Lesbian women, or women who have sex with women, experience health disparities in terms of prevention screening and desired health outcomes as compared to heterosexual women. Lesbian women are less likely to seek out care due to: stigma associated with being identified as lesbian, and previously experienced negative encounters with healthcare providers. This chapter discusses screening recommendations for sexual-minority women (lesbian, bisexual, and women who have sex with women). The screening includes breast cancer screening, cervical cancer screening and human papillomavirus, and screening for sexually transmitted infections. It explains the importance of using inclusive language, and presents sexual history questions. The chapter describes the approach to patient and provider communication. It also presents terminology used among lesbian women to describe their sexual practices. The chapter also discusses risk assessment and reduction.

Cancers of the breast and ovary impose a significant burden on women’s health. Most cancers are sporadic and there is limited ability to predict who will be affected. Family history of cancer is common, but specific features in the family pedigree can suggest a hereditary pattern and increased cancer risk for family members. Approximately 5% to 10% of breast and ovarian cancers are hereditary, due to a single gene germline mutation. Identification and screening of high-risk women are essential skills for healthcare practitioners. BRCA1 and BRCA2 gene mutations are responsible for hereditary breast and ovarian cancer syndrome, accounting for a large percentage of heritable cancers of the breast and ovary. A mutation in one of these genes has a profound impact on cancer risk. This chapter discusses the genetic testing for hereditary breast and ovarian cancer and details the management options for the unaffected woman who tests BRCA positive.

Adolescents experience barriers in access to sexual and reproductive health care, leading to a disproportionately high burden of disease and morbidity. Teens and young adults may avoid or delay accessing care due to perceived or experienced bias or judgement from healthcare providers or perceived or experienced inability to access care independently. Establishing positive, trusting relationships with adolescents is key to promotion of life-long health. Confidentiality plays a critical role in developing strong client-provider relationships, particularly for adolescent clients. Perception of confidentiality impacts an adolescent’s decision to seek care, disclose behaviors and concerns, as well as return for follow-up care. This chapter addresses the specific sexual and reproductive health needs of adolescents including care for common gynecologic conditions in adolescence as well as pregnancy. There is also information about mental health, suicide prevention, bullying, sexting, and age specific vaccination recommendations.

Women veterans deserve high-quality compassionate care in a safe, secure environment. Since the recent military reduction in force, there are more military men and women exiting the armed forces and transitioning to civilian life. The fastest growing sub-population of veterans is women veterans. Women comprise 15% of the armed forces. The military experiences of women veterans can and often do impact the remainder of their lives, physically and mentally. Many women veterans access health care through the Veterans Health Administration (VHA) via their local Veterans Affairs (VA) health care systems. However, most women veterans are seen in civilian medical care facilities. Health care providers need to recognize that the woman they are seeing today may have been in the military and is a former woman warrior. This chapter discusses specific areas of concern for female veterans in primary care, mental health care, trauma-informed care, VHA/VA services, and reproductive health care.

Human trafficking, also known as trafficking in persons or modern-day slavery, is a crime that involves compelling or coercing a person to provide labor or services or to engage in commercial sex acts. The coercion can be subtle or overt, physical, or psychological. The exploitation of a minor for commercial sex is human trafficking, regardless of whether any form of force, fraud, or coercion was used. Sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, soliciting, or advertising of a person for a commercial sex act. Sex trafficking is divided into two distinct subcategories: adult sex trafficking and child sex trafficking. This chapter discusses etiology and incidence, and risk factors of human trafficking, and guidelines for primary care providers responding to suspicion or disclosures of human trafficking. It also discusses trauma-informed care, treatment and management, definition and types of female genital mutilation.

Polyps are the most common benign tumors of cervix and are found most often during the menstruating years. They are soft, pear-shaped (finger-like), red to purple lesions, and are usually pedunculated growths from the surface of the cervical canal. They are very friable and contain a large number of blood vessels, particularly near the surface. Typically, polyps are not cancerous (benign) and are easy to remove. Polyps do not usually grow back. However, women who have polyps once are at risk of growing more polyps. Pelvic examination will reveal smooth, red, or purple finger-like growths on the cervix. They are often removed during a routine pelvic examination. A cervical biopsy will most often show cells that are consistent with a benign polyp. Rarely, there may be abnormal, precancerous, or cancer cells in a polyp.

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. IPV, domestic violence, and family violence are terms that have been used to refer to physical, sexual, and psychological violence, and stalking, within intimate partner relationships. The overwhelming majority of violence and abuse is perpetrated by men against women, however, IPV does occur in same-sex relationships. There are four main forms of IPV. They are physical violence, sexual violence, stalking, and psychological aggression. The United States Preventive Services Task Force (USPSTF) recommends IPV screening for all women of reproductive age. IPV is the most common cause of injury among women of child-bearing age and their children. Health care professionals should screen for IPV and learn the abuse indicators, supportive care, safety planning, and community resources available to support women victims of IPV.

Telehealth is a term that has been used interchangeably with telemedicine. It is defined as the use of medical information exchanged from one site to another through electronic communication to improve a patient’s health. Goals of telehealth include the following: Enhance overall patient outcomes; Make health care accessible to individuals in rural or isolated communities; Allow services to be more readily available for people with limited mobility, time, or transportation options; Lower healthcare costs. This chapter explores the basics of telehealth in women’s healthcare. Telehealth in women’s health is essential to providing accessible, innovative, and equitable health care services to the women’s health gender-related population. In an ever-evolving healthcare landscape, understanding the key components of telehealth service in women’s health is critical to ensuring patients receive optimal care and health outcomes. Telehealth services can be delivered in the following four ways: synchronously, asynchronously, mHealth, and remote patient monitoring.

This chapter focuses on introducing the reader to theories about stress and crisis and on promoting basic stress management and crisis intervention skills. Stress and crisis often intersect with trauma and disaster events and are foundational aspects of the scaffold being created, in the first four chapters of this book, for grasping the profound effects that stress, crisis, disaster, and trauma can have at individual and systemic levels.

Posttraumatic stress disorder (PTSD) is a condition that is characterized by profound neurochemical and neuroendocrine changes in the central nervous system (CNS). The physical response to trauma, in those susceptible to its development, can induce physical and behavioral changes. Understanding the impact of these neural changes is the basis for developing a rational medication therapy regimen for a client diagnosed with PTSD. The use of these medications is vital for symptom management so that the benefits of counseling can be realized. This chapter will discuss the neuronal and pathophysiological impact of trauma on the brain while subsequently describing how medications can impact symptom improvement. Medications that are discussed in this chapter include the use of antidepressants, antipsychotics, and other novel agents used in the pharmacotherapy of PTSD. Both U.S. Food and Drug Administration (FDA)-approved medications and “off-label” medications are explored.

In addition to traumas that heterosexual and cisgender people experience, queer and transgender people face a heterosexist and cissexist culture, in which marginalization and trauma against them is normalized or minimized. In this chapter, the experience of hate crimes and violence, relational and interpersonal trauma, religious based-trauma, and sociocultural and political-based trauma are covered in relation to how it impacts Lesbian, Gay, Bisexual, Trans, and Queer (LGBTQ) people. Clinical and counseling implications are discussed. The increase in mental health challenges is explained via the minority stress model. Implications for diagnosis and trauma-informed practices for queer and transgender people are discussed. Additionally, the role of the mental health professional as a social justice advocate is explored, including how social justice frameworks can be incorporated in the counseling environment.

This chapter focuses on a major occupational hazard associated with working in the human service field. The work exposure to traumatic material through compassionate listening, case reviews, working during a pandemic, responding to a fatality, delivering a death notification, and attending to acts of hate and terrorism and so much more requires an understanding of how each event has the potential to affect mental health workers in profound ways. There is a cost of caring, and human service professionals owe it to themselves—as well as to those for whom they work, to colleagues, and to loved ones—to learn about vicarious trauma and to understand how to intervene as needed, while creating healthy strategies for self-care.

This chapter focuses on integrative approaches to trauma therapy, crisis intervention, and disaster response. The purpose of the chapter is to identify and explain best practices for integrative mental health responses aimed at supporting survivors of trauma, crises, and disasters. While each unique situation requires a tailored response, this chapter describes the basic principles that apply to nearly all emergent, mass casualty, and traumatizing events.

Anemia is a common medical disorder of pregnancy. Two of the most common causes of anemia during pregnancy are iron deficiency and physiologic anemia caused by blood volume expansion greater than the red blood cell mass. However, other inherited and acquired causes of anemia should not be overlooked. Iron requirements increase significantly during pregnancy and, unfortunately, many individuals start pregnancy without sufficient stores to meet the increased demands. Health care providers need to educate individuals about the importance of taking an iron supplement during pregnancy and dietary sources of iron. This chapter addresses assessment of anemia during pregnancy, management, and patient education. Anemia may be characterized several ways such as by the causative mechanism, whether inherited or acquired, by a reduction in the number of red blood cells (RBCs) or the RBC size (mean corpuscular volume–MCV), which results in decreased ability to carry oxygen to tissues.

The Zika virus (ZIKV) and other viruses and/or vector-borne diseases are emerging infectious global health threats. This chapter reviews current knowledge of Zika infection, including risk of exposure, presentation, and potential maternal and fetal effects. It provides guidelines for preventing and managing this infection during pregnancy based on data that are known at this time. Although the chapter focuses on Zika infection, health care providers need to stay informed about all new emerging infectious agents that may pose a threat to their patients. Those who care for women and infants are encouraged to stay informed by frequently reviewing websites and guidelines provided by the Centers for Disease Control and Prevention, the American Academy of Nurse Practitioners, Nurse Practitioners in Women’s Health, the American College of Obstetricians and Gynecologists, the Society for Maternal–Fetal Medicine, the American Academy of Pediatrics, the Infectious Disease Society of America, and any other relevant organizations.

This chapter discusses disaster planning for pregnant and postpartum individuals and their infants, and provides guidelines for care whether evacuating or sheltering in place. Because injuries are common during disasters, it provides guidelines for assessment and management of minor trauma. More attention has been given to the need for disaster preparedness as a result of terrorist attacks and natural calamities, such as devastating hurricanes, tornadoes, wild-fires, tsunamis, and earthquakes, in various parts of the world. Despite these incidents, the public is still not adequately prepared to respond to a major disaster. Obstetric and Neonatal Nursing (AWHONN) position statement encourages nurses to participate in all phases of disaster planning. Obstetric, neonatal, and women’s health care providers can serve a vital role in addressing the many health needs of pregnant individuals, new mothers, and infants and reduce risk and morbidities.

The prenatal care provider needs to determine whether pregnant individuals or those contemplating pregnancy are at risk for offspring with genetic abnormalities or birth defects, including those caused by environmental exposures. A carefully elicited medical, genetic, family, and personal history will give important information about potential genetic problems. All pregnant individuals and those considering a future pregnancy should be offered carrier screening for cystic fibrosis, spinal muscular atrophy, and hemoglobinopathies (American College of Obstetricians and Gynecologists [ACOG], 2017a). A referral to a genetic counselor is essential when patients are at risk for genetic problems. All patients may wish to consider preconception and/or prenatal screening or diagnostic tests to determine risk to their offspring. If a patient requests repeat screening, ACOG recommends referral to a provider with genetics expertise to review previous results and determine the benefits and limitations of the request for subsequent rescreening.

This chapter explores sex, aging, and EMDR therapy. Aging and sexuality are not often discussed in the field of mental health, even though aging is something that we are all doing everyday. Older adults face menopause, sexual dysfunction/changes, and changes in body functioning and image. Internalized ageist myths and stereotypes can prevent older adults from having a positive outlook on the aging process. It is extremely important that these views do not prohibit older adults from getting help from healthcare providers. All healthcare providers need to be open and comfortable with talking about sex and aging.

Research and interest have grown over the past two decades about the impact of chronic illness on sexuality and relationships. Today, with the realization that with better quality of life individuals and couples may sustain some interest in sex, many national organizations that advocate for various chronic conditions now have website information, pamphlets, and books on the topic of sexuality, for example, the American Cancer Society. Medical and mental health providers who work with people with one particular illness may have some advantage in that their knowledge about sexual effects can be focused, but the provider who sees people with a broader array of medical problems, may need a systematic approach to collecting and understanding information in order to provide optimal treatment. The specific needs of people who identify as sexual and gender minority must be included in consideration of treatment.

Using a sex-positive framework to understand sexuality, the person’s own experience and meaning-making that is important, rather than social norms regarding sexual behavior. Insight and knowledge into sexuality require that providers pay attention to their own development, but our training reflects the reluctance of our culture as a whole to “go there” and attend to this aspect of the self of the provider, which is perhaps one of the most important tools providers have for treating clients. For most providers, learning how to address sexual topics requires specialized training that may be difficult to access, requiring travel and other expense. Providers need to have a thorough understanding of issues faced by sexual- and gender-minority identified clients in order to provide ethical treatment to everyone seeking services. Providers can become more comfortable with sexuality by seeking sex-positive instructors, reading more about sexuality, and seeking appropriate supervision with clients.

In men, the sexual response from desire to arousal to climax tends to be more linear and reflective of the Masters and Johnson model, as men experience a considerably more automatic response to sexual stimulation than do women, though clinically men sometimes resonate with Basson's responsive model of desire when it is described. It is noteworthy that, until a few decades ago, problems related to erectile function and ejaculation were thought to be primarily psychogenic; treatment consisted of psychoanalysis or marginally successful behavioral interventions. Currently, the field of sexual medicine believes that male sexual dysfunction is mainly due to physical problems. But there is still a place for mental health professionals in treating male sexual dysfunction, since medical interventions are not always dependable or effective on their own, and there still exist cases that are more psychological than physical.

For mental health professionals, sexual anatomy needs to be more than a catalogue of body parts and labels; it also must include information about what may be the client’s viewpoint of their anatomy and the social myths that can affect perception. In this edition, there is information about cisgender bodies and transgender bodies, gender affirmation surgery, as well as people who identify as intersex, who may have a gender that does not fit into the gender binary or male/female social construct. This chapter paints the stages of sexual development in broad strokes, in part because little has been written about this topic in regard to sexual or gender minority youth. Still, it is helpful to have such a framework so that the provider can determine whether a client’s complaints are typical or outside the norm of peers.

This chapter describes the current status of caregiving in the United States. Who are caregivers and what tasks they routinely do are discussed. The diversity of caregiving is also considered. Physical, psychological, social, and financial ramifications of caregiving are described along with benefits reported. The chapter concludes with recommendations on how healthcare professionals can support caregivers.

Nursing facilities often provide care for many different types of residents including those with diagnoses of dementia and mental illness. These diagnoses often have accompanying behavioral difficulties. Currently, there are three primary models used by mental health consultants in nursing facilities: the psychiatrist-centered models, the multidisciplinary team models, and the psychiatric nurse-centered models. Each of these models focuses on reducing symptoms and supporting staff interventions. The routine presence of qualified mental health clinicians in the nursing homes to provide consultation and to provide follow-up has been suggested as being very beneficial to both residents and staff in the nursing facility. This chapter discusses the role of the mental health team in the nursing facility, how referrals and assessments for mental healthcare are managed, the social worker’s role in relation to the mental health team, and some of the barriers to mental health services.

All counselors, regardless of setting, will work with clients affected by addiction. There is no longer a question as to whether or not individuals can become addicted to behaviors. That question has been unequivocally answered through decades of empirical data and scholarship, evidence from clinical work and successful treatment approaches, and changes in diagnostic manuals, global classifications of diseases, and definitions of addiction. Now, the pressing question is how to best prepare counselors and other mental health professionals to effectively serve individuals with behavioral addictions. Researchers, clinicians, and neuroscientists are making great strides in understanding behavioral addictions and collecting evidence regarding effective interventions, assessments, and treatment strategies. This chapter provides an information related to the nature of addictive behaviors, helpful strategies for recognizing and identifying behavioral addictions, and a public health model to guide conceptualizations of behavioral addictions.

Mental health professionals who work with students must be well-versed in the protective factors that maximize youth academic, social and personal success. One can and must cultivate healthy communities and teach youngsters to advocate for themselves as one advocate for them. Significant research points to strategic ways one can strengthen schools, families and communities. All too often, violence, substance abuse, bullying, sexual assault, suicidal ideation and more threaten student well-being. The profession calls upon professional school and mental health counselors to be ethical, skilled, culturally attuned and ready to engage in prevention and intervention as they work with students and families. This chapter expresses familiarity with social challenges to healthy child development. It helps to recognize the crucial role of professional school and clinical mental health counselors in the cultivation of positive school and community contexts. The chapter hypothesizes counseling from a strengths-based, curious, and creative stance.

Language and communication are crucial for establishing culturally safe environments of care for Lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied (LGBTQIA+) populations. This chapter helps the reader to understand the concept of implicit bias; reflect upon how that may affect our own biases and assumptions related to care. It explains differences between concepts of sex, gender, gender expression, gender identity, and sexual orientation and the associated terminology. The chapter enables the reader to utilize communication skills that are inclusive and welcoming to LGBTQIA+ populations. Health care providers and the direct care staff who assist in providing care can play a significant role in improving LGBTQIA+ health care by learning about their own biases, becoming aware of the systemic barriers to care that LGBTQIA+ patients face, and learning communication skills that create patient-centered care that is inclusive and welcoming.

Eye movement desensitization and reprocessing (EMDR) therapy is an eight-phase protocol. Dr. Shapiro and the EMDR International Association are precise about what EMDR therapy is and what it is not; and, even if one of the eight phases is eliminated, it cannot be called EMDR therapy. This chapter briefly touches on some of the eight phases and more extensively on others. An effort is made to enhance and expand on key areas that can assist the clinician in client selection, target selection, and adaptive resolution. The chapter offers a description of the goals and objectives of each phase as described by Shapiro. There must be an adequate level of trust between the clinician and client for EMDR processing to be successful. If a sufficient level of trust or bonding has not been established, do not undertake EMDR processing. Do not implement EMDR reprocessing unless the client is ready.

This chapter provides an overview of didactic and clinical accommodations, including information on accommodating the various forms of assessment that are used in health science programs. It offers specific guidance with regard to accommodating overnight call, students with color-vision deficiency, autism spectrum disorders, blood-borne diseases and those who are deaf and hard-of-hearing. A section on the inclusion of service animals helps programs develop appropriate protocols for animals that may be entering the clinic. Throughout the chapter, practice examples afford the reader an opportunity to apply the guidance to real student scenarios, while case examples provide a legal framework for determining reasonable clinical accommodations. Determining accommodations is an interactive process between the student and the disability resource professional (DRP) or responsible campus entity. The chapter helps DRPs and institutions understand how to work collaboratively to determine and implement reasonable accommodations in all types of health science education settings.

This chapter reintroduces the clinician to the basic components of Eye movement desensitization and reprocessing (EMDR) therapy through transcripts of therapy sessions. It introduces the EMDR reprocessing sessions in order of past, present, and future, as well as with the use of the cognitive interweave and informational plateaus and eye movement desensitization. The chapter presents these cases in this way to demonstrate to the reader what a successful session looks like when the client reprocesses disturbing material without any interventions by the clinician. As a newly trained EMDR therapy clinician, it is inadvisable to implement EMDR therapy starting with the most difficult client. Begin using this approach with clients with whom one believes success is possible. It is wise for any novice EMDR therapy-trained clinician to seek consultation as a strategic course of action with an EMDR International Association Approved Consultant.

Many Eye movement desensitization and reprocessing (EMDR) clients process in a straightforward manner with few direct therapeutic interventions on the part of the clinician. For others, however, processing to completion without any additional interventions is unlikely. The reasons for blocked processing are varied and multifaceted. This chapter explores guidelines for facilitating abreactions, strategies for blocked processing, and applying more proactive interventions for achieving full treatment effect. These interventions are intended to mimic a natural progression toward resolution. Clinicians who are trained in EMDR therapy are already familiar with many of the strategies particularly the strategies for clients who present with affect regulation difficulties or with complex trauma. Clinical supervision and/or consultation in these cases are always recommended. This chapter explores, three types of client responses—normal, overaccessing, and underaccessing—and strategies the clinician can apply when the client displays either low or high levels of emotions and/or blocked processing.

Service providers who work with people with sensory disabilities need to be aware of the various aspects that affect employment, social inclusion, and access to community services. Often, an interdisciplinary approach is necessary to reduce and/or eliminate barriers for people with sensory disabilities. This chapter addresses some of those factors, as well as services and technology to remove barriers and improve the lives of people with sensory disabilities. It examines the interactive effects of hearing disabilities and visual disabilities, and presents evidence-based strategies for people with sensory disabilities to use for navigating social and vocational landscapes. The chapter examines cultural implications of sensory disabilities, and common myths held by employers and the public. Finally, it discusses vocational issues such as employment discrimination, insufficient accommodations in the workplace, and the importance of services targeting effective employability and job placement, and some implications of the Americans with Disabilities Act.

Abnormal uterine bleeding (AUB) is one of the most common patient concerns in the adolescent population. AUB is defined by menstrual bleeding that occurs outside of the normal range and can include irregular bleeding patterns; prolonged or short bleeding episodes; and heavy or light bleeding. In order to determine abnormal bleeding amounts and/or patterns, it is important to understand the normal parameters for a menstrual cycle in this age group. Nurses and healthcare providers must collect as much information as possible about the menstrual bleeding to help determine the appropriate plan of care.

Alzheimer's disease (AD) and Traumatic Brain Injury are classified as neurocognitive disorders in the DSM®-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). For the purposes of illustrating the utility of the Intersectionality/Resiliency Formulation for diagnosis and effective treatment, this chapter highlights these diagnoses in detail along with their major differential diagnostic issues. It focuses on two of the most prevalent forms of neurocognitive disorder, in confidence that the lessons learned are widely applicable to persons with other neurocognitive disorders regardless of their age or situation. The chapter elaborates on the complex challenges of aging and its relationship to mental health diagnosis because the developmental phase of elderhood has come to be marginalized in society, resulting in a scarcity of mental health providers who have interest in caring for this population.

Although mental health professionals embrace broad assessment protocols, which attempt to incorporate biopsychosocial, and, more recently, the cultural and spiritual identities of the individual, attention is rarely given to the individual's unique internal and external sources of strength and support. The limitations of traditional medical model diagnosis, particularly in the form of the Diagnostic and Statistical Manual of Mental Disorders classification system, have been noted by many researchers and practitioners. At the same time, research has focused on predictive factors in treatment outcome, both in terms of client characteristics and in the utility of evidence-based treatment protocols applied to specific mental disorders. The cumulative themes in contemporary discussions of diagnostic systems and effective treatments, logically related to diagnosis, suggest the need for an additional core component of the diagnostic system, for which the authors advocate the Intersectionality/Resiliency Formulation.

This chapter examines three common childhood disorders (conduct disorders, anxiety disorders, and depressive disorders) using the Intersectionality/Resiliency Formation framework, with special attention to important developmental processes at play. It focuses on two specific disruptive disorders, oppositional defiant disorder and conduct disorder because these disruptive behavior disorders are more likely to arouse negative reactivity in persons in child's environment and also pull mental health professionals toward a negative focus on pathology. These two disorders are seen in mental health and community clinics more than any other disorders in minors, are often co-occurring with other psychiatric disorders, and may be complicated by substance abuse and severely delinquent behavior. As externalizing disorders, they are visible to observers and disruptive in the child's environment, whereas externalizing disorders are often less salient to caregivers, teachers, and peers. The chapter focuses on diagnostic developmental considerations when evaluating these and other common disorders in children and adolescents.

A journey into learning about dissociation usually begins with a therapist being unsuccessful in the treatment of traumatized children. An eye movement and desensitization and reprocessing (EMDR) clinician starts to seek information on how to help their clients by attending training, reading books, or engaging in “What am I missing?” discussions while in supervision. Therapists have an “aha moment” when they look through the lens of dissociation at the child's symptoms and behaviors. The gift of dissociation brings relief to many children in harmful situations. This chapter provides an understanding of the internal world of self-states and what that might look like in the child's external world and in the playroom. Recognizing and knowing the guiding principles of how to access self-states provide therapists the tools for effective treatment for the child and all of their caregivers.

This chapter reviews how clinicians can combine play therapy skills with eye movement desensitization and reprocessing (EMDR) therapy to treat young children who have experienced trauma. It presents a descriptive approach to integrating play therapy skills with the EMDR protocol for therapists already using play to facilitate trauma. Young children's trauma often arises from early neglect and abuse, resulting in emotional dysregulation and inappropriate behaviors. Child-centered play therapy, developmental play therapy, and EMDR are interventions that address these issues and are also effective relational therapies that can be even more powerful when combined. These therapies complement each other to allow successful treatment of complex trauma in our youngest clients. Through examples and a case study, therapists will appreciate how play therapy and EMDR work well together and how clinicians' play therapy skills can be easily incorporated into all phases of the EMDR protocol.

Sexually transmitted infections (STIs) are a global public health problem that impacts patients, families, and their communities. The best method for reducing negative health consequences is prevention. Prevention measures need to be patient-centered and individualized for the specific patient to prevent the transmission of STIs. Sexually transmitted infections can be shocking, and diagnosis is difficult for patients. Once the initial sexual health screening is collected, healthcare providers can determine the risk for a specific STI and tailor their health visit accordingly, addressing many preventive methods. Health education sometimes promotes an abstinence-based approach. This chapter helps the readers to identify strategies to prevent STIs and identify individuals who are at a higher risk for contracting an STI. It explains the importance of integrating STI prevention into primary healthcare and other healthcare services.

Not all sexually transmitted infections (STIs) are common infections such as gonorrhea, chlamydia, herpes, or human papillomavirus. Nurses need to be aware of other STIs that may cause infections so that when patients present with clinical symptoms, obtaining a sexual health history is not overlooked. Other viruses that can be transmitted through sexual contact include cytomegalovirus (CMV), Zika virus, and the Epstein–Barr virus (EBV). Knowing the different types of viruses and disease sequelae can help healthcare professionals to properly identify and treat as well as educate patients on essential aspects of STI prevention. This chapter helps the reader to identify different diseases that can cause STIs. It describes the different clinical symptoms for each illness and explains educational aspects of the infections useful to patients to prevent transmission and to treat the disease.

The optimal maternal position for labor and birth will vary based on the one preferred by the woman in labor, the one that best supports maternal and fetal perfusion and oxygenation, the one that enables the care providers to care for the patient or accomplish procedures. Limit supine, dorsal recumbent, and dorsal lithotomy positions as they increase the risk of fetal acid-base imbalance. Bath sheets, absorbent underpads, wash cloths, towels, pillows, a peanut ball, or a birth ball might also assist one in providing cleanliness, support, and comfort to your patient. This chapter illustrates various positions a woman can assume during labor with their advantages and disadvantages.

For women and their children to be safe, healthcare providers must have compassion, be vigilant and practice evidence-based care within a healthcare system that has a culture of safety. Safety requires nursing advocacy, communication, appropriate use of the chain of command, and evidence-based practice. Evidence-based practice is essential to maximize safety and minimize adverse outcomes. Evidence based practice needs to be efficient and equitable. Childbirth safety also requires competent, unbiased, compassionate, and vigilant care. Advocacy requires a nurse to recognize, verbalize, and mobilize. Communication among the healthcare team members is imperative to help ensure the individuals required to provide safe care to the mother and baby or babies are available in a timely manner. Competent nurses will individualize the plan of care and inform the obstetric care provider of threats to maternal and fetal safety so that interventions are customized to prevent adverse outcomes.

Health issues and care impact all people. This chapter takes an intersectional approach in looking at people from diverse cultural and ethnic backgrounds, as well as other intersectional factors such as social-economic status, education, age, immigrant status, and gender that impact on their health issues and access. A major factor that influences access to healthcare is immigration status. Some immigrants came when they were children and have lived in the United States for most of their lives. Other immigrants are recent arrivals and may have initially come as visitors, students, or with work permits. While children of immigrants now attend schools that teach about healthy life practices, adult migrants did not benefit from learning about preventive health measures. In addition to holding varied views on prevention, members of an immigrant family may pursue different health providers.

Suicide is a problem that knows no cultural boundaries. As the minority population in the United States continues to grow, it is essential for health and mental health providers to develop culturally relevant prevention and intervention efforts to address these at-risk populations. Risk and protective factors vary across culture and ethnicities, as do attitudes and perspectives regarding suicide acceptability. Intervention and prevention efforts should be guided by culturally relevant risk and protective factors for suicide and an understanding of attitudes toward suicide among the target population. This chapter explores the diverse demographic and ethnic profile of suicidal behavior in the United States and reviews known psychosocial risk factors for suicide within these cultural groups. It reviews the critical factors related to culture to be considered when conducting a risk assessment with suicidal clients. The chapter explores the treatment of suicidal individuals from culturally competent and evidence-based practice perspectives.

Increasingly, women are using complementary and alternative medicine (CAM) therapies for preventive and palliative care as alternative or adjunct therapies to their traditional medical care. This chapter discusses the most commonly used therapies for a variety of conditions that affect women. Women may not perceive vitamins, minerals, herbs, and supplements as medications. Because drug interactions exist with both prescription and over the counter products, it is important for the clinician to ask each woman about the use of CAM therapies at every visit. Women who are pregnant and/or breastfeeding should not use any CAM therapies without consulting their health care provider. Alternative therapies refer to treatment approaches that, though used for many years, have not been evaluated and tested by conventional methods and rigorous research. The chapter provides the general categories of CAM, reasons for selection/use of CAM, concerns regarding CAM, considerations, and frequently used/recommended CAM therapies.

Though the American Counseling Association Code of Ethics for professional counselors provides subsections for each area of practice related to clinical work and research, Section I engages in the more meta task of exploring how ethical dilemmas are actually resolved. In determining actions related to ethical dilemmas in their work with clients, the public, or other clinicians, counselors work to resolve these dilemmas with direct and open communication with all involved stakeholders. The chapter includes cases, assessed using the Corey, Corey, Corey, and Callanan (2015), Cottone (2001), and Forester-Miller and Davis (2016) models. This chapter highlights the resolving ethical issues including, protecting clients from harm, unacceptable business practices, deceased clients, interdisciplinary teamwork, and policies that are potentially harmful to clients.

Writing clear and descriptive clinical case notes is very different from most other types of writing. This chapter provides an overview on writing clear, concise, and effective case notes. Counselors have an explicitly stated legal and ethical duty to create and maintain client records on every client. Failure to maintain adequate records could form the basis of malpractice as it breaches the standard of care expected from a mental health professional. Counseling students should remember that like all other counseling training, developing good, clear, and concise clinical writing skills takes time and comes through experience. The practicum and internship placements are good beginning points for developing good clinical writing skills.

Health educators constitute an important profession that is necessary for promoting health, but is not sufficient. They must learn how—and be allowed—to collaborate with health providers who may not recognize their worth, and with patients/clients who may resist their guidance. Health professionals and older adults need to be informed about a great many health education topics. This chapter explores a few of these topics: smoking, alcohol, medication usage, injury prevention (fall prevention and motor vehicle/pedestrian safety), sexuality and intimacy, and sleep. Older adults can share intimate support in many ways. Practical health research findings are reported on in academic journals or popular media almost every day of the year and it is a challenge for health educators, providers, and patients/clients to stay current. A collaboration among the three groups is essential. Perhaps the most successful outcome of health education had to do with smoking cessation.

Empowerment for an older person means having the opportunity to learn, discuss, decide, and act on decisions. From the perspective of the health professional or health educator, empowerment of older patients in the clinic setting or clients at a community site means not only to provide service to them, but also to collaborate with them, to encourage their participation. Certain personality characteristics, such as patience, tolerance, and a positive attitude, enhance the health educator’s chances for collaborating successfully on a health goal. There are health-promoting strategies that may help. For those who are behavior management-oriented and like recordkeeping, the health contract might be helpful. There are support groups to help with chronic diseases, caregiving, coping with loss, and alcohol or other addiction problems. Empowerment, with its rewards and risks, is fast becoming a requirement in the era of chronic healthcare conditions that must be managed, sometimes for decades.

The field of health promotion has come a long way since it was initially defined as exercise, nutrition, and smoking cessation. Moreover, older adults were typically excluded from early writings on health promotion and disease prevention. They were old after all, perhaps resistant to change and without much of a future. Health promotion and aging now covers dozens of topics. Health professionals need to be careful about defining good health among older adults. Health promotion is a more proactive approach than primary prevention, which tends to imply a reaction to the prospect of disease. Directing a client’s anger or frustration into political advocacy work is a proactive, health-promoting enterprise that benefits both the individual and society. Medicare, Medicaid, and Social Security have had a tremendous impact on health. It is important, therefore, to review these legislative acts, as many people do not even understand the difference between Medicare and Medicaid.

For the health care social worker, flexibility to accommodate federal, state, and local policy changes, as well as adjusting to the changing roles of other health care professionals, has become the state of practice. In addition, predicting future trends and having knowledge of strategic management are required to forecast what changes will need to take place. As health care continues to advance, issues such as living with chronic pain only magnifies the social and emotional pain that people suffer. This makes the psychosocial aspects of self-care and providing services critical regardless of the technology available. If social workers do not respond to these demands, then they will be replaced with other professionals who perform similar functions. This chapter reviews the factors critical to the understanding and further development of health care social work. It highlights professional issues and challenges and highlights suggestions for the future.

Acute care hospitals and ambulatory health care facilities employ more social workers than other settings including individual and family services, schools, and state and local government agencies. The number of practicing health care professionals continues to rise and health care is now the largest employer in the United States. Acute care hospitals often include medical and surgical units, and patients need services that are required to be supervised by licensed medical personnel. Ambulatory settings provide diagnosis, treatment, and care that is not inpatient, and the treatment and care do not require the specialized services. This chapter identifies dialysis social work in nephrology settings as ambulatory care. It provides case exemplars to highlight acute and ambulatory care social work and the processes that are involved in assessment, intervention, and treatment. The chapter explicates areas of strength and concern in the present state of acute and ambulatory care social work practice delivery.

In conducting psychological assessments to identify psychopathology, it is essential that clinicians continue to engage in activities that help them remain current on the state of the science. The models to conceptualize psychopathology, the diagnostic criteria, and the instruments used to inform clinicians in arriving at diagnoses and treatment plans continue to evolve. The assessment of psychopathology is rooted in knowledge of the empirical evidence of the diagnostic criteria, and a lack of current information of the empirical evidence can lead to faulty application of assessments or incorrect conclusions regarding diagnoses. Interviews, behavioral observations, self-report inventories, psychological testing, historical/medical record review, functional assessment, and clinical judgment are all necessary in the formation of a diagnostic picture that provides an accurate depiction of clients’ current issues and the selection of interventions that are likely to be the most effective.

Helping people with disabilities to identify, request, and implement reasonable accommodations in various educational, community, and employment settings is a hallmark of the rehabilitation counseling practice. The rehabilitation counseling process is guided by comprehensive assessments of the client’s aptitudes, achievement, skills, interests, and values, and it is essential that clients who require accommodations to participate in valid assessments have access to those accommodations. Testing accommodations are legal, ethical, and best-practice imperatives for rehabilitation and healthcare professionals, and they are viewed as a fundamental right of participation in educational, human service, community, and vocational environments. For the purpose of testing accommodations, it is most helpful to examine categories of limitations as opposed to categories of disability. It is most useful to match the types of accommodations with the specific types of limitations. The chapter considers limitation in the areas of cognitive and neurological abilities, motor abilities, and sensory abilities.

This chapter presents a review of adaptive behavior assessment from conceptual, technical, and practical perspectives. Although adaptive behavior is a construct with relevance across multiple disability populations served by rehabilitation professionals, its greatest relevance concerns persons with intellectual disabilities (ID). This chapter presents adaptive behavior assessment within an ID context. It begins by describing the population of persons with ID and how they are defined through federal legislation and professional associations. Specific focus is placed on the growing importance of adaptive behavior in the process of identifying persons with this disability. The chapter then presents a review of standardized and informal approaches to adaptive behavior assessment. To illustrate its professional importance and use of best-practice approaches, the chapter then addresses three practice areas where adaptive behavior assessment plays a key role in contemporary practice with persons with ID, including death penalty evaluations, community-based habilitation, and culturally responsive assessment.

Older adults who are not only living longer, but actually in better health too, could boost the economy by virtue of their longer periods of productivity, their ability to earn and save more income over time, and their purchases and consumption of more goods. Furthermore, because of their accumulated wisdom, skills, and talents, they have much that they can contribute to our social environment. This chapter focuses on the longevity dividend and the importance of mobilizing all sectors of the society to realize the opportunities and address the challenges of an aging society. It includes demographic information related to aging in the United States as compared with that of other countries, as well as a discussion about the detrimental effects of ageism on older adults and on society as a whole. It is especially important for gerontology professionals to understand and avoid ageism.

Health care delivery models increasingly rely on social workers and social worker case managers because of their specialization in identifying and meeting the needs of patients postdischarge. This includes accessing the necessary care and treatment resources in the community, such as elder care services, fraternal/religious organizations, government programs, meal delivery services, and pharmacy assistance programs. This chapter presents a general definition of the role of the health care social worker along with a discussion of the issue of role ambiguity and confusion. It outlines some of the differences between health care social workers and the other related disciplines. The chapter identifies new trends in collaborative teamwork and highlights the role and/or lack of the social worker. Health care social work needs to be viewed as the professional “bridge” that links the patient; the multidisciplinary, interdisciplinary, transdisciplinary, and pandisciplinary teams; and the environment.

Health and wellness coaching involves strategies that health care professionals can provide to individuals/clients/consumers to assist them in maintaining good health. These efforts can also be directed toward helping patients to improve unhealthy conditions in order to prevent illness or disease. The inclusion of complementary and alternative medicine (CAM) with an emphasis on wellness and health is often associated with the medical model in a number of health care settings, and fits well with both the strength-based and holistic approaches of social work, counseling, and coaching. The chapter discusses prevention, wellness counseling and health and wellness coaching, and the various CAM approaches currently used in health care. It discusses each aspect of wellness counseling from the perspective of the social work practitioner. The chapter includes aspects of CAM and its relevance to social work practice.

This chapter addresses single-system design, an approach to monitor clients’ progress. While reading this chapter, consider the following questions: Which type of single-subject design would be most appropriate for social workers to use with their clients to assess progress? How will social workers integrate different types of measurements in single-system design? Would it be possible for social workers to have more than one client in a design at a time? If yes, what type of design would that be? And what additional resources will social workers need to help accomplish single-system designs? The purpose of this chapter is to present a fundamental tool of the role “clinician–researchers” and a central mechanism through which valid research can be conducted in clinical settings: the single-system design. Single-system designs are quasi-experimental research designs that involve assessing change in a dependent variable on a single research case or subject.

An effective maternal care workforce is sufficient in numbers, diversified by skills, and appropriately distributed to meet the needs of the population. The critical issues destabilizing the work-force and creating barriers to maternal care are the increasing need for maternal care providers, both midwives and obstetricians, and the geographical maldistribution of the workforce across the globe. This chapter describes projections about the shortage of the maternal care workforce and the closure of maternity care sites, especially in rural America. It discusses maternal mortality and severe maternal morbidity in relation to workforce issues and availability of maternity care sites in the United States. The chapter then identifies current and emerging strategies to develop a diversified workforce and site accessibility for maternal care, especially in rural America. It ends with posing critical questions and discussion points about the crippling of health and the loss of life among America’s mothers.

All of a woman’s prior life experiences and her individual way of facing these experiences influence how she approaches childbearing. Whether pregnancy is planned or unintended, relished or endured, birth is a turning point. Every woman’s childbearing journey is uniquely informed by prior life experiences, and the journey itself becomes a part of her very being. This chapter examines the influence of prior life experiences, as they affect childbearing outcome, describes how childbearing experiences and outcomes can have a lifelong impact and discusses how health professionals can use life course theory to evaluate undermining social determinants affecting childbearing outcome. It poses critical questions about life course theory as it pertains to America’s maternal health crisis. It is an opportunity to think about the effects of prior life and health experiences on maternal morbidity and mortality. The solutions to this national epidemic lie in interdisciplinary, imaginative conversation and problem solving.

This chapter summarizes factors influencing maternal health, morbidity, and mortality in the United States, examines themes in the key informant interviews and describes a road map for nursing advocacy and practice that promotes maternal health in the United States. A growing shortage of maternal healthcare providers, the lack of diversification of the workforce that reflects the face of America, and closure of rural facilities continues to be a problem. Scaling up the availability of midwifery care, especially in rural and underserved areas, is a widely proposed solution. The nursing profession is central to implementing the road map toward equity. As the largest cadre of health professionals in the nation, nurses provide a substantial amount of care to America’s mothers. Early life experiences, social, psychological, and environmental factors, are critical social determinants. Examining these factors from life course theory perspective can help healthcare providers understand the gestalt of women’s lives.

There are several misconceptions and assumptions that can reduce the effectiveness of counseling with children and adolescents. New therapists and counselors in training may need to ultimately unlearn assumptions that they carried with them—knowingly or not—before entering professional training programs. This chapter reviews some common misconceptions and assumptions made by counselors at all levels. The field of motivational interviewing has emerged to address the resistance to change and the challenges associated with preparing clients for change. It seems that rational, irrational, positive, and negative thinking are important to untangle when working with children and adolescents. The goal is to help clients to challenge erroneous thinking, distortions, or faulty interpretations that lead them to negative outcomes as well as help them to anchor their academic, interpersonal, and other efforts in an effective understanding of their current abilities, skills, and context.

Professional health and wellness coaches (HWCs), along with allied healthcare professionals trained to use basic coaching skills, offer the promise in assisting patients to prevent or better manage their chronic disease in making sustainable healthy lifestyle changes. While the HWC does not assume the traditional expert approach of many types of healthcare professionals, there is an element of sharing health information with clients. Specifically, when the HWC believes that objective information might help the client in advancing the coaching process or the client requests information, information is shared, after permission is granted by the client. The HWC strategically employs interaction skills by asking open-ended questions, providing affirmations, responding with perceptive reflections and summary statements in order to engage the client, define his or her focus, resolve ambivalence, evoke motivation, and move toward action.

The self-awareness of how to take care of oneself will enable one to hold an emotionally demanding vocation beyond the career's honeymoon phase. This chapter addresses how to prioritize self-care in a field that ironically forgets it occasionally and introduce the process of finding a comfortable, worldview-fitting therapeutic model. Developing self-care means looking after one's own well-being. This can include transforming internal dialogue, practicing boundaries, and consistently practicing mindfulness related to these. The hope of developing self-care is to alleviate the stress of life as it begins to be heavy rather than waiting until it feels like responsibilities are teetering out of control. There are four types of self-care: physical, cognitive, emotional, and spiritual. The chapter helps the reader to know how to maintain self-advocacy in self-care both short and long term for a greater overall well-being physically, emotionally, cognitively, and spiritually.

This chapter focuses on the period when the structural family therapy (SF) was beginning to mature, around the mid-1970s. It provides more information about the continuing evolution of SF. It also provides some of the basic concepts of SF as well as resources where a reader can gain more knowledge of SF, such as reading materials, training centers, programs to train to be a structural family therapist. The structural family therapist pays attention to the evolution of roles in the family and introduces interventions that change the roles of family members and thus the structure of the family. SF allows the therapist to intervene with any part of the system and utilizing multiple perspectives as the system is connected through patterns of interaction. The goal of this approach is to restructure how a family has organized itself through dysfunctional interactions between its members, alleviating symptoms in patients.

Eating disorders are complex and difficult to treat. One of the most significant reasons for difficulty with respect to treatment is not only the degree to which these disorders can be life threatening, but perhaps more significantly, the degree to which the eating disorder fights tooth and nail to ensure its survival. Strong emotional reactions, often referred to as countertransference reactions, to patients with an eating disorder are common and can range from care and concern to frustration and rage. Acknowledging and identifying one's own countertransference reactions can help both the person feeling them and the patient as well. This is particularly true for treatment providers who can risk harm to themselves and/or the patient if countertransference reactions remain unidentified. By contrast, when countertransference reactions are identified and appropriately understood the treatment provider may learn more about himself or herself as well as the patient, which ultimately can benefit treatment.

Narrative therapy is a postmodern approach that respects the client as the expert of his or her destiny. It acknowledges how a person's perceptions and experiences result in certain beliefs and actions. Narrative therapy is based on the idea that a person's life and relationships are shaped by the "stories" a person creates or, are created for them in relationships. The narrative therapist assists clients to resolve their problems by helping them to separate themselves from the problems that keep them from fulfilling lives, assisting them to challenge how they currently live, and negotiating a newer, more preferred story. The narrative therapist empowers the client to "reauthor" his or her life by identifying unique outcomes and deconstructing the problem's effect on their life. Therapy emphasizes the requirement of changing the narrative in order to change how the client interacts with the problem.

This chapter focuses on who is involved in the treatment of eating disorders, the various levels of care, modes of treatment, and treatment approaches available to individuals dealing with an eating disorder and their families. It provides an introduction to what forms and approaches of treatment are commonly used. The American Psychiatric Association recommends that a team of professionals be actively involved in the treatment of someone with an eating disorder. This reflects the highly complex nature of eating disorders and the need to be sure that not only the individual's psychological health is being attended to but also his or her nutritional needs and medical well-being. This team is referred to as a multidisciplinary treatment team and at minimum should include a licensed mental health professional, a licensed medical professional, and a registered dietitian.

Solution-focused narrative therapy (SFNT) is an integrated model of two postmodern language-based therapies working within a non-pathological approach. The therapist and client are collaborators in developing a solution-oriented narrative framework for a re-authoring process of the client's life. A collaboration of this kind abandons the idea that the therapist is the expert solving problems. This process allows the client to develop hope for an alternative future. The therapy model does not assume that there is something referred to as client resistance. This chapter offers ideas on working with individuals as well as families. In SFNT, problems are identified separately from the client's identity. The client and the problem are separated to allow the client a better objective view of the situation they are facing. The therapist holds the viewpoint that each client possesses the needed abilities, skills, and further tools to solve those challenges and any change that is essential.

In the field of family therapy, there is a need for working with families struggling with medical problems. The collaboration of both medicine and psychology in addressing the particular familial and individual issues that occur in dealing with illness have led to the medical family therapy (MedFT) model. MedFT represents a meta framework that encompasses overarching principles within which any mode of psychotherapy can be practiced. What sets MedFT apart from other family therapy theories is the routine collaboration with medical professionals as well as seeing illness as part of the systems. Collaboration is a primary aspect; medical family therapists need to have an understanding of the medical system to embrace a multidisciplinary team approach with physicians and other healthcare providers. The hope is that the MedFT therapist will aid the family, along with the medical staff, traverse illness and journey united together in coping with the effects of illness.

There is a natural hierarchy within most families, with parents and primary caregivers as leaders. When the family hierarchy is unbalanced, serious problems arise. It is the strategic family therapist's job to realign the family by teaching parents and primary caregivers how to lead. Once the natural balance and order in the family is achieved, problems dissipate. Strategic therapists took the concept of the positive feedback loop and made it central to their model. Strategic family therapists believe that to change family organizational patterns and therefore alleviate the identified problem, the routine in which the clients communicate with one another must be altered. This chapter discusses the tools therapist may use: directives, prescribing the symptom, unbalancing, therapeutic double bind, reframing, restraining, and using metaphors throughout the session to assist the family or individual to make changes in their lives.

The training and credentialing process in behavior analysis are similar to that of medical professionals or other licensed behavioral health providers such as clinical psychologists, clinical social workers, school psychologists, and marriage and family therapists. This chapter outlines the steps behavior analyst trainees need to take to become a credentialed behavior analyst. It discusses the differences between practicum, internship, and fieldwork experiences. To set behavior analyst trainees on the path to success, the chapter provides some guidelines to help one's self-reflect before to begin their journey and offered information about what they should expect from supervision. One can find that supervised learning experiences are crucial for all practitioners (e.g., nurses, physicians, medical technicians, dentists, dental hygienists, counselors, therapists, social workers, and teachers) and a significant part of the training that will help them relate to other medical, mental, and behavioral health services providers.

This chapter helps the reader to understand what a needs assessment is and be acquainted with a framework within which to conduct a needs assessment. and to be familiar with the core concepts of a needs assessment. It helps the reader to be familiar with strategies that encompass a needs assessment. Needs assessments can be carried out by a wide cast of people. Social workers and public health workers, as well as city planners, can carry out needs assessments, as can government organizations. Local citizens or groups of people can also be responsible for carrying out a needs assessment. The chapter provides an overview of strategies to develop a needs assessment. When used in combination with a health behavior framework, a needs assessment can help one determine the needs of a community and attempt to build community support for this resource or policy change through media advocacy and coalition building.

Physical activity for older adults has become a central feature of our culture. Physical activity programs intended for older adults call for an understanding of the social, psychological, and physical factors that influence their receptivity and effectiveness in supporting individual well-being. This chapter is organized into three sections, each addressing older adult social integration and physical activity in specific ways that are applicable to health professionals. Section one defines key terms, presents concepts on aging, and offers evidence to enhance well-being through social integration and physical activity. Section two provides a practical approach to working with older adults through physical activity that includes benefits, guidelines, recommendations, opportunities and barriers to physical activity, and a resource guide to best practices and approaches for older adults. In section three, two cases, based on individuals the authors have worked with, provide physical activity progressions and considerations for social integration.

The assessment of sex and relationship problems is dependent, in part, on the setting in which issues are presented, the training of the provider, and practical matters such as time constraints. In the PLISSIT model, P stands for permission, LI and SS stand for limited information and simple suggestions, and IT stands for intensive therapy. Initial assessment of sexual problems is nearly always the same, whatever the setting. The following six-step assessment will cover most any situation: establishing rapport; defining the problem; ruling out medical and other organic causes; if no medical cause, or if there are medical causes and the mental health professional is working in collaboration with healthcare provider, establishing a realistic goal; providing information and suggestions that may resolve the problem; and if two or three attempts to resolve the problem with information and suggestions is ineffective, treating or referring for treatment with intensive therapy.

Sexuality is a core part of human identity. Physicians, nurse practitioners, or educators who work in gynecology, obstetrics, urology, endocrinology, or family practice can help women, men, and couples cope with the sexual and emotional tensions that may occur before, during, and after pregnancy. They can offer information and suggestions for women trying to recover their sexuality after having a baby, or normalize that men sometimes have erectile dysfunction when they are trying to impregnate their partner. This chapter describes models of sexual behavior such as human sexual response, circular desire, dual control model, and systemic model. In terms of sexuality and intimacy, healthcare providers and mental health providers have not been trained to ask couples before, during, and after pregnancy about the state of their relationship and the effect of childbearing upon it. Lesbian, gay, bisexual, and transgender (LGBT) couples who want to have children may also seek services.

Sex therapy addresses sexual function, but goes beyond offering information and solutions to dig deeper into an understanding of why the sexual symptom occurred. Like other psychotherapists, sex therapists rely on a variety of theoretical approaches to organizing and treating presenting problems, for example, emotionally focused therapy, narrative therapy, cognitive-behavioral therapy, family therapy, and so on. This chapter discusses Murray Bowen’s Intergenerational Theory. Mental health professionals will be familiar with the symptoms and treatment of posttraumatic stress disorder (PTSD). Symptoms commonly associated with PTSD, such as flashbacks and nightmares, can interfere with sexual function. Sexual difficulties related to PTSD include the development of a sexual aversion, low desire and problems with arousal, anorgasmia, and painful intercourse. The chapter describes interventions such as deep diaphragmatic breathing, rapid eye movement desensitization, body-centered approaches, and cognitive therapy. Finally, the chapter discusses perinatal depression, its risk factors, and interventions.

This chapter briefly describes palliative and end-of-life care, benefits of palliative care, and the role of palliative social workers. The aim of palliative care is to improve quality of life for the patient and family. Palliative care specialists facilitate communication among the patient, healthcare providers, and family members to better understand the illness and goals of care. Palliative care is delivered in a wide range of settings and with different models of care. These settings include: inpatient facilities, including intensive care units (ICUs), emergency departments, outpatient settings, community-based settings, long-term care facilities, and home-based settings. Palliative care is a deeply rewarding practice area because it involves developing and using advanced clinical skills, is stimulating and challenging, involves interdisciplinary collaboration, and, most importantly, offers the opportunity for making a very meaningful contribution to patients and family members as they experience one of the most important transitions in their lives.