PRAC 66656675 Clinical Skills Self-Assessment FormTi.docxLacieKlineeb
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Tina Cherry
College of Nursing-PMHNP, Walden University
NRNP PRAC 6665C: Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I
Jannia Mendez MSN APRN PMHNP BC
September 4, 2022
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Desired Clinical Skills for
Students to Achieve
Confident (Can
complete
independently)
Mostly
confident (Can
complete with
supervision)
Beginning (Have
performed with
supervision or
needs
supervision to
feel confident)
New (Have
never performed
or does not
apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs
and symptoms of
psychiatric illness across the
lifespan
X
Differentiating between
pathophysiological and
psychopathological
conditions
X
Performing and interpreting
a comprehensive and/or
interval history and physical
examination (including
laboratory and diagnostic
studies)
X
Performing and interpreting
a mental status
examination
X
Performing and interpreting
a psychosocial assessment
and family psychiatric
history
X
Performing and interpreting
a functional assessment
(activities of daily living,
occupational, social, leisure,
educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing
a differential diagnoses list
X
Formulating diagnoses
according to DSM 5-TR
based on assessment data
X
Differentiating between
normal/abnormal age-
related physiological and
psychological
X
symptoms/changes
Pharmacotherapeutic skills in:
Selecting appropriate
evidence based clinical
practice guidelines for
medication plan (e.g.,
risk/benefit, patient
preference, developmental
considerations, financial,
the process of informed
consent, symptom
management)
X
Evaluating patient response
and modify plan as
necessary
X
Documenting (e.g., adverse
reaction, the patient
response, changes to the
plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of
therapeutic modalities
across the lifespan
X
Selecting appropriate
evidence based clinical
practice guidelines for
psychotherapeutic plan
(e.g., risk/benefit, patient
preference, developmental
considerations, financial,
the process of informed
consent, symptom
management, modality
appropriate for situation)
X
Applies age appropriate
psychotherapeutic
counseling techniques with
individuals and/or any
caregivers
X
Develop an age appropriate
individualized plan of care
X
Provide psychoeducation to
individuals and/or any
caregivers
X
Promote health and disease
prevention techniques
Self-assessment skill:
Develop SMART goals for
practicum experiences
X
Evaluating outcomes of
practicum goals and modify
plan as necessary
X
Documenting and reflecting
on learning experiences
X
Professional skills:
Maintains professional
boundaries and therapeutic
relationship with clients and
staff
X
Collaborate with.
PRAC 66656675 Clinical Skills Self-Assessment FormTi.docxLacieKlineeb
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Tina Cherry
College of Nursing-PMHNP, Walden University
NRNP PRAC 6665C: Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I
Jannia Mendez MSN APRN PMHNP BC
September 4, 2022
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Desired Clinical Skills for
Students to Achieve
Confident (Can
complete
independently)
Mostly
confident (Can
complete with
supervision)
Beginning (Have
performed with
supervision or
needs
supervision to
feel confident)
New (Have
never performed
or does not
apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs
and symptoms of
psychiatric illness across the
lifespan
X
Differentiating between
pathophysiological and
psychopathological
conditions
X
Performing and interpreting
a comprehensive and/or
interval history and physical
examination (including
laboratory and diagnostic
studies)
X
Performing and interpreting
a mental status
examination
X
Performing and interpreting
a psychosocial assessment
and family psychiatric
history
X
Performing and interpreting
a functional assessment
(activities of daily living,
occupational, social, leisure,
educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing
a differential diagnoses list
X
Formulating diagnoses
according to DSM 5-TR
based on assessment data
X
Differentiating between
normal/abnormal age-
related physiological and
psychological
X
symptoms/changes
Pharmacotherapeutic skills in:
Selecting appropriate
evidence based clinical
practice guidelines for
medication plan (e.g.,
risk/benefit, patient
preference, developmental
considerations, financial,
the process of informed
consent, symptom
management)
X
Evaluating patient response
and modify plan as
necessary
X
Documenting (e.g., adverse
reaction, the patient
response, changes to the
plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of
therapeutic modalities
across the lifespan
X
Selecting appropriate
evidence based clinical
practice guidelines for
psychotherapeutic plan
(e.g., risk/benefit, patient
preference, developmental
considerations, financial,
the process of informed
consent, symptom
management, modality
appropriate for situation)
X
Applies age appropriate
psychotherapeutic
counseling techniques with
individuals and/or any
caregivers
X
Develop an age appropriate
individualized plan of care
X
Provide psychoeducation to
individuals and/or any
caregivers
X
Promote health and disease
prevention techniques
Self-assessment skill:
Develop SMART goals for
practicum experiences
X
Evaluating outcomes of
practicum goals and modify
plan as necessary
X
Documenting and reflecting
on learning experiences
X
Professional skills:
Maintains professional
boundaries and therapeutic
relationship with clients and
staff
X
Collaborate with.
RXP International Presents an Overview of Prescribing PsychologistsRXP International
This presentation was developed by Dr. Elaine Levine the first prescribing psychologist in New Mexico. In it, she described the Psychobiosocial Model of care which is a holistic model referenced in The Integration of Psychopharmacology and Psychotherapy in PTSD Treatment Biopsychosocial model of care, In E. Carll Ed., Trauma Psychology: Issues in Violence,
Disaster, Health and Illness. It also includes an overview of the requirements and responsibilities of prescribing psychologists in New Mexico.
Case study Psychopharmacologic Approaches to Treatment of PsychopaMaximaSheffield592
Case study Psychopharmacologic Approaches to Treatment of Psychopathology (laureate-media.com)
Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.
To prepare for this Assignment:
· Review this week’s Learning Resources, including the Medication Resources indicated for this week.
· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.
The Assignment: 5 pages
Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
· Which decision did you select?
· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· What were you hoping ...
Client, counselorprescriberCounselors can serve as an impo.docxmccormicknadine86
Client, counselor
prescriber
Counselors can serve as an important link between clients and the medical
professionals who prescribe them antidepressants
R
oughly one in 10 Americans
over the age of 11 takes
.antidepressant medication,
according to data released this past fall
by the Centers for Disease Control and
Prevention. Antidepressants are the
third most common prescription taken
by Americans of all ages and the most
common among Americans ages 18-44.
The rise in popularity of antidepressants
has been meteoric in recent decades.
Since 1988, the rate of antidepressant
use nationwide among all ages increased
almost 400 percent.
These data, collected as part of
the National Health and Nutrition
Examination Surveys between 2005 and
2008, don't surprise Dixie Meyer. In fact,
they further support the message she
tries to share with counselors: You need
to know about the antidepressants your
clients are taking.
Antidepressants, which are prescribed
not just for depression but also for
anxiety disorders, pain disorders, learning
disabilities and more, are the medication
most requested by patients, says Meyer,
an assistant professor in the Department
of Counseling and Family Therapy at
St. Louis University and a member of
the American Counseling Association.
She notes that primary care physicians
prescribe the majority of antidepressants.
"This suggests that a large portion of
our clients on antidepressants sought out
the medication without knowledge of
why individuals need medications, and
in most cases, an expert on psychotropic
medications did not prescribe the
medications," says Meyer, who teaches
psychopharmacology and has been
researching the topic since 2007.
"While counselors are not experts on
antidepressants either, counselors need
By Lynne Shailcross
to understand when their clients may
need to have the medication reassessed
or when the counselor may need to meet
with the medication prescriber."
Elisabeth Bennett, chair of the
Department of Counselor Education
at Gonzaga University, says even
though counselors are not prescribing
the medications, they are in a prime
position to assist clients who are taking
antidepressants. "Medical professionals
see their psychiatric patients an average
of about eight minutes each ... three
to four meetings per year. This is not
enough time to do all the tasks they
must do, let alone to build a relationship
[with the patient, which] is likely the
most critical element contributing to
successful compliance and treatment,"
says Bennett, an ACA member who
also works as a counselor in private
practice and has researched, taught
and presented on neuropsychology and
psychopharmacology.
Counselors, on the other hand, see
their clients two to four times per
month for an average of 50 minutes per
session, Bennett says. When counselors
understand what an antidepressant is
meant to do and what side effects it
may cause, they can better prepare their
clients to follow the regimen prescribed
by the medical ...
Jennifer L. NaegeleDr. Daniel WestHAD - 517Jun.docxdonnajames55
Jennifer L. Naegele
Dr. Daniel West
HAD - 517
June 6, 2020
Week 6 Reflection
“What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.” - Unknown
Introduction
The essence of learning a course in schools is to apply the skills, knowledge, and theories in the day to day operations at home, in the workplace, and in other positions in life. the skills and knowledge acquired during learning are determined by reflecting the concept learned and figuring out how these concepts can be applied in future life. According to Socrates, “the unexamined life is not worth living.” The quote encourages individuals to reflect on the issue that one has passed and projects on how the future might look. In doing so, one is required to remain focus and avoid destructive issues such as fear. In life, to achieve success one should learn from the mistakes and live beyond the frustrations that come from these failures.
What I Learned This Week
This week's reading discusses the need for self-determination in life to achieve goals in life. Life is full of challenges and thus it's essential to remain dedicated and optimistic; being positive in life helps make one overcome the challenges of life. In life, without dedication and hope, individuals' potential starts declining, and this the beginning of failure. Life is characterized by two events – the ups and downs. In the time of down one should remain focused, positive, and determined; during the ups, one should be humble and careful to protect the good thing.
Amending My Behaviors
This week’s reading will play a significant role in amending my behavior; the learning will empower my sense of life and contribute positivity. The readings have helped me to restructure my mind to remain hopeful and continue anticipating the future. Hope plays a substantial role in making keep moving and this betters over livers as we keep pursuing the best (Ross, 2017). By remaining positive even when one is down, make one keep trying, and hence at the end of the day success is achieved. Thus, I will learn to create a positive mood, and this will equip me with the capacity to remain determined even when this is not getting in the right path.
Ideas I can Use at Work and In Relationships
Positive minds, attitudes, and emotions are essential even in the workplace. In the workplace, being positive will help me to influence my colleagues to work hard toward the organization's objectives (Ashkanasy, 2016). A positive person can work under various conditions even though they seem to be challenging. Working in all conditions helps one to earn recognition from their organization and management. As a result, when a promotion comes, I am more like to be considered based on these observations. Positivity helps to create exemplary working conditions that will be emulated by others for the good of the company.
How I will Advance Globalization and Promote Social Justice
The skills l.
If you are looking for the best psychiatrist in Gurgaon, you may be overwhelmed by the number of options available. How do you choose the right one for your needs? What factors should you consider before making an appointment? How can you ensure that you get the best treatment possible? In this blog post, we will answer these questions and more, and help you find the best psychiatric and mental hospital in Gurgaon
The art of being a failure as a therapist (haley, 1969)Scott Miller
A fantastic article written nearly 50 years ago that is as timely today as it was then. The author outlines several beliefs and practices sure to increase your chances of failing as a therapist.
Niyati Gupta, Student of sem 2 from department of journalism and mass communication, JIMS Vasant Kunj II talk about when do you need a psychologist??
Have a Look!!
For more updates: visit: jimssouthdelhi.com
1. Are alcohol addiction programs effective?
2. Fighting a Battle: An Alcohol Addiction Treatment.
3. Addiction to Amphetamine: Amphetamine Abuse Treatment.
4. Methadone Addiction Treatment – An Overview.
5. The Importance of Prescription Drug Addiction Treatment.
Photo Credit: Getty Images/iStockphoto
Week 4: Therapy for Patients With Major
Depressive Disorder (MDD)
Mood disorders can impact every facet of a human being’s life, making the most basic activities
difficult for patients and their families. This was the case for 13-year-old Jeanette, who was
struggling at home and at school. For more than 8 years, Jeanette suffered from temper
tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.
As a PNP working with pediatric patients, you must be able to assess whether these symptoms
are caused by psychological, social, or underlying growth and development issues. You must
then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you explore the assessment and treatment of
three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision
tree, will specifically center on one of the most vulnerable populations, pediatrics. Please
remember, you must also consider the ethical and legal implications of these therapies. You will
also complete a Quiz on the concepts addressed throughout this module.
Learning Objectives
Students will:
• Assess patient factors and history to develop personalized plans of antidepressant therapy
across the lifespan
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in
pediatric, adult, and geriatric patients requiring antidepressant therapy
• Synthesize knowledge of providing care to pediatric, adult, and geriatric patients
presenting for antidepressant therapy
• Analyze ethical and legal implications related to prescribing antidepressant therapy to
patients across the lifespan
Assignment: Assessing and Treating Pediatric
Patients With Mood Disorders
When pediatric patients present with mood disorders, the process of assessing, diagnosing, and
treating them can be quite complex. Children not only present with different signs and symptoms
than adult patients with the same disorders, they also metabolize medications much differently.
Yet, there may be times when the same psychopharmacologic treatments may be used in both
pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse
practitioners must exercise caution when prescribing psychotropic medications to these patients.
For this Assignment, as you examine the patient case study in this week’s Learning Resources,
consider how you might assess and treat pediatric patients presenting with mood disorders.
To prepare for this Assignment:
• Review this week’s Learning Resources, including the Medication Resources indicated
for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment
and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages
Examine Case Study: An African American Child Suffering From Depression. You will be asked ...
learning objectives 16 16.1 Who seeks therapy and what are the goa.docxcroysierkathey
learning objectives 16 16.1 Who seeks therapy and what are the goals of therapy? 16.2 How is the success of psychotherapy measured? 16.3 What are some of the factors that must be considered to provide optimal treatment? 16.4 What psychological approaches are used to treat abnormal behavior? 16.5 What roles do social values and culture play in psychotherapy? 16.6 What biological approaches to treating abnormal behavior are available? Most of us have experienced a time or situation when we were dramatically helped by talking things over with a relative or friend. Most therapists, like all good listeners, rely on receptiveness, warmth, and empathy and take a nonjudgmental approach to the problems their clients present. But there is more to therapy than just giving someone an opportunity to talk. Therapists also introduce into the relationship psychological interventions that are designed to promote new understandings, behaviors, or both on the client’s part. The fact that these interventions are deliberately planned and systematically guided by certain theoretical preconceptions is what distinguishes professional therapy from more informal helping relationships. An Overview of Treatment The belief that people with psychological problems can change—can learn more adaptive ways of perceiving, evaluating, and behaving—is the conviction underlying all psychotherapy. Achieving these changes is by no means easy. Sometimes a person’s view of the world and her or his self-concept are distorted because of pathological early relationships that have been reinforced by years of negative life experiences. In other instances, environmental factors such as an unsatisfying job, an unhappy relationship, or financial stresses must be the focus of attention in addition to psychotherapy. Because change can be hard, people sometimes find it easier to bear their present problems than to challenge themselves to chart a different life course. Therapy also takes time. Even a highly skilled and experienced therapist cannot undo a person’s entire past history and, within a short time, prepare him or her to cope adequately with difficult life situations. Therapy offers no magical transformations. Nevertheless, it holds promise even for the most severe mental disorders. Moreover, contrary to common opinion, psychotherapy can be less expensive in the long run than alternative modes of intervention (Dobson et al., 2008; Gabbard et al., 1997). Numerous therapeutic approaches exist, ranging from psychoanalysis to Zen meditation. However, the era of managed care has prompted new and increasingly stringent demands that the efficacy of treatments be empirically demonstrated. This chapter will explore some of the most widely accepted psychological and biological treatment approaches in use today. Although we recognize that different groups of mental health professionals often have their own preferences with respect to the use of the terms client and patient, in this chapter we use ...
Running Head Case study1Case study 5Case Stud.docxtodd271
Running Head: Case study 1
Case study 5
Case Study
Walden University
Name
NURS – 6630N
March 9, 2019
Case Study
Optimizing the dosing of medicines for neonates and children remains a challenge. The importance of pharmacokinetic (PK) and pharmacodynamics (PD) research is recognized both in medicines regulation and pediatric clinical pharmacology, yet there remain barriers to undertaking high-quality PK and PD studies. While these studies are essential in understanding the dose–concentration–effect relationship and should underpin dosing recommendations, this review examines how challenges affecting the design and conduct of pediatric pharmacological studies can be overcome using targeted pharmacometric strategies. Model-based approaches confer benefits at all stages of the drug life-cycle, from identifying the first dose to be used in children, to clinical trial design, and optimizing the dosing regimens of older, off-patent medications. To benefit patients, strategies to ensure that new PK, PD and trial data are incorporated into evidence-based dosing recommendations are needed.
The client selected is an African American child having depression with normal development milestone. Other aspects reveal that the child has high ratings in depression scale. The criterion is used to diagnose the child.
Decision point one
In this case, we had to prescribe the first choice of drug to get an effective effect. Some Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice to use in children with depressive disorder. The best medicine is Zoloft having sertraline. Now we decided the starting dose and that was 25mg to be administered orally. According to Vitiello (2012), if the medicine does not work in starting dose, we need to increase the dose. The child had been prescribed Zoloft and he came back with no change in his mental health.
Decision point two
If the drug is not working in a low dose, we need to increase the dose. Decision point two involved increasing the dose from 25mg to 50mg.The purpose of increasing the dose was to lower the depressive symptoms. Being within the range, we expected minimal desired effects (Stahl, 2013). Giving a single dose is more likely to give persistent desired effects in client. The patient experienced 50 percent decrease in symptoms. Hence Zoloft was successful in managing the patient’s depression. You must be cautious about the side effects of sertraline. One of the major is suicidal thoughts.
Decision point three
Decision point three is to decide if the dose will be maintained or increased to get rid of symptoms completely. The best decision is to maintain the dose because if the patient has shown 50 percent improvement then he will show more with the passage of time. His dose had been maintained now he further experienced decrease in symptoms. The best treatment is the complete remission as it is the main aim in contemporary psychopharmacology (Stahl, 2013). Then I recommended.
1 Network Analysis and Design This assignment is.docxoswald1horne84988
1
Network Analysis and Design
This assignment is worth 30%.
Deadline: Mon, Week 12
Part A: HQ LAN Upgrade (35%)
Background:
ABC is a big company in the US. ABC has employed you as the IT officer of the company.
Your job is to analyse the performance of the HQ LAN, suggest changes to improve the
network performance and provide a report to your boss.
Settings:
Run all simulations for 30 minutes to simulate a working day.
The graphs should be time averaged
Duplicate scenario for each possible setup
Tasks:
1. Analyse the current performance of the HQ LAN for each level and comment on it.
You are required to show all relevant graphs. The graphs for each level can be
overlaid. (10%)
2. Some staffs are unhappy about the speed of the network. Anything that takes more
than 1 second is not desirable. You have decided to try the following to improve the
network performance. Show the relevant graphs and comment on the results: (5%)
a. Increase the link speeds of
i. HQ_Router1 to HQ_Router3 from 1 Gbps to 10 Gbps and
ii. HQ_Router2 to HQ_Router3 from 1 Gbps to 10 Gbps
b. Increase the LANs for level 1, 2 and 3 from 100 Mbps to 1 Gbps
c. Try out 1 other way that meets the requirement.
3. After meeting the requirement, the company has decided to purchase an Ethernet
Server and placed it in the HQ LAN. (10%)
a. Rename it to HQ Server
b. Use a 1Gbps link
c. Set Application: Supported Services to All
d. Set statistics to view the following:
i. Server DB Task Processing Time (Heavy)
ii. Server Email Task Processing Time (Heavy)
iii. Server HTTP Task Processing Time (Heavy)
iv. Server Performance Task Processing Time
e. Show the performance of the HQ Server with the required graphs and
comment on the results
f. Justify the location of the server
g. State at least 3 security measures you will take to protect the HQ LAN from
malicious attacks
4. What would you do so that all the 4 statistics of the HQ server are less than 0.025 s?
Show all relevant graphs. (3 marks)
2
5. Prepare a report and state the additional amount of money that is needed for the
changes you have made to meet the additional requirements. Refer to the given price
list in the Appendix. (7%)
a. Your report should include a content page, a summary of the addressed issues,
objectives, budgeting, proposed solutions and conclusion.
Part B: Network Design (65%)
Background:
Due to your excellent work in the analysis of the HQ LAN, you are now assigned the new
task of designing the LAN for one of ABC’s client, XYZ. The company XYZ is made up of 4
sections and the number of people in each section is as shown below.
1. Research – 20
2. Technical – 10
3. Guests – 4
4. Executives – 2
Set up the following staff profile:
1. Research: file transfer (light), web browsing (heavy) and file print (light)
2. Technical: Database Access (heavy), telnet (heavy) and email (light)
3. Guests: Em.
1 Name _____________________________ MTH129 Fall .docxoswald1horne84988
1
Name: _____________________________
MTH129 Fall 2018 - FINAL EXAM A
Show all work neatly on paper provided. Label all work. Place final answers on the answer sheet.
PART I: Omit 1 complete question. Place an “X” on the problems & answer space you are omitting.
1. Find the inverse of the following functions:
a. 𝑓(𝑥) = 2𝑥 − 3
b. 𝑓(𝑥) =
3𝑥 +1
𝑥−2
2. If 𝑓(𝑥) = 𝑥 2 − 2𝑥 + 3 and 𝑔(𝑥) = −3𝑥 + 4, find the following:
a. (𝑓°𝑔)(𝑥) b. (𝑓°𝑔)(2)
3. Find the domain for the following expression:
a) √𝑥 + 5 𝑏) 7𝑥 2 + 3𝑥 − 1 𝑐)
𝑥 2+4
𝑥 2−9
4. Find the radian measures of the angles with the given degree measures.
a) 81°
Find the degree measures of the angles with the given radian measures.
b)
13𝜋
6
5. Solve the following equations:
a) (5t) = 20
b) 6000 = 40(15)t
6. Expand the following logarithmic expressions:
a. log(𝐴𝐵2 )
b. ln(
4
√3
)
7. Describe how the graph of each function can be obtained from the graph f
a. 𝑦 = 𝑓(𝑥) − 8
b. 𝑦 = 𝑓(𝑥 + 4) − 5
8. A real number t is given 𝑡 =
2𝜋
3
a. Find the reference number for t.
b. Find the terminal point P(x,y) on the unit circle determined by t
c. The unit circle is centered at __________________ and has a radius of _________________
PART II: Omit 1 complete question. Place an “X” on the problems & answer space you are omitting.
2
1. A sum of $7,000 is invested at an interest rate of 4
1
2
% per year, compounding monthly. (round all answers to
the nearest cent)
a. Find the amount of the investment after 2
1
2
years.
b. How long will it take for the investment to amount to $12,000?
c. Using the information in part (a), find the amount of the investment if compounded quarterly.
2. When a company charges price p dollars for one of its products, its revenue is given by
𝑅 = 𝑓(𝑝) = 500𝑝(30 − 𝑝)
a. Create a quadratic function for price with respect to revenue.
b. What price should they charge in order to maximize their revenue?
c. What is the maximum revenue?
d. What would be the revenue if the price was set at $10?
e. Sketch a rough graph – indicate the intercepts and the maximum coordinates.
3. The charges for a taxi ride are an initial charge of $2.50 and $0.85 for each mile driven.
a. Write a function for the charge of a taxi ride as a linear function of the distance traveled.
b. What is the cost of a 12 mile trip?
c. Find the equation of a line that passes through the following points: (1,-2) , (2,5) Express in 𝑦 =
𝑚𝑥 + 𝑏 form
d. Graph part ( c )
4. a. Divide the following polynomial and factor completely.
𝑃(𝑥) = 3𝑥 4 − 9𝑥 3 − 2𝑥 2 + 5𝑥 + 3; 𝑐 = 3
b. Given polynomial−𝑥 2 + 5𝑥 − 6, state the end behavior of its graph.
c. Using the polynomial on part ( c ), would this g
1 Lab 8 -Ballistic Pendulum Since you will be desig.docxoswald1horne84988
1
Lab 8 -Ballistic Pendulum
Since you will be designing your own procedure you will have two
class periods to take the required data.
The goal of this lab is to measure the speed of a ball that is fired
from a projectile launcher using two different methods. The
Projectile launcher has three different settings, “Short Range,”
“Medium Range” and “Long Range,” however you will only need to
determine the speed for any ONE of these Range settings.
Method 1 involves firing the ball directly into the “Ballistic
Pendulum” shown below in Figure 2 for which limited instructions will be provided. Method 2
is entirely up to your group. While you have significant freedom to design your own procedure,
you will need to worry about the random and systematic uncertainties you are introducing
based on your procedure. This manual will provide a few hints to help reduce a few of those
uncertainties.
The ballistic pendulum pictured in Figure 2 is important canonical problem students study to
explore the conservation of momentum and energy. The ball is fired by the projectile launcher
into a “perfectly inelastic collision” with the pendulum. The pendulum then swings to some
maximum angle which is measured by an Angle Indicator.
Caution: The pendulum has a plastic hinge and Angle Indicator which are both fragile. Be
gentle.
Study the ballistic pendulum carefully. Before we begin, here are a few things to consider and
be aware of in Figure 2:
Projectile launcher
Angle indicator (curved
black bar)
Clamp
Pendulum (can be removed
for measurements)
Figure 2: Ballistic Pendulum
Plumb bob
Firing string
Release
point
Figure 1: Projectile Launcher
Bolt for removing pendulum
2
A. Clamping the ballistic pendulum to the table will reduce random uncertainties in the
speed with which the projectile launcher releases the ball. Similarly, you should check
that the various bolts are snug and that the ball is always fully inside the launcher (not
rolling around inside the barrel of launcher).
B. If the lab bench is not perfectly horizontal the plumb bob and angle indicator will not
read zero degrees before you begin your experiment. You should fix AND/OR account
for these discrepancies.
C. In Figure 3 you will notice a tiny gap between the launcher and the pendulum. This
important gap prevents the launcher from contacting the pendulum directly as the ball
is fired. Without this gap an unknown amount of momentum is transferred from the
launcher directly to the pendulum (in addition to the momentum transferred by the
ball) significantly complicating our experiment.
Figure 3: Important gap between Launcher and Pendulum
Equipment
1 Ballistic Pendulum (shown in Figure 2)
A bag with three balls
1 loading rod
1 Clamp
1 triple beam balance scale
Safety goggles for each group member
Any equipment found in your equipment drawer.
Reasonable equipment reque.
1 I Samuel 8-10 Israel Asks for a King 8 When S.docxoswald1horne84988
1
I Samuel 8-10
Israel Asks for a King
8 When Samuel grew old, he appointed his sons as Israel’s leaders.[a]2 The
name of his firstborn was Joel and the name of his second was Abijah, and
they served at Beersheba. 3 But his sons did not follow his ways. They turned
aside after dishonest gain and accepted bribes and perverted justice.
4 So all the elders of Israel gathered together and came to Samuel at
Ramah. 5 They said to him, “You are old, and your sons do not follow your
ways; now appoint a king to lead[b] us, such as all the other nationshave.”
6 But when they said, “Give us a king to lead us,” this displeasedSamuel; so
he prayed to the LORD. 7 And the LORD told him: “Listen to all that the people
are saying to you; it is not you they have rejected, but they have rejected
me as their king. 8 As they have done from the day I brought them up out of
Egypt until this day, forsaking me and serving other gods, so they are doing
to you. 9 Now listen to them; but warn them solemnly and let them
know what the king who will reign over them will claim as his rights.”
10 Samuel told all the words of the LORD to the people who were asking him
for a king. 11 He said, “This is what the king who will reign over you will claim
as his rights: He will take your sons and make them serve with his chariots
and horses, and they will run in front of his chariots. 12 Some he will assign to
be commanders of thousands and commanders of fifties, and others to plow
his ground and reap his harvest, and still others to make weapons of war
and equipment for his chariots. 13 He will take your daughters to be
perfumers and cooks and bakers. 14 He will take the best of your fields and
vineyards and olive groves and give them to his attendants. 15 He will take a
tenth of your grain and of your vintage and give it to his officials and
attendants. 16 Your male and female servants and the best of your cattle[c] and
donkeys he will take for his own use. 17 He will take a tenth of your flocks,
and you yourselves will become his slaves. 18 When that day comes, you will
cry out for relief from the king you have chosen, but the LORD will not
answer you in that day.”
https://www.biblegateway.com/passage/?search=1%20Samuel+8&version=NIV#fen-NIV-7371a
https://www.biblegateway.com/passage/?search=1%20Samuel+8&version=NIV#fen-NIV-7375b
https://www.biblegateway.com/passage/?search=1%20Samuel+8&version=NIV#fen-NIV-7386c
2
19 But the people refused to listen to Samuel. “No!” they said. “We wanta
king over us. 20 Then we will be like all the other nations, with a king to lead
us and to go out before us and fight our battles.”
21 When Samuel heard all that the people said, he repeated it before
the LORD. 22 The LORD answered, “Listen to them and give them a king.”
Then Samuel said to the Israelites, “Everyone go back to your own town.”
Samuel Anoints Saul
9 There was a Benjamite, a man of standing, whose n.
1 Journal Entry #9 What principle did you select .docxoswald1horne84988
1
Journal Entry #9
What principle did you select?
I selected principle 1 of part 1, “Don’t criticize, condemn or complain”.
Who did you interact with?
For this assignment I interacted with my younger cousin.
What was the context?
I had visited my Aunty and she and her husband asked me to stay a while as I was on school
break. They accommodated me and I decided in return to help look after my cousin in the period
when he got out of school and before they got back from work. He is 5 years old and can be quite
the handful.
What did you expect?
I expected that an authoritative approach would easily compel him to follow my instructions so
that the transition from school life into home life would be easy.
What happened?
At first, I used commanding language to get him to change out of his uniform or properly store
his back pack and books before stepping out to play. The first day was difficult and the way I
deal with him were not getting through. On the 2nd day, the same was observed. On the 3rd day,
before he could drop his back pack and run out, I offered to make him a sandwich to eat before
he left to play if he would change and clean up. He rushed up stairs and freshened up. On the
next day, he came home and rushed up to change and freshen up all on his own. I had not
initially offered; but I made him a sandwich regardless.
How did it make you feel?
It made me feel good to be able to get through to my cousin. After this, if I ever needed him to
do something in a better way than previously, I would encourage him onto a different way of
accomplishing the same. I would often offer praise after adoption of the new suggested method
was adopted or offered incentive.
2
What did you learn?
I learnt that in criticizing a person’s action, it is difficult to deter their belief in their methods,
values or beliefs. This usually just gives them the will to justify or defend their positions. It is
almost an exercise in futility to attempt to effect change by complaining, condemning or
criticizing.
What surprised you?
I was surprised by how fast the change was effected after the shift in direction I took to approach
my cousin. In not criticizing his way of doing things any longer and employing a different tactic,
I was able to influence his routine as well as build good rapport with him.
Going forward, how can you apply what you learnt?
Going forward I will attempt to understand that everyone has a belief or image of their own that I
should respect. These beliefs, systems and values are crucial to their inherent dignity and to
criticize or attack this will only fuel conflict.
Running head: Physical activity project 1
Physical activity project:
A 7-day analysis and action plans
Student Name
National University
Physical activity project 2
Introduction
Physical activity (PA) has been a major component of public health since the rise of
chronic illnesses .
1
HCA 448 Case 2 for 10/04/2018
Recently, a patient was transferred to a cardiac intensive care unit (CICU) at Methodist Hospital.
Methodist is a 250-bed hospital, which is one of five hospitals in the University Health System.
The patient was a retired 72-year-old man, who recently (i.e., 25 days ago) had a mild heart
attack and was treated and released from a sister hospital, which is in the same system as
Methodist Hospital. An otherwise health individual, Mr. Charlie Johnson (a husband, father of 4,
and grandfather of 12) is in now need or lots of medication and a battery of tests. To the nurses
on shift, it appears that the entire Johnson family is in patient’s room watching the clinical staff
treated Mr. Johnson. The family overhears everything and they want to know what is being done
to (and for) their loved one. In addition, they want to know the meaning behind the various beeps
coming from the many machines attached to Mr. Johnson.
Over the past 10 years, the latest U.S. News and World report has ranked Methodist Hospital as
one of the Best Hospitals for Cardiology & Heart Surgery. However, it is important to note that
over the past few years, the unit has dropped in the rankings.
Katherine Ross RN, the patient care director of the CICU, which has 14 beds, has held this post
for two years. (See Figure) The unit has a $20 million budget. Ms. Ross has worked at Methodist
Hospital for 16 years. She spends 50 percent of her time on patient safety, 25 percent on staffing
and recruitment, and 20 percent with nurses in relation to their satisfaction with the work and
with families relative to their satisfaction with care. Ten percent of Ms. Ross’s time is spent on
administrative duties. According to Ms. Ross, “I like is working with exceptional nurses who are
very smart and do what it takes with limited resources. However, we don’t always feel
empowered, despite the existence of shared governance, a structure I help to coordinate.”
2
Relationship with Nurses on the Unit:
Nurses on the unit work a three day a week, 12 hours a shift. Ms. Ross says, “we did an
employee opinion survey that went to all employees on the unit, 50 people in all, but only 13
responded. Some of them weren’t sure who their supervisor was. The employees aren’t happy
but our patients are happy.” She adds that “my name is on the unit, not the medical director’s. If
anything goes wrong with the unit, they blame it on nursing. Yet I’m brushed off by people
whom I have to deal with outside of the unit. For example, we have a problem with machines
that analyze blood gases. I spoke with the people there about the technology. This was four
weeks ago. It’s a patient safety issue. I sent them e-mails. I need the work to get done, the staff
don’t feel empowered if I’m not empowered. This goes for other departments as well. For
example, respiratory therapy starts using a new ventilator witho.
RXP International Presents an Overview of Prescribing PsychologistsRXP International
This presentation was developed by Dr. Elaine Levine the first prescribing psychologist in New Mexico. In it, she described the Psychobiosocial Model of care which is a holistic model referenced in The Integration of Psychopharmacology and Psychotherapy in PTSD Treatment Biopsychosocial model of care, In E. Carll Ed., Trauma Psychology: Issues in Violence,
Disaster, Health and Illness. It also includes an overview of the requirements and responsibilities of prescribing psychologists in New Mexico.
Case study Psychopharmacologic Approaches to Treatment of PsychopaMaximaSheffield592
Case study Psychopharmacologic Approaches to Treatment of Psychopathology (laureate-media.com)
Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.
To prepare for this Assignment:
· Review this week’s Learning Resources, including the Medication Resources indicated for this week.
· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.
The Assignment: 5 pages
Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
· Which decision did you select?
· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
· What were you hoping ...
Client, counselorprescriberCounselors can serve as an impo.docxmccormicknadine86
Client, counselor
prescriber
Counselors can serve as an important link between clients and the medical
professionals who prescribe them antidepressants
R
oughly one in 10 Americans
over the age of 11 takes
.antidepressant medication,
according to data released this past fall
by the Centers for Disease Control and
Prevention. Antidepressants are the
third most common prescription taken
by Americans of all ages and the most
common among Americans ages 18-44.
The rise in popularity of antidepressants
has been meteoric in recent decades.
Since 1988, the rate of antidepressant
use nationwide among all ages increased
almost 400 percent.
These data, collected as part of
the National Health and Nutrition
Examination Surveys between 2005 and
2008, don't surprise Dixie Meyer. In fact,
they further support the message she
tries to share with counselors: You need
to know about the antidepressants your
clients are taking.
Antidepressants, which are prescribed
not just for depression but also for
anxiety disorders, pain disorders, learning
disabilities and more, are the medication
most requested by patients, says Meyer,
an assistant professor in the Department
of Counseling and Family Therapy at
St. Louis University and a member of
the American Counseling Association.
She notes that primary care physicians
prescribe the majority of antidepressants.
"This suggests that a large portion of
our clients on antidepressants sought out
the medication without knowledge of
why individuals need medications, and
in most cases, an expert on psychotropic
medications did not prescribe the
medications," says Meyer, who teaches
psychopharmacology and has been
researching the topic since 2007.
"While counselors are not experts on
antidepressants either, counselors need
By Lynne Shailcross
to understand when their clients may
need to have the medication reassessed
or when the counselor may need to meet
with the medication prescriber."
Elisabeth Bennett, chair of the
Department of Counselor Education
at Gonzaga University, says even
though counselors are not prescribing
the medications, they are in a prime
position to assist clients who are taking
antidepressants. "Medical professionals
see their psychiatric patients an average
of about eight minutes each ... three
to four meetings per year. This is not
enough time to do all the tasks they
must do, let alone to build a relationship
[with the patient, which] is likely the
most critical element contributing to
successful compliance and treatment,"
says Bennett, an ACA member who
also works as a counselor in private
practice and has researched, taught
and presented on neuropsychology and
psychopharmacology.
Counselors, on the other hand, see
their clients two to four times per
month for an average of 50 minutes per
session, Bennett says. When counselors
understand what an antidepressant is
meant to do and what side effects it
may cause, they can better prepare their
clients to follow the regimen prescribed
by the medical ...
Jennifer L. NaegeleDr. Daniel WestHAD - 517Jun.docxdonnajames55
Jennifer L. Naegele
Dr. Daniel West
HAD - 517
June 6, 2020
Week 6 Reflection
“What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.” - Unknown
Introduction
The essence of learning a course in schools is to apply the skills, knowledge, and theories in the day to day operations at home, in the workplace, and in other positions in life. the skills and knowledge acquired during learning are determined by reflecting the concept learned and figuring out how these concepts can be applied in future life. According to Socrates, “the unexamined life is not worth living.” The quote encourages individuals to reflect on the issue that one has passed and projects on how the future might look. In doing so, one is required to remain focus and avoid destructive issues such as fear. In life, to achieve success one should learn from the mistakes and live beyond the frustrations that come from these failures.
What I Learned This Week
This week's reading discusses the need for self-determination in life to achieve goals in life. Life is full of challenges and thus it's essential to remain dedicated and optimistic; being positive in life helps make one overcome the challenges of life. In life, without dedication and hope, individuals' potential starts declining, and this the beginning of failure. Life is characterized by two events – the ups and downs. In the time of down one should remain focused, positive, and determined; during the ups, one should be humble and careful to protect the good thing.
Amending My Behaviors
This week’s reading will play a significant role in amending my behavior; the learning will empower my sense of life and contribute positivity. The readings have helped me to restructure my mind to remain hopeful and continue anticipating the future. Hope plays a substantial role in making keep moving and this betters over livers as we keep pursuing the best (Ross, 2017). By remaining positive even when one is down, make one keep trying, and hence at the end of the day success is achieved. Thus, I will learn to create a positive mood, and this will equip me with the capacity to remain determined even when this is not getting in the right path.
Ideas I can Use at Work and In Relationships
Positive minds, attitudes, and emotions are essential even in the workplace. In the workplace, being positive will help me to influence my colleagues to work hard toward the organization's objectives (Ashkanasy, 2016). A positive person can work under various conditions even though they seem to be challenging. Working in all conditions helps one to earn recognition from their organization and management. As a result, when a promotion comes, I am more like to be considered based on these observations. Positivity helps to create exemplary working conditions that will be emulated by others for the good of the company.
How I will Advance Globalization and Promote Social Justice
The skills l.
If you are looking for the best psychiatrist in Gurgaon, you may be overwhelmed by the number of options available. How do you choose the right one for your needs? What factors should you consider before making an appointment? How can you ensure that you get the best treatment possible? In this blog post, we will answer these questions and more, and help you find the best psychiatric and mental hospital in Gurgaon
The art of being a failure as a therapist (haley, 1969)Scott Miller
A fantastic article written nearly 50 years ago that is as timely today as it was then. The author outlines several beliefs and practices sure to increase your chances of failing as a therapist.
Niyati Gupta, Student of sem 2 from department of journalism and mass communication, JIMS Vasant Kunj II talk about when do you need a psychologist??
Have a Look!!
For more updates: visit: jimssouthdelhi.com
1. Are alcohol addiction programs effective?
2. Fighting a Battle: An Alcohol Addiction Treatment.
3. Addiction to Amphetamine: Amphetamine Abuse Treatment.
4. Methadone Addiction Treatment – An Overview.
5. The Importance of Prescription Drug Addiction Treatment.
Photo Credit: Getty Images/iStockphoto
Week 4: Therapy for Patients With Major
Depressive Disorder (MDD)
Mood disorders can impact every facet of a human being’s life, making the most basic activities
difficult for patients and their families. This was the case for 13-year-old Jeanette, who was
struggling at home and at school. For more than 8 years, Jeanette suffered from temper
tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.
As a PNP working with pediatric patients, you must be able to assess whether these symptoms
are caused by psychological, social, or underlying growth and development issues. You must
then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you explore the assessment and treatment of
three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision
tree, will specifically center on one of the most vulnerable populations, pediatrics. Please
remember, you must also consider the ethical and legal implications of these therapies. You will
also complete a Quiz on the concepts addressed throughout this module.
Learning Objectives
Students will:
• Assess patient factors and history to develop personalized plans of antidepressant therapy
across the lifespan
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in
pediatric, adult, and geriatric patients requiring antidepressant therapy
• Synthesize knowledge of providing care to pediatric, adult, and geriatric patients
presenting for antidepressant therapy
• Analyze ethical and legal implications related to prescribing antidepressant therapy to
patients across the lifespan
Assignment: Assessing and Treating Pediatric
Patients With Mood Disorders
When pediatric patients present with mood disorders, the process of assessing, diagnosing, and
treating them can be quite complex. Children not only present with different signs and symptoms
than adult patients with the same disorders, they also metabolize medications much differently.
Yet, there may be times when the same psychopharmacologic treatments may be used in both
pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse
practitioners must exercise caution when prescribing psychotropic medications to these patients.
For this Assignment, as you examine the patient case study in this week’s Learning Resources,
consider how you might assess and treat pediatric patients presenting with mood disorders.
To prepare for this Assignment:
• Review this week’s Learning Resources, including the Medication Resources indicated
for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment
and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages
Examine Case Study: An African American Child Suffering From Depression. You will be asked ...
learning objectives 16 16.1 Who seeks therapy and what are the goa.docxcroysierkathey
learning objectives 16 16.1 Who seeks therapy and what are the goals of therapy? 16.2 How is the success of psychotherapy measured? 16.3 What are some of the factors that must be considered to provide optimal treatment? 16.4 What psychological approaches are used to treat abnormal behavior? 16.5 What roles do social values and culture play in psychotherapy? 16.6 What biological approaches to treating abnormal behavior are available? Most of us have experienced a time or situation when we were dramatically helped by talking things over with a relative or friend. Most therapists, like all good listeners, rely on receptiveness, warmth, and empathy and take a nonjudgmental approach to the problems their clients present. But there is more to therapy than just giving someone an opportunity to talk. Therapists also introduce into the relationship psychological interventions that are designed to promote new understandings, behaviors, or both on the client’s part. The fact that these interventions are deliberately planned and systematically guided by certain theoretical preconceptions is what distinguishes professional therapy from more informal helping relationships. An Overview of Treatment The belief that people with psychological problems can change—can learn more adaptive ways of perceiving, evaluating, and behaving—is the conviction underlying all psychotherapy. Achieving these changes is by no means easy. Sometimes a person’s view of the world and her or his self-concept are distorted because of pathological early relationships that have been reinforced by years of negative life experiences. In other instances, environmental factors such as an unsatisfying job, an unhappy relationship, or financial stresses must be the focus of attention in addition to psychotherapy. Because change can be hard, people sometimes find it easier to bear their present problems than to challenge themselves to chart a different life course. Therapy also takes time. Even a highly skilled and experienced therapist cannot undo a person’s entire past history and, within a short time, prepare him or her to cope adequately with difficult life situations. Therapy offers no magical transformations. Nevertheless, it holds promise even for the most severe mental disorders. Moreover, contrary to common opinion, psychotherapy can be less expensive in the long run than alternative modes of intervention (Dobson et al., 2008; Gabbard et al., 1997). Numerous therapeutic approaches exist, ranging from psychoanalysis to Zen meditation. However, the era of managed care has prompted new and increasingly stringent demands that the efficacy of treatments be empirically demonstrated. This chapter will explore some of the most widely accepted psychological and biological treatment approaches in use today. Although we recognize that different groups of mental health professionals often have their own preferences with respect to the use of the terms client and patient, in this chapter we use ...
Running Head Case study1Case study 5Case Stud.docxtodd271
Running Head: Case study 1
Case study 5
Case Study
Walden University
Name
NURS – 6630N
March 9, 2019
Case Study
Optimizing the dosing of medicines for neonates and children remains a challenge. The importance of pharmacokinetic (PK) and pharmacodynamics (PD) research is recognized both in medicines regulation and pediatric clinical pharmacology, yet there remain barriers to undertaking high-quality PK and PD studies. While these studies are essential in understanding the dose–concentration–effect relationship and should underpin dosing recommendations, this review examines how challenges affecting the design and conduct of pediatric pharmacological studies can be overcome using targeted pharmacometric strategies. Model-based approaches confer benefits at all stages of the drug life-cycle, from identifying the first dose to be used in children, to clinical trial design, and optimizing the dosing regimens of older, off-patent medications. To benefit patients, strategies to ensure that new PK, PD and trial data are incorporated into evidence-based dosing recommendations are needed.
The client selected is an African American child having depression with normal development milestone. Other aspects reveal that the child has high ratings in depression scale. The criterion is used to diagnose the child.
Decision point one
In this case, we had to prescribe the first choice of drug to get an effective effect. Some Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice to use in children with depressive disorder. The best medicine is Zoloft having sertraline. Now we decided the starting dose and that was 25mg to be administered orally. According to Vitiello (2012), if the medicine does not work in starting dose, we need to increase the dose. The child had been prescribed Zoloft and he came back with no change in his mental health.
Decision point two
If the drug is not working in a low dose, we need to increase the dose. Decision point two involved increasing the dose from 25mg to 50mg.The purpose of increasing the dose was to lower the depressive symptoms. Being within the range, we expected minimal desired effects (Stahl, 2013). Giving a single dose is more likely to give persistent desired effects in client. The patient experienced 50 percent decrease in symptoms. Hence Zoloft was successful in managing the patient’s depression. You must be cautious about the side effects of sertraline. One of the major is suicidal thoughts.
Decision point three
Decision point three is to decide if the dose will be maintained or increased to get rid of symptoms completely. The best decision is to maintain the dose because if the patient has shown 50 percent improvement then he will show more with the passage of time. His dose had been maintained now he further experienced decrease in symptoms. The best treatment is the complete remission as it is the main aim in contemporary psychopharmacology (Stahl, 2013). Then I recommended.
1 Network Analysis and Design This assignment is.docxoswald1horne84988
1
Network Analysis and Design
This assignment is worth 30%.
Deadline: Mon, Week 12
Part A: HQ LAN Upgrade (35%)
Background:
ABC is a big company in the US. ABC has employed you as the IT officer of the company.
Your job is to analyse the performance of the HQ LAN, suggest changes to improve the
network performance and provide a report to your boss.
Settings:
Run all simulations for 30 minutes to simulate a working day.
The graphs should be time averaged
Duplicate scenario for each possible setup
Tasks:
1. Analyse the current performance of the HQ LAN for each level and comment on it.
You are required to show all relevant graphs. The graphs for each level can be
overlaid. (10%)
2. Some staffs are unhappy about the speed of the network. Anything that takes more
than 1 second is not desirable. You have decided to try the following to improve the
network performance. Show the relevant graphs and comment on the results: (5%)
a. Increase the link speeds of
i. HQ_Router1 to HQ_Router3 from 1 Gbps to 10 Gbps and
ii. HQ_Router2 to HQ_Router3 from 1 Gbps to 10 Gbps
b. Increase the LANs for level 1, 2 and 3 from 100 Mbps to 1 Gbps
c. Try out 1 other way that meets the requirement.
3. After meeting the requirement, the company has decided to purchase an Ethernet
Server and placed it in the HQ LAN. (10%)
a. Rename it to HQ Server
b. Use a 1Gbps link
c. Set Application: Supported Services to All
d. Set statistics to view the following:
i. Server DB Task Processing Time (Heavy)
ii. Server Email Task Processing Time (Heavy)
iii. Server HTTP Task Processing Time (Heavy)
iv. Server Performance Task Processing Time
e. Show the performance of the HQ Server with the required graphs and
comment on the results
f. Justify the location of the server
g. State at least 3 security measures you will take to protect the HQ LAN from
malicious attacks
4. What would you do so that all the 4 statistics of the HQ server are less than 0.025 s?
Show all relevant graphs. (3 marks)
2
5. Prepare a report and state the additional amount of money that is needed for the
changes you have made to meet the additional requirements. Refer to the given price
list in the Appendix. (7%)
a. Your report should include a content page, a summary of the addressed issues,
objectives, budgeting, proposed solutions and conclusion.
Part B: Network Design (65%)
Background:
Due to your excellent work in the analysis of the HQ LAN, you are now assigned the new
task of designing the LAN for one of ABC’s client, XYZ. The company XYZ is made up of 4
sections and the number of people in each section is as shown below.
1. Research – 20
2. Technical – 10
3. Guests – 4
4. Executives – 2
Set up the following staff profile:
1. Research: file transfer (light), web browsing (heavy) and file print (light)
2. Technical: Database Access (heavy), telnet (heavy) and email (light)
3. Guests: Em.
1 Name _____________________________ MTH129 Fall .docxoswald1horne84988
1
Name: _____________________________
MTH129 Fall 2018 - FINAL EXAM A
Show all work neatly on paper provided. Label all work. Place final answers on the answer sheet.
PART I: Omit 1 complete question. Place an “X” on the problems & answer space you are omitting.
1. Find the inverse of the following functions:
a. 𝑓(𝑥) = 2𝑥 − 3
b. 𝑓(𝑥) =
3𝑥 +1
𝑥−2
2. If 𝑓(𝑥) = 𝑥 2 − 2𝑥 + 3 and 𝑔(𝑥) = −3𝑥 + 4, find the following:
a. (𝑓°𝑔)(𝑥) b. (𝑓°𝑔)(2)
3. Find the domain for the following expression:
a) √𝑥 + 5 𝑏) 7𝑥 2 + 3𝑥 − 1 𝑐)
𝑥 2+4
𝑥 2−9
4. Find the radian measures of the angles with the given degree measures.
a) 81°
Find the degree measures of the angles with the given radian measures.
b)
13𝜋
6
5. Solve the following equations:
a) (5t) = 20
b) 6000 = 40(15)t
6. Expand the following logarithmic expressions:
a. log(𝐴𝐵2 )
b. ln(
4
√3
)
7. Describe how the graph of each function can be obtained from the graph f
a. 𝑦 = 𝑓(𝑥) − 8
b. 𝑦 = 𝑓(𝑥 + 4) − 5
8. A real number t is given 𝑡 =
2𝜋
3
a. Find the reference number for t.
b. Find the terminal point P(x,y) on the unit circle determined by t
c. The unit circle is centered at __________________ and has a radius of _________________
PART II: Omit 1 complete question. Place an “X” on the problems & answer space you are omitting.
2
1. A sum of $7,000 is invested at an interest rate of 4
1
2
% per year, compounding monthly. (round all answers to
the nearest cent)
a. Find the amount of the investment after 2
1
2
years.
b. How long will it take for the investment to amount to $12,000?
c. Using the information in part (a), find the amount of the investment if compounded quarterly.
2. When a company charges price p dollars for one of its products, its revenue is given by
𝑅 = 𝑓(𝑝) = 500𝑝(30 − 𝑝)
a. Create a quadratic function for price with respect to revenue.
b. What price should they charge in order to maximize their revenue?
c. What is the maximum revenue?
d. What would be the revenue if the price was set at $10?
e. Sketch a rough graph – indicate the intercepts and the maximum coordinates.
3. The charges for a taxi ride are an initial charge of $2.50 and $0.85 for each mile driven.
a. Write a function for the charge of a taxi ride as a linear function of the distance traveled.
b. What is the cost of a 12 mile trip?
c. Find the equation of a line that passes through the following points: (1,-2) , (2,5) Express in 𝑦 =
𝑚𝑥 + 𝑏 form
d. Graph part ( c )
4. a. Divide the following polynomial and factor completely.
𝑃(𝑥) = 3𝑥 4 − 9𝑥 3 − 2𝑥 2 + 5𝑥 + 3; 𝑐 = 3
b. Given polynomial−𝑥 2 + 5𝑥 − 6, state the end behavior of its graph.
c. Using the polynomial on part ( c ), would this g
1 Lab 8 -Ballistic Pendulum Since you will be desig.docxoswald1horne84988
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Lab 8 -Ballistic Pendulum
Since you will be designing your own procedure you will have two
class periods to take the required data.
The goal of this lab is to measure the speed of a ball that is fired
from a projectile launcher using two different methods. The
Projectile launcher has three different settings, “Short Range,”
“Medium Range” and “Long Range,” however you will only need to
determine the speed for any ONE of these Range settings.
Method 1 involves firing the ball directly into the “Ballistic
Pendulum” shown below in Figure 2 for which limited instructions will be provided. Method 2
is entirely up to your group. While you have significant freedom to design your own procedure,
you will need to worry about the random and systematic uncertainties you are introducing
based on your procedure. This manual will provide a few hints to help reduce a few of those
uncertainties.
The ballistic pendulum pictured in Figure 2 is important canonical problem students study to
explore the conservation of momentum and energy. The ball is fired by the projectile launcher
into a “perfectly inelastic collision” with the pendulum. The pendulum then swings to some
maximum angle which is measured by an Angle Indicator.
Caution: The pendulum has a plastic hinge and Angle Indicator which are both fragile. Be
gentle.
Study the ballistic pendulum carefully. Before we begin, here are a few things to consider and
be aware of in Figure 2:
Projectile launcher
Angle indicator (curved
black bar)
Clamp
Pendulum (can be removed
for measurements)
Figure 2: Ballistic Pendulum
Plumb bob
Firing string
Release
point
Figure 1: Projectile Launcher
Bolt for removing pendulum
2
A. Clamping the ballistic pendulum to the table will reduce random uncertainties in the
speed with which the projectile launcher releases the ball. Similarly, you should check
that the various bolts are snug and that the ball is always fully inside the launcher (not
rolling around inside the barrel of launcher).
B. If the lab bench is not perfectly horizontal the plumb bob and angle indicator will not
read zero degrees before you begin your experiment. You should fix AND/OR account
for these discrepancies.
C. In Figure 3 you will notice a tiny gap between the launcher and the pendulum. This
important gap prevents the launcher from contacting the pendulum directly as the ball
is fired. Without this gap an unknown amount of momentum is transferred from the
launcher directly to the pendulum (in addition to the momentum transferred by the
ball) significantly complicating our experiment.
Figure 3: Important gap between Launcher and Pendulum
Equipment
1 Ballistic Pendulum (shown in Figure 2)
A bag with three balls
1 loading rod
1 Clamp
1 triple beam balance scale
Safety goggles for each group member
Any equipment found in your equipment drawer.
Reasonable equipment reque.
1 I Samuel 8-10 Israel Asks for a King 8 When S.docxoswald1horne84988
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I Samuel 8-10
Israel Asks for a King
8 When Samuel grew old, he appointed his sons as Israel’s leaders.[a]2 The
name of his firstborn was Joel and the name of his second was Abijah, and
they served at Beersheba. 3 But his sons did not follow his ways. They turned
aside after dishonest gain and accepted bribes and perverted justice.
4 So all the elders of Israel gathered together and came to Samuel at
Ramah. 5 They said to him, “You are old, and your sons do not follow your
ways; now appoint a king to lead[b] us, such as all the other nationshave.”
6 But when they said, “Give us a king to lead us,” this displeasedSamuel; so
he prayed to the LORD. 7 And the LORD told him: “Listen to all that the people
are saying to you; it is not you they have rejected, but they have rejected
me as their king. 8 As they have done from the day I brought them up out of
Egypt until this day, forsaking me and serving other gods, so they are doing
to you. 9 Now listen to them; but warn them solemnly and let them
know what the king who will reign over them will claim as his rights.”
10 Samuel told all the words of the LORD to the people who were asking him
for a king. 11 He said, “This is what the king who will reign over you will claim
as his rights: He will take your sons and make them serve with his chariots
and horses, and they will run in front of his chariots. 12 Some he will assign to
be commanders of thousands and commanders of fifties, and others to plow
his ground and reap his harvest, and still others to make weapons of war
and equipment for his chariots. 13 He will take your daughters to be
perfumers and cooks and bakers. 14 He will take the best of your fields and
vineyards and olive groves and give them to his attendants. 15 He will take a
tenth of your grain and of your vintage and give it to his officials and
attendants. 16 Your male and female servants and the best of your cattle[c] and
donkeys he will take for his own use. 17 He will take a tenth of your flocks,
and you yourselves will become his slaves. 18 When that day comes, you will
cry out for relief from the king you have chosen, but the LORD will not
answer you in that day.”
https://www.biblegateway.com/passage/?search=1%20Samuel+8&version=NIV#fen-NIV-7371a
https://www.biblegateway.com/passage/?search=1%20Samuel+8&version=NIV#fen-NIV-7375b
https://www.biblegateway.com/passage/?search=1%20Samuel+8&version=NIV#fen-NIV-7386c
2
19 But the people refused to listen to Samuel. “No!” they said. “We wanta
king over us. 20 Then we will be like all the other nations, with a king to lead
us and to go out before us and fight our battles.”
21 When Samuel heard all that the people said, he repeated it before
the LORD. 22 The LORD answered, “Listen to them and give them a king.”
Then Samuel said to the Israelites, “Everyone go back to your own town.”
Samuel Anoints Saul
9 There was a Benjamite, a man of standing, whose n.
1 Journal Entry #9 What principle did you select .docxoswald1horne84988
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Journal Entry #9
What principle did you select?
I selected principle 1 of part 1, “Don’t criticize, condemn or complain”.
Who did you interact with?
For this assignment I interacted with my younger cousin.
What was the context?
I had visited my Aunty and she and her husband asked me to stay a while as I was on school
break. They accommodated me and I decided in return to help look after my cousin in the period
when he got out of school and before they got back from work. He is 5 years old and can be quite
the handful.
What did you expect?
I expected that an authoritative approach would easily compel him to follow my instructions so
that the transition from school life into home life would be easy.
What happened?
At first, I used commanding language to get him to change out of his uniform or properly store
his back pack and books before stepping out to play. The first day was difficult and the way I
deal with him were not getting through. On the 2nd day, the same was observed. On the 3rd day,
before he could drop his back pack and run out, I offered to make him a sandwich to eat before
he left to play if he would change and clean up. He rushed up stairs and freshened up. On the
next day, he came home and rushed up to change and freshen up all on his own. I had not
initially offered; but I made him a sandwich regardless.
How did it make you feel?
It made me feel good to be able to get through to my cousin. After this, if I ever needed him to
do something in a better way than previously, I would encourage him onto a different way of
accomplishing the same. I would often offer praise after adoption of the new suggested method
was adopted or offered incentive.
2
What did you learn?
I learnt that in criticizing a person’s action, it is difficult to deter their belief in their methods,
values or beliefs. This usually just gives them the will to justify or defend their positions. It is
almost an exercise in futility to attempt to effect change by complaining, condemning or
criticizing.
What surprised you?
I was surprised by how fast the change was effected after the shift in direction I took to approach
my cousin. In not criticizing his way of doing things any longer and employing a different tactic,
I was able to influence his routine as well as build good rapport with him.
Going forward, how can you apply what you learnt?
Going forward I will attempt to understand that everyone has a belief or image of their own that I
should respect. These beliefs, systems and values are crucial to their inherent dignity and to
criticize or attack this will only fuel conflict.
Running head: Physical activity project 1
Physical activity project:
A 7-day analysis and action plans
Student Name
National University
Physical activity project 2
Introduction
Physical activity (PA) has been a major component of public health since the rise of
chronic illnesses .
1
HCA 448 Case 2 for 10/04/2018
Recently, a patient was transferred to a cardiac intensive care unit (CICU) at Methodist Hospital.
Methodist is a 250-bed hospital, which is one of five hospitals in the University Health System.
The patient was a retired 72-year-old man, who recently (i.e., 25 days ago) had a mild heart
attack and was treated and released from a sister hospital, which is in the same system as
Methodist Hospital. An otherwise health individual, Mr. Charlie Johnson (a husband, father of 4,
and grandfather of 12) is in now need or lots of medication and a battery of tests. To the nurses
on shift, it appears that the entire Johnson family is in patient’s room watching the clinical staff
treated Mr. Johnson. The family overhears everything and they want to know what is being done
to (and for) their loved one. In addition, they want to know the meaning behind the various beeps
coming from the many machines attached to Mr. Johnson.
Over the past 10 years, the latest U.S. News and World report has ranked Methodist Hospital as
one of the Best Hospitals for Cardiology & Heart Surgery. However, it is important to note that
over the past few years, the unit has dropped in the rankings.
Katherine Ross RN, the patient care director of the CICU, which has 14 beds, has held this post
for two years. (See Figure) The unit has a $20 million budget. Ms. Ross has worked at Methodist
Hospital for 16 years. She spends 50 percent of her time on patient safety, 25 percent on staffing
and recruitment, and 20 percent with nurses in relation to their satisfaction with the work and
with families relative to their satisfaction with care. Ten percent of Ms. Ross’s time is spent on
administrative duties. According to Ms. Ross, “I like is working with exceptional nurses who are
very smart and do what it takes with limited resources. However, we don’t always feel
empowered, despite the existence of shared governance, a structure I help to coordinate.”
2
Relationship with Nurses on the Unit:
Nurses on the unit work a three day a week, 12 hours a shift. Ms. Ross says, “we did an
employee opinion survey that went to all employees on the unit, 50 people in all, but only 13
responded. Some of them weren’t sure who their supervisor was. The employees aren’t happy
but our patients are happy.” She adds that “my name is on the unit, not the medical director’s. If
anything goes wrong with the unit, they blame it on nursing. Yet I’m brushed off by people
whom I have to deal with outside of the unit. For example, we have a problem with machines
that analyze blood gases. I spoke with the people there about the technology. This was four
weeks ago. It’s a patient safety issue. I sent them e-mails. I need the work to get done, the staff
don’t feel empowered if I’m not empowered. This goes for other departments as well. For
example, respiratory therapy starts using a new ventilator witho.
1
HC2091: Finance for Business
Trimester 2 2018
Group Assignment
Assessment Value: 20%
Due Date: Sunday 23:59 pm, Week 10
Group: 2- 4 students
Length: Min 2500 words
INSTRUCTIONS
Students are required to form a group to study, undertake research, analyse and conduct academic
work within the areas of business finance covered in learning materials Topics 1 to 10 inclusive.
The assignment should examine the main issues, including underlying theories, implement
performance measures used and explain the firm financial performance. Your group is strongly
advised to reference professional websites, journal articles and text books in this assignment (case
study).
Tasks
This assessment task is a written report and analysis of the financial performance of a selected
listed company on the ASX in order to provide financial and investment advice to a wealthy
investor. This assignment requires your group to undertake a comprehensive examination of a
firm’s financial performance based on update financial statements of the chosen companies.
Group Arrangement
This assignment must be completed IN Group. Each group can be from 2 to maximum 4 student
members. Each group will choose 1 company and once the company has been chosen, the other
group cannot choose the same company. First come first served rule applies here, it means you
need to form your group, choose on company from the list of ASX and register them with your
lecturer as soon as possible. Once your lecturer registers your chosen company, it cannot be
chosen by any other group. Your lecturer then will put your group on Black Board to enable you
to interact and discuss on the issues of your group assignment using Black Board environment.
However, face to face meeting, discussion and other methods of communication are needed to
ensure quality of group work. Each group needs to have your own arrangement so that all the
group members will contribute equally in the group work. If not, a Contribution Statement,
which clearly indicated individual contribution (in terms of percentage) of each member, should
be submitted as a separate item in your assignment. Your individual contribution then will be
assessed based on contribution statement to avoid any free riders.
2
Submission
Please make sure that your group member’s name and surname, student ID, subject name, and
code and lecture’s name are written on the cover sheet of the submitted assignment.
When you submit your assignment electronically, please save the file as ‘Group Assignment-
your group name .doc’. You are required to submit the assignment at Group Assignment
Final Submission, which is under Group Assignment and Due Dates on Black Board.
Submitted work should be your original work showing your creativity. Please ensure the self-
check for plagiarism to be done before final submission (plagiarism check is not over 30% .
1 ECE 175 Computer Programming for Engineering Applica.docxoswald1horne84988
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ECE 175: Computer Programming for Engineering Applications
Homework Assignment 6
Due: Tuesday March 12, 2019 by 11.59 pm
Conventions: Name your C programs as hwxpy.c where x corresponds to the homework number and y
corresponds to the problem number. For example, the C program for homework 6, problem 1 should be
named as hw6p1.c.
Write comments to your programs. Programs with no comments will receive PARTIAL credit. For each
program that you turn in, at least the following information should be included at the top of the C file:
- Author and Date created
- Brief description of the program:
- input(s) and output(s)
- brief description or relationship between inputs and outputs
Submission Instructions: Use the designated Dropbox on D2L to submit your homework.
Submit only the .c files.
Problem 1 (15 points) Write a program that returns the minimum value and its location, max
value and its location and average value of an array of integers. Your program should call a
single function that returns that min and its location, max and its location and mean value of
the array. Print the results in the main function (not within the array_func function).
See sample code execution below. The declaration of this function is given below:
void array_func (int *x, int size, int *min_p, int *minloc_p, int *max_p, int *maxloc_p, double *mean_p)
/* x is a pointer to the first array element
size is the array size
min_p is a pointer to a variable min in the main function that holds the minimum
minloc_p is a pointer to a variable minloc in the main function that holds the location where the
minimum is.
max_p is a pointer to a variable max in the main function that holds the maximum
maxloc_p is a pointer to a variable maxloc in the main function that holds the location where the
maximum is.
mean_p is a pointer to a variable mean in the main function that holds the mean */
Declare the following array of integers within the main function:
Sample code execution:
int data_ar[] = { -3, 5, 6, 7, 12, 3, 4, 6, 19, 23, 100, 3, 4, -2, 9, 43, 32, 45,
32, 2, 3, 2, -1, 8 };
int data_ar2[] = { -679,-758,-744,-393,-656,-172,-707,-32,-277,-47,-98,-824,-695,
-318,-951,-35,-439,-382,-766,-796,-187,-490,-446,-647};
int data_ar3[] = {-142, -2, -56, -60, 114, -249, 45, -139, -25, 17, 75, -27, 158,
-48, 33, 67, 9, 89, 33, -78, -180, 186, 218, -274};
2
Problem 2 (20 points): A barcode scanner verifies the 12-digit code scanned by comparing the
code’s last digit to its own computation of the check digit calculated from the first 11 digits as
follows:
1. Calculate the sum of the digits in the odd-numbered indices (the first, third, …, ninth
digits) and multiply this sum by 3.
2. Calculate the sum of the digits in the even-numbered indices (the 0th, second, … tenth
digits).
3. Add the results from step 1 and 2. If the last digit of the addition result is 0, then 0 is the
check digit. .
1 Cinemark Holdings Inc. Simulated ERM Program .docxoswald1horne84988
1
Cinemark Holdings Inc.: Simulated ERM Program
Ben Li, Assistant Vice President of Compliance, is assigned the responsibility of developing an ERM
program at Cinemark Holdings Inc. (CHI). Over the past year, Ben has put in place the following ERM
activities:
Risk Identification and Assessment
The risk identification and assessment process steps are as follows:
1) Conduct online surveys of the heads of the 10 business segments and their 1-2 direct reports (15
people) and their mid-level managers (80 people). Exhibit 1 shows the instructions that are
included in the online survey. Exhibit 2 shows samples of the information collected from the
online survey.
2) Each of the 10 business segments separately organizes and compiles the results of the online
survey. They typically compile a robust list of 70-80 potential key risks. Each business segment
then prioritizes their top-5 risks and reports them to Ben Li, resulting in a total of 50 key risks (a
partial sample of the top-50 risk list is shown in Exhibit 3).
3) A consensus meeting is conducted where the 50 risks are shared with the top 10 members of
senior management in an open-group setting at an offsite one-day event. The 50 risks are each
discussed one at a time, after which the facilitator has the group collectively discuss and score
them for likelihood and severity. The risk ranking is calculated as the likelihood score plus the
severity score; the control effectiveness score is used to determine if there is room to improve
the controls and is used in the risk decision making process step. The top-20 risks are identified
as the key risks to CHI and are selected for additional mitigation and advanced to the risk
decision making stage. A Heat Map (see Exhibit 4) is provided to assist in this effort.
4) The 30 risks remaining from the 50 discussed at the consensus meeting are considered the non-
key risks, and these are monitored with key risk indicators to see if, over time, either the
likelihood and/or severity is increasing to the level which would result in one of these being
elevated to a key risk.
Risk Decision Making
Ben Li formed a Risk Committee to look at the risk identification and assessment information and to
define CHI’s risk appetite and risk limits, which were defined as follows:
Risk Appetite
CHI will maintain its overall risk profile in a manner consistent with our mission and vision and with the
expectations of our shareholders.
Risk Limits
CHI will also avoid any individual risk exposures deemed excessive by its Risk Committee; the individual
risk exposures will be determined separately for each key risk. CHI has zero tolerance for risks related to
internal fraud or violations of the employee code of conduct.
2
Ben Li expanded the role of the Risk Committee to also select and implement the risk mitigation for each
of the 20 key risks, at the same time as the committee determines the risk limits. .
1 Figure 1 Picture of Richard Selzer Richard Selz.docxoswald1horne84988
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Figure 1 Picture of Richard Selzer
Richard Selzer
What I Saw at the Abortion
I am a surgeon. Sick flesh is everyday news. Escaping blood, all the outpourings of
disease, meaty tumors that terrify–I touch these to destroy them. But I do not make symbols of
them.
What I am saying is that I have seen and I am used to seeing. I am a man who has a
trade, who has practiced it long enough to see no news in any of it. Picture me, then. A
professional in his forties, three children, living in a university town—so, necessarily, well—
enlightened? Enough, anyhow. Successful in my work, yes. No overriding religious posture.
Nothing special, then, your routine fellow, trying to do his work and doing it well enough. Picture
me, this professional, a sort of scientist, if you please, in possession of the standard admirable
opinions, positions, convictions, and so on–on this and that matter–on abortion, for example.
All right. Now listen.
It is the western wing of the fourth floor of a great university hospital. I am present
because I asked to be present. I wanted to see what I had never seen: an abortion.
The patient is Jamaican. She lies on the table in that state of notable submissiveness I
have always seen in patients. Now and then she smiles at one of the nurses as though
acknowledging a secret.
A nurse draws down the sheet, lays bare the abdomen. The belly mounds gently in the
twenty-fourth week of pregnancy. The chief surgeon paints it with a sponge soaked in red
antiseptic. He does this three times, each time a fresh sponge. He covers the area with a sterile
sheet, an aperture in its center. He is a kindly man who teaches as he works, who pauses to
reassure the woman.
He begins.
“A little pinprick,” he says to the woman. He inserts the point of a tiny needle at the
midline of the lower portion of her abdomen, on the downslope. He infiltrates local anesthetic into
the skin, where it forms a small white bubble.
The woman grimaces. “That is all you will feel,” the doctor says, “except for a little
pressure. But no more pain.” She smiles again. She seems to relax. She settles comfortably on
the table. The worst is over.
The doctor selects a three-and-one-half-inch needle bearing a central stylet. He places
the point at the site of the previous injection. He aims it straight up and down, perpendicular.
Next he takes hold of her abdomen with his left hand, palming the womb, steadying it. He thrusts
with his right hand. The needle sinks into the abdominal wall.
“Oh,” says the woman quietly.
But I guess it is not pain she feels. It is more a recognition that the deed is being done. Another
thrust and he has speared the uterus.
“We are in,” he says. He has felt the muscular wall of the organ gripping the shaft of his
needle. A further slight pressure on the needle advances it a bit more. He takes his left hand
2
from the woman’s abdomen. He retracts the filament of the stylet from the bar.
1 Films on Africa 1. A star () next to a film i.docxoswald1horne84988
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Films on Africa
1. A star (*) next to a film indicates that portions of that film might be shown in class in the course of
the semester.
2. All films are in DVD format, unless indicated otherwise.
3. Available: at the Madden and Fresno County Public Libraries, via Netflix, Blackboard or on-line.
4. For the on-line films, you can click on the link and this will lead you directly to the film.
5. Please be advised that a few films have the following notice: Warning: Contains scenes which some
viewers may find disturbing. You decide whether you want to watch them or not.
6. Some films are available on-line via VOD.
7. Let your instructor know if a link is no longer working.
The Africans (9 VHS films – each 60 min or 5 DVDs – each 120 min): Co-
production of WETA-TV and BBC-TV. Presented by Ali A. Mazrui. 1986.
Available at Madden Media & Fresno Public Libraries
Vol. 1 – The Nature of a continent*
Summary: Examines Africa as the birthplace of humankind and discusses
the impact of geography on African history, including the role of the Nile
in the origin of civilization and the introduction of Islam to Africa through its Arabic borders.
Vol. 2 – A Legacy of lifestyles*
Summary: This program explores how African contemporary lifestyles are influenced by
indigenous, Islamic and Western factors. It compares simple African societies with those that
are more complex and centralized, and examines the importance of family life.
Vol. 3 – New gods
Summary: This program examines the factors that influence religion in Africa, paying particular
attention to how traditional religions, Islam, and Christianity co-exist and influence each other.
Vol. 4 – Tools of exploitation
Summary: The impact of the West on Africa and the impact of Africa on the development of the
West are contrasted with an emphasis on the manner in which Africa's human and natural
resources have been exploited before, during, and after the colonial period.
Vol. 5 – New conflicts
Summary: Explores the tensions inherent in the juxtaposition of 3 African heritages, looking at
the ways in which these conflicts have contributed to the rise of the nationalist movement, the
warrior tradition of indigenous Africa, the jihad tradition of Islam, and modern guerilla warfare.
Vol. 6 – In search of stability
Summary: Gives an overview of the several means of governing in Africa. Examines new social
orders to illustrate an Africa in search of a viable form of government in the post-independence
period.
1.
2
Vol. 7 – A Garden of Eden in decay?
Summary: Identifies the problems of a continent that produces what it does not consume and
consumes what it does not produce. Shows Africa's struggle between economic dependence
and decay.
Vol. 8 – A Clash of cultures*
Summary: Discusses the conflicts and compromises which emerge from the coexistence of
many African traditions and modern life. Explores the question of whet.
1 Contemporary Approaches in Management of Risk in .docxoswald1horne84988
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Contemporary Approaches in Management of Risk in Engineering Organizations
Assignment-1
Literature review
Student name: Hari Kiran Penumudi
student id: 217473484
Table of Contents
2
INTRODUCTION………………………………………………………………………3-4
OBJECTIVES & DELIVERABLES…………………………………………………....4
REVIEW OF LITERATURE…………………………………………………………....5-13
Risk and Risk Management………………………………………………………5-6
Risk Management Frameworks……………………………………………….....6-10
Importance of Risk Management in Engineering………………………….........10-13
GENERAL PROBLEM STATEMENT…………………………………………………13-14
RESEARH STRATEGY…………………………………………………………………14-15
RESOURCES REQUIREMENTS……………………………………………………….16
PROJECT PLANNING…………………………………………………………………..16
REFERNCES…………………………………………………………………………….17-19
Contemporary Approaches in Management of Risk in Engineering Organizations
3
Introduction
The term, ‘risk’ as defined by the Oxford English dictionary is a possibility to meet with any
kind of danger or suffer harm. Risk is a serious issue that every organization has to deal with in
their everyday operations. However, nature and magnitude of risks largely vary from
organization to organization and often depend on the type of the organization. Therefore,
organizations irrespective of their type of operations keep a risk management team that looks
after every risk to which an organization is vulnerable. Organizations in the field of engineering
also have to come across some inherent risks that negatively impact their operations. Engineering
may be defined as the process of applying science to practical purposes of designing structures,
systems, machines and similar things. Therefore, like every other organization, risk assessment
and management is also an integral part of engineering organizations. Since the task of
engineering is mostly complex, the risks in this area are also very complicated. If risks in
engineering field are not mitigated effectively it may produce long-term danger that may affect
both the organizational services and the society in whole. Hence, the activity of risk management
within engineering organizations must be undertaken seriously and measured thoroughly in order
to reduce the threat of risks. Amyotte et al., (2006) simply puts it like within the engineering
practice, an inbuilt risk is always present. Studies have found that despite the knowledge of
inherent risks within the field and activity of engineering, organizations are not very aware in
imparting knowledge about risk management to their engineers. From this the need of education
regarding the risk management approaches arises. Therefore, this paper tries to find out
approaches to management of risks and importance of these approaches within the area of
engineering. Bringing on the contemporary evidence from the literature review related to risk
management approaches, the paper examines how those approaches can be helpful for
4 .
1
Assignment front Sheet
Qualification Unit number and title
Pearson BTEC Levels 4 and 5 Higher
Nationals in Health and Social Care (RQF)
HNHS 17: Effective Reporting and Record-keeping in
Health and Social Care Services
Student name Assessor name Internal Verifier
B. Maher F. Khan
Date issued: Final Submission:
12/10/2018 18/01/2019
Assignment title
Effective Reporting and Record-keeping in Health and Social
Care services
Submission Format
This work will be submitted in 2 different formats:
Assessment 1 should be submitted as a word-processed report document in a standard report
style, which requires the use of headings, titles and appropriate captions. You may also choose
to include pictures, graphs and charts where relevant to support your work. The recommended
word count for this assignment is 1500–2000 words, though you will not be penalised for
exceeding this total.
Assessment 2 requires the submission of evidence from a mock training event on record-
keeping. This will include a set of materials used in the event, to include an electronic
presentation, evidence of your own record-keeping across a range of types of records, as well as
where you will demonstrate you have evaluated the effectiveness of your own completion of
relevant records. The recommended word count for the presentation is 1000–1500 words
(including speaker notes), though you will not be penalised for exceeding this total.
For both assessments, any material that is derived from other sources must be suitably
referenced using a standard form of citation. Provide a bibliography using the Harvard
referencing system.
Unit Learning Outcomes
LO1 Describe the legal and regulatory aspects of reporting and record keeping in a care setting
LO2 Explore the internal and external recording requirements in a care setting
Assignment Brief and Guidance
2
Purpose of this assignment:
The purpose of the assignment is to assess the learner firstly in relation to both the legal and
regulatory aspects of reporting and record keeping in a care setting through producing an internal
evaluative review of record keeping in their own care setting. Secondly, the learner will be
assessed on the internal and external recording requirements in a care setting. Thirdly, the learner
will be assessed on Review the use of technology in reporting and recording service user care in a
care setting and fourthly the learner will demonstrate how to keep and maintain records in own care
setting in line with national and local policies.
Breakdown of assignment:
Assignment:
You need to produce one written piece of work of 2,500 words (+/- 10%) covering all the
assessment criterion in LO1-LO4 as one document.
Unit Learning Outcomes
LO1 Describe the legal and regulatory aspects of reporting and record keeping in a care
setting
LO2 Explore the internal and external recording.
1 BBS300 Empirical Research Methods for Business .docxoswald1horne84988
1
BBS300 Empirical Research Methods for Business
TSA, 2018
Assignment 1
Due: Sunday, 7 October 2018,
23:55 PM
This assignment covers material from Sessions 1-4 and is worth 20% of your total mark
of BBS300. Your solutions should be properly presented, and it is important that you
double-check your spelling and grammar and thoroughly proofread your assignment
before submitting. Instructions for assignment submission are presented in
the “Assignment 1” link and must be strictly adhered to. No marks will be
awarded to assignments that are submitted after the due date and time.
All analyses must be carried out using SPSS, and no marks will be awarded
for assignment questions where SPSS output supporting your answer is not
provided in your Microsoft Word file submitted for the Assignment.
Questions
In this assignment, we will examine the “Real Estate Market” dataset (described at the
end of the assignment ) and “Employee Satisfaction” dataset. Before beginning the
assignment, read through the descriptions of these dataset and their variables carefully.
The “Real Estate Market” dataset can be found in the file “realestatemarket.sav,” and
the “Employee Satisfaction” dataset can be found in the file “employeesatisfaction.sav.”
You will need to carefully inspect both SPSS data files to be sure that the
specification of variable types is correct and, where appropriate, value
labels are entered.
1. (12 marks)
2
Use appropriate graphical displays and measures of centrality and dispersion
to summarise the following four variables in the “Real Estate Market” dataset. For
graphical displays for numeric data, be sure to comment on not only the shape of
the distribution but also compliance with a normal distribution. Be sure to
include relevant SPSS output (graphs, tables) to support your answers.
(a) Price.
(b) Lot Size.
(c) Material.
(d) Condition.
2. (8 marks)
Again consider the variable Price, which records the property price (in AUD). It
is of interest to know if this is associated with the distance of the property is
located to the train station. It i s al so of i nter e st t o kn o w if th e p rop ert y
pri ce s are a sso ciate d with di st an ce to t h e ne ar e st b u s sto p. Carry out
appropriate statistical techniques to assess whether there is a significant
association between the property price and distance to the nearest train (To train)
station and the nearest bus stop (To bus). Be sure to thoroughly assess the
assumptions of your particular analysis, and be sure to include relevant SPSS
output (graphs, tables) to support your answers.
3. (7 marks)
Consider the “Employee Satisfaction” dataset, which asked participants to provide their
level of regularity to a series of thirteen statements. Conduct an appropriate analysis
to assess the reliability of responses to these statements. If the reliability will
increa.
1 ASSIGNMENT 7 C – MERGING DATA FILES IN STATA Do.docxoswald1horne84988
1
ASSIGNMENT 7 C – MERGING DATA FILES IN STATA
Download the world development data covering the years 2000-2016 from the website
“http://databank.worldbank.org/data/reports.aspx?source=World-Governance-Indicators” for the
following upper-middle-income countries.
Countries of Interest:
Albania Ecuador Montenegro
Algeria Equatorial Guinea Namibia
American Samoa Fiji Nauru
Argentina Gabon Panama
Azerbaijan Grenada Paraguay
Belarus Guyana Peru
Belize Iran, Islamic Rep. Romania
Bosnia and Herzegovina Iraq Russian Federation
Botswana Jamaica Samoa
Brazil Kazakhstan Serbia
Bulgaria Lebanon South Africa
China Libya St. Lucia
Colombia Macedonia, FYR St. Vincent and the Grenadines
Costa Rica Malaysia Suriname
Croatia Maldives Thailand
Cuba Marshall Islands Tonga
Dominica Mauritius Turkey
Dominican Republic Mexico Turkmenistan
Tuvalu
Venezuela, RB
Variables of Interest
Control of Corruption: Estimate
Government Effectiveness: Estimate
Political Stability and Absence of Violence/Terrorism:
Estimate
Regulatory Quality: Estimate
Rule of Law: Estimate
Voice and Accountability: Estimate
2
STEP 1 - Download the data from the World-Governance-Indicators database as shown below
STEP 2 - Check the variables of interest
3
Please make sure you are checking the variables with “Estimates”.
TO VIEW THE DEFINITIONS OF THE VARIABLES
4
Step 3 – Select countries of interest
5
Step 4 – Click on “Time” and select the “year range” you are interested in (2000-2016)
6
Step 5 – Click on the “Layout” as shown below
Change the time layout to “Row,” series to “Column” and Country to “Row.”
Next, click on the “apply changes.”
Step 6 – Click on the “Download option” and select “Excel” as shown below
7
STEP 7: Using Excel, Replace the Missing Values With “.” (See previous assignments)
STEP 8: SAVE THE EXCEL DATA FILE ON YOUR COMPUTER PREFERABLY IN A
FOLDER
STEP 9: IMPORT YOUR DATA INTO STATA AND NAME YOUR DATA SET
“WORLD_GOVERNANCE_INDICATORS.” (See previous assignments for steps)
8
STEP 10; RENAME THE VARIABLES AS SHOWN BELOW (See previous assignments for
steps)
Using stata, merge the data set from “ASSIGNMENT 3B” with this dataset
VERY IMPORTANT Note: Merging two datasets requires that both have at least one variable in
common (either string or numeric).
This statement requires that the variable name for “Time” and “Country” should be the same in the two
data set
MERGING THE DATASET FROM “ASSIGNMENT 3” WITH THE DATA FROM THE
WORLD GOVERNANCE INDICATORS
Merging data files in stata
https://www.youtube.com/watch?v=EV-5PztbHs0
https://www.youtube.com/watch?v=Uh7C0mlhB3g&t=54s
https://www.youtube.com/watch?v=2etG_34ODoc
I will strongly encourage you to watch these videos before merging
I will also strongly recommend you read the notes in the link below before you star.
1 Assessment details for ALL students Assessment item.docxoswald1horne84988
1
Assessment details for ALL students
Assessment item 3 - Individual submission
Due date: Week 12 Monday (1 Oct 2018) 11:55 pm AEST
Weighting:
Length:
50% (or 50 marks)
There is no word limit for this report
Objectives
This assessment item relates to the unit learning outcomes as stated in the unit profile.
Enabling objectives
1. Analyse a case study and identify issues associated with the business;
2. Develop and deploy the application in IBM Bluemix;
3. Evaluate existing and new functionalities to address business problems;
4. Prepare a document to report your activities using text and multimedia (for example screenshots, videos).
General Information
The purpose of this assignment is to create a cloud based simulating environment which will help to
identify/understand the problem stated in the given case study using analysis tools available in IBM
Bluemix. In assignment three, you are working individually. By doing this assignment, you will
learn to use skills and knowledge of emerging technologies like cloud computing, IoT, to simulate a
business scenario to capture operational data and share with a visualization tool. You will acquire a
good understanding of smart application design in a cloud environment for efficient application
configuration and deployment.
What do you need to do?
The assignment requires you to do the following -
• Download the ‘Starter_Code_For_Assignment_Three.rar’ given in week 8 to
configure, and deploy a cloud based smart/IoT (Internet of Things) application to
simulate the business case.
• Choose a case study out of given two below and analyse the case study to
understand the business problem and design a solution for those problems.
• Deploy the starter source code in your Bluemix account and modify it to address
all required milestones mentioned in your chosen case study.
• Finally prepare a report according to given format and specifications below and
submit it in Moodle.
2
Report format and specifications -
You are required to submit a written report in a single Microsoft Word (.doc or .docx)
document. There is no word limit but any unnecessary information included in the report
may result in reduced marks.
The report must contain the following content (feel free to define your own sections,
as long as you include all the required content):
o Cover page/title page and Table of contents
o URL of the app and login details of the IBM Bluemix account
o Introduction
o Case study analysis which will report –
o Business problems you have identified in the case study
o Possible solutions for each and how do these solutions address the
business problems?
o What are the solutions you implemented in the application?
o The step by step process you have followed to configure and deploy the smart app
for business case simulation. You may choose to use screenshots and notes to
enrich your report but you must have a video of the pr.
1
CDU APA 6th
Referencing Style Guide
(February 2019 version)
2
Contents
APA Fundamentals .......................................................................................... 3
Reference List ................................................................................................... 3
Citing in the text ............................................................................................... 5
Paraphrase ................................................................................................... 5
Direct quotes................................................................................................. 5
Secondary source .......................................................................................... 6
Personal communications............................................................................. 6
Examples .......................................................................................................... 7
Book .............................................................................................................. 7
eBook ............................................................................................................ 7
Journal article with doi ................................................................................ 7
Journal article without doi ........................................................................... 7
Web page ...................................................................................................... 7
Books - print and online ................................................................................... 8
Single author ................................................................................................ 8
eBook/electronic book ................................................................................ 11
Journal articles, Conference papers and Newspaper articles ........................ 13
Multimedia ..................................................................................................... 16
YouTube or Streaming video ..................................................................... 16
Online images ................................................................................................. 17
Web sources and online documents ................................................................ 20
Web page .................................................................................................... 20
Document from a website ........................................................................... 21
Legislation and cases ...................................................................................... 23
Common abbreviations .................................................................................. 24
Appendix 1: How to write an APA reference when information is missing .. 25
Appendix 2: Author layout.
1
BIOL 102: Lab 9
Simulated ABO and Rh Blood Typing
Objectives:
After completing this laboratory assignment, students will be able to:
• explain the biology of blood typing systems ABO and Rh
• explain the genetics of blood types
• determine the blood types of several patients
Introduction:
Before Karl Landsteiner discovered the ABO human blood groups in 1901, it was thought that all blood was the
same. This misunderstanding led to fatal blood transfusions. Later, in 1940, Landsteiner was part of a team
who discovered another blood group, the Rh blood group system. There are many blood group systems known
today, but the ABO and the Rh blood groups are the most important ones used for blood transfusions. The
designation Rh is derived from the Rhesus monkey in which the existence of the Rh blood group was
discovered.
Although all blood is made of the same basic elements, not all blood is alike. In fact, there are eight different
common blood types, which are determined by the presence or absence of certain antigens – substances that
can trigger an immune response if they are foreign to the body – on the surface of the red blood cells (RBCs
also known as erythrocytes).
ABO System:
The antigens on RBCs are agglutinating antigens or agglutinogens. They have been designated as A and B.
Antibodies against antigens A and B begin to build up in the blood plasma shortly after birth. A person
normally produces antibodies (agglutinins) against those antigens that are not present on his/her erythrocytes
but does not produce antibodies against those antigens that are present on his/her erythrocytes.
• A person who is blood type A will have A antigens on the surface of her/his RBCs and will have
antibodies against B antigens (anti-B antibodies). See picture below.
• A person with blood type B will have B antigens on the surface of her/his RBCs and will have antibodies
against antigen A (anti-A antibodies).
• A person with blood type O will have neither A nor B antigens on the surface of her/his RBCs and has
BOTH anti-A and anti-B antibodies.
• A person with blood type AB will have both A and B antigens on the surface of her/his RBCs and has
neither anti-A nor anti-B antibodies.
The individual’s blood type is based on the antigens (not the antibodies) he/she has. The four blood groups
are known as types A, B, AB, and O. Blood type O, characterized by an absence of A and B agglutinogens, is
the most common in the United States (45% of the population). Type A is the next in frequency, found in 39%
of the population. The incidences of types B and AB are 12% and 4%, respectively.
2
Table 1: The ABO System
Blood
Type
Antigens on
RBCs
Antibodies
in the Blood
Can GIVE Blood
to Groups:
Can RECEIVE
Blood from Groups:
A A Anti-B A, AB O, A
B B Anti-A B, AB O, B
AB A and B
Neither anti-A
nor anti-B
AB O, A, B, AB
O
Neither A nor
B
Both anti-A.
1
Business Intelligence Case
Project Background
Mell Industries is a national manufacturing firm that specializes in textiles based out of
Chicago. Starting out as a small factory in Warrenville, Illinois, the firm experienced a period of steady
growth over the past twenty-four years. Steadily opening new warehouses and factories in the
surrounding areas in Michigan and Indianapolis until eventually moving their base of operations to
Chicago. Due to this expansion, Mell Industries is at the height of its production and hopes to avoid any
interferences or deceleration of growth.
In recent years, the firm has been under heavy media scrutiny for supposedly compensating its
female staff unfairly lower compared to male counterparts. This was initiated when a disgruntled
employee leaked the company payroll allegedly showcasing an unjust gap of income between the
female employee and her male counterpart. This type of gender pay gap is highly criticized and as a
precaution, Mell Industries has hired Cal Poly Pomona to conduct research to determine the validity of
these claims. Mell Industries has provided Cal Poly Pomona with a data set of a sample population of
747 employees. Mell Industries has also offered Cal Poly Pomona compensation for any promising
information gathered. Mell Industries may use information gathered from this project in future
employee compensation decisions.
The initial dataset has been given to you in the form of an excel spreadsheet titled
Case_dataset.xlsx consisting of 12 columns labeled:
● Column A - Employee ID
● Column B - Gender
● Column C - Date of Birth
● Column D - Date of Hire
● Column E - Termination Date
● Column F - Occupation
● Column G - Salary
● Column H to L - Employee Evaluation Metrics
In addition, Mell Industries provided the latest annual employee performance review evaluation
results rating each employee in various performance categories. They have turned over this information
separately and as a consultant, it is your task to provide Mell Industries with the most accurate and
relevant information in a digestible form. Furthermore, using excel skills learned during the course, you
will manipulate and analyze the data set in order to make appropriate managerial decisions. You will
utilize excel functions highlighted in this project as well as a pivot table and chart to form a decision
support system in order to answer the critical thinking questions.
Project Objective
The purpose of this project is to perform a methodical data analysis to assist the company make
an informed decision. This could also serve as a basis for implementing critical adjustments to certain
business aspects if necessary. Illustrate the business process by condensing a large set of data, to
present relevant information with data visualization. We will be utilizing Microsoft Excel 2016 to
complete this project.
2
TA.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
15. z
0
-2-
Week 1 Learning Resources
Perkinson, R. R. (2012). Chemical dependency counseling: A
practical guide (4th ed.). Thousand Oaks, CA: SAGE.
. Chapter 1, “The First Contact”
Focus on the descriptions of client perspectives in the
“Treatment Works” and “How to Develop the Therapeutic
Alliance” sections and how these descriptions relate to the
codes of ethics and principles addictions professional should
follow (see this week’s Discussion area). Also focus on the
information on treatment facilities and group practice to learn
more about the need for multidisciplinary teams for your
Assignment.
. Chapter 14, “The Clinical Staff”
Focus on the various types of professionals that might need to
be included in the multidisciplinary team.
· American Psychological Association. (2013). Ethical
principles of psychologists and code of conduct. Retrieved
from http://www.apa.org/ethics/code/index.aspx
Focus on the Preamble, which provides a rationale for following
codes of ethical principles and standards. Focus also on the
General Principles, which sets the stage for other information
on ethics violations.
17. staff had a great deal of respect for each individual member of
the staff and listen
carefully to each other. No one staff member is more important
than another is. All are equal and essential
for recovery. They work together like a symphony all playing
the same masterpiece.
A good staff is fun. The staff members enjoy working together
and supporting each other in the war
against addiction . A good staff laughs a lot. Sometimes you
have to laugh to keep the disease from getting
you down.
Everyone has input into the clients' treatment plans, but
everyone has his or her own area of specializa-
tion. Professional boundaries are important and should be
respected and guarded. To question another
person's skills or decisions when you do not know their
profession is silly Let them do what they are
trained to do and trust that they have you and the client's best
interest at heart. If you stay within your own
boundaries-the boundaries of the chemical dependency
counselor-then you will be a lot better off, you
will feel better, and you will give better quality treatment. All
staff members are experts in their chosen
fields. They are licensed or certified by their respective boards,
and you have to believe that they know what
they are doing.
223
224 CHEMICAL DEPENDENCY COUNSELING
The Physician/Addictionologist
18. Source: Comstock Images/I'hinkstock.
The medical doctor is in charge of all medical treatment. This
physician has the most training in the total
disease process . A physician completes a premedical bachelor
's degree, 3 or 4 years of advanced medical
training, and at least 1 year of interning. Many physicians go on
to specialize in one or more areas of medi-
cine. Physicians can have a specialty in addiction called
addictionology
All clients must have a complete history and physical
examination given by a physician . If you have any
questions about any type of physical disease or medical
treatment, then the physician is the person to rely
on. It is important to establish a professional working
relationship with the physician . He or she is a wealth
of information . Do not be intimidated by professionals with
advanced degrees. They are just people like
you-fallible and human. Discuss your client's case with them,
and respect their judgment. Good physicians
are easy to talk to and readily admit that they do not know
everything. They often need you to tell them how
the client is responding to treatment.
The physician will be in close contact with you, particularly if
your client has a medical condition that
requires treatment. Close consultation with the physician will
prevent you from assuming that behavior
caused by an organic disease is a psychological problem.
The physician is in charge of any medication order. If you
believe that your client needs pharmacological
treatment, then you need to tell the physician or nurse. Once
you have discussed this issue carefully with
19. the medical staff, your job is over. The physician will examine
the client and make the determination based
on his or her own clinical judgment. Do not argue with the
physician or the nurse about what they are doing.
They know more about it than you do. Trust them to do their
job. You must keep the medical staff advised
about your client's condition if they are not doing well or might
be having side effects to the medication. Let
them know your concerns and leave it to them to treat the
medical condition.
The Psychologist/Psychiatrist
All treatment centers should have a consulting psychologist or
psychiatrist. The psychologist/psychiatrist has
advanced training in the diagnosis and treatment of mental
disorders. A psychiatrist is a medical doctor with
3 years of residency in psychiatry. A psychologist has a 2-year
master's degree and a 4-year doctorate degree
·er 14 The Clinical Staff 225
- _ 1 year of internship during the doctoral training and 1 year
postdoctorate. These two professionals are
best-trained mental health professionals . Only psychiatrists can
order medications , and usually only psy-
ogists are heavily trained in psychotherapy, particularly
evidence-based cognitive behavioral therapy and
ological testing.
Two thirds of chemically dependent clients have a concomitant
psychiatric diagnosis. They have prob-
such as depression, anxiety, and/or personality disorders in
20. conjunction with their addiction. Clients
~ not do well in recovery unless these disorders are treated
effectively (Frances & Franklin, 1988; Ries &
er, 2009; Talbott, Hales, & Yudofsky, 1988; Woody eta!. ,
1984) . It is important to have a professional in
center who can deal with these coexisting problems.
The Joint Commission on Accreditation of Health care
Organizations GCAHO) and the Commission on
__ creditation of Rehabilitation Facilities (CARF) requires that
all clients in inpatient substance abuse treat-
em receive a psychiatric/psychological evaluation. This
examination includes a mental status examina-
n, a determination of current and past psychiatric/psychological
abnormality, a determination of the
..; egree of danger to self or others, and a brief
neuropsychological assessment. It is from this examination
- - !at you will learn about any secondary diagnosis and will
develop a treatment plan. The psychiatrist or
• sychologist will tell you what to do. Follow his or her
directions as precisely as you can. Use this profes-
: io nal as a valuable information source. This professional
understands the development of personality and
-· e forces that motivate behavior. If you are confused by a
client, talk the situation over carefully with the
psychiatrist or psychologist.
The Social Worker/Mental Health Counselor
Social workers and mental health counselors are wonderful
mental health professionals . They usually have
been through a 2- to 3-year graduate program and are licensed
by the state . These mental health profes-
21. ionals have many fine qualities. They are excellent therapists
and group leaders. They understand the
community of mental health professionals and are often charged
with testing and treating co-occurring
disorders and arranging for continuing care placements in
continuing care, including referrals to other
professionals , halfway houses, and group homes. These
professionals are good at about anything and can
handle almost any mental health task except ordering
medication . They are a lot like mental health profes-
ionals or professional counselors who have a master 's degree in
counseling and have many things to offer
you and your clients .
The Nurse
There are two types of nurses: (1) registered nurses and (2)
licensed practical nurses. Registered nurses
complete a registered nurse 's degree from an accredited
institution. Most go on for a bachelor's degree .
Licensed practical nurses complete a 1-year vocational-
technical program in nursing.
Nurses are frontline medical personnel. They take responsibility
for the client in the absence of the
p hysician. In an inpatient setting, they usually are guiding the
ship and are available 24 hours a day.
There is a tendency in some centers for there to be some
conflict between the nursing staff and the
counseling staff. This is a big mistake for all concerned . A
good clinical staff has little of these turf
battles . Each staff member should feel comfortable with his or
her unique function in the treatment
setting.
22. Nurses are second in command in medical treatment . Only the
doctor has more medical authority.
The physician writes the orders , and the nurses carry them out.
In many facilities, there are standing
orders that allow nurses to make medical decisions . This is
necessary to reduce response time and to
'
226 CHEMICAL DEPENDENCY COUNSELING
prevent the physician from being called every time a decision is
made. If a nurse tells you to do something,
then you should carry out this order as if it came from the
physician.
Nurses will listen to you and help you. You will find them to be
supportive. They tend to be caring
people who are willing to go the extra mile to provide good
quality care. They are used to charting and usu-
ally are wonderfully self-disciplined.
The Clinical Director
The clinical director has the primary responsibility for making
sure that the clinical team provides the
best possible treatment. This individual develops and
implements the whole treatment program. He or
she has advanced training and experience in treating addiction
and co-occurring disorders. The clinical
director makes sure that the team is working well together and
is accomplishing its goals. The clinical
director decides who does what , when, how, and with whom.
23. This person leads the clinical team and the
client population. The clinical director has administrative
experience. This individual usually sees the
clients and the staff who are having more severe problems. All
program and policy changes go through
the clinical director.
The Clinical Supervisor
The clinical supervisor is an addiction counselor with several
years of experience in counseling and supervi-
sion. This individual's primary responsibility is to supervise the
counseling staff. The clinical supervisor will
be doing some hands-on work with the clients and will be
sitting in on some of your individual sessions and
groups. He or she makes up the work schedule. You should use
this person often . The clinical director and
clinical supervisor are your mentors. This person will set a good
example for how to take a client through
treatment effectively. If you have any questions about treatment
planning, charting, or therapy, then these
are the first people to ask. You should receive continuing
education from the supervisory personnel. If you
feel as though you have any weak points in your training, then
ask them for in-service training sessions to
build your expertise.
The clinical supervisor will be going over your charts to be sure
that you are treating the clients accord-
ing to ]CAHO or CARF. ]CAHO and CARF require specific
standards of care to be met before it will allow a
facility to receive accreditation. (You can order a copy of the
standards by contacting JCAHO, 875 North
Michigan Avenue, Chicago, IL 60611 or CARF International,
4891 E. Grant Road, Tucson, AZ 85712 USA, 520-
325-1044 or 888-28106531 voice(fTY, 520-318-1129 fax .)
24. The Chemical Dependency Counselor
Chemical dependency counselors must meet state standards set
by a certification board. They take special-
ized college courses and work for at least 1 year in a treatment
setting under a qualified supervisor. In most
states, they have to pass a national examination and are state
certified . Counselors must show competency
in 12 core function areas: (1) screening, (2) intake, (3)
orientation, (4) assessment, (5) treatment planning,
(6) counseling, (7) case management, (8) crisis intervention, (9)
client education, (10) referral, (11) reports
and record keeping, and (12) consultatio n. Many counselors are
involved in their own recovery programs ,
but many are not. It does not seem to matter. It is the on-the-job
training in addictions and personal experi-
ence that gives addictions counselors their unique professional
character. They are excellent highly qualified
health care professionals.
Ch apter 14 The Clinical Staff 227
The Rehabilitation Technician or Aide
Rehabilitation technicians, sometimes called aides, usually are
individuals with no formal training in addic-
tion . Sometimes they are people who are getting their degrees
in addiction and need experience. These
people do a variety of work assigned by supervisory personnel.
They work with the clients, sometimes indi-
Yidually and sometimes in groups. They work under the direct
supervision of the counseling staff. It is your
responsibility to help them to function effectively around the
25. client population. Many times , the tech or aid
ays just the right thing at just the right time to turn a client
toward recovery. Never forget that they are
mart, willing, and able to go the extra mile for you and your
clients .
There often is some conflict about how far these people should
go in treating clients. For the most part,
the care they offer should be highly structured and supervised
by someone on the clinical staff. You will find
th at much of the real work in treatment is offered by these
individuals. You must see to it that they offer
quality care. The only way of doing this is to listen to them,
talk to them , and educate them. They might be
in recovery and know the 12 -step program well, but you can
still improve their skills by extending yourself
to support, educate , and encourage them. They are working
harder than you often think and are having
more effect than you can possibly imagine.
The Recreational Therapist
Source: Paul Sutherland/fhinkstock.
The recreational therapist is a certified coordinator in charge of
getting the clients involved in fun, construc-
tive exercise and leisure time activities. This individual will be
doing an activities assessment to see what the
clients are doing for entertainment, play; or fun. The activities
coordinator will develop an exercise program
for each client. Most addiction clients have lost the capacity to
have fun in sobriety They need to be encour-
aged to develop healthy recreational activities and hobbies.
They need to learn how to have fun clean and
sober. It is important that you encourage your clients to become
active in pleasure-oriented activities in
26. recovery The clients who enjoy sobriety will be more likely to
stay sober. One of the most important things
that clients can do in their recovery program is to establish
regular exercise habits. All clients should be
e ncouraged to exercise on a daily basis. The recreational
therapist needs to be a lot of fun to be with and
228 CHEMICAL DEPENDENCY COUNSELING
very encouraging. Most addicts have not exercised or enjoyed
recreational activities in a long time, so they
need someone fun to encourage them to try new activities .
Clinical Staffmg
The clinical staff makes up the treatment team. The staff usually
meets once a day, usually at each shift
change, to discuss the clients' status . Once a week, the staff
meets for a more formal clinical staffing. Here
the clients will be discussed in more detail, and each problem
on the problem list will be evaluated.
The staff must be constantly kept informed about how the
clients are doing in treatment. In these meet-
ings, treatment plans will be updated. A multidisciplinary staff
can take clients through treatment much more
effectively More expertise comes into play, and many heads are
much better than one.
Clinical staffing is your opportunity to discuss a client with the
whole team. You can get advice and help
from everyone at the same time. The client is reassessed
throughout treatment to determine current clinical
problems, needs, and responses to treatment. The assessment
27. includes major changes in the client, family,
or life events that could complicate or alter treatment. A client
could have just learned that his wife is divorc-
ing him or that he is being prosecuted for a crime. Someone in
the client's immediate family could die or
become ill. All changes in treatment need to be documented in
the client record.
The atmosphere of clinical staffing is a professional one . The
principal matter of concern is the cli-
ents. You must assume that all members of the professional
staff are willing and able to help. The staff
members should be supportive of each other. Treating addiction
is emotionally draining, and everyone
occasionally will make mistakes. The atmosphere in clinical
staffing should be one of mutual respect. You
should enjoy clinical staff meetings. They should be educational
, and they should help you to develop
your professional skills.
How to Present a Client
You will present each of your clients to the clinical staff and
will discuss how treatment generally is going. If
you have any questions , now is the time to ask them. The first
time that you present a client, you need to be
thorough. As the client remains in treatment, you need to cover
just the pertinent issues. An outline for case
presentation is handy to use your first few times. The outline
might look something like this:
1. Identifying data
2. Present illness
3. Past history
28. 4. Family history
5. Social history
6. Medical history
7. Mental status examination
8. Most likely diagnosis
9. Formulation
a. Predisposing factors
b. Psychosocial stressors
c. Stress that precipitated treatment
10. Further assessment you propose
-..apte r 14 The Clinical Staff 229
11. Treatment plan
12 . Prognosis
Your presentation should sound something like this:
Jason Roberts is a 43-year-old black male who just got his third
DWI. He has been drinking heavily for
the past 20 years. He is divorced with two children. He lives
alone. He came to treatment after spending
the night in jail. He is working on his chemical use history and
problem assessment form. He is doing
well around the unit so far. He is in good physical health except
for some mild withdrawal symptoms.
29. His CWJA scores have averaged around 8 to 14. He seems to be
getting along well with his treatment
peers. In group, he did admit to a drinking problem. He seems
committed to treatment. He says he does
not want to go on living this way anymore. I talked to his oldest
son this morning, and the family is sup-
portive of treatment. He is in some withdrawal, but he seems to
be handling that okay He needs to visit
with the psychologist to rule out other psychiatric disorders .
He is depressed and reports he is not
sleeping well. His diagnosis is alcohol dependence-severe-with
a possible substance induced depres-
sion or a major depression. He will be working through the
steps, and we will probably address his
depression depending on the psychologist's report.
The case presentation globally advises the treatment team of the
client's condition and describes how
the client is doing in treatment. After you present the client,
each member of the treatment team can com-
ment. The physician or the nursing staff may have something to
share about withdrawal or the medical
condition for which the client is being treated. The dietitian
may make a report on the client's diet. The
recreational therapist may have a comment on how the client
has been using his or her leisure time. The
other counselors may have something to say about what they
see. As the primary counselor, you collate this
material and enter the staff's input into the client record. These
progress notes do not have to be very long,
bu t they do have to show that the treatment team is reassessing
the client and changing the treatment plan
where necessary
Team Building
30. A good staff is constantly building the team. These staff
members are actively encouraging each other and
reinforcing each other's work. When you see someone do a good
job , you say so: "You did a good job with
Mark this morning. I was impressed with how you handled
yourself. " These comments are very reinforcing
to fellow staff members. The staff members often put so much
energy into the clients that they forget that
they have needs , too. This is emotionally difficult work, and
everyone needs support. A good team knows
this. Each member goes out of his or her way to treat each other
well.
New team members are welcomed and are assisted in adjusting
to the flow of treatment. Every treatment
center is different, and new staff members need orientation on
both an intellectual and an emotional level.
A good team's members constantly talk each other up to insiders
as well as outsiders. They never talk
someone on the staff down. You can share the truth about
someone without damaging his or her reputation .
The members of a good staff communicate well together. They
share openly how they feel and what they
think. They work together as a group. If a personal problem
develops between staff members, then the
problem is handled by a supervisor.
A good staff 's members never gossip about each other. Gossip
is one of the most harmful things that
can occur in any staff organization. Gossip will cause a team to
fail. Everyone 's life outside of the center
should be private. Unless someone decides to confide in you,
keep out of the issue. Do not spread damaging
rumors about anyone. A good way of checking yourself is to
refuse to repeat anything unless you have the
permission of the person in question .
31. 230 CHEMICAL DEPENDENCY COUNSELING
Good staff members get support, not treatment, from their
fellow staff members. It is a mistake for
someone in recovery to think they no longer need their 12-step
meetings because they have the support
of the clinical team. The clinical staff does not exist to treat
you; it exists to treat the clients. If you want
to see someone on the staff for a brief consultation about a
problem, that is fine, but keep it short. Do not
be afraid to seek outside help for your problems. Your mental
and physical health directly affects your job
performance. If your problems are bogging you down , then you
cannot be effective. Becoming involved
in a good program of recovery will make you a better counselor
and a better person. One of the best ways
of learning about good therapy is to go to a good therapist .
Make sure that this therapist is highly qualified
in his or her field .
A good clinical staff does not "subgroup" against each other.
This is where a smaller group of staff mem-
bers gets together and talks about the other members. This is
very common, and it is a disaster for the
clinical team. If you are having problems with a staff member,
then go to that staff member first and try to
work the issue through. If you are unable to resolve the
problem, then go to your supervisor and get him or
her to help you. If you and the supervisor cannot handle the
problem, then it needs to be addressed before
the clinical staff as a whole. Do not let problems fester. The
only way of resolving problems is to get everyone
together and have each person share how he or she feels. Any
32. problem can be solved in an atmosphere of
love and truth. The staff needs to practice what it preaches to
the clients.
The following guidelines are excellent for maintaining
productive staff interaction.
Commitment to Coworkers
As your coworker with a shared goal of providing excellent care
to our clients , I commit myself to the
following:
1. I will accept responsibility for establishing and maintaining
healthy interpersonal relationships with
you and every member of this staff. I will talk to you promptly
if I am having a problem with you. The
only time I will discuss it with another person is when I need
advice or help in deciding how to com-
municate to you appropriately
2. I will establish and maintain a relationship of functional trust
with you and every member of this staff.
My relationships with each of you will be equally respectful ,
regardless of job titles or levels of edu-
cational preparation.
3. I will not engage in the "3 Bs" (bickering, back-stabbing, and
bitching) and will ask you not to do [so]
as well.
4. I will not complain about another team member and ask you
not to do [so] as well. If I hear you doing
so, I will ask you to talk to that person.
5. I will accept you as you are today, forgiving past problems,
33. and ask you to do the same with me.
6. I will be committed to finding solutions to problems, rather
than complaining about them, and ask
you to do the same.
7. I will affirm your contribution to quality client care.
8. I will remember that neither of us is perfect and that human
errors are opportunities, not for shame
or guilt but rather for forgiveness and growth. (Manthey, 1991)
Signature and date
:=hapter 14 The Clinical Staff 231
Boundaries
i:·eryone on the clinical team needs to know and respect each
other's professional boundaries. You need to
- ow what each person's function is in treatment. Once you
know that a part of treatment is not in your area
:expertise, stay out of that area. Everyone on the staff wants to
hear what you think-that is helpful-but
o not concern yourself with client care outside of your area of
specialization. You are an addiction coun-
selor, not a physician or a nurse. You should not concern
yourself with who gets certain medications, but
:uu should express your concern about your client's signs and
symptoms. Many counselors spend long
:ours worrying about whether or not their clients are being
properly treated by the medical staff. If you
~-orry that your medical staff is inadequate, then work
34. somewhere else. Never accept a job in an institution
dlat gives substandard care . Once you decide to accept a
position, act as if your staff is the greatest. Be grate-
:i.Jl fo r all of the good work the staff is doing.
Most staff problems are attitude problems, and attitudes can
change . You need to keep a positive atti-
LUde about you and your coworkers . This will go a long way
toward making your day more pleasant and
enj oyable. If you see your attitude slipping, then talk about this
with your supervisor. Check your own life.
How are you doing? Many times , a negative attitude flags
personal problems that need to be addressed
ou tside of the treatment center. Remember that if you do not
take good care of yourself you are not going
:o be very helpful to others. If you are suffering, your staff and
clients will suffer. Do not hesitate to get help
~om your supervisor or an outside counselor. Most treatment
centers have an employment assistant pro-
=ess ional (EAP) who will see you a few times and, if you need
it, will help you get a referral to the right
profess ional.
Staff-Client Problems
The staff and the clients will constantly have problems with
each other. It is the nature of transference and
countertransference that there will be conflict. As the clients'
maladaptive attitudes and behaviors come into
play, the staff can teach new methods of dealing with problems.
Never agree that a client has been treated unfairly by a staff
member until you first talk with the staff
member. Clients will attempt to use you in a manipulative way
against someone else. Remember the staff
comes first. You must not subgroup with clients against staff.
35. This decreases the effectiveness of the entire
fac ility. You must prevent clients from using their old
manipulative skills. If a client is having a problem with
a staff member, then arrange for the staff member and the client
to meet to see whether they can resolve
m e issue together. You are teaching the client how to resolve
interpersonal problems . If the client has a
p roblem with someone, then he or she has to go to that person
to resolve the issue .
Certain clients will try to pit the staff members against each
other. This is common for borderline and
antisocial clients. This must be resolved by the staff as a whole.
A client usually attempts this by telling differ-
ent staff members different things. The only way of making this
manipulation stop is to call everyone together
3t the same time . This way, the client cannot continue to
manipulate. Any other means of trying to solve this
problem will not work because the lies will continue to operate .
Once everyone gets together with the client
3t the same time, you will have a more accurate picture of what
the problem is and how to resolve it.
What to Do When a Client Does Not Like a Counselor
Sometimes a client will want to change counselors. This client
needs to share how he or she feels with the
current counselor often with a supervisor present. Something
might be going wrong with the therapeutic
alliance. This matter needs to be discussed with the counselor
and the client who are having the problem.
232 CHEMICAL DEPENDENCY COUNSELING
37. and worked through. The client needs to see
that the situation has changed. The client is not in the original
situation anymore. He or she is in a new situ-
ation that demands a new level of trust. What about the new
situation makes the client feel that he or she
cannot trust someone? What is the most rational decision for the
client to make? Trust issues must be
resolved for the client to move forward in treatment. The client
will remain stuck until he or she can trust
someone. Once the client trusts one person, the client can
transfer the trust to someone else, the group ,
and then the Higher Power.
What to Do When a Client Complains About a Rule
Many staff-client problems revolve around rule violations.
Clients will say that they did not break the rule ,
and they may have a very good story to tell about the situation.
You must support other staff members in
-..:.pter 14 The Clinical Staff 233
:.e things they direct the clients to do. Support their
consequences. They were there, and you were not
--ere. Talk about how to do it next time if you need to but do
not change the consequence . If you do this,
ur staff members will be unable to discipline the clients. If the
clients learn that the rules can be manipu-
-ed, then all of the rules become meaningless. Bring all
members involved in the situation together, and
- the issue through. In very rare instances, the person who
leveled the consequence may remove the
38. _ equence or change it to something more appropriate. This
should be done only by the person who
-elect the consequence.
~o chemically dependent persons want to obey the rules, but the
rules exist to protect them from harm.
:1ce they understand that the rules are for them rather than
against them, they will be more likely to obey
:. e rules. Clients who are breaking the rules need to see how
this tendency feeds into their addiction. If they
.earn how to follow the rules-particularly the rule of the 12-step
program-then this is recovery.
The Work Environment
_-~.treatment center should be a fun place to work. People who
come into recovery at their worst are at their
.xst in a few short weeks. This is an extremely rewarding
environment. It is a place full of great joy Real
Ye abounds in a good treatment center. Clients and staff alike
enjoy their days. If you do not genuinely
enjoy your work, then you are at the wrong place or you are in
the wrong business. Chemically dependent
persons are a lot of fun to work with. They laugh and have a
good time. They have been the life of the party
:he staff can learn how to have fun at work. If the staff members
work together and love each other, then
Lhey can grow from each work day
Good treatment must be done in an atmosphere of love and
trust. Staff members must support each
other through the good times as well as the bad times. The old
saying applies: "When the going gets tough,
Lhe tough get going." Even during periods of stress , the well-
functioning staff pulls together and works things
40. in world full of self-hatred and shame . They do not want any-
one to know the terrible truth about their pain. They put on a
false front of being fine. You might suspect something is
wrong, and you would be right, but there seems to be little you
can do to help an addict see the truth . Most addicts die of their
addiction . Ninety-five percent of untreated alcoholics die of
2 CHEMICAL DEPENDENCY COUNSELING
alcoholism an average of 26 years early. The death certificate
might read heart disease, cancer, or some-
thing else to protect the family, but the real reason is addiction .
Addiction is more than a behavior problem. Repeated drug use
causes long-lasting changes in the brain,
so the addict loses voluntary control. Addicts are obsessed with
doing what they hate doing. The addiction
is the only way they know how to feel normal. Not to use causes
withdrawal, which is too painful to consider.
In time, the addict's brain changes to the point that they cannot
get high and they cannot get sober. This is
when addicts feel hopeless , helpless, and powerless, and their
lives are unmanageable. This is when many
of them come in for treatment.
In America, 51.1% of the population drinks alcohol , and a little
less than a third of them will have a
substance use disorder sometime in their lifetime (Substance
Abuse and Mental Health Services
Administration [SAMHSA], 2007). In the United States, almost
one million people die of substance abuse
disorders annually. This does not count the people who die of
diabetes, coronary artery disease, and can-
cer caused by drinking, smoking, poor eating, and lack of
41. exercising. Heavy drinking or drug use contrib-
utes to illnesses in each of the top three causes of death: heart
disease, cancer, and stroke . At least 13 .8
million Americans develop problems associated with drinking.
Over many years of following alcohol and
drug problems, studies find that 78% of high school seniors
have tried alcohol. Fifty-three percent have
tried illegal drugs. Fifty-seven percent of high school seniors
have tried cigarettes, and 27% are current
smokers. Addiction is one of the most horrible plagues to attack
the human race . According to the Centers
for Disease Control and Prevention (CDC) , 25% of Americans
die as a direct result of substance abuse
(Heron et al. , 2009).
Millions of Americans are dying annually of preventable
conditions.
• 443 ,000 die of tobacco products.
• 365,000 die of improper diet and exercise habits.
• 75 ,000 die of alcohol abuse.
• 75,000 die of microbial agents.
• 55 ,000 of toxic agents.
• 32,000 die of adverse reactions to prescription drugs.
• 26,000 die of automobile accidents.
• 29,000 die offirearms.
• 29,300 die of homicide.
• 20,000 die of sexual behavior.
• 17,000 die of illegal drugs CAnnual Causes of Death in the
United States ," 2011).
Treatment Works
Most addicts will quit on their own by making a highly
motivated personal choice then working hard at
recovery, usually with multiple attempts at quitting and periods
42. of relapse and reevaluation. Most of the
people who quit on their own have learned about treatment and
recovery through someone who is in
recovery, or from a health care professional. These people make
the choice that the negative conse-
quences of continued use outweigh the rewards of continued use
. They go through the same motivational
steps that a client needs to make in treatment (DiClemente,
2006b). Some clients cannot seem to quit on
their own, and they need treatment. We know from many years
of scientific experiments that addiction
treatment works. For every dollar spent on treatment, the
economy saves $7 in heath care and costs to
society. Most clients who work a program of recovery stay
clean and sober. To get clean, clients have to
come out of hiding and use their journey to help others. By
sharing our experience, strength, and hope,
addicts in recovery give others reasons to get clean. Working
the program means getting honest, going to
Chapter 1 The First Contact 3
recovery group meetings , and making conscious contact with a
higher power of their own understanding
(Johnston, O'Malley, Bachman, & Schulenberg, 2008;
McLellan, 2006).
Your first meeting with an addict might be accidental or it
might be by appointment. During the inter-
view, you-if you look and listen closely-will sense something is
wrong with this person, but you do not
know what it is. You have a clinical thermometer inside of you
that you will learn to trust. This is more than
intuition; it is a gift. The skill is to watch the client so carefully
43. and listen so intensely that you pick up cues
that others miss. The person might look depressed and anxious.
Her face may be red and swollen, his eyes
watery and red, or the person may be markedly thin with scabs
caused by "meth bugs." He might have a fine
hand tremor or have difficulty sitting still. Sometimes the
person's head hangs in depression that looks like
shame. Something is wrong, and it will nag at you . That
clinical thermometer feels uncomfortable, and you
do not like it.
If you are reading this manual, you have probably been a
natural born healer all of your life. When you
were a little kid, you cared a little more about puppies and
kittens than others did. People in school talked
to you and told you secrets when they would not talk to anyone
else. People recognize a healer when they
see one .
There is another side of you that is very different. It has been in
trouble with clients like this before.
Sometimes being a healer is not good. Sometimes you have to
tell people the truth when they do not want
to hear it. They can rebel against you and fight. You have
learned that sometimes it is best to let the truth
go-or worse, lie to yourself and your clients and let them go.
You hate that part of yourself, but you have
learned how to live with it. After all, you live in a world full of
litigation and managed care. Fear has overcome
your best judgment many times.
And there is that client sitting in your office , crying out for the
healer in you . Clients desperately need
someone to tell them the truth. This time if you let the problem
go, if you take the easy way out, the client
may die. Addiction is like brain cancer. To let this client out of
44. your office without confronting the truth is to
be responsible for the client's death.
Yet you have confronted addicts before. Addicts seem to have
two sides of them. One side knows they
are in trouble while the other side knows they can continue the
addiction safely. You and your client are in
a life or death battle with the truth. The trick is to help the
client win . You are up against a great enemy.
Alcoholics Anonymous (AA) (2002a) says this illness is
"cunning, baffling and powerful" (pp. 58-59).
The battle lines are drawn. The illness inside of the client is
confident of victory. It thinks that you will
take the easy way out. You will handle the acute problem and
let the client go home. You will not ask the
questions that could lead to the truth. That would be too much
trouble; besides, you are too busy.
The enemy does not know that you are a healer. You will not
lie, and you will not let the addict go home
to die. You are going to fight. This is who you are, and it is who
you will always be. To be anything else leaves
you in shame.
The Motivational Interview
So you decide to take action. Either you do this yourself or you
call in an addiction professional to do it for
you. You suspect your client is addicted. Your client does not
even want to know the reason because to know
the truth confronts him or her with change. Your job is to go
with the client toward the truth. It does no
good to go against the client's idea of himself or herself.
Arguing with the client will not work because the
addict is an expert at giving every excuse in the world for
46. My boyfriend has a problem.
I have a physical problem.
I am depressed.
I am anxious .
I have a stomachache.
I cannot sleep.
The excuses go on and on, and they might confuse you if you
are caught up in them . They are all part
of a tangled web of deceit. Remember, your job is to walk with
the client toward the truth, not against the
client toward the truth. You are going to spend most of your
time agreeing with the client. When the client
is honest, you are going to agree. When the client is dishonest,
you are going to probe for .the truth. Look
at it this way: If the client is listening to you, you can work. If
the client is not listening to you, anything you
say is useless.
Watch the client's nonverbal behavior very carefully. You are a
healer, and you have the gift of supersen-
sitivity Your intuition will tell you whether the client is going
with you or resisting. When the client goes with
you, you feel peace. When the client goes against you, you feel
uncomfortable. When the client is ready, you
Chapter 1 The First Contact 5
will educate him or her about the disease. This is a gentle
47. process, and it takes time. If you are in a hurry,
this is not going to work.
The client has been using the addiction for a long time to
relieve pain . All addictions tell the brain, Good
choice! All organisms have a way of finding their way in a
complicated lethal environment. They learn which
foods are good and which are bad. They find the best way
through the jungle. They learn what is safe and
what is dangerous. We learn these things deep in the reptilian
brain. What is good is remembered. If it is very
good, it is remembered after one experience. The addiction has
been good to this client for many years, but
now it is destructive. The very thing that gave the client joy
now gives pain. This process fools the client.
Remember, the addiction has always said, Good choice! So how
can it be a bad choice? You are fighting with
the client's basic understanding of the world, and he or she will
be convinced that you are wrong. You must
help the client see that the addiction is no longer a good choice-
it is a deadly choice. The addict cannot
see this alone, but AA has an old saying: "What we cannot do
alone, we can do together. " The client cannot
discover the truth without your help. You must guide the client
toward a decision he or she finds impossible.
You need to help clients see that they need to stop the addictive
behavior.
What you are looking for is the truth. The client will rarely tell
you accurate symptoms. You have to look
for signs of the disease. You will continue to investigate-
testing; smelling the air; ordering laboratory stud-
ies; and talking to family, friends, court workers, school
personnel, and anyone else who can help you until
you uncover the truth.
48. Your client cannot tell you the truth because the client does not
know the truth. Addiction hijacks a cli-
ent's thinking, a web of self-deception. Remember, you are the
healer. You care for your clients even if they
hate themselves. You are going to love them even though they
are being deceptive. You are going to help
them even though they do not understand what you are doing.
How to Develop the Therapeutic Alliance
From the first contact, your client is learning some important
things about you . You are friendly You are on
his or her side. You are not going to beat up, shame, or blame
your client. You answer any questions. You
are honest, and you hold nothing back. You discuss every option
in detail. You are committed to do what is
best for the client. You provide the information, and the client
makes the decisions. The client sees you as a
concerned professional. In time, the client begins to hope that
you can help. The therapeutic alliance is built
from an initial foundation of love, trust, and commitment.
You show the client that he or she does not have to feel alone.
Neither of you can recover alone. Both of you
are needed in cooperation with each other to solve the problem.
The client knows things that you do not know.
The client knows himself or herself better than anyone else
does, and he or she needs to learn how to share his
or her life with you. Likewise, you have knowledge that the
client does not have. You know the tools of recovery
The client must trust you. To establish this trust, you must be
honest and consistent. You must prove to
the client, repeatedly, that you are going to be actively involved
in his or her individual growth . You are not
going to argue or shame the client; you are going to try to
49. understand him or her. When you say you are
going to do something, you do it. When you make a promise,
you keep it. You never try to get something
from a client without using the truth. You never manipulate,
even to get something good. The first time a
client might catch you in a lie, even a small one, your alliance
is weakened.
If you work in a treatment facility or group practice, the client
must learn that your staff works as a team.
You can share with the whole team what the client tells you-
even in confidence. The client will occasionally
test this. The client will tell you that he or she has something to
share, but that it can only be shared with
you. The client wants you to keep it secret. Many early
professionals fall into this trap. The truth is that all
facts are friendly and all information is vital to recovery. You
must explain to the client that if he or she feels
too uncomfortable sharing certain information that the client
should keep it secret for the time being. Maybe
they can share this information later when they feel more
comfortable.
The client must understand that you are committed to his or her
recovery, but you cannot recover for
the client. You cannot do the work by yourself. You must work
together, cooperatively You can only teach
the tools of recovery. The client must use the tools to stay
sober.
1lL ........__
I
50. 6 CHEMICAL DEPENDENCY COUNSELING
How to Do a Motivational Interview
In the first interview, you begin to motivate clients to see the
truth about their problem . Questions about
alcohol and other drug use are most appropriately asked as a
part of the history of personal habits, such as
use of tobacco products and caffeine. Questions should be asked
candidly and in a non judgmental manner
to avoid defensiveness. Remember that this is client-centered
interviewing, not professional-centered, and
the interview should incorporate the following elements (with
the client being free of alcohol at the time of
the screening) (DiClemente, 2006a; Prochaska, 2003) :
• Offer empathic, objective feedback of data.
• Work with ambivalence.
• Meet the client's expectations.
• Assess the client's readiness for change.
• Assess barriers and strengths significant to recovery efforts.
• Reinterpret the client's experiences in light of the current
problem .
• Negotiate a follow-up plan.
• Provide hope.
Exa mple of a Mo tivational In terview
Professional: Hello, Frank, I am ________ _ (your name). Why
did you come in to see me
today?
Client: My wife wanted me to talk to you.
Professional: Why did she want that?
51. Client: I do not know.
Professional: I talked to your wife on the phone yesterday, and
she said she was concerned about your
drinking .
Client: She is always concerned about something. Her father
was an alcoholic so she thinks everyone
drinks too much. (The client looks irritated.)
Professional: Sounds like things are not going well at home?
(The professional mirrors the client's feelings
and facial expression. When you mirror a person 's expression,
you validate his or her
worldview.)
Client: I do not know. It is just that she gets all worked up
about everything.
Professional: Your wife said you have been drinking heavily
every day. She is afraid for you.
Client: I work hard , and I like to come home and relax with a
few beers. Is anything wrong with that?
(The client is obviously irritated with coming to the interview.
So Ja r, the client is saying, My
wife has a lot of problems.)
Professional: There 's nothing wrong with relaxing. How do you
relax? (The professional goes with the cli-
ent's point of view.)
Client: I have a couple of beers. So what.
Professional: Your wife says you have been drinking a 12-pack
a day
52. Client: It is not that much.
Professional: Are you drinking more than a couple of beers a
day? (The professional is gently pulling for
the truth.)
Chapter 1 The First Contact 7
Client: Maybe a little more.
Professional: Is it around 12?
Client: I work hard, and I deserve to relax. (Tbe client is
resisting, and the professional backs off a little.
It is important to keep the client's ears open. Be empathic,
tender, and understanding. Try to
see the problem from the client's point of view. Once you enter
the client's world and under-
stand his or her point of view, you will get clues about what
will motivate the client to change.
This client is mad at his wife and he needs some help with that,
but what is his real problem?)
Professional: I like to relax after a hard day, too. Your wife
sounds afraid for you. What is frightening her?
Client: My wife just sits around all day and watches television
while I am working my tail off.
Professional: So you really need to relax when you come home.
Particularly if you feel like you are pulling
the load all by yourself?
53. Client: Yeah , she sits around and thinks about things to argue
with me about.
Professional: Do you think your wife loves you? (This is
pulling the client toward the truth. Why is
his wife worried about him?)
Client: Well , yeah, I think she does. (The client
visibly softens.)
Professional: It is great to have a wife who loves you.
Client:
Sounds like you are a lucky man. (The
professional reinterprets the client's expe-
rience in light of the alcohol problem.)
But I am not drinking too much. I am just
drinking a few beers.
Professional: You said it was 12 . (The professional
reminds the client what he said earlier to
cement the fact.) What is the most beer
you have ever drunk in a full day?
Client: Oh, I do not know.
Professional: Give me a guess.
Client: Well, on the weekends I can drink up to a
case if I am watching a ball game.
Professional: That is a lot of beer. (The professional
determines the client is an alcoholic but
does not jump the gun; the client is not
54. ready yet.)
Client: Not if I am drinking all day.
Professional: Did you know that if you drink more than
three beers a day; more than three times a
week, your organs are dying? Alcohol is a
poison. It kills the brain, heart, kidneys,
every cell in the body. If you are drinking
more than three drinks per day, you are
More substance abuse pictures are available at
www.brainplace.com.
8 CHEMICAL DEPENDENCY COUNSELING
literally killing yourself. That might be why your wife is
worried about you? (The professional
believes the client's ears are open, so it is time to try a little
education.)
I want to show you a single photon emission computed
tomography (SPECT) scan pictures
of a healthy brain and a brain of someone who abuses alcohol.
The client quickly looks away He does not want to see a picture
of his brain dying. However, he did see
it, and he could not make that fact go away. He has to rapidly
deny the professional's statements and the
pictures or admit that he has a problem. A part of him knows he
has a drinking problem, and now it is con-
firmed. It is not only his wife 's opinion but now a picture and a
professional's opinion confirm the diagnosis.
He has not admitted it yet, but he knows he has been drinking
55. too much.
The professional begins negotiating and assessing the client's
readiness for change.
Professional: Bob, have you ever worried about your drinking?
Client: No, honestly, I have not. (This comes across as real.
When the words and the client's affect
match, they are probably telling the truth. Most addicts think
their addictive behavior is
normal.)
Professional: Maybe that is because you did not understand how
much you could drink safely If alcohol is
killing you, do you not want to know?
Client: Well, sure.
Professional: Looking at these pictures, and thinking about how
much you have been drinking, do you
think you have been drinking too much? (The professional is
taking the biggest chance
of all.)
Client: Maybe? (Maybe is very close to a yes. The client has
admitted that he drinks too much. That
moves him from the precontemplation phase to the
contemplation phase. For the first time,
he is considering the negative consequences of his drinking.
This is a huge step toward
recovery.)
Professional: Did you know that 95% of untreated alcoholics die
of their alcoholism? And they die 26 years
earlier than they would otherwise.
56. The client says nothing.
Professional: Knowing what you know now, would you like to
learn how to drink less or even stop
drinking entirely? (The professional is negotiating how far the
client is willing to go to get
better.)
Client: I did not know it was that bad. (Now the client is
contemplating change. We are on the road
to recovery. With a gentle approach, the professional can
negotiate and listen to the client's
life from his or her perspective, allowing the client to move
toward the truth.)
Professional: Why don't we meet again with your wife and talk
about what we can do to help you two feel
better? Would that be all right with you?
Client: If you think it will help.
Professional: Most people who try to get better get better.
Client: Okay, let's do it. (A commitment to change has occurred.
Now the client realizes he has
a problem and is making plans to take action. These are the first
giant steps toward
recovery.)
Chapter 1 The First Contact 9
Questions to Ask the Adult Client
57. The National Institute on Alcohol Abuse and Alcoholism
(NIAAA) has developed the following low-risk
drinking guidelines:
Men should drink no more than two drinks a day and no more
than four drinks on a single occasion.
Women and clients over 65 years of age should drink no more
than one drink a day and no more than
three drinks on a single occasion.
Pregnant clients and those with medical problems complicated
by alcohol use should abstain completely
("U.S. Surgeon General Releases Advisory on Alcohol Use in
Pregnancy," 2005).
We could also add that no person should ingest an illegal
substance.
If a person cannot stop something they want to stop, it is an
addiction.
At some time during the first interview, certain questions need
to be asked to assess addiction problems.
They have to be answered honestly to give you a clear picture
of the extent of the problem . Most clients who
have addiction problems will be evasive or deny their addiction,
so the questions should be asked of the
client, as well as a reliable family member.
The following questions and flags are taken from the American
Society of Addiction Medicine (ASAM)
(http://www.asam.org):
1. Have you ever tried to cut down on your drinking?
58. 2. Have you ever felt annoyed when someone talked to you
about your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink in the morning to settle yourself
down?
5. Has alcohol or drugs ever caused your family problems?
6. Has a physician ever told you to cut down on or quit use of
alcohol?
7. When drinking/using drugs, have you ever had a memory loss
or a blackout?
Similar questions could be asked about gambling or any other
addictive behavior. If clients answer yes
to any one of these questions, it is a red flag for addiction. If
they answer yes to two questions, it is probably
addiction. Make sure you do not just ask the client. Ask family
members, friends, and anyone else who can
give you collateral information. (See Figures 1.1 through 1.5.)
Figure 1.1 Client History/Behavioral Observation Red Flags for
Addiction
I
Tremor/perspiring/tachycardia
Evidence of current intoxication
Prescription drug-seeking behavior
Frequent falls; unexplained bruises
59. Diabetes-elevated blood pressure; ulcers nonresponsive to
treatment
Frequent hospitalizations
Gunshot/knife wound
Suicide talk/attempt; depression
Pregnancy (screen all)
10
Figure 1.2 Laboratory Reel Flags for Adult Alcohol/Drug Abuse
Mean corpuscular volume (MCV)-Over 95
Mean corpuscular hemoglobin (MCH)-High
Gamma-glutamyl transferase (GGT)-High
Serum glutamic-oxaloacetic transaminase (SGOT)-High
Bilirubin-High
Triglycerides- High
Anemia
Positive urinalysis for alcohol
CHEMI CAL DEPENDEN CY COUNSELING
Figure 1.3 Client History/Behavioral Observation Red Flags for
60. Adolescent Alcohol Abuse
Physical injuries: motor vehicle accident (MVA) , gunshot/knife
wound , unexplained or repeated injuries
Evidence of current use (e.g., dilated/pinpoint pupils , tremors,
perspiring , tachycardia, slurred/rapid speech)
Persistent cough (cigarette smoking is a risk factor)
Engages in risky behavior (e.g. , unprotected sex)
Marked fall in academic/extracurricular performance
Suicide talk/attempt; depression
Sexually transmitted diseases
Staphylococcus infection on face , arms, legs
Unexplained weight loss
Pregnancy (screen all)
Figure 1.4 Laboratory Red Flags for Adolescent Alcohol/Drug
Abuse
• Positive urinalysis for alcohol/illicit drugs
• Hepatitis A-B-C
• GGT-High
• SGOT-High
• Bilirubin-High
Figure 1.5 Interview Questions for Suspected Addiction Among
Adolescents
61. Questions to Ask the Adolescent Client
1. When did you first use alcohol on your own, away from
family/caregivers?
2. How often do you use alcohol or drugs? When was your last
use?
3. How often have you been drunk or high?
11
Cnapter 1 The First Contact
I . Has your alcohol or drug use caused you problems with your
friendships, family, school, community, etc.? Have your grades
slipped?
5 . Have you had problems with the law?
6. Have you ever tried to quit/cut down? What happened?
7. Are you concerned about your alcohol or drug use?
Questions to Ask the Parent/Caregiver
1. Do you know/suspect your child is using alcohol/other drugs?
2. Has your child's behavior changed significantly in the past 6
months (e.g., sneaky, secretive, isolated,
assaultive, aggressive, hostile)?
3. Has the school, community, or legal system talked to you
about your child?
62. 4. Has there been a marked fall in academic/extracurricular
performance?
5. Do you believe an alcohol/other drug assessment might be
helpful?
What to Do If There Are One or More Red Flags
Once you have one or more red flags, you have several
important actions to take:
1. Advise the client of the risk.
11
2. Advise abstinence or moderation. Men should be advised to
drink no more than three drinks at a
time and no more than three nights a week. Women should be
advised to drink no more than two
drinks at a time and no more than three nights per week. More
drinking than this will result in dis-
ease. This is a harm reduction approach where you teach a
client how to drink responsibly This
would not be appropriate for someone who has a serious
drinking problem.
3. Advise against any illegal drug use.
4. Schedule a follow-up visit to monitor progress.
Natural History of Addiction
Addiction can begin at any age, and it often occurs in
individuals with no history of psychological problems .
When the addictive substance is readily available, inexpensive,
and rapid acting, the incidence of use
63. increases. Whenever the individual is ignorant of healthy
alcohol or drug use, susceptible to heavily using
peers, or has a high genetic predisposition to abuse or to
antisocial personality disorder, abuse may increase.
This is also true if the client is poorly socialized into the
culture, in pain, or if the culture makes a substance
the recreational drug of choice.
Risk Factors
Risk factor 1: Substance or behavior is readily available.
Risk factor 2: Substance use or addictive behavior is cheap.
Risk factor 3: The addictive chemicals reach the brain quickly
Risk factor 4: Addiction is a pain reliever.
Risk factor 5: Addiction is more common in certain occupations
(bartending).
12
Risk factor 6: Addiction is prevalent in the peer group.
Risk factor 7: Addiction is preferred in deviant subcultures.
Risk factor 8: Social instability is found.
Risk factor 9: There is a genetic predisposition.
Risk factor 10: The family is dysfunctional.
CHEMICAL DEPENDENCY COUNSELING
64. Risk factor 11: Comorbid psychiatric disorders are present
(Vaillant, 2003).
How to Diagnose an Addiction Problem
Cocaine
Abuser
Neutral
Cues
Cocaine
Cues
13
9.5
6
Source: From · ~ctivation of Memory Circuits During Cue-Elic-
ited Cocaine Craving", by S. Grant eta!., 1996, Proceedings of
the National Academy of Sciences, USA, 93, pp. 12040-12045.
In the assessment , you must determine if the
clients fit into your range of experience and
care. Do you have the ability to deal with his or
her problem, or do you need to refer to some-
one else? Does the client have a problem with
chemicals or an addictive behavior? Is he or she
motivated to get better? Does the client have the
resources necessary for treatment? Is the indi-
vidual well enough to see you? For the most
part, you will start by asking yourself certain
basic questions: Does this person have signs and
65. symptoms of addiction? Does he or she need
treatment? Is he or she motivated for treatment?
What kind of treatment does she or he need?
For the benefit of third-party payers, it is impor-
tant to use assessment instruments to docu-
ment (1) diagnosis, (2) severity of addiction,
and (3) motivation and rehabilitation potential.
Third-party reviewers will often have more faith
in a test battery than your clinical opinion.
There are a number of companies that sell inexpensive,
disposable breathalyzers and drug screening
instruments, including Prevent (1-800-624-1404); Bi-
TechNostix (1-888-339-9964); Random Drug Screens, Inc.
(1-803-772-0027); Drug Screens, Inc. (1-800-482-0693); hair
screens; Pharmchec Drugs of Abuse Patch, which
lasts 2 weeks; a new GGT alcohol screen that will test for
alcohol injection for 80 hours after use; ankle brace-
lets that measure alcohol in the sweat of probationers 24 hours ,
7 days a week. Order a number of these tests ,
and have them readily available for assessment, treatment, and
continued care monitoring. Positive tests are
only suggestive of drug and alcohol use, so before any legal or
workplace action is taken, the test should be
confirmed by both an approved immunoassay and gas
chromatography/mass spectrometry, which can be
administered and analyzed by a health care provider (SAMHSA,
2007). Two quick screening tests for alcohol-
ism have been developed: the Short Michigan Alcoholism
Screening Test (SMAST) (see Appendix 2) , (Selzer,
Winokur, & van Rooijen, 1975) and the CAGE questionnaire
(Ewing, 1984; Selzer et al., 1975). The Michigan
Alcoholism Screening Test (MAST) or SMAST has greater than
90% sensitivity to detect alcoholism. It can be
administered to either the client or the spouse.
66. The Substance Abuse Subtle Screening Inventory (SASSI) (1-
800-726-0526; www.sassi.com) was devel-
oped to screen clients when defensive and in denial. The SASSI
measures defensiveness and the subtle
attributes that are common in chemically dependent persons. It
is a difficult test to fake, unlike the SMAST
or the CAGE. Clients can complete the SASSI in 10 to 15
minutes, and it takes 1 or 2 minutes to score. It
identifies accurately 98% of clients who need residential
treatment, 90% of nonusers, and 87% of early stage
abusers. This is a good test for those clients with whom you are
still unsure about the diagnosis after your
first few interviews-clients who continue to be evasive (Miller,
1985).
Cha pter 1 The First Contact 13
The Addiction Severity Index (ASI) and the Teen-Addiction
Severity Index (T-ASI) (1 -215-399-0980) are
idely used, structured interviews for adults and teens and are
designed to provide important information
about the severity of the client's substance abuse problem.
These instruments assess seven dimensions
rypically of concern in addiction , including medical status ,
employment/support status, drug/alcohol use,
legal status , family history, family/social relationships, and
psychiatric status. The tests are administrated by
a trained technician. The ASI is an excellent tool for delineating
the client's case management needs
(Kaminer, Bukstein, & Tarter, 1991; McLellan, Lubarsky, &
Woody, 1980).
The Adolescent Alcohol Involvement Scale (AAIS) is a 14-item,
self-report questionnaire that takes about
67. 15 minutes to administer. It evaluates the type and frequency of
drinking, the last drinking episode, reasons
fo r the onset of drinking behavior, drinking context, short- and
long-term effects of drinking, perceptions
about drinking and how others perceive his or her drinking
(Mayer & Filstead, 1979; Mee-Lee, 1988; Mee-Lee,
Hoffman, & Smith, 1992) (1-800-755-6299). The RAATE-CE is
a 35-item scale that assesses treatment readiness
and examines client awareness of problems ; behavioral intent
to change; capacity to anticipate future treat-
ment needs; and medical, psychiatric, or environmental
complications . The RAATE-CE determines the client's
level of acceptance and readiness to engage in treatment and
targets impediments to change.
How to Intervene
• Nonproblem Usage: If the client is low-risk for addiction , you
should provide positive prevention
messages that support the client has continued positive lifestyle
. A client with a positive family history of
addiction should be warned about their increased vulnerability
to addiction and the need for vigilance.
• Problem With Addiction : The client who has had recurrent
problems due to addiction should be
encouraged to abstain from , or at least reduce , his or her
addictive behavior. A client such as this should be
trongly encouraged to abstain from all illegal drugs and
addictive behaviors . You should discuss the biopsy-
chosocial complications of addiction (see Appendix 8). A client
who is encouraged to cut down on his or her
addictive behavior should be provided with the brochure from
NIAAA (see Appendix 9). It is essential that
these clients be reassessed frequently to monitor their ability to
68. comply with your recommended limits.
• Addiction : Addicts need to have their diagnoses carefully
discussed with them and a treatment plan
negotiated. You need to be empathic and address the problems
that seem to be caused by or made worse
by the client's continued addictive behavior. The client needs to
hear that this illness is not his or her fau lt
and that there is excellent treatment available that will help the
individual to stay clean and sober. The client
needs to hear that only 4% of addicts can quit on their own over
the course of a year, but 50% can quit over
the course of a year if they go through treatment. Seventy
percent can quit over the course of a year if they
also attend AA meetings regularly, and 90% can stay sober if
they go through treatment, attend meetings, and
go to continuing care once a week for a year (Hoffmann , 1991 ,
1994; Hoffman & Harrison, 1987) . The client
should also be told about the potential benefits of naltrexone,
accamprosate, and disulfiram when used
along with formal treatment programs. Carefully discuss the
ASAM client placement criteria to help you and
the client negotiate the best treatment plan possible to bring the
addiction under control. (See Figure 1.6.) The
fo llowing questions may be helpful in negotiating a treatment
plan:
1. Is the client a danger to self or others (suicidal and homicidal
ideation, impaired judgment while
intoxicated, history of delirium tremens) ?
2. Has the client ever been able to stay clean for 3 or more
days?
3. What happened when the client stopped the addictive
behavior in the past? How serious were the
69. withdrawal symptoms?
4. Has the client ever been able to stay completely abstinent for
long periods?
5. Why did previous attempts at staying clean fail?
6. How does the family understand alcoholism and its
treatment?
14 CHEMICAL DEPENDENCY COUNSELING
Figure 1.6 Positive and Negative Prognostic Factors
Positive Prognostic Factors
• Lack of physical dependence
• Intact family
• Stable job
• Presence of prior treatment (prognosis improves for clients
who have been through one
to three treatments)
• Absence of psychiatric disease
• Presence of long-term monitoring arrangement, such as a
Physician Effectiveness Program or Employee
Assistance Program
Negative Prognostic Factors
• More severe, advanced dependency
• Presence of intoxication at office visits
• Loss of job
70. • Loss of home
• Loss of family
• Multiple, unsuccessful attempts at treatment
• Severe physiological dependence
• Coexisting psychiatric disorders
• Absence of long-term monitoring (Conigliaro, Reyes, Parran,
& Schultz, 2003)
How to Assess Motivation
Constantly ask yourself about the client's stage of motivation
and introduce appropriate motivating strate-
gies to move the client up a motivational level. This book will
give you many ways of doing this. No client is
alike, so you must be creative in helping the client to see the
inaccuracies in his or her thinking and move
away from the lies toward the truth.
The Stages of Motivation
Precontemplation
The individual is not intending to take action in regards to his
or her substance abuse problem in the
near future.
Tasks: Tiy to increase awareness of the need to change; increase
concern about the current pattern of behavior.
Goal: Make a serious consideration of change.
Contempla tion
The individual examines the current behavior and the potential
for change in a risk-reward analysis.
71. Tasks: Analyze the pros and cons of the current behavior and of
the costs and benefits of change.
Goal: Write a list of the positive and negative consequences of
continued use.
Preparation
The individual makes a commitment to take action to change
and develops a plan for change.
Tasks: Increase commitment and create a change plan.
Goal: Create an action plan to be implemented in the near
future.
'
Cha pter 1 The First Contact 15
Action
The individual implements the plan and takes steps to change
and begins new behavior patterns.
Tasks: Implement change and revise the plan as needed while
sustaining commitment in the face of
difficulty.
Goal: Develop a successful action for changing behavior and
establish a new pattern of behavior for a
significant period of time (3-6 months).
Maintenance
72. The new behavior is sustained for an extended period of time
and is consolidated into the lifestyle of
the individual.
Tasks: Sustain change over time and integrate the behavior into
everyday life.
Goal: Sustain long-term change of the old behavior and
establish a new pattern of behavior (DiClemente,
2006a; Prochaska & DiClemente, 1983; Prochaska, DiClemente,
& Norcross, 1992; Prochaska, Norcross,
& DiClemente, 1994).
Motivating Strategies
Clients at different stages of motivation will need different
motivating strategies to keep them moving toward
recovery, and these stages are not static. Clients can shift back
and forth through the stages for various rea-
sons or spontaneously. Clients in the precontemplation stage
underestimate the benefits of change and
overestimate its cost. They are not aware that they are making
mistakes in judgment, and they believe they
are right. Environmental events can trigger a person to move up
to the contemplation stage. An arrest, a
spouse threatening to leave, or a formal intervention can all
increase motivation to change. Persons in the
precontemplation stage cannot be treated as if they are in the
action stage. If they are pressured to take
action , they will terminate treatment (Prochaska, 2003).
A client in the preparation stage has a plan of action to cut
down or quit his or her addictive behavior in
the near future. Such a client is ready for input from
professionals, counselors , or self-help books. The client
should be recruited and motivated for action. Action is the
73. client changing his or her behavior to cut down
or quit the addiction. This is the client who has entered early
recovery and is involved in treatment
(DiClemente, 2006a).
In the maintenance stage , the client is still changing his or her
behavior to be better and is working
to prevent relapse. A client who relapses is not well prepared
for the prolonged effort it takes to stay
clean and sober. All clients need to be followed in long-term
containing care because addiction is
fraught with relapse and clients need encouragement and
support for years to stay in recovery. Addicts
typically do not have the skills to work a program in early
recovery. This takes time, commitment, and
discipline, constantly trying to raise the client's consciousness
about the causes, consequences, and
possible treatments for a particular problem. Denial is
unconscious, and one must help the client raise
the material from unconscious to conscious . Clients can make a
better decision consciously than they
can without automatically thinking about the consequences of
their addictive behavior. Interventions
that increase awareness include observation, confrontation,
interpretation , feedback, and education,
pointing out the need to reevaluate the environment and change
behavior. Encourage the client to
reevaluate his or her self-image and explain how this is
negatively affected by the addictive behavior.
Encourage the client to learn the new skills of being honest,
helping others, and seeking a relationship
with a higher power (DiClemente , 2006a).
In order to help motivate clients to progress from one stage to
the next, it is necessary to know the
principles and processes of change (DiClemente, 2006a;
74. Prochaska, 2003; Prochaska & DiClemente, 1983;
Prochaska et al., 1992; Prochaska et al., 1994).
16 CH EM ICAL DEPE N DE NCY CO UN SELIN G
Figure 1.7 Processes of Change for the Client in
Precontemplation Stage
1. Consciousness raising involves increasing the client's
awareness of the causes, consequences, and
responses to the alcohol problem.
2. Dramatic relief involves increasing the cl ient's emotional
arousal about one 's current behavior and the
relief that can come from changing.
3. Environmental reevaluation has the client assess the effects
the alcohol problem has on one's social
environment and how changing would affect that environment.
4. Self-reevaluation has the client assess his or her image of
one's self free from alcohol problems.
5. Self-liberation involves the belief that one can change and
the commitment and recommitment to act on
that belief.
6. Counter-conditioning requires the learning of healthier
behaviors that can substitute for drinking alcohol.
7. Contingency management involves the systematic use of
reinforcers and punishments for taking steps in a
particular direction .
75. 8. Stimulus control involves modifying the environment to
increase cues that promote healthy responses and I
decrease cues that lead to relapse .
'Wf•
The fo llowing proce ss sho uld be ap plied to clients in the p
reco ntem platio n s tage (see Figure 1.7)
(DiCle me nte, 2006a; Proch aska, 2003; Proch aska & DiCle m
e nte, 1983; Prochaska et a!. , 1994) .
Helping relatio nships com bine caring, o p enness, trust , and
acceptance , as well as fam ily and community
suppo rt fo r change.