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There is also a large literature on intervening with youth engaging in general delinquent behavior that supports that programs that follow the risk/need/responsivity principals have better outcomes (Lipsey symptoms after flu shot bimatoprost 3ml mastercard, Howell symptoms after miscarriage buy bimatoprost 3 ml otc, Kelly medicine allergy purchase bimatoprost 3ml with amex, Chapman new medicine bimatoprost 3 ml online, & Carver, 2010; Vieira, Skilling, & Peterson-Badali, 2009). As noted earlier, adolescents who have engaged in sexually abusive behavior are much more likely to engage in non-sexual re-offenses than sexual re-offenses. Importance of the Therapeutic Relationship There is strong support for the importance of therapeutic relationship variables (Karver, Handelsman, Fields, & Bickman, 2006) in the treatment of youth and families. Research and clinical practice with adult sex offender (Marshall, 2005) and adolescents (Smallbone, Crissman, & Rayment-McHugh, 2009) also supports the importance of the therapeutic relationship variables. Treatment will be most effective when the adolescent and family are treated with respect and where hope is present. Treatment will be least effective when harsh, confrontational treatment styles are employed. Treatment will be more effective if there is a focus on developing approach goals rather than being limited to the narrow focus of what should be avoided. Approach goals are defined as striving for more positive achievements and prosocial behaviors that are incompatible with sex offending (Mann, Webster, Schofield, & Marshall, 2004). Treating the Whole Youth It is important to treat those factors most relevant to reoffending. However, it is clearly recognized that many youth who engage in sexually abusive behavior, especially those at higher risk, have a number of other issues including significant general behavioral problems, co-morbid psychiatric issues, family dysfunction, and trauma. While these issues may not be directly related to reoffending, they should be addressed due to the impact on the youth and potential interference of the youth reaching their maximum potential and leading a healthy, fulfilled life. Treatment as Part of a Broader Social-Ecological Approach Youth who engage in sexually abusive behavior are impacted by a number of systems and providers need to recognize the impact these systems can have on the youth, both positive and negative. Families of adolescents who engage in sexually abusive families vary on a number of characteristic some with significant family dysfunction, some that function well. In all cases, where appropriate, families should be part of the treatment process. In cases in which abuse, neglect or other significant issues preclude direct involvement, the youth may well still feel a connection to the family and this should not be dismissed. In such cases intervention should strive to involve other potential adult support systems. Many youth experience problems in school, have poor peer selection and make poor use of leisure time, all factors that can increase at least risk for general offending. In cases where there are multiple problems, the addition of in-home services that actually work with community resources can be an important component of comprehensive management. Youth who engage in sexually abusive behavior are many times involved with the juvenile justice system and/or the social services system. It is important that those providing therapeutic service develop relationships with these workers. Treatment Targets Assessment should guide the selection of the treatment needs since not all youth present with the same dynamic risk factors and treatment will need to be individualized. However, currently the following are thought to be the most relevant dynamic risk factors to address in the treatment of adolescents who have engaged in sexually abusive behavior: Attitudes and justifications supportive of offending Emotional Management Social Competence/Relationship Skills Healthy Sexuality Ability to establish peer relationships General self-management skills Family Education/Functioning Sexual Deviation or Sexual Preoccupation (if applicable) Development of Positive Life Goals Individualized Issues as Needed Treatment Modalities Various treatment modalities are used with adolescents who have engaged in sexually abusive behavior. While early clinical literature suggested that group therapy was the preferred modality, there is little evidence supporting one modality as superior to others. Caregiver(s) experience a variety of emotions and reactions to learning that their child has engaged in sexually abusive behavior. While specifics are tailored to the individual family, there are some basic components of family therapy. Provides education regarding adolescents who have engaged in sexually abusive behavior and issues specific to their youth. Group Therapy Group therapy provides a modality to address a variety of risk factors. Group therapy can be specifically beneficial in targeting interpersonal-based risk factors such as power and control interactions, social isolation, communication, passive and aggressive patterns of interactions and other interpersonal, social issues. Skills Focused Group Therapy Provides skills building focused interventions such as anger management, conflict resolution, problem solving, decision making, etc. Individual Therapy Individual therapy is used to address specific individual issues, comorbid conditions, and special needs. Individual therapy can also be utilized to reinforce and prepare for work in the group therapy setting.

Most people stop having night terrors and episodes of somnambulism as they get older symptoms diverticulitis buy bimatoprost with american express. Some people remember dreams frequently medicine xarelto buy bimatoprost 3 ml on-line, sometimes more than one per night medicine used for pink eye discount 3 ml bimatoprost otc, while others are not aware of whether we dream or not medications prescribed for anxiety buy bimatoprost with mastercard. Some of us even report lucid dreams in which we are aware that we are dreaming and can control the storyline of the dream. Dreams are a difficult research area for psychologists because they rely almost entirely on self-reports. However, validating these theories is difficult with the limited access researchers currently have to dreams. Freudian psychoanalysis emphasizes dream interpretation as a method to uncover the repressed information in the unconscious mind. Freud said that dreams were wish fulfilling, meaning that in our dreams we act out our unconscious desires. If you dream about showing up at school naked, the manifest content is your nudity, the room you see yourself in at school, the people present, and so on. More important to Freud was the latent content, which is the unconscious meaning of the manifest content. Freud thought that even during sleep, our ego protected us from the material in the unconscious mind (thus the term protected sleep) by presenting these repressed desires in the form of symbols. So showing up naked at school would represent a symbol in this type of analysis, perhaps of vulnerability or anxiety. Check any bookstore, and you will find multiple dream interpretation books based on this theory. Consequently, this analysis is mostly used in psychoanalytic therapy and in pop psychology rather than in research. The activation-synthesis theory of dreaming looks at dreams first as biological phenomena. Researchers know that our minds are very good at explaining events, even when the events have a purely physiological cause. Split-brain patients (see Chapter 3) sometimes make up elaborate explanations for behaviors caused by their operation. According to this theory, dreams, while interesting, have no more meaning than any other physiological reflex in our body. The information-processing theory of dreaming falls somewhere in between the Freudian and activation-synthesis theories. This theory points out that stress during the day will increase the number and intensity of dreams during the night. One of these is posthypnotic amnesia, when people report forgetting events that occurred while they were hypnotized. The hypnotist may also implant a posthypnotic suggestion, a suggestion that a hypnotized person behave in a certain way after he or she is brought out of hypnosis. Like many other topics regarding consciousness, many questions about hypnosis are not completely answered. Role theory states that hypnosis is not an alternate state of consciousness at all. This theory points out that some people are more easily hypnotized than others, a characteristic called hypnotic suggestibility. People with high hypnotic suggestibility share some other characteristics as well. They tend to have richer fantasy lives, follow directions well, and be able to focus intensely on a single task for a long period of time. Perhaps during hypnosis, people are acting out the role of a hypnotized person and following the suggestions of the hypnotist because that is what is expected of the role. They point out that hypnosis meets some parts of the definition for an altered state of consciousness.

The provider also assists 10 family members in developing the skills necessary to support the special needs of the child symptoms 9 days before period purchase bimatoprost mastercard. Services may include supportive counseling symptoms zoloft withdrawal order bimatoprost with american express, parental training and education treatment high blood pressure cheap bimatoprost 3 ml online, development of coping skills and stress management techniques symptoms hyperthyroidism purchase bimatoprost american express, respite care, parental support groups, transportation, and financial assistance. Partners in the Treatment Process ­ Family members also serve as equal contributors in the problem-solving process. They should work with treatment providers to identify the goals of treatment and to plan realistic strategies to achieve these goals. Additionally, family members should play a key role in implementing these strategies to help ensure that treatment goals are met. When performing these functions, family members should not be afraid to ask questions and to voice their opinions and preferences. It is crucial that they are fully informed and that their preferences are considered in all treatment decisions. Service Providers ­ the treatment process is incomplete without the direct services provided to the child by family members. They are responsible for providing emotional support and information to the child and other family members, and for filling in the gaps in the services being received by the child. Furthermore, they often coordinate the services being received by the child by requesting and convening meetings, and transporting the child to appointments. This includes keeping all follow-up appointments, becoming knowledgeable about any prescribed medications, and keeping track of all treatments that have been unsuccessful. They should therefore actively advocate for the child in order to ensure that s/he receives the appropriate services, and voice any concerns regarding undesirable practices and policies. There are several local, state, and national organizations that can assist parents and caregivers in these efforts, allowing them to serve as part of a larger voice in their community. Evaluators and Researchers ­ It is important that families participate in research and evaluation activities so that their opinions can be heard regarding which treatments and services are most beneficial and convenient. The input of family members is crucial to ensure that all children receive services that are efficient and effective. While much of this research requires the involvement of the family for a significant length of time, the input of caregivers and other family members is extremely important. Although the child is the most important focus of treatment, family members can help by offering support and encouragement, and by creating a favorable environment. Family members can help their child while they are receiving treatment by recognizing and praising small achievements, modifying expectations during stressful periods, measuring progress on the basis of the improvements made, and being flexible, while trying to maintain a normal routine (Psychiatry 24x7. Families are ultimately responsible for determining what services and supports their children receive. It is crucial to remember that children are different and their needs are very diverse. These recommendations also hold true for children who come in contact with the juvenile justice system. Family involvement is particularly critical for these youth to ensure positive outcomes (Osher & Hunt, 2002). Ideally, families should remain involved at each stage, so they can be involved in decision-making and treatment (Osher & Hunt). Without family involvement, it is extremely difficult for service providers to ensure that the gains achieved by the child in treatment are maintained and solidified. Moreover, the combined efforts of service providers, family members, and advocates are necessary to ensure that the services provided in the community effectively meet the needs of all children and families. If parents are not comfortable with a particular clinician or treatment option or are confused about specific recommendations, they should consider a second opinion. If medication is suggested as a treatment option, families must be informed of all associated risks and benefits. Once my child is discharged, how will it be decided what types of ongoing treatment will be necessary, how often, and for how long? The primary values of the system of care philosophy are that services for children are: community-based; child-centered and family-focused; and culturally competent. Families are designated partners in the design of effective mental health services and supports.

The service provider can elect to use percentages when creating a treatment goal treatment 5cm ovarian cyst discount bimatoprost american express, however medications metabolized by cyp2d6 order cheapest bimatoprost, they must give a baseline so that an auditor can determine success towards goals treatment trends effective 3 ml bimatoprost. If treatment goals are meant to be met in less than 12 months or for the remained of the track cancer treatment 60 minutes bimatoprost 3 ml amex, please indicate the time frame. These strategies are behavioral health interventions and address the impairment(s) identified in the Assessment. Therapist, case manager) Modality and service provided Frequency/intensity/duration Location (if not at the office) Purpose/intent/impact to address a specific mental health impairment this section should define concrete strategies/actions that will be utilized to assist the client/family to meet the identified clinical treatment goals. There can be multiple strategies (different service types) for the same clinical treatment goal. Service types may include medication services, group therapy, individual therapy, case management brokerage, and for the full-service partnership clients, intensive case management. Each of the strategies needs to be specific/provide description of service modality. Be sure to allow for a range of frequency in the event your frequency often varies. This is especially true for case managed clients who, at times, may require more intensive care. Non-specific frequency such as "as needed" and/or "ad hoc" do not meet documentation requirements. Case management strategies usually are expressed as in the service of the development of independent living skills, and not on symptoms per se. Provider will support client to express unresolved grief to reduce symptoms of depression in weekly individual sessions for the next 12 months. Over the next six months, case manager will meet with the client-primarily in the field-one to six times per week to teach, model, and implement skills (social and adult living skills) necessary to help maintain housing. Mental Health Clinic to provide medication management one to eight times per three months (appointments, prescriptions, injections, and refills) to decrease anxiety. The case manager will collaborate with treatment team, including psychiatrist, psychotherapist, and/or community support workers one to four times per month to provide continuity of care. Example of a weak and/or unacceptable documentation of a strategy: As needed Case Management Example of an acceptably documented intervention: Explanation of acceptable documentation: Group services for 12 months Case Manager will provide case management services twice monthly for the next year to support the client in maintaining current residential placement. Therapist will facilitate the depression group weekly for the next 12 months to help reduce her feelings of isolation. In the acceptable strategy the documentation is specific and will help the client to understand intended services. The client could read these interventions and know why medication support may help them. Medication support Psychiatrist and nurses will provide medication management services (prescriptions, refills, and shots) 1-8 times every 3 months to manage impulsivity and anxiety. Their focus must be consistent with the mental health goals and strategies identified on the plan. If a service modality needs to be added, then this would need to be documented in an addended plan or on the back of the Partnership Plan. If this is a new client (currently not receiving any services), the service provider will have 60 days from the admission date to complete their documents for service authorization. In the event services 28 are being transferred from one clinic to another and the client is still open on the original track, it is recommended the new provider complete an initial assessment. It is good practice to review the risks and benefits of the services with the individual as often as clinically relevant. If they write two separate plans, there again they need to differentiate services provided to prevent overlap. Please remember that when clinical staff complete a progress note, a claim to the state is submitted; therefore, all progress notes must be accurate and factual. This is an aspect of compliance, and compliance is the personal responsibility of all clinical and administrative staff. Medical Necessity is established by ensuring that interventions meet the following two criteria: 1. The focus of the proposed intervention is to address the mental health symptoms identified in association with an "included diagnosis", and 2. It is expected the proposed intervention will benefit the consumer by significantly diminishing the impairment or preventing significant deterioration in an important area of life functioning. The proposed intervention(s) should help the client improve or maintain his/her functioning in an important area(s) of life.

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