Transcript Application of emerging best practices

Robin VanEerden, MS, LPC, NCC, NADD-CC
Astrid Berry, BA, QIDP, NADD-DDS
March, 2015
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Benchmarks:
2a - The NADD DD Certified Specialist
demonstrates understanding of
assessments, their purpose, when they may
be needed and how to obtain them.
2b - The NADD DD Certified Specialist
understands the connection between
assessment and service delivery.
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COMPETENCY
2a
Specialist demonstrates an understanding
of assessments, their purpose, when they
may be needed and how to obtain them
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Evaluative process to determine plan of
treatment
Multi-faceted in approach
Medical/health
 Social/emotional
 Etiology
 Psychiatric
 Behavioral
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Medical
Everyday Life
Syndrome Specific (ASD, FASD)
Trauma
Psychiatric
Behavioral Supports
Crisis Support Issues
Wellness
Sexual Offending/Problematic Sexual Behavior
Training Needs
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Intelligence testing (Weschler)
Risk (VISCAT)
Adaptive skills (ABS-RC)
Safety (home and safety, fall risk)
Health (HRST)
Sexuality (SSKAAT-R)
Behavioral (FBA, ABC, MAS)
Psychiatric (symptom checklists/scales)
Human Needs/Motivational (Reiss)
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Assessment
1.
Source of Information and Reason for
Referral
2.
History of Presenting Problem and Past
Psychiatric History
3.
Family Health History
4.
Social and Developmental History
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Assessment
1. Source of Information and Reason for Referral
•
Who made the referral?
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What is different from baseline behavior?
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Why make the referral now?
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Assessment
2. History of Presenting Problem
and Past Psychiatric History
•
How long has the problem
occurred?
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History of mental health
treatment
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Assessment
3.
Personal and Family Health History
•
Medical, psychiatric, and substance abuse
history
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Psychotropic medications
• Side effects/reactions
• Efficacy – therapeutic trial
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Medical conditions
• Genetic disorders
• Hypo/hyper thyroid condition
• Constipation
• Epilepsy
• Diabetes
• Gastrointestinal problem
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Assessment
4. Social/Developmental History
• Developmental milestones
• Relevant school history
• Work/vocational history
• Current work/vocational status
• Legal issues
• Relevant family relationships
• Drug/alcohol history
• Abuse history (emotional/physical/sexual)
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Assessment
Behavioral Status
A. Recent Changes (what changed, when
and what were circumstances)
B. Challenge (defined objectively)
C. Quality of Life Issues
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Determining Root Cause
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283 Causes of ID identified in 1994
Prenatal causes dominated diagnosis
1200 + Genetic causes of ID in 2014
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Phenotype and
Genotypes
Definition of Genotype
A complete inheritable genetic identity – the set of
genes an individual carries
Definition of Phenotype:
The phenotype of a genetic syndrome is the set of
physical characteristics produced by a genetic
abnormality or genotype. (DM-ID, 2009)
Definition of Behavioral Phenotype:
The specific and characteristic repertoire exhibited by
people with a genetic disorder (Flint & Yale, 1994)
Fletcher, 2013
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Down Syndrome
FASD
Angelman Syndrome
Fragile X
Williams Syndrome
http://medgen.genetics.utah.edu/photographs.htm
Smith-Magenis
Prader-Willi
Sensory Integration - is defined as the neurological
process that organizes sensation from one’s own
body and the environment, thus making it
possible to use the body effectively within the
environment.
Specifically, it deals with how the brain processes
multiple sensory modality outputs into usable
functional outputs.
Sensory Integration Dysfunction - the term is used
informally in the medical literature to describe any
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such difficulty.
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Physical Health
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24 Hours Sleep Data (month cycle)
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Medication Changes
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Eating Patterns
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Environmental Changes
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Mood Charting
• Symptoms and Behavioral
Manifestations
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Anger management therapies
Social skills training
Coping skills training
Self-management skills training
Trauma informed therapies
Cognitive restructuring therapies
Other cognitive behavioral therapies
Contingency management/token programs
Behavior support/positive behavior support
approaches
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NON-NEGOTIABLES
items that a person cannot live without to maintain their health and safety within a
community setting.
STRONG PREFERENCES
Such things as music, sports, parties, crafts, movies, and church activities may be
listed here.
HIGHLY DESIRABLES
These are the hopes and dreams of the individual. Anything from a vacation in Hawaii
to a new winter coat may be listed here depending on the individual’s immediate
needs and dreams for the future.
WHAT DO YOU NEED TO KNOW?
Issues as eating habits, personal care, and safety issues may be covered here. There
may be certain things that upset an individual such as loud noises. These are listed
here also.
SUPPORTS/BARRIERS
An example for an individual who is fearful of or cannot negotiate stairs, a one-floor
home is recommended. This area may also include financial supports, behavioral
supports, therapeutic supports, and medical supports if needed.
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Record of a person’s life, their history
Puts behavior and emotions in perspective so they
make sense
Provides context - “the why”
How history impacted development
Prenatal---Birth----Early Childhood---Adolescence---Adult--Senior
Medication
Trauma
Illness/Injury
Development
Life Events
Personal Experiences
Life Stages/stressors
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Human Needs
Assessment
Acceptance:
Attention:
Eat:
Helps other:
Independence:
Learning:
Order:
Physical activity:
Romance:
Social Contact:
Tranquility:
Vengeance:
offend
Steven Reiss 2009
Need
Need
Need
Need
Need
Need
Need
Need
Need
Need
to avoid criticism
to be worthy of notice
to consume food
for altruism
Need for self-reliance
for knowledge
Need for organization
for muscle exercises
for sex
for peer companionship
to be free of anxiety and stress
to get even with those who
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COMPETENCY
2b
Specialist understands connection between
assessment and service delivery
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Consider what these mean for each
person
Biomedical - medical, psychiatric, neuropsychiatric,
genetic
Psychological - cognitive, emotional/motivational,
behavioral
Environmental - physical, social, interpersonal,
program
How do we frame services in relation to these?
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Coordination of care
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Stakeholder engagement
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Integration of funding streams
Resource allocation
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Natural resources
Financial alignment
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Person directed
Support networks
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Physical and behavioral health care, long term
services
Person centered life plans
Life long planning
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Every life stage
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Wellness Recovery Action Plan (WRAP)
Certified Peer Specialists
Personal Medicine Tools
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WRAPs© are developed by the person
Includes:
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person’s symptoms of mental health challenges in their own
words
triggers that might cause recurrence of symptoms
coping strategies that work and those that do not
strategies to employ in a crisis
what to do if all else fails
MH Advance Directives
o who to contact in a MH emergency
o preferred hospital
o current medications
o do’s and don’ts during a psychiatric crisis
WRAPs© for people with learning distinctions
Copeland Center for Wellness and Recovery
http://copelandcenter.com
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Person having received or receiving mental health services
Undergone training on how to assist others in regaining
control over their own lives
Role:
• Provide emotional support and insight
• Help individuals expand social support network
• Assist in creating WRAPs, help develop community skills,
develop creative ways to address issues
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Natural and personal tools to help someone feel
better and more empowered in their lives
music – gardening- walking- exercise- puzzlesdancingreading- cooking – card games – drawing – painting
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aroma therapy – massage – singing – baths exercising
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Consider . . . How would this model guide service planning?
Assessment Process – what tools are available and useful in this
case?
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Medical/health
Social/emotional
Etiology
Psychiatric
Behavioral
Is service delivery?
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Person centered
Based on human needs
Takes into consideration the life span
Utilizes recovery tools like peer specialists, WRAPs, Personal Medicine
Based in Positive Behavioral Support
What are the
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Staffing/Network issues to be considered
Teaching/instructional milieus
Resources needed
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For more information, please contact
Dr. Robert J. Fletcher
NADD
132 Fair Street, Kingston, NY 12401
Telephone 845 331-4336
E-mail [email protected]
www.thenadd.org
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