Foundations 5-9 key concepts

List and describe the eight core areas of study infused into all CACREP programs.

• Professional orientation and ethical practice

• Social and cultural diversity

• Human growth and development

• Career development

• Counseling and helping relationships

• Group work

• Assessment

• Research and program evaluation

List and describe the three components of CACREP-accredited Clinical Mental Health

1. Common core curriculum: knowledge and skills that are foundational to all graduate counseling students regardless of specialization

2. Standards for specialization: knowledge, skills, and practices that are expected of students preparing to go into a specific area of specialization

3. Professional practice experience: courses that provide opportunity to apply theory and develop counseling skills while working under supervision

Explain the value of professional practice experiences and describe the requirements for Practicum and Internships for CACREP-accredited programs.

• Value: to gain experience and supervision prior to becoming a professional counselor. These hours also count towards the hours needed for licensure as long as you're in a CACREP program.

• Practicum: 100 clock hours w/1 hr of individual supervision and 1.5 hours of group supervision per week

• Internship: 600 clock hours w/240 being direct client contact hours. Avg. of 1hr/wk individual supervision typically with site supervisor and 1.5hr/wk group supervision w/faculty

Describe and differentiate between registry, certification, and licensure

• Registry: a list of members of a professional group; simplest and least restrictive method of credentialing. Just need to provide info and pay a small fee to be listed.

• Certification: process by which an individual demonstrates his/her competency in meeting or exceeding standards of quality that have been set forth by the profession itself (NBCC)

  • NCC

  • CCHMC

  • MAC

• Licensure: legal process by which an individual demonstrates his/her competency in meeting or exceeding standards of practice that have been set forth by the state to regulate the profession

  • Regulates professional titles

  • Regulate scope of practice

  • Legally define basic terms

  • Establish a licensure board for the state

  • Delineate requirements for licensure

Know and understand the components of the five primary stages of the people-helping process

1. Establishing the relationship

   1. Establishes a mutual commitment to a collaborative process and goals of counseling

      1. Personal warmth, empathy, and acceptance

2. Assessing or defining the present problem

   1. Information gathering and decision making, plotting course of action or formalized treatment plan, important data provided for determining whether or not the implemented strategies are having their desired effects

   2. Getting a functional diagnosis as well as identifying and demographic info, biopsychosocial history, family constellation, behavioral observation and mental status exam

3. Identifying and setting goals

   1. Who, what, direction (increase, decrease, maintain), conditions (context where behavior is to occur), degree (at what level of proficiency - quality, quantity, or level of stability), timeframe (projected date of goal attainment)

4. Choosing and implementing interventions

   1. Therapeutic contract formed by concise statement of presenting problem and diagnosis, identified goals, and selected strategies

   2. Provides roadmap for client

   3. Fundamental to establish informed consent for proposed treatment

5. Planning and introducing termination and follow-up

   1. Manage termination w/sensitivity, intentionality, and good therapeutic judgement; booster sessions

Know the purpose of the DSM-V and its dimensional approach as opposed to the categorical approach of the DSM-IV with its five dimensions

• DSM-V Purpose: diagnostic classification w/objectively based criteria for defining various disorders within its classification system

  • Dimensional approach: each symptom is seen as lying on a continuum of severity or intensity

  • Recognizes the developmental nature of psychopathology, with more attention given to how expressions of symptoms are expressed in younger populations

• DSM-IV-TR: 5 axes/dimensions and had a categorical approach, meaning it assumed that specific forms of mental illness can be reliably distinguished from other forms, based on the unique sets of observable symptoms.

• Eventually: Axes I-III of DSM-VR-TR were collapsed into a single level of diagnosis that includes clinical, personality, and medical categories. Axis IV was revised to better fit w/ICD terminology. Axis V was removed in DSM V and replaced with WHO Disability Scale 2.0 to assess level of functional disability

• DSM-V follows each of its codes with the corresponding ICD-10-CM

Know the organizational structure and application of the ICD-10 for the diagnosis of mental disorders

• ICD-10: official system used across health care settings in the US. ICD-10-CM is used worldwide and creates a uniform system for reporting health information for WHO.

• Using the ICD-10: the first three characters specify the diagnostic category w/decimals specifying (ex. F10.23 is Alcohol dependence w/withdrawal while F40.0 is agoraphobia)

• Mental health clinicians use only one chapter, with the chapter being organized into 10 categories

  • F01-F09 Mental Disorders due to known physiological conditions

  • F10-F19 mental and behavioral disorders due to psychoactive substance use

  • F20-29 schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders

  • F30-39 Mood (affective) disorders

  • F40-49 Anxiety, Dissociative, Stress-Related, Somatoform and other Nonpsychotic mental Disorders

  • F50-59 Behavioral Syndromes Associated with Physiological Disturbances and Physical Factors

Describe and explain a goal statement and its components

1. Goal statements

   1. Should include:

      1. Who - who will be performing the behavior

      2. Direction - increase, decrease, or maintain behavior

      3. Behavior, thought, or affect - what is the person to do or not do

      4. Conditions - settings in which behavior is or is not to be performed (trigger events or antecedent conditions)

      5. Degree - level of performance, quality, quantity, stability

      6. Time frame

Identify and explain modalities of intervention for mental health counselors

1. Task or work related groups: developed in order to work on specific objectives to solve a problem

2. Psychoeducational groups: group experiences intentionally structured to teach knowledge and skills for the wellness and prevention of relational, psychological, and educational problems

3. Psychotherapy groups: the application of group processes and techniques for the treatment of psychological disturbance

4. Group counseling: the application of group processes and techniques to help participants resolve difficult but normal problems of living

5. Family counseling: assumes the family is the most basic unit and is, therefore, the most appropriate target for intervention

6. Consultation: a helping process in which a specialized professional (consultant) assists another party (consultee) in carrying out work or role related activities within the client system

List and explain aspects of the post-deinstitutionalization era including least restrictive treatment and evidenced-based treatments

• The Postdeinstitutionalization Era: The shift towards community-based mental health care and the challenges of serving individuals with severe mental illness in these settings. The decline in the rates of psychiatric patients in inpatient facilities was precipitated in part by shifts in treatment philosophy as well as changes in funding and reimbursement policies + policy changes making it more difficult to institutionalize patients involuntarily.

• Least Restrictive Treatment: The ethical and legal imperative to provide the least restrictive level of care necessary to meet the client's needs, prioritizing autonomy and community integration. Matching the treatment’s level of intensity w/severity of the condition to ensure restraints on client’s personal freedoms are minimal. Guided by the minimum sufficiency principle: clients participate in programs exerting the least restriction necessary for the provision of the desired outcomes. The main goal of hospitalization now is client stabilization before releasing them to community-based agencies and practitioners.

• Evidence-Based Treatments: The increasing emphasis on using interventions supported by empirical research to ensure treatment efficacy and accountability. Brought on by attention to quality control and accountability by clients, third party reimbursers (gov/insurance), and professional orgs like ACA, APA, SAMHSA. Counselors have an ethical and moral responsibility to know whether interventions they use actually promote the welfare of their clients or do harm.

Explain consumer movement

• Key people:

  • Dorothea Dix advocated for state funding of hospitals to treat people with mental illnesses in the mid-1800s by raising awareness of the deplorable conditions and treatment of the mentally ill. Her efforts led to the establishment of large hospitals, which became the primary treatment setting for mental disorders until the community mental health movement.

  • Clifford Beers, a former mental patient, wrote a book(A Mind That Found Itself)  about his experiences with abusive treatment and the poor conditions of mental institutions. He helped increase awareness about the plight of mental patients and advocated for reforms. He also co-founded the National Committee for Mental Hygiene in 1909, later renamed the National Mental Health Association in 1950.

  • Elizabeth Packard campaigned to change legislation regarding involuntary commitment. She had been committed to a mental institution against her will and fought to ensure others would have the right to a jury trial to determine their sanity in such cases.

• Underlying assumption of the consumer movement is that people with shared experiences can be more helpful and can provide more supportive environments than those who have not experienced psychiatric treatment. There was a strong desire to put a stop to the oppressive stigma that came w/psychiatric diagnoses and to develop appropriate control of its treatment. Consequences included: consumer-developed and managed systems of care, self-help groups, client advocacy organizations, and the recovery perspective. Consumer movement/support groups have emerged to assist clients and families w/three vital needs: support, education, and empowerment.

Explain recovery and identify the 10 components of recovery philosophy

• Recovery: journey of healing and transformation enabling a person w/mental health problem(s) to live a meaningful life in a community of his/her choice while striving to achieve his/her full potential

  • self direction: consumer directed recovery, they know themselves best (goals, unique path to attainment)

  • person-centered: ongoing recovery journey builds on client strengths, needs, preferences, cultural background, etc

  • empowerment: clients have the right to choose and speak for themselves, enabling them to control their own destiny

  • holistic: recovery is not just limited to treatment but encompasses all aspects of client’s life

  • non-linear: recovery is a process/journey w/occasional setbacks and growing

  • strength-based: recovery builds upon inherent and acquired strengths and coping skills

  • peer support: other clients in recovery create an invaluable support system

  • respect: respect and full inclusion in mental health systems and community, eliminating stigma and discrimination

  • responsibility: taking responsibility of recovery journeys to provide increased meaning

  • hope: fundamental and essential message of recovery

Understand the traditional continuum of mental health care and its expanding settings of professional practice

Psychoeducation and consultation: least restrictive treatment and least expensive to society

Crisis services: immediately after psychoed

Outpatient services: middle of the road

Day treatment: penultimate most restrictive and most expensive to clients and society

Inpatient services: most restrictive treatment and most expensive to clients and society

Know and explain the difficulties and efforts being done to help provide services to special populations

• Homeless populations:

  • Counselors believe they are too difficult to help

  • transient population and can overlap with other populations like SUD

  • difficulty connecting to services

  • brokered case management

  • assertive community treatment

  • Models of service of delivery: Place/Train psychiatric recovery model

  • mental health and substance abuse services provided on site

• Severe and persistent mental illness

  • Clinical mental health counseling attends to both elements or wellness and pathology
    - Many community mental health program utilize Assertive Community Treatment (ACT)
    - Ensure clients receive all necessary services to remain and function optimally in the community

Know the several specific settings where mental health and community counselors work and their associated responsibilities

• Crisis/Emergency Management: CACREP has provided guidelines by infusing crisis and trauma based practice, disaster response, and emergency management systems in 2016 standards

• Agency/Community Mental Health Centers: Fast paced, Diagnosis assessment, Administrate tests, such as Beck Depression Inventory II, Have the ability to create training programs
  Work along side other physicians

• Private Practice: Office autonomy, Self-care is essential, There are a number of drawbacks, Difficult to find relevant and required continuing education hours, Operating costs are extensive

• Substance Use Treatment Programs: At risk for burnout, Clients often resistant of treatment, High attrition and relapse rate

• Small College Counseling Center: Variety of opportunities serve in various roles on the college campus or community

• University Health Service: Completes intake, Individual/group counseling, Develop educational programs, workshops, Design flyers and pamphlets

• Equine Therapy: The horse becomes a tool for emotional growth, Wellness oriented, Addresses underlying symptoms of pathology

• Home-Based Therapy: Services in the home or at school, Personal safety is of utmost importance, Work with other medical professionals

Understand the transition to integrated behavioral health in primary health care settings

Since physical and mental health are directly related, in order to holistically heal the client integrated setting with multiple health professionals are gaining presence.

Know and understand the three primary reasons for using appraisal and research in clinical mental health counseling

1. Mental health professionals must be able to determine the extent to which their interventions are truly effective

2. discussions of new therapeutic techniques and preventive psychoeduction in the professional literature introduce mental health professionals to ideas that they can apply in their practice

3. Recent developments in statistical analyses and research methodologies are allowing researchers to investigate complex phenomena, interactions, and nonlinear relationships that were not possible previously.

Define and understand key concepts such as reliability and validity and how these relate to appraisal and research

reliability: refers to the degree to which items on tests and scores obtained from tests are consistent, dependable, and repeatable

Validity: the extent to which an instrument accurately measures what it says it measures

How it relates: validity relates to the confidence we can have in the results and the extent to which they can be generalized. For reliability, the focus becomes consistency of methods, conditions, and results. Operational definitions can be used to safeguard against threats to validity and reliability by guiding research toward more precise measurement of the construct being investigated and reduce measurement error.

Know and describe different categories of appraisal techniques

Intelligence tests
- Intelligence: one's capacity to learn and one's ability to reason, judge, and effectively adapt to the environment
- Originated in 1905- Alfred Binet
- Terman in 1916 expanded by introducing intelligence quotient (IQ)
- Wechsler scales developed for different age groups
- Achievement tests: appraisal instruments that measure a person's degree of learning in a specific subject or task
- Boston Public School System in 1845 Began to substitute written exams instead of the oral exams in order to really test the students level of achievement
- George Fisher in 1864 Developed an objective test for EnglishBy early 1900s, objective formats became the norm
- Zone of proximal development: the range of tasks currently beyond the child's capabilities that can be mastered through the verbal guidance and modeling of a more skilled child or adult
- Aptitude tests are used in a variety of settings to predict what people can learn, jobs they could do, or careers they could pursue and interest inventories to get an idea of a examinees likes a dislikes and interests- used in career counseling mostly

Personality tests
- Personality: the relatively stable and distinctive characteristics of behavior that reflects the person's reactions to the environment and unique adjustment to life
- Personality traits
- Personality states
- Personality types

Self-concept
- Self report clinical scales
- Clinical scales focus on specific dimensions of the clients experience Usually brief and written in objective formats

Know the five specific tasks of ethical practice in appraisal

Test selection
- Determine the specific question(s) to be answered
- Be sensitive to the specific needs and characteristics of the client

Test administration
- Must be careful to follow instructions to ensure tests are standardized
- Make sure the client has a comfortable and quiet place to take the test

Test interpretation
- Conclusions never based solely on test results

Test reporting
- Fully inform clients for rationale for testing
- Communicate results clearly and directly

Storage of test related materials
- MHC are responsible for making sure these files are secured

Know and describe the specific models of research design

Within-subject designs
- Investigates individual under both experimental and non-experimental conditions and are sometimes known as N=1 studies
- Characterized by single-subject rule, one variable manipulated at a time

Qualitative methods
- Use words rather than numbers to describe phenomena

- Meta analysis: sophisticated statistical approach used in conducting literature reviews
- Relies on the concept of error variance

Experimental methods: researcher deliberately manipulates variables and measures the effect

Correlational methods: used to explain relationship between two or more variables; communicated by calculating a correlation coefficient

Sequential design: design combines longitudinal and cross-sectional approaches in order
to assess trends according to selected factors (e.g. age and developmental progression compared among different cohorts)

Longitudinal design: design used to collect data that occurs over time and at specific
points in time

Cross-sectional: occur when data are collected from a random sample of persons representing a given population at one point in time

Structural equation modeling: a set of statistical techniques that enables researchers to fit networks of constructs within sets of data

Observational research: refers to methods in which the researcher observes and records the ongoing behavior of participants, but does not seek to exert influence on the situation or manipulate behavior in any way

Explain and describe the considerations of ethical practice in research

1. Human subject review board (IRB)

2. Informed consent: accurate description of all features of the investigation

3. Confidentiality: personal identity of participants must be protected

4. Ethical guidelines apply to internet-based research

5. Ethical reporting of results: limits of investigation and possible alternative interpretations, credit to those making significant contributions