Paul Brasler – High Risk Clients: Effectively Handle Five of the Most Critical Scenarios You’ll Face as a Clinician

Outline

• Client Assessment: Ask the Right Questions
  • Conduct comprehensive assessments
    • Mini mental status exam
    • Lethality assessment: Suicide and homicide
    • Substance use assessment
    • Trauma assessment
  • Tips and strategies for eliciting the right information
• The Suicidal Client: More than 13 Reasons Why
  • High-risk populations—who is most at risk?
  • Implicit and explicit expressions of suicidal ideation and intent
  • Self-injurious behavior and suicidal ideation
  • Suicide assessment and interviews: Ideation, plans, means, intent
  • What do I do now? —Disposition & safety planning
    • Why “No-Harm Contracts” are harmful
    • Breaking client confidentiality
    • When in doubt, do what?
  • Hospitalization process
  • After the ER: When clients are not admitted
  • Case studies:
    • Michelle—Teenagers experiencing suicidal ideation
    • William—The intersection of substance use, mental illness and suicidality
• The Violent Client: Manage Dangerous Situations
  • Dealing with our fears: Clinicians’ safety concerns
  • When the clinician is the target
  • When others are the target
  • De-escalation techniques
  • Preventative planning
    • Office layout
    • Keeping good boundaries
    • Police involvement before a crisis
  • Safety planning
  • When to call 911
  • Hospitalization process
  • Duty to warn
  • Case studies:
    • George—Handle a violent client
    • Dale—Practice Duty to Warn
• The Addicted Client: What ALL Clinicians Need to Know
  • How misdiagnosis harms clients
  • Signs of intoxication
  • Imminent risk: Signs and symptoms of overdose
  • Identify withdrawal syndromes
  • Accurate diagnosis and treatment matching
  • Drug basics that clinicians should know:
    • Opioids and the opioid crisis (heroin, fentanyl and emerging drugs)
    • Stimulants (cocaine, “bath salts,” methamphetamine)
    • Cannabinoids (“shatter,” spice)
    • Other chemicals (DXM, “Special K,” Ayahuasca)
  • When and how to refer to a higher level of care
  • Case studies:
    • Percy—Opioid crisis in the waiting room
    • Cathy—Bipolar Disorder? Think again
• The Traumatized Client: Help Without Hurting
  • Recognize trauma in clients
  • The risk of misdiagnosis
  • Dangers of improper treatment
  • Strategies for trauma-informed care
    • First and foremost: Safety inside and outside the clinic
    • The role of mindfulness
    • Go slow…but go
  • Understand Levels of Safety
  • Triune Brain Model and trauma
  • Bereavement: Not always trauma
  • The intersection of trauma, mental health, substance abuse and medical problems
  • Case studies:
    • Brian—Trauma missed
    • Mick—“How deep can I bury this?”
• Medical vs. Psychiatric Problems: Limiting Harm
  • “What Could Kill the Patient First?”
  • Collaborative care with primary physician
  • Medical emergencies that present with psychological symptoms
  • Signs and symptoms: Limit client harm by recognizing a medical emergency
    • Medication-Related Disorders
    • Traumatic Brain Injury (TBI)
    • Neurocognitive Disorders
    • Other Neurological Illnesses
  • Case studies:
    • Steven and the Zombies—Organic disorders
    • “Granny has schizophrenia!”
• High Risk Clinicians: After the Crisis
  • Protect your license and manage liability
  • Documentation: What you need to know
  • Debriefing and supervision
  • Vicarious trauma
  • Addressing compassion fatigue
  • Case study:
    • Dave and me

• Limitations and Potential Risks

  • Limited controlled studies
  • Seek supervision when necessary
  • Weigh out risk of intervening versus not intervening