How to Talk So Mental Health Will Listen Shaping Supports to Fit the Person Jeff Sneddon, LCSW
Dec 31, 2015
How to Talk So Mental Health Will Listen
Shaping Supports toFit the Person
Jeff Sneddon, LCSW
IntroductionWho am I and why am I here?
Context of Presentation
Review Some Facts
Agenda
What is currently in our bag of Tricks The Why’s and How’s of Mental Health
Assessments Diagnostic Process and Difficulties What is Therapy, What do we Want, and
What do we do? Working with insurance, CCO’s Open discussion and problem solving Evaluation
What is currently in our bag of tricks: Objectives
Review the critical components of Case Management Services that we have at our disposal for use in referring individuals for Behavioral Health Services and Advocacy.
What is currently in our bag of tricks?American with Disabilities Act
◦ Title II Section 201-204Rehabilitation Act
◦ Section 504 Oregon Revised Statutes
◦ ORS 659A.103 and 659A.142Oregon Administrative Rules
◦ 309-011-0070 thru 309-011-0095Person Centered Planning and Referral
ProcessDevelopment and Monitoring of Plans of
Care.
Bag-O-Tricks: ADAAn individual with a disability who, with or
without reasonable modifications to rules, policies, or practices…, meets the essential eligibility requirements for the receipt of services or participation in programs or activities provided by a public entity shall by reason of such disability be excluded from participation in or be denied the benefits of…
Bag-O-Tricks: ORSIt is the public policy of Oregon to
guarantee individuals the fullest possible participation in the social and economic life of the state…to participate in and receive the benefits of the services, programs, and activities of state government…without discrimination on the basis of disability; and
It is unlawful practice to exclude from participation in or deny the benefits of the services programs or activities or to make any distinction, discrimination, or restriction because of a disability.
Bag-O-Tricks: Rehab Act Agencies that receive Federal financial
assistance can not deny individuals the opportunity to participate in or benefit from programs, services or other benefits.
Bag-O-Tricks: Person Centered Planning and Referral Process Person Centered Planning looks at an
individuals wants, needs, and desires systemically with input from families, friends, and paid care givers.
Address unmet needs and make referrals to resources to secure unmet needs.
Ability to provide critical information to resources to assist in accessing services and supports.
Bag-O-Tricks: Plans of CareCase Managers/Personal Agents assist in
the development of plans of care and individualized measurable goals to meet an agreed upon outcome.
Case Mangers/Personal Agents Monitor the plans of care to and continue to address any unmet needs or provide guidance for revision.
Assessments: ObjectivesUnderstand what a Bio-Psycho-Social
Assessment includes. Know how to prepare ourselves to be
able to assist with providing assistance and support to our consumers.
Bio-Psycho-Social AssessmentImportant basic questions to know:What is the primary concern? How long has this been occurring?How often does this happen?Has there been a recent significant change or event?Are there any other behaviors of concern?Are there any medical conditions or
medications?What is the developmental and social history?
Bio-Psychosocial Assessment DomainsIdentification and Chief ComplaintBiological Psychological Social Environmental Risk FactorsMental Status ExaminationClinical FormulationDiagnosisRecommendations for intervention
Diagnositics: ObjectivesIncrease our understanding of the
diagnostic process. Understand how modifications can be
made to criteria.
Using the DSM Three factors when using the DSM1. It only describes particular conditions – it
does not provide intervention strategies2. There can be some tendency to focus on
the individual pathology instead of on a client’s interaction with the environment
3. Third reason for wariness when using the DSM concerns imperfections in its categories – individuals and their behaviors are complex and difficult to place in neat, compact categories.
16 Major Diagnostic Classes1. Disorders Usually first Diagnosed in
Infancy, Childhood or Adolescence2. Dementia, Alzheimer, and other Cognitive
Disorders3. Substance Related Disorders4. Schizophrenia and other Psychotic
Disorders5. Mood Disorders6. Anxiety Disorders7. Somatoform Disorders 8. Factitious Disorders
16 Major Diagnostic Classes ctd.9. Dissociative Disorders10. Sexual Disorders11. Eating Disorders 12. Sleep Disorders13. Impulse Control Disorders14. Adjustment Disorders15. Personality Disorders16. Mental Disorders Due to a General Medical
Condition not Elsewhere Classified
Multi-Axial Classification System
Axis I: Clinical Disorders Axis II : Personality Disorders & Intellectual
Disability Axis III : Current general medical conditions Axis IV : Psychosocial stressors Axis V : Global Assessment of Functioning
Diagnostic Complications
Diagnostic OvershadowingIntellectual Distortion Psychosocial Masking Cognitive DisintegrationBaseline Exaggeration
Diagnostic OvershadowingA phenomenon where clinicians
attribute behavior to the developmental disability and not to a co-existing mental illness symptom.
◦An individual with profound ID believes that they can drive a car.
Intellectual DistortionConcrete thinking and impaired
communication result in poor communication about their own experience (Sovner, 1986).
◦ Individual describes self as ‘scared’ instead of ‘mad’ because of poor verbal skills.
Psychosocial MaskingImpoverished social skills and life
experiences result in unsophisticated presentation of a disorder or misdiagnosis of unusual behaviour as a psychiatric disorder (Sovner, 1986).
◦Giggling and silliness is misdiagnosed as psychosis.
Cognitive DisintegrationBizarre behavior is presented in response
to minor stressors that could be misdiagnosed as a psychiatric disorder (Sovner, 1986).
◦A client is highly disruptive and complains a lot after a preferred staff member leaves, but is diagnosed with schizophrenia.
Baseline ExaggerationPrior to the onset of a disorder there
are high levels of unusual behaviors, making it difficult to recognize the onset of a new disorder (Sovner, 1986).◦A person who already had poor social
skills and was withdrawn becomes more so and begins to experience other signs and symptoms of depression. This is missed because staff reports are inaccurate and staff turn-over means that no-one is aware of the overall change in the person’s functioning.
Putting it all togetherPresent a solid case for treatment Discuss the ramifications of the lack of
treatment Benefit vs AccommodationInquire about specialization and ask for a
referralSell yourself, MH does not like to do CMDiscuss how you can facilitate a IDT to
support the clinical workLiterature is one sidedDevelopmentally appropriate services
Helpful Links: Child Development Institute:
http://childdevelopmentinfo.com/Online Mendelian Inheritance in
Man: http://omim.org/AAIDD Reading Room:
http://www.aaidd.org