Cces

Front 1

Question 1.
What other information do you need and how would you proceed with assessment on this case?

Back 1

ACARTI
CBEP
PICAP
D-OSSIMA
RISK

Front 2

Question 1- ACARTI

Back 2

age/ethnicity
consent to treat
assent
referral source
tx modality
identified client

Front 3

Question 1- CBEP

Back 3

cognitive, behavioral, physical, emotional issues

Front 4

Question 1- PICAP

Back 4

parent forms
parental informed consent
assent from client
purpose of interview
my role

Front 5

Question 1- D-OSSIMA

Back 5

direct obs
SUDS
self-report
interview (biopsychosocial)
mini mental status
assent

Front 6

Question 1- biopsychosocial interview (13 areas)
Questions for CHILD and PARENT + examples

Back 6

employment
drug use
romantic relationships
social
symptoms (onset, duration, context, frequency, intensity)
why now treatment
prior tx helpful
any prior parasuicidal, homicidal, other risks
child abuse (known?)
culture/religion
school
legal issues
family life
medical hx

Front 7

Question 1- Mini mental status exam (11)

Back 7

attention
memory
insight/judgment
affect
thought processes
speech
psychomotor bx
hallucinations
delusions
orientation x4
appearance

Front 8

Question 1- collateral sources + examples of questions for each

Back 8

parent
teacher
ROI!!

Front 9

Question 1- ALWAYS extra steps (5)

Back 9

risk assessment (ALWAYS)
referral to PCP/neuro/etc
Mental measurement
yearbook + consult
review informed consent, limitations w/both
BRIEF FUNCTIONAL ANALYSIS

Front 10

Question 1- types of semistructured interviews

Back 10

KSADS-PL

Front 11

parental assessments

Back 11

YOQ-parent version
Parent CDI
parent CBCL
bx assessment scale for children (BASC)

Front 12

CBEP example

Back 12

Zach’s presenting concerns can be best described by addressing his behavioral, cognitive, emotional, or physical problems. Zach is engaging in high-risk behavior such as driving dangerously on his motorcycle, selling and using hard drugs (e.g., crack and heroin), punching holes in walls, and threatening to harm his mother. Zach has also been truant from school. Zach likely has maladaptive cognitions that influence his behavior. Zach is likely experiencing emotional distress given the reported conflicts between him and his mother. Finally, Zach probably experiences physical problems (e.g., withdrawal and hypertension) from using hard drugs.

Front 13

biopsychosocial interview example

Back 13

. I would then conduct a biopsychosocial semi-structured clinical interview with Zach individually and his mother to obtain a complete description (e.g., frequency, intensity, and duration) of his presenting problems. I would obtain a complete history including medical and mental health, family, education, social functioning, and legal involvement. I would ask about prior treatment and past coping methods Zach and his mother have used, successfully or unsuccessfully, to deal with problems. I would observe and make note of any maladaptive thoughts or behaviors related to his presenting problems. I may conduct a brief functional analysis to determine antecedents and consequences of Zach’s at-risk and disruptive behavior. I would use idiographic measures such as the Subjective Units of Distress (SUDs) rating scale to get a self-report assessment of Zach’s presenting problems. To obtain a baseline, I would ask Zach and his mother to monitor his SUDs ratings and the frequency, duration, and intensity of his b

Front 14

measures must be demographically appropriate
-self report, parent, teacher
- review items with both
- review mental measurements yearbook, consult with supervisor

Back 14

Administering self-report, parent, and teacher versions of standardized measures that are appropriate given Zach’s demographics will provide a more thorough assessment. I would interpret the results with caution and review endorsed items with Zach and his mother during our next session. I would review the Mental Measurements Yearbook and consult with supervisors and/or colleagues to obtain additional appropriate measures. I would encourage Zach to obtain an evaluation, if he has not done so, from his primary care physician to rule out any medical problems, as well as a comprehensive drug and alcohol evaluation given his substance use. Although further information is needed, I may encourage Zach to see a psychiatrist to obtain a medication evaluation.

Front 15

Question 2
First line

Back 15

Given the existing stigma attached to some mental health diagnoses, I will strive to include the least pathologizing and most inclusive dx that accounts for probs

Front 16

Question 2
automatic considerations (5)

Back 16

medical problems
substance use
diversity considerations
MR
comorbidity

Front 17

Question 2
automatic rule outs
Axis II

Back 17

age for PDs
MR!!

Front 18

Question 2
Axis III

Back 18

deferred pending physician report

Front 19

Question 2
Axis I rule outs

Back 19

Mood Dx
Anxiety Dx
Comorbidity

Front 20

Question 2
Axis VI

Back 20

Hays addressing model
cultural influences while considering Axes I and II

Front 21

Question 2
Axis II

Back 21

To diagnose a PD under 18, features must have been present for at least 1 year EXCEPT ASPD

Front 22

Question 3
Behavioral theory
maladaptive behaviors

Back 22

maladaptive behaviors are the problems as opposed to symptoms

Front 23

Question 3
behavioral therapist focuses treatment on

Back 23

maladaptive behaviors because they are more observable and quantifiable, although some consider thoughts constitute "secondary" behaviors

Front 24

Question 3
recurring behaviors a result of contingencies that follow

Back 24

rewarding contingency (reinforcer)
aversive contingency (punishment)
less likely to occur w punishment, more likely to reoccur with reinforcement

Front 25

Question 3
behavior therapist identifies

Back 25

contingencies associated w maladaptive behaviors

Front 26

Question 3
once contingencies IDed

Back 26

helps client engage in new bx associated w rewarding contingencies, introduces new bx as replacement for maladaptive bx

Front 27

Question 3
behavioral therapist alter

Back 27

alter contingencies associated with maladaptive bx, adding more aversive contingencies or lessening the rewarding ones

Front 28

Question 3
behavioral therapists concerned with measuring

Back 28

treatment progress, assess bx change by frequency, severity, intensity, duration of sx

Front 29

Question 3
bx therapy advantageous in that

Back 29

progress can be monitored over time

Front 30

Question 3
OPEN FBOT RPMS

Back 30

focus on bx bc they are observable
thoughts secondary bx
reinforcers increase bx
punishment decreases bx
measured over time
strengths

Behavioral theory posits that behaviors develop, change, and are maintained by learning. Behavioral therapists focus on overt behaviors, as these are measurable and observable; some behavioral therapists indicate that thoughts constitute secondary behaviors. Behavior therapy is useful because changes/progress can be measured over time. Behavior therapists believe that behaviors are controlled by the contingencies that follow them (rein vs. pun). Example of cause (bio + classical), maintenance
(operant), strengths

Front 31

Question 3
causes

Back 31

genetic predisposition
Bandura social learning (observing others)
physical problem
life events and stressors
substances
sociocultural factors
BE SPECIFIC ABOUT WHICH/COMBO

Front 32

Question 3
maintenance (antecedents, resulting in consequences)

Back 32

ex) social isolation- positively reinforces bc don't have to expend E
(antecedents- decreased motivation, feeling depressed, consequence- relief)
classical conditioning

Front 33

Question 3
caused by classical conditioning

Back 33

fear and anx paired with unconditioned/neutral stimulus, neutral stimulus then becomes conditioned stimulus

Front 34

Question 3
maintained through operant conditioning

Back 34

negative reinforcement- escape an aversive situation (removing an aversive stimulus)

positive reinforcement (addition of a stimulus)

Front 35

Question 3
example of negative reinforcement

Back 35

isolating in room- escapes stressful social interactions (takes something aversive away)
- maintains prob because he feels better afterward
ALL reinforcers increase likelihood of bx

Front 36

Question 3
example of positive reinforcement

Back 36

depressed person gets attention from others (adding sthg), maintains bx because they like it

Front 37

Question 3
client strengths

Back 37

came to therapy
1 friend?
any positive relationships
any sort of insight
willing to work with you
family/other support
cooperative during interview

Front 38

Question 3
example of antecedents and consequences w operant conditioning

Back 38

antecedents include stress, short term consequence is avoidance, but long term the isolation is reinforced bc feels relief from isolating

Front 39

Question 3
opening line

Back 39

bx devo, change, continue as a result of learning. bx are predominantly controlled by consequences and are likely to increase in frequency if followed by reinforcers and decrease if followed by punishments

Front 40

Question 3
Goal of BT

Back 40

eliminate maladaptive behaviors (including thoughts, feelings, overt behaviors)

Front 41

Question 3
job of BT therapist

Back 41

help client identify antecedents that trigger bx, consequences that reinforce or maintain problematic bx

Front 42

Question 3
cause cannot be inferred for certainty

Back 42

hypotheses of cause of bx

Front 43

Question 4
4. State your goals, interventions, and how you would monitor progress over time

Back 43

CRAMST
ROGR
CRITE
CD MONITOR (specific examples= YOQ, CDI, etc.)

Front 44

Question 4
CRAMST

Back 44

collaborative
goals are attainable, measurable, specific, realistic, timely

Front 45

Question 4
ROGR

Back 45

relevant outcome goals to presenting problem + referral!!!

Front 46

Question 4
RITE

Back 46

relevant interventions to treat + evidence based

Front 47

Question 4
CD MONITOR- give specific examples!

Back 47

standardized measures:
CDI
RCMAS
YOQ
CBCL
self-report (SUDS)
progress over time (current-desired)

Front 48

Question 4
list RITE

Back 48

interventions:
psychoeducation
behavioral activation
(activity scheduling, reward planning)
sleep hygiene (psychoed)
relaxation strategies
cognitive restructuring
parent/child skill building (social skills training, parent training)

Front 49

Question 4
RITE (acronym for interventions used in BT)

Back 49

PBARCS
psychoeducation
behavioral activation (reward planning, activity scheduling)
relaxation strategies (deep breathing, PMR)
cognitive restructuring
parent/child skill building

Front 50

Question 4
Opening line- Lambert 30

Back 50

With all clients, I work to set treatment goals collaboratively, as collaboration helps maintain the therapeutic relationship. According to Lambert (1992), 30% of change is accounted for by the therapeutic relationship, whereas 15% of change is accounted for by technique.

Front 51

Question 4
Opening
CRAMST
LT (1-3)
ST (1-2)

Back 51

opening, Lambert stats on change, collaboration, specific, measureable, attainable, realistic, timely, long term goals (sleep through the night, improve ability to x, increase parent awareness of y)
ST= decrease/increase from x to y, subclinical range

Front 52

Question 4
LT vs ST

Back 52

LT are overall goals with no markers except maybe clinical/subclinical on large measures like CBCL, whereas short term goals have current and desired, and may be #times a day, %iles, short-term measures (?) ex cdi, rcmas

Front 53

Question 4
Opening
CRAMST
LT vs ST (ROGR)
CRITE (rationale for BT, efficacious, consent)

Back 53

collaborative on interventions. explain rationale for BT and obtain assent, consent. explain that BT has been efficacious tx for children social/prob-solving skills. explain common interventions

Front 54

Question 4
CRITE + examples
(CRITE REC)

Back 54

collaborate on interventions, rationale for BT, assent/consent, efficacious, examples of common interventions (prob solving, social skills, disruptive behavior and sensation seeking

Front 55

Question 4
Opening
CRAMST
LT vs ST (ROGR)
CRITE + examples
CD MONITOR*** (list examples of how to monitor progress)

Back 55

current and desired monitoring using both idiographic (SUDS) and standardized (YOQ, CBCL) on weekly/biweekly/monthly basis

Front 56

Question 4
CD-MONITOR + calculate

Back 56

Monitoring- will show x and parent a graph, which could reinforce success or inform delivery of tx (adjust if not improving, baseline), clinical significance markers using statistical approach by jacobsen and truax

Front 57

Question 5
What potential legal/ethical issues do you see?

Back 57

SOAD RISK
WP DUTY
ACANED kids legal
CICBM ethics

Front 58

Question 5
SOAD RISK

Back 58

self (suicide att, impulse control, level of hopelessness, SLAP-P)
others- previous bx, impulse control, SLAP-P
other
also child abuse/exposure to DV is a risk (and legal)
SEPARATE!!

Front 59

Question 5
self risk factors and what to look for

Back 59

past attempts, impulse control, level of hopelessness, specificity lethality, access, plan, protective factors, family hx, recent life stressors, coping skills, subs use, any other risky bx

Front 60

Question 5
other risk

Back 60

previous bx, impulse control, SLAP-P

Front 61

Question 5
what should you do with suicide risk?

Back 61

least restrictive methods
increase # sessions/phone check ins, increase focus on safety/coping strategies, work with support system, contract for safety if willing
- if not, voluntary hosp and work as advocate, call 911/crisis line, in OR, psych can't petition the court for inpatient (only doctors), we can send ct to hospital, but they have to decide whether or not to keep them --> CONFIDENTIALITY!

Front 62

Question 5
ACANED legal and acknowledgement of understanding

Back 62

abuse, consent to tx (voluntary, understandable, repeated back, age considerations, limitations of conf), assent, neglect/noncustodial parental rights, elder, devo delay abuse

Front 63

Question 5
child abuse laws in OR

Back 63

mandated reporters in OR- if reasonable cause to believe child has been abuse, DISCRETION if privileged communication (in context of dx/tx)
- you can break confidentiality without minor's consent to inform third parties- condition deteriorated to inpatient care or detox
- abuse types are physical, mental injury, sexual abuse, neglect, threat of harm (health/welfare) incl drugs, buying/selling, meth

Front 64

Question 5
other abuse laws

Back 64

not mandated for elder abuse
mandated for devo delay unless priveleged communication

Front 65

Question 5
duty to protect, explanation to client and clinical response

Back 65

- if at serious risk of harm, necessary steps taken to ensure her safety by conducting a thorough risk assessment that include thoughts, plan, intent (specificity, lethality, accessibility) and level of hopelessness, impulsivity, and protective factors.
--safety planning, increase in number or length of sessions, phone checkin, safety plan, voluntary commitment or if not consult with supervisor and document prior to breaking confidentiality
- if necessary contact police or physician to pursue voluntary
- consider least restrictive and work collaboratively

Front 66

Question 5
duty to warn

Back 66

duty to warn- OR has neither accepted nor rejected tarasoff (that would require psych to warn identified victim if serious/imminent risk were present), and CONSULT and DOCUMENT, conduct assessment (SLAP-P)
**Tarasoff case: when there is clear and immediate threat of
serious harm to identifiable victim, a therapist has a duty to protect
the intended victim by breaking confidentiality (by warning, telling
police, getting person hospitalized, etc.)
b. Oregon has neither adopted nor rejected Tarasoff; we have no
clear duty to warn others
c. Oregon law says that psychologists may disclose confidential
information if there is a clear and immediate threat of harm (gives
us discretion)

Front 67

Question 5 ethics
CICBM

Back 67

confidentiality (and lims!)
competence (to treat, evaluate own level- perhaps ADDRESSING model)
informed consent
multiple roles (appropriate boundaries, clarify my role at onset- re: ethics)
beneficence/nonmaleficence (work in best interest and avoid harm)

Front 68

Question 5
example of if ct is abusing child

Back 68

If Jen were to indicate that she was abusing a child or a disabled person I would be mandated to report the abuse. However, if this was indicated during a privileged communication, I would be considered a discretionary reporter in the state of Oregon. If this issue were present, I would urge Jen to make a report on her own. Again, I would consult and document prior to breaking confidentiality. Other safety issues that could be relevant include domestic violence. Again, if present I would engage Jen in safety planning.

Front 69

Question 5
ethics re: multiple roles (clarify R and R)

Back 69

10.02 Therapy Involving Couples or Families
(a) When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. This clarification includes the psychologist’s role and the probable uses of the services provided or the information obtained. (See also Standard 4.02, Discussing the Limits of Confidentiality.)
(b) If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately. (See also Standard 3.05c, Multiple Relationships.)

Front 70

Question 5 outline
- opening (all risk assessments)
- self and other harm and assessment
- child abuse/dv
- adjust tx goals if so
- collaborative, supervised, documented response to self/other, abuse/dv
- least restrictive method
- clearly state OR laws re: risk, abuse, age of consent (duty to protect, warn, report)
- ethical considerations
CICBEM
- state that throughout all, consult w/supervisor, literature,, document, collaborative, beneficence/nonmaleficence

Back 70

Risk assessment- including risk to self (including suicide and other self-harm), others (homicide), abuse, and DV exposure, is sthg that I engage in with all my clients. Throughout the informed consent process (describe), which client/mother will be asked to repeat back for understanding, limitations of confidentiality (including legal obligations to report, protect, warn) will be elaborated. I will assess client for self harm (SLAP-P, impulsivity, level of hope, previous attempts) given history of x. I will assess for other harm (SLAP-P, impulsivity, hopelessness, past bx). I will ask if he has experienced abuse/DV, or used substances. Client's responses to these risk assessments may change tx goals and plans. For example, he reported XYZ. I would document, consult, least restrictive possible...For example, voluntary hosp, increased length/frequency of sessions, phone checkins, inform mother (collaboratively if possible, but allowed to disclose if reach inpatient deterioration). Explain discretion for abuse

Front 71

Question 5 outline- last part (starting with duties)

Back 71

Explain noncustodial parental rights. inform client about duty to report, protect (ensure safety), warn (neither accepted nor rejected Tarasoff which would require psychs to warn identified victim if serious imminent risk present).
Ethical considerations of confidentiality (lims) would be explained in IC and documented, consulted (supervisor, literature), competency (gain training, consult, refer, culture), multiple roles (keep appropriate boundaries. Would make best attempt to do no harm (nonmaleficence) and keep best interest in mind. Hopefully reflected in collaborative tx planning and appropriate consultation, supervision, tx strategies, and adherence to ethical and legal guidelines.

Front 72

All acronyms (1-5)

Back 72

1. ACARTI, CBEP, DOSSIMA, PICAP, RISK
2. age for PDs, MR, rule outs
3. OPEN FBOT RPMS
4. OPEN, CRAMST, ROGR, CRITE, LTST, CD MONITOR, examples of each + rationale/consent/efficacious for BT
5. SOAD RISK, WP DUTY, CICBM ethics, ACANED legal

Front 73

Duty to protect (OR law)

Back 73

Duty to protect (may include civil commitment)
a. consider whether person needs this level of treatment (severity,
lethality, accessibility, etc.)
b. consider hierarchy of least restrictive methods (don’t seek
involuntary hospitalization first)

Front 74

How to proceed with legal/ethical/risk issue
- required in CCE

Back 74

1. If law applies, should clearly state what Oregon law says about all issues
brought up
2. Specifically discuss clinical response to each issue (i.e., clearly state which
issue discussing; for example, if says will consider hospitalization, should also
clearly state whether that is due to possible harm to self, others, or both).
Some actions may include:
o Breaking confidentiality (be specific about who you would contact and
why)
o Referrals (who and why?)
o Escalation in services (e.g., more frequent contacts, hospitalization,
etc.)
o Change in treatment strategies
o Other appropriate actions (e.g., consult, look in the literature, etc.)

Front 75

Question 6
Arredondo's (1996) model of cultural competency

Back 75

knowledge
skills
attitudes and beliefs about self/client
intervention
(KSABSCI)
knowledge, skills, att/beliefs about self/client, intervention

Front 76

Question 6
how I will gain competence

Back 76

consult with supervisor
consult with competent provider other than supervisor
look in literature
attend cultural events
attend training
refer out if not (document actions and rationale)

Front 77

Question 6
specific areas of diversity

Back 77

age-hormone and social climate
gender- illusion of power, reinforce aggressive bx

Front 78

Question 5
RISK- separate

Back 78

indicate SEPARATELY what you'd do for self, other, neglect, abuse, dv risk