Understanding Screening in Therapy

Motivating People for Change with Screening and Engagement

Estimated read time: 1:20

Summary

In this engaging and informative video, Dr. Donal Snipes delves into the world of screening and engagement as crucial aspects of the therapeutic process. Throughout the presentation, Dr. Snipes highlights the importance of screening as a preliminary step in identifying potential issues clients may face, from mental health and substance abuse to physical health concerns such as diabetes. By emphasizing the collaborative nature of screening across different professionals, including counselors, doctors, and pharmacists, the video underscores the role of screening in fostering early intervention and informed decision-making. The importance of client engagement is also emphasized, illustrating how effective communication and a welcoming environment can encourage clients to actively participate in their assessment and treatment plans.

Highlights

Dr. Snipes introduces the purpose of screening, emphasizing its role in determining the probability of a problem and needed interventions. 🎯
Screening can be performed by anyone, from HR officers to doctors, illustrating its versatility in various settings. 🏢
Engaging clients with clarity and empathy is emphasized to ensure they understand the screening process and its benefits. 🤝
The video explains how to screen for immediate needs, such as in cases of substance abuse or depression, showcasing its critical role in urgent interventions. 🚨
Several potential influences on client engagement, like stigma and cultural factors, are discussed, highlighting the need for sensitive and inclusive practices. 🤗

Key Takeaways

Screening is a collaborative process that can involve various professionals such as counselors, doctors, and even pharmacists. 🏥
It is essential to engage clients through effective communication and creating a welcoming environment. 💬
Screening identifies potential issues but is not a diagnosis. It's the first step towards informed treatment planning. 🛠️
The immediacy of needs, like detoxification for substance abuse, is determined through screening. ⏰
Cultural sensitivity and client collaboration are vital for accurate and effective screening processes. 🌐

Overview

Screening is a vital part of the therapeutic process that helps in identifying potential issues such as mental and physical health problems, determining the immediacy of needs, and planning informed interventions. It’s a collaborative tool used by various professionals to ensure holistic client care.

Dr. Snipes brilliantly articulates the significance of screening in therapy, stressing how it offers a preliminary understanding of a client's situation without instantly jumping to conclusions. Screenings help professionals decide whether a more in-depth assessment is necessary, setting the stage for effective treatment planning.

Engagement plays a crucial role in the screening process. By establishing rapport, showing empathy, and ensuring clear communication, professionals can effectively involve clients in their own care journey. This not only aids in accurate screenings but also enhances the overall therapy experience, making clients feel valued and understood.

Chapters

00:00 - 00:30: Introduction to Screening and Engagement This chapter, titled "Introduction to Screening and Engagement," focuses on the screening process, specifically the selection of instruments and gathering of additional information. Dr. Donal Snipes, the host, guides viewers through essential skills for engaging with clients, discusses various factors that influence engagement, defines what screening entails, explains how to conduct a screening, and outlines different types of screening instruments.
00:30 - 01:00: Purpose and Process of Screening Screening is a method used to assess the likelihood of a problem by reviewing the current situation, symptoms, and additional information. This process can be conducted by various individuals, including counselors, clients, significant others, Human Resources officers, pastors, nurses, and doctors. The chapter elucidates the purpose and procedures involved in the screening process, emphasizing its broad applicability and utility in different contexts.
01:00 - 01:30: Importance of Screening Screening is a preliminary process, not a diagnostic one, used to identify potential problems that might need further investigation. It is employed by various Human Service Personnel to assess eligibility for services and make necessary referrals. Many individuals engaged with the Social Services System are subject to numerous types of screenings.
01:30 - 02:00: Transparency and Consent in Screening The chapter covers the role of screening in identifying individuals' needs and determining the types of services they may benefit from. It highlights how screening helps in assessing the immediacy of need, using the example of substance abuse screening, where immediate needs like detoxification can be identified based on observable factors such as intoxication.
02:00 - 02:30: Collaborative Screening The chapter focuses on the concept of collaborative screening, emphasizing the importance of prioritizing cases based on immediacy and severity. It discusses how individuals with more pressing issues, such as those expressing suicidal ideation, require urgent attention compared to those experiencing prolonged periods of apathy or lack of motivation. The chapter also highlights the need for a transparent screening process that facilitates effective identification and prioritization of cases.
02:30 - 03:00: Screening Tools and Methods In the chapter 'Screening Tools and Methods', the focus is on the importance of transparency and comprehensiveness in screening processes. The speaker emphasizes the need for clear communication with individuals undergoing screenings to ensure they understand the procedures. An example highlighted in the chapter is the routine screening for diabetes across all patients due to its prevalence. This illustrates the practice of integrating various screenings into standard assessments to address diverse health issues proactively.
03:00 - 03:30: Engagement in Screening In this chapter, the focus is on the process of engaging patients in screening for pre-diabetes or diabetes. It describes how the healthcare provider asks a series of screening questions to identify individuals who might have an undiagnosed condition. If the patient answers affirmatively to these questions, they are referred to their doctor for further evaluation. The healthcare provider emphasizes that this is not a diagnosis but rather a precautionary step, and it could be benign.
03:30 - 04:00: Creating a Welcoming Environment In the chapter titled 'Creating a Welcoming Environment,' the importance of regular self-screening for health issues, such as skin cancer, is emphasized. It is advised to regularly monitor one's moles for changes and to consult a doctor if any suspicious changes are detected. The chapter promotes proactive health measures and the need for professional medical guidance when self-detection raises concerns.
04:00 - 04:30: Factors Impacting Engagement The chapter titled 'Factors Impacting Engagement' discusses the importance of informed consent in the screening process. It highlights that while written consent is not always mandatory, verbal consent is essential, whereby the individual is informed about the nature of the questions and their right to respond or not. This process of screening is crucial as it helps in identifying early warning signs and facilitates the provision of early intervention services and resources.
04:30 - 05:00: Screening for Substance Use and Mental Health The chapter discusses the importance of screening children who are having difficulties in school to determine potential underlying causes such as substance use or mental health issues. By identifying these issues early, appropriate referrals to resources can be made. The act of screening serves as the initial step to engage individuals in the therapeutic relationship and treatment process. It is not the treatment itself but rather opens the pathway for necessary interventions.
05:00 - 05:30: Use of Screening Instruments The chapter "Use of Screening Instruments" highlights the initial interaction in a behavioral health setting. It discusses how screening instruments signal that help is available and facilitate referrals for assessment based on observations or specific circumstances. It also notes that in community behavioral health settings, there is often a bypass of the screening phase, with individuals proceeding directly to make assessment appointments.
05:30 - 06:00: Gathering Ancillary Information This chapter discusses the process of screening in the context of mental health or substance abuse treatment. It highlights the role of intake counselors who conduct screenings either in the field or over the phone. The primary goal of these screenings is to determine the urgency of the situation and guide the next appropriate steps, such as whether a person needs to be referred to detox, crisis stabilization, or can be directed straight to an assessment. Emphasis is also placed on the importance of the client's internal motivation as a key factor in their engagement with treatment.
06:00 - 06:30: Conclusion on Screening and Engagement The chapter discusses the importance of rapid engagement in the screening process to avoid increasing anxiety or making subjects feel judged. It emphasizes helping individuals understand how the screening questions can aid in improving their well-being and guiding their energy toward achieving a rich and meaningful life.

Motivating People for Change with Screening and Engagement Transcription

00:00 - 00:30 hey there everybody and welcome to this video on the purpose instrument selection and ancillary information gathering process that we go through for screening I'm your host Dr Donal Snipes in this video we're going to review key skills for engagement discuss factors impacting engagement Define screening explore how to do a screening and identify types of screening instruments
00:30 - 01:00 screening is the process by which the counselor or anybody actually the client and significant others review the current situation symptoms and collateral information to determine the probability of a problem screening can be done by anybody it can be done by a Human Resources officer it can be done by a pastor a nurse a doctor um it can be done
01:00 - 01:30 by a pharmacist for example screening is not a diagnosis it's a process to determine is there a problem that may need or might there be a problem that may need further investigation screening is used by all types of Human Service Personnel to determine eligibility and appropriateness of services and needed referrals a lot of people who are involved in the Social Services System under go multiple different screenings
01:30 - 02:00 in order to determine what types of needs they may have and what types of services they may benefit from screening also helps determine the immediacy of need if I'm screening someone for substance abuse for example and I can tell by smelling that they are deeply intoxicated then that's going to be what we call a clue that they probably have a more immediate need for detoxification
02:00 - 02:30 than somebody who says yeah I binge drink occasionally on the weekends if I'm screening for depression someone who is discussing suicidal ideation is going to have a greater immediacy of need than someone who is talking about how they've been apathetic and unmotivated for 6 months screening needs to be a transparent process you don't want to
02:30 - 03:00 engage in screening with somebody and not have them understand what's going going on you want to make sure that you are upfront about what you're doing one of the things when I do my assessment with people I actually do engage in multiple different screenings for other issues for example diabetes is something that I screen for with every single patient because there's such a high proportion of people who have
03:00 - 03:30 pre-diabetes or diabetes who haven't been diagnosed so I ask them a bunch of questions that are screening questions to determine if they might be having a problem uh that could develop into diabetes if they answer yes to the questions then I refer them to their doctor I make sure they understand I have not diagnosed them it could be just completely benign
03:30 - 04:00 but better to get it checked out than not to have it checked out we do the same thing with screening for moles for skin cancer we look hopefully you're looking at your moles on a regular um to make sure that they're not changing if they're changing you have screened it and you've said hey doing this self screening I determine that there is a potential need to have a doctor look at it and D diagnose whether this is a
04:00 - 04:30 problem or not screening requires informed consent you don't necessarily have to have a written informed consent but you need to have a verbal consent from the person I am going to ask you these questions and you have the right to answer them or not answer them screening identifies early warning signs and helps provide early intervention services and or resource
04:30 - 05:00 if a child is having difficulty in school well okay they're having difficulty that's an issue but then we need to screen the child to identify what might be causing the issue and make referrals to resources as necessary screening is the first opportunity to engage the person in the therapeutic relationship and the treatment process screening is not treatment but it opens the door and it
05:00 - 05:30 says hey there might be something going on that I can help with or that these people over here can help with would you like to walk through the door sometimes based on observation or other circumstances people may be referred directly for assessment and I'll be honest if you are working in community behavioral health a lot of times we skip over the screening um the person calls they make an appointment for an ass assessment a
05:30 - 06:00 screening is something that is typically done in the field where or on the phone where where a intake counselor um may be asking particular questions to screen for the immediacy do I need to refer this person over to detox or crisis stabilization or can I refer them directly for an assessment the client's internal motivation is the primary reason for engaging in treatment if they are not
06:00 - 06:30 internally motivated they're probably not going to engage so rapid engagement is vital when we ask these screening questions we don't want to increase their anxiety we don't want want them to feel judged we want to help them understand how the questions we're asking may help them feel better may help them use their energy in a way to move toward their rich and meaningful
06:30 - 07:00 life successful screening should be brief and when I say brief I mean less than five minutes if you're asking them 40 questions that's too long you're going to lose a lot of people it should be conducted in a variety of settings by a range of professionals on Persons deemed to be at risk teachers if they had the time would be excellent for screening school counselors are are excellent for
07:00 - 07:30 screening um again pediatricians doctors nurses pharmacists all have the ability to conduct screening when your company has Wellness fairs they are offering the opportunity for a variety of screenings from high blood pressure to blood sugar issues to depending on what they bring in a lot of screenings can be done in a very short period of time for people to
07:30 - 08:00 help them identify emerging issues we know it's much easier to address an emerging issue or prevent it allog together than it is to try to treat something that is firmly entrenched successful screening should be a collaboration among a multi-disciplinary team as I mentioned before I know that
08:00 - 08:30 diabetes and um irregular blood sugar can cause a variety of mood and behavioral symptoms however I'm not a doctor so I am going to recognize that some of these symptoms may be caused by situational factors and cognitions and Trauma and all this other stuff but some of them also could be caused by physiological issues when I do assess ments
08:30 - 09:00 I I don't require I strongly encourage people to have a comprehensive physical that addresses or screens for vitamin D deficiency um anemia blood sugar problems in order to determine if there's a physiological uh cause or contributing factor to their presenting issue if a doctor screens for
09:00 - 09:30 depression that's great you know they don't have the time or the inclination probably to do therapy every week so they're going to refer to a counselor a counselor doesn't have the ability to write prescriptions or test blood sugar so we're going to refer to a medical doctor and that's what that collaboration is for it's for me to say hey I recognize that what you do or what you address May impact what's going on
09:30 - 10:00 with my client but it's outside of my scope so I'm going to screen for things that I cannot diagnose and if the person screens positive I'm going to refer to you successful screening also needs to be sensitive to racial cultural socioeconomic and gender related concerns enough said and it should be developed from information gathered from multiple sources when possible most screenings
10:00 - 10:30 are done based on client self-report and that's good but it's not great a lot of people with addictions are in denial about their addiction or they don't want to admit their addiction so they're not going to tell you about stuff that may mean that they screen as um possibly having an addiction so if you have ancillary
10:30 - 11:00 information in the screening it helps support your ultimate conclusion you want to screen for signs and symptoms of intoxication and withdrawal in everybody not just somebody presenting for substance use issues is super important because intoxication and withdrawal can also look like mood issues intoxication and substance Miss use can contribute to
11:00 - 11:30 mood symptoms three key elements that we have in screening we want to verify that the person's behavior deviates from the norm for their culture their age their you know everything and not pathologize something that is considered culturally normal we want to rule out all n non-drug rated causes of their behavior if they are
11:30 - 12:00 staggering for example and slurring their words all right well that your first thought may be that's intoxication well yeah that's probably my first thought too but blood sugar being out of whack can also cause that um thamin deficiency uh that gets really bad called we cor theof syndrome can also cause that so we want to look and say is there anything else going on that
12:00 - 12:30 other than being intoxicated or withdrawing that may be contributing to this and we're Nikki corov and I know I'm on a tangent here but just bear with me is caused by a thamin deficiency and that thamin deficiency initially was thought to be caused by alcoholism and so the only time we really saw that diagnosis of we Nikki corov was in people who were hardcore
12:30 - 13:00 alcoholic but we're finding that people with other conditions Also may develop weiki corsac covs including anorexia bulimia and people who have had uh gastric bypass all of them are at risk for having severe deficiencies in the body's ability to process or access uh thamin
13:00 - 13:30 therefore I do not consider weiki corov a necessarily a drug rated cause want to make sure that I evaluate what might what might be going on and then we need to use diagnostic procedures to determine the types of drugs being used and I probably should have used the word screening procedures to determine the types of drugs being used those little cups that people pee in for their on-site drug tests those
13:30 - 14:00 are screening tools those are not diagnostic tools those do not tell you for sure that this person has been using alcohol or cocaine or opioids or barbituates it says there's a such and such probability it's giving you a it's basically like a pregnancy test for drugs you know you're you're seeing if you see two lines or if you see one line but they're not 100% accurate some of
14:00 - 14:30 them are not even 80% accurate and it's really important that we recognize the limitations of on-site screening tests and we send those tests off if you're making a diagnosis or if there's some consequence to the person's results that those results are sent off and looked at by a mass spectrometer to determine whether
14:30 - 15:00 their test was they were positive because they actually used that drug or something else caused a false positive in terms of screening and assessing what's going on with clients we want we can screen for their mental health we can screen for depression anxiety anger we can screen for trauma history we can screen for safety and environmental needs we can screen for physical health needs and we're not I'm not a doctor I can't tell
15:00 - 15:30 you what to eat or you know what you need to do to fix something physically but if I screen you and you talk about being in pain all the time then guess what I'm going to refer you to your physician so they can start working with you on that pain and I will start working with you on coping strategies so you don't use or abuse drugs in order to cope with that pain we want a screen for other
15:30 - 16:00 wraparound needs that may prevent the person from accessing treatment or may prevent the person from uh healing you know what else is going on in their life that may be contributing to their distress are they in a domestically violent relationship are they financially really struggling are they homeless are they what else is going on that they may need and you want to think
16:00 - 16:30 about maso's hierarchy here what physiological needs are not being fully and adequately meant and what resources can we refer them to what safety needs are not being fully and adequately met and what resources can we refer them to screening is not diagnosis it's saying hey I see you have a need let me connect you with somebody who can help you fulfill that need and we want to screen for whether
16:30 - 17:00 somebody is a danger to sell for others if you are doing a mental health or substance abuse screening this is something you need to screen for and if they if the person talks about um wanting to hurt themselves or others then you need to refer to somebody who can do a thorough assessment in terms of screening methods you can inter interview the person the
17:00 - 17:30 client guess what go figure how awesome is that you can also screen by talking to significant others if the person is too intoxicated to answer the screening questions then you can talk to significant others if you're dealing with children you're going to want to gather information from significant others if the client is an adult and is able to answer the questions themselves that's great and and if they're willing to let
17:30 - 18:00 significant others kind of round out the picture that's great you can use screening instruments and there's lots of screening instruments out there um a lot of free evidence-based instruments are out there we're going to talk about those in a minute but they're impersonal the nice thing about them is the person doesn't have to confess if you will to anyone it's something they can do on their own so a pharmacist can hand somebody a uh self assessment sheet
18:00 - 18:30 for dementia for um anxiety for something else if they're concerned about a person's status and that can serve as a screening um the screening instruments ideally are done with a clinician or with a person like a pastor who can process it with them we don't want to just hand them a screening instrument and say you know fill this
18:30 - 19:00 out when you get home and you know good luck we want to make sure that they know what to do with it once they've filled it out but it does provide a um structure and a framework for people who are not clinically trained to get the information that they need and take the appropriate steps and then as I mentioned earlier lab tests are great screening methods
19:00 - 19:30 whether it is at a doctor's office where you're getting blood drawn or something when they draw your blood they're not diagnosing anything they're looking to see if your you know all your things are in their normal parameters and if they're not then the doctor has to say hm wonder why that is let me let's figure out what's going on let's do a f further diagnostic assessment with substance abuse most people are not going to start out with a
19:30 - 20:00 lab test lab urine test unless it's a pre uh pre-employment or a workers comp issue most people who are in substance abuse treatment are going to do some sort of onsite screening test and that gives information now as I mentioned earlier you can have false positives but you can also have false negatives people can dilute their urine enough or take
20:00 - 20:30 certain things that can make it so their urine does not trigger the two lines on the urine test if you have suspicions even if it comes up negative if you have suspicions it's important to send it off for a diagnostic evaluation from a mass spectrometer screening is not assessment
20:30 - 21:00 or diagnosis when you are engaging somebody in the screening process you want to demonstrate or you want to use verbal and non-verbal skills that establish Rapport and promote engagement you don't want to have somebody come in and go okay you are number 26437 um and then start rattling off these questions without even looking at them look at them welcome them look at
21:00 - 21:30 them don't sit there at your desk and just kind of look over your shoulder turn so you're facing them acknowledge them call them by name ask them how their day is it takes about two seconds to help somebody feel a little bit relaxed tell them what you're getting ready to do make sure they feel like they are informed you know and able to answer or not answer the questions and then begin asking questions but they are a
21:30 - 22:00 person they're not a number and they need that eye contact they need to feel like they are important to you at that moment discuss the rationale purpose and procedures associated with screening you don't need to go in depth into I'm going to ask you questions on this questionnaire that was validated and blah blah blah and written by so they don't care they don't care uh but tell
22:00 - 22:30 them the screening process all I'm going to do is ask you a few questions and screening is not a diagnosis screening just helps us determine where to best refer you if there is a problem screening helps us determine if there might be something that needs further investigation assess immediate needs including detoxification notice if their pupils
22:30 - 23:00 are pinpoint or their pupils are blown if they're slurring their words if they have any signs of intoxication or withdrawal if they're itching if they're scratching a lot could be eczema could be dry skin could be that they're having a uh intoxication reaction so it is important to notice that and when you're screening you're not just hearing what they say you're also seeing in them if I'm screening somebody for depression and they're
23:00 - 23:30 telling me it's all good and I'm looking at them and they doesn't look like they bathed in about a week and I can smell them from across the room I'm going to start wondering if their nonverbals say I'm depressed but they're telling me nope everything's fine the the two don't Jive so it's important to pay attention that's another reason you got to look at the person to their nonverbals 80% of our
23:30 - 24:00 communication is nonverbal when I turn and I look at you and I make eye contact with you that communicates something if I don't turn what does that communicate that communicates you're not important you're not willing you're not worthy of my attention so it is important to make sure that we actually engage with the person administer evidence-based screening instruments to identify physical needs medical conditions and
24:00 - 24:30 co-occurring mental health issues I told you earlier that I regularly screen for diabetes in people that I work with where did I get that screening instrument The Diabetes Association um if you screen for depression there are depression instruments out there that can help you screen for mental health issues it it's actually super easy you can go to the DSM currently dsm5
24:30 - 25:00 TR and look at the diagnostic criteria and you just go through it with them it's not brain surgery what's in that book is not a secret your basic screening instruments are developed based on those criteria so just ask them do you experience this symptom yes or no do you experience this symptom yes or no and that's it it's not you don't have to have some super expensive instrument in order to do a screening determining
25:00 - 25:30 diagnosis is a little bit more of an art but screening can be pretty straightforward obtain relevant history you know ask them if they're depressed or they're talking about feeling depressed how long's it been going on what do you triggered it if you know have you had other episodes like this that's all important information to help you determine are they having a bad day
25:30 - 26:00 or do they need to be evaluated for major depressive disorder interpret the results of screening and determine the appropriate course of action once you have the results then you want to talk about it with the person and say okay this is what I'm seeing based on this screening there might be an issue that could be resolved uh um by talking with your doctor or by seeing a
26:00 - 26:30 therapist or what have you what is going to what is something that you're willing to do and we want to make sure that we provide options for the people but we don't just automatically say okay you screen for all these things here are 17 referrals see you next no we want to talk with them about what the appropriate course of action is for them at this time they may not be willing to go to treatment they may be willing to
26:30 - 27:00 consider support groups or um something else so we want to talk with them about what they're willing to do engagement puts the clinician in the best position to negotiate with the client about what to do and how to do it engaged clients are more likely to participate willingly be treatment compliant and successfully complete treatment what what does engagement mean engagement means I've bought into it I
27:00 - 27:30 believe that there's a problem and I'm motivated to work with you to try to solve this problem an engaged client is one that is with the program in order to improve engagement I want you to think about times that you've gone to a counselor or a doctor or something else [Music] and they've told you to do something and they haven't engaged you they've just
27:30 - 28:00 said hey you know you're 20 lbs overweight you need to start getting healthy here are the 17 things you need to do come back in six months did you follow it were you engaged in that did you feel empowered did you feel like it was important to do did you feel overwhelmed by everything an overwhelmed person is probably not going to be engaged so we need to engage the person and say heyy here's what I see as a
28:00 - 28:30 problem here's why I think it's a problem and how it's causing your distress here are the options that I see and I am here to help you accomplish these goals establish Rapport and an effective working Alliance in which the person feels heard and understood being respectful non-judgmental and attentive respectful nonverbals again you want to communicate
28:30 - 29:00 that non-verbally not being closed off not being just looking at your computer treat them like a human being you want to be non-judgmental if they start talking to you about being in a domestically violent relationship and unable or unwilling to leave questioning them on that being judgmental about that is going to destroy Rapport we want to hear where
29:00 - 29:30 where they are and be respectful of their current circumstances we can still provide resources and referrals but we need to be respectful to not force our opinions and our beliefs and our fears onto them and we need to be attentive not answering our phones not answering emails while we're trying to talk to them when they are with us we
29:30 - 30:00 are with them 100% And motivate and engage the client in identified service needs it can be really overwhelming for a person once they've gone through a screening if you say okay well here's what I want you to do I need you to go make an appointment to go see your doctor and get a blood test run and it would be ideal if if you called this place and got set up for an assessment
30:00 - 30:30 for counseling or got on the waiting list for detoxification well to you that may not sound like a big deal because that's what you do on the daily you help people connect to a person who is already struggling who already feels exhausted and overwhelmed and who may be um intimidated by doctors and treatment centers and all that other stuff or fear how much it's going to cost there's a lot of reasons why people may not follow
30:30 - 31:00 through so we need to talk to them and say okay these are the things that I think would be helpful what concerns do you have about it and what is it that I can do to help you take advantage of those resources that are out there for you for making appointments sometimes you may need to help them make those appointments or sit there with them while they make the appointment because it causes them so much
31:00 - 31:30 anxiety to call the doctor's office and make an appointment that they may not do it so okay well before you leave let's go ahead and have you just call your doctor and make that appointment that way that's out of the way create a welcoming environment Pleasant for the person and sensitive to their age if you are seeing children then having an office that's designed for 30s somethings that's not going to
31:30 - 32:00 be welcoming and the child's going to be like okay this feels like Mom's living room or Grandma's living room um and they're probably going to be less comfortable if you are seeing adults then obviously you don't want to have the entire office decorated for play therapy make sure it is sensitive to gender and if you are seeing people if you are seeing
32:00 - 32:30 men it's important to help them feel welcome in your environment you don't want it to have it be overly flowery and fluffy and um fancy because that may make them feel uncomfortable likewise you don't want it to be too austere for people who prefer things that are more decorative and that doesn't necessarily always follow along gender lines
32:30 - 33:00 but recognize the different temperaments and personalities that are coming into your office you want it to be sensitive to disability if they've got chronic low back pain making sure that you have a chair or seating arrangements where they can that has lumbar support and they can put their feet on a an ottoman or something to reduce the strain on their lower back back if they are in a wheelchair or on
33:00 - 33:30 crutches or using a walker making sure that you don't have obstructions that are going to keep them from being able to get into your office and move around pay attention to sensitivities a lot of people have sensory sensitivities whether it is sound smell or sights people who have epilepsy for example are extreme ex sensitive to flickering lights people who have migraines are also sensitive to
33:30 - 34:00 flickering lights it can really trigger a migraine make sure if you've got fluorescent lights that they're not flickering uh smells a lot of people can get easily overwhelmed by smells making sure to keep it smell neutral uh I know for me I am extremely sensitive to uh voc's volatile organic compounds reading I was reading my grandfather's Bible the
34:00 - 34:30 other day and I opened it and I was reading it for you know I don't know five or 10 minutes and I started to get this wicked headache turns out the paper as it decomposes releases voc's I know I'm sensitive to voc's because if I'm around paint I'll have a migraine in 15 minutes um but I didn't think about the books so the same sort of thing goes for our clients with sensitivities don't wear perfume that's
34:30 - 35:00 too strong or cologne that's too strong um and be sensitive to their sensory stuff and sounds humming from fluorescent lights can be absolutely deafening to some people and I'm you know in general I'm thinking people who are neurotypical people who are neuroatypical may be ex exceptionally sensitive to some of these sights smells
35:00 - 35:30 or sounds and remember neuro atypicality is not just autism spectrum it's ADHD it's schizophrenia we see a lot of people um with a variety of different mental health issues who have some degree of neuro atypicality we want to make sure that it's sensitive to sexual orientation if you've got somebody coming and and religion let's just put them both together if you've got
35:30 - 36:00 somebody coming into your office that may be of a different sexual orientation or religion than you um it may be intimidating if you w if they walk in and what they see is rejecting representative of a culture or a religion that rejects who they are do you have to have Pro prosexual orientation things it's
36:00 - 36:30 ideal it's ideal um to make sure that people know that they are welcome and regardless of how they're wired how they're made how they're you know they're being they are welcome and they are accepted and socioeconomic status is also important people who are of a lower sces for example walking in into a super fufo office on the 20th floor of some
36:30 - 37:00 building may feel intimidated because they're around a bunch of people that they are of a different socioeconomic class they may feel um very isolated and may not feel accepted it's important to be aware it doesn't mean that you have to move your office but make sure that people feel welcome when they come in how do you do that well one of the best ways to do
37:00 - 37:30 that is to ask when people come in hey I just open my new office and I'm looking for suggestions for making this feel more welcoming and inviting what is one thing that I could do that you think would make it more welcoming and inviting you don't have to implement everybody's suggestions but if you're asking the people you serve then you're going to be able to modify your environment in a way that's meaningful
37:30 - 38:00 to them instead of assuming and guessing certain factors impact engagement stigma is a big one stigma about diagnosis whether it's depression or schizophrenia or addiction or something else seems like a lot of stuff out there has a stigma associated with it we need to help people recognize that mental health diagnosis
38:00 - 38:30 are very similar to physical health diagnoses if you've got Crohn's disease there's no Stigma against Crohn's disease why is there a stigma against bipolar disorder you know it's it's just it is what it is and we need to help the person figure out how to live with it in a way that they can move toward their rich and meaningful life uh some cultures are very anti- uh Mental Health Services anti-al
38:30 - 39:00 illness because they perceive it as bringing shame to the family or a punishment from God and we want to understand that and work with them within their culture as they see it it's not our place to tell us tell somebody that their cultural beliefs are wrong we if they are embracing those beliefs if those belie beliefs are meaningful to them we need to say okay
39:00 - 39:30 how can I help you best navigate this issue in your culture and there's a stigma about help seeking many cultures believe that you should keep your problems in the family you shouldn't go out and tell other people about it or it shows weakness if you have to go see a therapist and obviously I disagree with those but that comes from being a therapist that
39:30 - 40:00 comes from the culture and the environment that I was raised in and it's important that I validate if somebody feels like there's a stigma about seeking help instead of saying you're just making a mountain out of a mole hill suck it up buttercup it's important that I say I I hear that this is causing you a lot of anxiety what can I do to help you feel safer when I first came came to Nashville I worked in a clinic in in Nashville and we had a lot of um
40:00 - 40:30 high-profile clients that were coming into our treatment center and of course they didn't want to be photographed by the paparazzi going into the front door of an addiction treatment center so we had uh different arrangements made where they could park around back so their car wouldn't be um scene or they could actually park over at the restaurant nearby and walk over if they wanted to
40:30 - 41:00 and then they were able to come in the back and leave out the back so they didn't have to walk through the lobby where other people were waiting and that allowed them a certain amount of feeling safe so ultimately again it's important if we're engaging them we not only need to help them feel empowered but we also need to hear and validate their concerns and say okay I hear where you're coming
41:00 - 41:30 from how can we work together to deal with this issue they may have expectations about the effectiveness of treatment if they think it's going to be super effective then they're probably going to be on board if they've been in treatment before or they doubt the effectiveness of treatment they're probably not going to be engaged they're going to be like eh you know I'll dip my toe in and we'll see so it's important to help them identify goals that they'll be able
41:30 - 42:00 to accomplish to see the effectiveness of treatment it's important to provide them research that helps them understand the effectiveness of that particular treatment method they may have different expectations about their role or power in the treatment process some people come to treatment and they expect me to fix them and I'm like I don't get paid enough to do that and they usually look at me like I have three heads I said I
42:00 - 42:30 can't change you only you can change you I am here to provide you support suggestions tools and it's up to you to figure out which ones are going to be useful to you and start using them and I can help you become proficient at using them but you have to do the work and I will be there to guide and support you and they may have weird expectations
42:30 - 43:00 or unfounded expectations about the treatment process itself if I check into residential this these are all the things that are going to happen let's be very transparent about what group therapy looks like in your organization be transparent about the tasks that the person's going to participate in as a member of that treatment program that's all an informed consent and once we
43:00 - 43:30 um clarify people's expectations they tend to become more engaged in the process it's not as scary anymore so they feel knowledgeable it's kind of like if I'm driving into Nashville and I need to go to some building in the middle of the city I'm not going to be I'm going to be kind of apprehensive about doing it unless I know the route if I've already asked Google Maps how to get there and I have the directions and
43:30 - 44:00 I've looked at it on the map and I can see how it's going to go I feel more confident I'm if you will if you want to I'm more engaged in driving there because I'm expecting okay I turn left here and this is where I'm going to go I feel more confident and then likableness and I know we don't like to talk about this but it is just a human reality people will be more engaged in
44:00 - 44:30 the process and engaged with you if you've got good social skills go figure and if they've got good social skills you're going to be more likely to engage with them if they've got good social skills so if they don't have good social skills you're going to have to work doubly hard to engage them in the process likewise if you're attentive to them they're going to be more engaged um and
44:30 - 45:00 if they're attentive to you they're going to be more engaged you want to make sure that you've got the client attention they're not sitting there playing on their mobile device or just aing you the whole time and as much as I hate to say it attractiveness when clients come in and they are unattractive it often impacts the
45:00 - 45:30 therapist level of Engagement with them research has shown it it's one of those human factors we can work in our own minds to make sure that we um buffer against this but we do need to understand that there is a tendency for it to happen clients who are struggling with addiction who who may be homeless they may come in and be disheveled um they may smell bad they
45:30 - 46:00 may there there's lots of things that may be going on we need to see that as a symptom of their present condition and not representative of who they are and recognize their attractiveness as a human being likewise and I know you don't want to hear this but it's a reality your attractiveness if you show up to work and you've got baby vomit on one shoulder you forgot to
46:00 - 46:30 brush your hair you your your clothes are all wrinkled and disheveled then the client is going to look at you and go H you know not really sure if this person cares about me because they don't even care about themselves attractiveness doesn't necessarily mean whether you are a you know model it
46:30 - 47:00 means how well do you take care of yourself and how do you present yourself and finally projection and transference issues if you remind a client of somebody that they despise or somebody that they're afraid of then they're going to be less likely to engage with you and it's going to be make take more work on your part to help them feel safe and secure and recognize that you are different from that person likewise if a client comes in and
47:00 - 47:30 reminds you of somebody that you have had bad experiences with then you are going to have to actively work to remind yourself that this is a different person and engage with the person that's in front of you not your memory of the past person First Impressions impact engagement as I mentioned earlier your professional presentation if you're
47:30 - 48:00 wearing jeans in a t-shirt even if they're well pressed and you're seeing clients that are paying $300 an hour even for screening that's not going to probably engender a lot of confidence unless maybe it's casual Friday so make having a professional presentation is important and one that is appropriate to that environment if I dress in like a three-piece business
48:00 - 48:30 suit and high heels and I'm planning on working with six-year-olds that might not go over so well either do I need to be um bathed and you know have my hair brushed and Polished and stuff yes and probably I would wear a polo shirt and some you know black slacks or something I'm still dressed nicely but it's in a way that is not going to
48:30 - 49:00 be intimidating to the six-year-old be prompt their time is just as important as your time and if you're late it communicates that their time is not important be courteous smile say hi not everybody likes to shake hands that's okay um but treat them with courtesy they are another human being and handle your paperwork smoothly
49:00 - 49:30 if you're shuffling around and going I know I've got that form here somewhere just a second um they're not going to have a lot of confidence in your skills make sure that you are ready for that person that comes in to do their screening remember you're probably the first person they're seeing at your organization so you're setting the tone for how organized efficient and competent your entire organization
49:30 - 50:00 is make sure the environment is calm clean and comfortable not too formal or informal make sure to avoid interruptions if you're in a if you're in a group office make sure when you shut your door you have a sign on the outside that says in session or there's some way that people know now's not the time to just stick your head in and it provides appropriate privacy
50:00 - 50:30 as I mentioned earlier not everybody's going to feel comfortable going through the waiting room or if they have had a session and they've been crying they may not want to go back out through the waiting room we want to make sure that they have appropriate privacy during this initial interview the screening establish trust and develop rapport be empathetic with the person not only
50:30 - 51:00 about their condition but about how much courage it took to come in today convey warmth and respect and explore the person's strengths and skills instead of starting out looking for deficits and problems let's talk about their strengths and their skills all right you're here today because you you've been feeling depressed and you know it's really hard to do what you need to do when you don't have energy and you know you just can't get motivated for anything tell me about
51:00 - 51:30 how you have survived until now what things have you done that's helped just a little bit that helps the person start thinking about what they can do instead of what they can't facilitate the client's understanding of the screening purpose and procedures explore the person's awareness of their problems and expectations regarding treatment and recovery so for example asking them how
51:30 - 52:00 are these symptoms keeping you from living your rich and meaningful life how is this lack of motivation and cons constant exhaustion how's it keeping you from living your rich and meaningful life how is are your behaviors how is drinking until you pass out every night impacting your ability to live your rich and meaningful life again what has worked to help you
52:00 - 52:30 address these things at least a little bit and what hasn't why do we ask about the hasn't because we don't want to have them feel like we're going to make them repeat things that haven't worked in the past remember one client came in and she sat down and before I had even started talking doing the screening she said I'm not going to any of those meetings okay my name's Dr Snipes how are you I
52:30 - 53:00 mean literally she walked in she was already on the defensive because she had been through this process before and instead of hearing what hadn't worked for her people kept trying to make her do the same thing over and over again and expect different results and we know that that's insane ask them was it hasn't worked and if it's something that you think is important talk with them about why it didn't work and whether they're willing to consider
53:00 - 53:30 making some modifications and trying something similar and if they say no okay remember in this initial interview we're screening we're empowering we're engaging we don't want to start telling people well once you get into the program then I'm going to start making you do all these things you don't want to do well do you think they're going to engage and come back no and ask them what do you think might work this time what might help most
53:30 - 54:00 people have an idea about what might help them this time so let's start building off their strengths off their hopes off their what they anticipate what they believe is going to work and then determine if a further assessment is needed so after you get all this information and their expectations about treatment and stuff determine with them whether a further assessment is needed and
54:00 - 54:30 appropriate when you're screening for substance use or mental health issues it's important to get information about the circumstances of contact are they being sent there by a criminal attorney or the courts or a civil or involuntary referral if so they're probably not going to tell you the 100% truth they're going to skew things to make themselves look good human look at the client's demeanor and behavior are they oriented to person
54:30 - 55:00 place time and purpose do they know who they are who you are where they are what time it is and why they're there and you may say well of course they do no you'd be surprised how's their short and long-term memory you know you introduced yourself when they came in 10 15 minutes into the interview ask them what your name is or ask them the name of the treatment center that they're at or whatever to see if they can remember
55:00 - 55:30 something in the recent past and then ask them about something from the distant past that you know the answer to not about their life because you don't know the answer to that but for example who was the president before the person who's president now assess their coherence and judgment are they getting it do they understand the severity of the problem are they having any
55:30 - 56:00 hallucinations or delusions seeing things or hearing things that are not there or believing things that other people would totally just not concur with are they showing signs of depression anxiety or trauma you're screening for it you're not diagnosing it are they showing signs of suicidal thoughts or behaviors you're screening for it these are all things that you need to screen for because if they are
56:00 - 56:30 not oriented if their memory is having problems if they're not coherent or M having good judgment if they've got hallucinations or delusions they're showing signs of suicidal thoughts and behaviors obviously that is a more imminent immediate assessment and referral as opposed to someone who is presenting with who is who is oriented and their memory is fine they've got good judgment
56:30 - 57:00 but they're depressed not to say that that person doesn't need help but the immediacy or the urgency of the referral is going to be uh determined based on some of those things look for signs of acute intoxication or withdrawal know your pharmacology know about the pupils know about you know smelling it on them and do they have any sign physical
57:00 - 57:30 signs of drug use like needle marks or self-injury like if they are engaging in self-injurious Behavior cutting themselves ask them about prior involvement in mental health treatment their use of prescription medication herbs and what we call neut Tropics or over-the-counter herbs and stuff to try to help you feel better including CBD ask about recent traumas have there been any deaths or losses recently in
57:30 - 58:00 your life ask about a family history of mental illness for genetic as well as environmental reasons mental illness often runs in families and also is there anything else that you want to tell me that you think might help me determine if there's a need to make a referral that's information that the person will spontaneously
58:00 - 58:30 offer in terms of screening instruments they can be developed by the agency or you can just use standardized instruments the cage very simple have you tried to cut down and been unable to do you feel annoyed when people ask you about your substance use do you feel guilty when you use and do you need to use when you first get up have an eye opener in order to get through the day the audit is another screening tool
58:30 - 59:00 that screens for alcohol use the gain SS it's the global appraisal of individual needs and the Michigan alcohol screening test and The Sassy which is the S substance abuse subtle screening inventory the audit the gain the Mast and The Sassy are all paper-based screening instruments but they're available and as I mentioned earlier you can also just go straight to the DSM that's pretty
59:00 - 59:30 straightforward currently there are no accessible screening instruments for Behavioral addictions including internet gaming disorder gambling food addiction pornography addiction sex addiction Etc you can ask the person you know again this is just screening are there behaviors that you continue to engage in despite knowing that they're causing you problems in your life such as Internet gaming
59:30 - 60:00 gambling food pornography that really cuts to the core of addiction issues and if they say yes then you can ask have you tried to cut down and been unable to and if they say yes then that's what I would consider a positive screening and criteria or grounds for a referral for a further assessment for mental health screening remember most people who have an addiction issue
60:00 - 60:30 have concurrent mental health issues going on they're depressed they're grieving they've got trauma lots of trauma so we want to screen there's the modified M Mini screen there's the mental status exam the mini mental status exam the brief symptom inventory the brief psychiatric rating scale and the symptom checklist 90r it's important that you know the names of these screening instruments for your test um will you actually see them in
60:30 - 61:00 clinic probably not but it is important to understand that what they are and that they exist for your test from screening for mental health just like screening for substance use you can go to that dsm5 TR and look at the symptoms look at the criteria and ask them the questions in terms of gathering ancillary information you need to get a release of information you can't just call up their
61:00 - 61:30 boss or their attorney and go hey I screened Jim Bob today and I was wondering if you could give me some information you need to have that signed release of information um ideally they would allow you to talk to significant others lawyers or criminal justice if the referral came from there when I worked with involuntary referrals from the criminal justice system whe and the Civil Justice System I insisted that they bring me a copy of
61:30 - 62:00 their wrap sheet their their convictions and their arrest sheet um and that was just part of the ancillary information you can also ask them if you can't get release for talking to their uh other people if I asked your mother or your spouse or your kids about this issue What would would they say you will gather more ancillary information in the assessment so if you
62:00 - 62:30 can't get much or any at all don't worry about it screening is only to determine if there might be a need to proceed to an assessment even if it does and you refer for an assessment not all assessments will result in diagnosis or at least not the diagnosis that you're thinking of so you may screen somebody who's presenting with depression for example you refer them for an assessment they go through the entire assessment and instead of getting
62:30 - 63:00 diagnosed with clinical depression they're diagnosed with hypothyroid all right you know hypothyroid and clinical depression have very similar symptoms but very very different treatments screening is the initial contact to decide if a person may need a more in-depth assessment it is a brief encounter but requires the person to be engaged in the process in order to get
63:00 - 63:30 an accurate result they need to feel comfortable they need to feel um respected in that environment how well the person is engaged in the screening process is a direct predictor of whether they will continue anyone can conduct a screening the client can self screen a significant other can do a screening a casework worker an attorney nurses doctors clergy even pharmacists so screening is one of
63:30 - 64:00 those things that we really should be doing more with the people that we work with in order to make sure that we're helping them address whatever underlying issues are causing their presenting symptoms