underpin successful coping and resilience.
Compassion is essential to effective health and social care. Compassion for the self comprises three elements: self-kindness (feelings of warmth, acceptance and understanding towards the self), common humanity (a recognition that personal suffering and failure is part of the shared human experience) and mindfulness (taking a balanced and nonjudgemental approach to experiencing negative emotions).
Emotional self-efficacy is a key aspect of resilience in social work. Particular benefits were found for emotional self-efficacy, which encompasses the ability to perceive and understand emotion in the self and others, appreciate the complexity of emotions and use emotions to facilitate thought.
Aspects of emotional literacy are a powerful predictor of psychological well-being.
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Assessments for Reflections
Literature Review
Essau, C. A., Olaya, B., Sasagawa, S., Pithia, J., Bray, D., & Ollendick, T. H. (2014). Integrating video-feedback and cognitive preparation, social skills training and behavioral activation in a cognitive behavioral therapy in the treatment of childhood anxiety. Journal of Affective Disorders, 167, 261–267. https://doi.org/10.1016/j.jad.2014.05.056
This is a study that measured the effectiveness of a trans diagnostic prevention program, super skills for life (SSL) and children with anxiety issues. It’s a great resource for measurements available for this population. SSL is based on the principles of CBT, behavioral action, social skills, training, and uses video feedback and cognitive preparation as part of treatment. Results were positive. Anxiety symptoms were significantly reduced. Also had a positive effect on hyperactivity, conduct, and peer problems, although it took longer for these effects to occur.
Several questionnaires were used in the study as measures:
Social skills questionnaire, SSQ measured social skills.
Rosenberg self-esteem scale was used to measure child’s self-esteem.
Child anxiety impact scale CAIS-C was used to measure anxiety related difficulties in school, social and home family domains.
Spence children’s anxiety scale (SCAS 1998) was used to measure symptoms of anxiety disorders, including separation anxiety, social anxiety, obsessive, compulsive, manic panic disorder, specific fear, and generalized anxiety disorder. Likert type scale.
Strengths and difficulties questionnaire (SDQ Goodman, 1997) was used to measure children’s general difficulties and positive attributes, including emotional symptoms Conduct problems, hyperactivity peer problems and prosocial behavior.
Performance questionnaire, (PQC), was used by children to rate their performance, and how they felt during a speech.
Behavioral signs of anxiety scale was used to measure behavioral indicators of anxiety during the speech task.
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How Demographics Influence Client Experiences
Literature Review
Solomon, D. T., Heck, N., Reed, O. M., & Smith, D. W. (2017). Conducting culturally competent intake interviews with LGBTQ youth. Psychology of Sexual Orientation and Gender Diversity, 4(4), 403.
Gender and sexual orientation are complex and salient aspects of youths’ identities and directly impact social, emotional, and behavioral functioning. Therefore, an important part of culturally competent treatment with LGBTQ clients is the comprehensive assessment of any facets of identity that should be incorporated into treatment planning. Because LGBTQ individuals often experience microaggressions early in the treatment process, the intake process presents an opportunity to avoid pitfalls and create a strong therapeutic relationship as the foundation for the rest of treatment. Clinicians should be prepared to assess the relevant strengths and difficulties of all young clients, but must also be aware of specific areas of assessment for LGBTQ clients.
Fung, K., & Lo, T. (2017). An integrative clinical approach to cultural competent psychotherapy. Journal of Contemporary Psychotherapy, 47(2), 65-73.
This article discusses core concepts of cultural competence for psychotherapists to consider… specifically whether Western concepts of mental illness and its interventions are culturally valid or relevant in other societies.
This article critically examines psychotherapy from a cultural competence perspective by: (I) describing a set of core concepts of cultural competence; (II) identifying core components of culturally competent psychotherapy; and (III) proposing a three-tier cultural analysis of psychotherapy. This complements the cultural adaptation of evidence-based therapies providing care to diverse communities.
An understanding of diverse cultures (gay culture, deaf culture, youth culture, disability culture, etc.) can help therapists gain an appreciation of the presenting issues. Cultural Competence can be divided into three interacting levels: Macro = the societal level; Mezzo = the institutional or programmatic level; and Micro = the individual clinical level.
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On Grief
Literature Review
Chua, J. Z. H. R. (2020). Continuing Bonds in Adult Sibling Bereavement (Doctoral dissertation, Alliant International University).
This is a dissertation. Current findings espoused bereaved siblings who had poorer lifespan sibling relationships were more likely to experience higher levels of prolonged grief, while individuals who had stronger lifespan siblingship articulated higher levels of normative grief.
Grief Support Links:
For participants in the United States
1. Compassionate friends
Contact details: https://www.compassionatefriends.org/
2. Grief.com
Contact details: https://grief.com/grief-support-group-directory/
3. National Suicide Prevention Lifeline
Contact details: +1-800-273-TALK (8255) 24 hours
4. National Hopeline Network
Contact details: +1-800) 442-4673
5. Crisis Text Line
Contact details: Text DBSA to 741741 24 hours
Avoiding Grief: Why it doesn’t work. (2018, January 12). Grief In Common. https://www.griefincommon.com/blog/avoiding-grief-why-it-doesnt-work/
Somewhere between avoidance and floundering there could be a place that allows a griever to sit with their grief without being totally and completely swept away by it. !
Overworking, over caring for others, abuse of drugs & or alcohol, traveling and never staying put, isolating and avoiding all triggers… KEY POINT: grief is patient. There is nothing in our lives more patient than grief — it will sit and wait for acknowledgement. Sometimes healing doesn’t begin until YEARS after a loss.