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.

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.

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.

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.

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 explains a set of guidelines to help mental health professionals and clients move away from the gender stereotypes that perpetuate inequality and illness. Identifying dominance requires conscious awareness and understanding of how gender mediates between mental health and relationship issues. An understanding of what limits equality is significantly increased when we examine how gendered power plays out in a particular relationship and consider how it intersects with other social positions such as socioeconomic status, race, ethnicity, and sexual orientation. To contextualize emotion, the therapist draws on knowledge of societal and cultural patterns, such as gendered power structures and ideals for masculinity and femininity that touch all people’s lives in a particular society. Therapists who seek to support women and men equally take an active position that allows the non-neutral aspects of gendered lives to become visible.

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.

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.

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 professionals are often called upon to intervene in complex ethical dilemmas that involve respecting an older adult's autonomy while also considering protective interventions to ensure safety. This chapter addresses the foundational ethical competencies for psychologists and geropsychologists including the unique challenges associated with surrogate decision making, legal, clinical, and psychosocial interventions specific to working with vulnerable older adults, ethical dilemmas that can emerge within various situations including assessment and integrated care settings, detection and intervention strategies in cases of elder abuse, neglect, and exploitation, and ethical approaches to research with older adults. Finally, the authors discuss the multicultural dimensions that influence how ethical and legal issues are conceptualized and addressed. The micro-and macrosystems in which older adults live and thrive require a level of cultural sensitivity, an understanding of aging processes, and knowledge about professional ethics and legal standards involved in decision making.

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.

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 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.

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.

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.

In the early 20th century, asthma was considered as one of the “Holy Seven” psychosomatic disorders and thus was thought to be amenable to psychological therapy. In multiple case reports, hypnosis has been reported to have beneficial effects on the subjective aspects of asthma, which include symptom frequency and severity, coping with asthma-specific fears, managing acute attacks, and frequency of medication use and health visits. Asthma is treated with a combination of anti-inflammatory and bronchodilator medications that typically are inhaled. Hypnosis may also be efficacious for decreasing airway obstruction and stabilizing airway hyper-responsiveness in some individuals. There are several additional hypnotic techniques, such as breathing techniques, subconscious exploration, and age regression, which can be useful in the treatment of patients with asthma. Patients can be taught to use some of these techniques through self-hypnosis on an as-needed basis.

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.

Self-care is critical when someone works with clients or patients who have experienced trauma. Providers might also be dealing with their own trauma history. Burnout is possible, as are compassion fatigue and secondary traumatic stress. Burnout is a gradual process. Secondary traumatic stress can be gradual but can also happen suddenly. Burnout is a process during which a person disconnects from work and relationships. The common causes of burnout are overwork, unrealistic expectations, lack of sense of coherence, perfectionism, and codependency and overinvolvement. Compassion fatigue appears to be relatively common among those who work with abuse survivors. Countertransference is a psychoanalytic term that has relevance to trauma work. Providers should take time to take care of their bodies. This means getting enough sleep, eating nutritious foods, exercising, connecting with others, and maintaining a spiritual life.

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.

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.

Chronic renal failure poses a singular challenge for health professionals who deal with illness-related disability and rehabilitation. The course of progressive chronic kidney disease (CKD) leading to renal failure often spans many years; during the period before dialysis or renal transplantation is undertaken, the patient may experience disabilities related to cardiovascular disease, anemia, malnutrition, metabolic bone disease, neuropathy, muscle wasting, and acid-base and electrolyte disturbances. Dialysis treatment and transplantation significantly prolong the lives of patients with renal failure. A better understanding of the pathophysiological basis for many of the disabling aspects of chronic renal failure has led to therapies that may reduce the frequency and/or severity of these aspects of the disease. Prevention of disability and rehabilitation has become increasingly important as the number of patients treated with dialysis therapy and renal transplantation has become more common.

This chapter defines chronic pain, types, and causes; describes medical characteristics of two emerging chronic pain conditions namely chronic migraines and fibromyalgia; and discusses symptomology, diagnosis, and treatment issues associated with these conditions. It explores the medical, psychosocial, and vocational aspects of chronic pain, and examines the characteristics of populations most likely to experience chronic pain. The chapter presents recommendations for providing responsive rehabilitation counseling services to the growing numbers of individuals living with chronic pain who are served by rehabilitation counselors across all employment settings. As myths about chronic pain are so prevalent, rehabilitation counselors must carefully examine their own potential biases and misconceptions about chronic pain, its causes, and treatment. Complementary health approaches are often used by people with chronic pain and may include yoga, spinal manipulation, massage therapy, heat and cold applications, meditation, acupuncture, herbal medicines, vitamins, and minerals.

Chronic pain syndromes are composed of a multifactorial relationship between biologically based neurological triggers and pathways; psychologically mediated moods, emotions, and behaviors; and socially developed responses, interactions, and consequences. The complex interplay between these factors can devastate a patient’s quality of life, as well as make the diagnoses, treatment, and ongoing management of chronic pain syndromes by health care professionals exceedingly difficult, resulting in psychological and physical disability. In chronic pain, the imprinted signals and perceived pain may persist for several weeks, months, or even years after the original injury has healed. Treatment of chronic pain creates yet another dimension of complexity, as it requires a multimech-anistic, multimodal, or multidisciplinary approach for effective management. Chronic pain often is mixed nociceptive and neuropathic or primarily neuropathic and is associated with imprinted neuroanatomical and chemical changes in the peripheral and central nervous systems, which results in abnormal processing.

This chapter focuses on office automation and systems that are useful in the mental health field, along with principles to be aware of when considering the use or purchase of such systems. Most managers have to rely on input from outside in order to form an opinion about how to resolve complex issues. The complexity of the issue increases significantly when the current federal health care laws are incorporated into the task of choosing appropriate clinical information management software. The significance of Health Insurance Portability and Accountability Act (HIPAA) would seem to dictate at least a brief foray into its content because it lays the foundation for virtually everything that is happening in the clinical information management (CIM) realm. The information provided in the chapter can give a backdrop by which current practices can be examined for goodness of fit with the available client information management systems.

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.

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.

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.

This chapter explores four common ethical principles impacting neonatal care such as autonomy, beneficence, nonmaleficence and justice. It discusses recommendations for palliative and end-of-life care for infants and identifies situations and conditions that create moral distress. The chapter analyzes case presentations to identify the critical issues affecting the family and staff and synthesizes an approach to infants at the end of life, including care of families. It describes important aspects of critical discussions with parents in the neonatal intensive care unit (NICU). The chapter suggests best practices for communicating with parents and professional care for high-risk infant. Advances in neonatology and perinatology have affected major improvements in mortality and morbidity of high-risk infants. Neonatal health care providers strive to provide care that will promote the best interests of infants who are unable to make their own decisions.

This chapter highlights the importance of identifying a concussion team leader (CTL) one person in the building who is responsible for facilitating the concussion team. The school nurse is essential in collaborating with district administration in the formulation of a concussion management policy. A signed release of information (ROI) is important to allow the school to receive and discuss medical information related to a concussion with a student’s health care provider. It is also essential that the concussion team model include a procedure for periodic review of the team structure and the concussion management policy, given the changes in concussion protocol that grow out of research. This chapter includes a discussion of maintaining student privacy through following Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations.

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.

The U.S. health care system is a highly complex and often volatile mixture of free enterprise, philanthropy, and public sector health care. It is also the most expensive health care system in the world both in per capita dollars spent and in the proportion of national economic output spent on health care. This chapter provides a general overview of the organizational structure of the U.S. health care system; in particular, how dollars are allocated to health care purchase in terms of the facilities, services, technologies, and human resources that comprise the resources of the health care system. Significant attention is also devoted to the structure of the health care “safety net” generally defined as the clinics, hospitals, and individual health care providers that care for a disproportionate share of the poor, the uninsured, those afflicted by stigmatizing health conditions, and persons otherwise isolated from the mainstream health care system.

Identity gives people a sense of constancy and centeredness across the sometimes-turbulent change that comes with living. This chapter presents the developmental concept of identity through its manifestations at different levels of community, revealing a complex and systemic context for rehabilitation counseling. Each level of identity such as personal, social, and collective, denotes a potential point of counseling exchange with the family. The chapter describes how the experience of disability challenges the family system and how that experience is inculcated at each level of identity for each participating member. It is important for a family-inclusive profession to contemplate the meaning of rehabilitation counseling in the context of family identity. The working alliance between the counselor and the family eschews the clinical for an intentional community of purpose that emerges from a joint common cause: full community inclusion for the person with a disability, and support for the participating family.

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.

The fundamental challenge in partnering with persons with diabetes to improve health outcomes is that while the clinical treatment and education occur in the health care provider’s office, patients’ health behaviors occur on an ongoing basis outside the provider’s office, in the patient’s home, school, community, and workplace. Without insulin, the glucose accumulates dangerously in the blood causing the symptoms of diabetes and damaging body organs. The disease develops gradually as normal glucose tolerance progresses to impaired glucose tolerance to overt diabetes under the influence of risk factors such as obesity, inactivity, genetics, and a high carbohydrate diet. The early stages of diabetes may be asymptomatic; however, as hyperglycemia worsens, frequent urination, frequent thirst, fatigue, and weakness will occur. Diabetic neuropathy correlates directly with the duration of diabetes and the degree of poor glucose control.

This chapter begins with a discussion of the importance of a clear understanding of psychiatric diagnoses for all allied health professionals. Given the historical prevalence of psychiatric diagnoses, it is a good use of our time to review the seminal diagnostic systems that inform diagnosis in clinical counseling. Clinical counselors and other mental health professionals may be the first health care providers to have established any type of therapeutic relationship with their client, revealing information that previously had never been a focus of any other professionals’ clinical attention. The accurate diagnosis of psychiatric conditions leads to appropriate referrals, selection of the most appropriate evidence-based treatments, and ultimately amelioration or elimination of problematic symptoms that negatively impact health and functioning. The most commonly used diagnostic system for psychiatric conditions worldwide is the International Classification of Diseases (ICD) system.

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.

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.

To develop an appreciation for the electronic health record (EHR) it is important to understand the barriers to its adoption among mental health professionals. This includes the belief that it is easier and more convenient to document care using paper and pen. The chapter mentions a scenario, where even if the emergency room personnel were able to gain access to the patient’s paper medical record, they would have had a hard time understanding the record’s content. Another common problem with the paper record is the lack of organization especially under circumstances in which the patient has multiple mental health issues. After addressing a major concern with EHRs among mental health professionals and the inherent problems with paper records, the chapter focuses on the functionality that makes the EHR an appealing proposition. When health care data are stored electronically, the capability to share data among health care providers is heightened.

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.

This chapter examines the claims and evidence for a variety of treatments that fall under the umbrella term of “complementary and alternative medicine (CAM)” used to treat physical and mental health problems. Evidence-based treatments (EBTs), Non-EBTs, Poorly studied treatments (PSTs) are three types of treatments, each with varying levels of evidence for its use or nonuse. A placebo can refer to any type of sham or inactive medical treatment or procedure. Most susceptible to the placebo effect appear to be pain, depression, asthma, sleep problems, and irritable bowel syndrome. In addition to the placebo effect, a particularly frequent way that bias can creep into our decision making about health care is something called regression to the mean (RTM). In blinded studies, the trial participants are divided into two groups: active treatment and placebo control. Many CAM practitioner groups have successfully lobbied to obtain governmental licensure and regulation.

This chapter reviews the research on expect respect, second step, and the recognize, understand, label, express, and regulate emotions (RULER) program, curricula with outcome data from US schools for step-by-step implementation by mental health professionals in the hopes of ameliorating this serious epidemic and enhancing the academic, behavioral, social, and emotional functioning of children and adolescents. School bullying and peer victimization are pervasive phenomena that affect many youth. Bullying may inflict harm or distress on the targeted youth including physical, psychological, social, or educational harm. Direct bullying is a relatively open aggressive act on the targeted youth, whereas indirect bullying is not directly communicated to the student being targeted. Moreover, physical, verbal, relational, and damage to property have been identified as specific forms or dimensions of bullying. Positive Behavioral Interventions and Supports (PBIS) is an evidence-based framework for reducing a wide variety of problem behavior in school settings.

This chapter provides information on the best ways of providing optimal services for culturally and linguistically diverse (CLD) children and their families. One factor that significantly influences child well-being is whether the child is raised in a low-socioeconomic-status household. Despite the challenges and complexities involved in service provision, professionals have an ethical and professional responsibility to appropriately assess and intervene when diverse students struggle. Assessing language proficiency, acquiring relevant background information and selecting and using appropriate assessment tools are considered best practices when working with English language learners (ELLs). The evidence-based practice movement has become a professional priority given the importance of identifying effective interventions that can enhance service delivery to children, adolescents, and adults. The chapter concludes with a bibliography of readings and resources to assist mental health professionals in delivering high-quality services.

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.

Reproductive health for teens has primarily focused on preventing or delaying pregnancies and sexually transmitted infections (STIs) rather than treating infertility issues, even though these concerns exist. This chapter presents a case exemplar for considerations related to adolescent infertility. It points to the need for improved understanding of current adolescent infertility rates how many women are actually affected but not evaluated carefully by health care providers. Research on family planning and promoting adolescent fertility options among adolescents with chronic illness such as sickle cell disease, immunotherapy, and oncology conditions that use gonadotoxic treatments has increased in recent years. Although concerted health care and regulatory efforts should continue to focus on preventing unwanted pregnancies among teens, it is critical that efforts include dispelling false beliefs about fertility and providing accurate information about menstrual cycles and conception.

This chapter discusses the client’s ability to self-regulate and handle high levels of affect. The maintaining factors of the effects of trauma- or anxiety-based disorders include fear, avoidance, and loss of control. Building or reinforcing coping strategies allows the client to regain some sense of control over what is happening, which, in turn, can have a positive impact on the fear and avoidance. Many novice Eye Movement Desensitization Reprocessing (EMDR) therapists report additional performance anxiety when their client is a mental health professional. Hyperarousal after a traumatic experience is normal. It occurs when a person’s brain believes that person is at risk again because it misreads an external signal or trigger. Grounding techniques can be taught very easily to clients and are another tool to help the client prepare for dealing with a possible abreaction while undergoing EMDR therapy.

Rehabilitation counselors work with individuals with chronic illness or disability (CID) and the profession is responding to the growing need for family support. There has been a call for family inclusion in research agendas and training programs. This chapter describes the impact of progressive chronic illness on the family and explores its meaning in the context of rehabilitation counseling. It identifies the role of the rehabilitation counselor in serving the family. The chapter discusses the impact on families and rehabilitation counseling of HIV and multiple sclerosis (MS) as examples of chronic illness. The majority of rehabilitation literature framing psychosocial adaptation to CID has focused on antecedents, process, and outcomes. Rehabilitation professionals should recognize the roles family members will take such as caregivers, de facto health providers, partners, and key social supports for the member with a CID.

Today, disability is conceptualized as a biopsychosocial phenomenon that reflects an interaction between the person and her or his environment, of which the family system is a critical component. This chapter provides rehabilitation health professionals with a set of tools (i.e., theoretical constructs) used to understand families of a person with a disability from family systems and social–ecological perspectives. It familiarizes rehabilitation health professionals with specific family systems and social–ecological interventions as they relate to individuals with a disability and increases rehabilitation counselors’ sensitivity to the cultural and social context that impacts the families of a person with a disability. The chapter then introduces rehabilitation health professionals to a social–ecological approach that addresses the needs of families of an individual with a disability, and addresses the limitations of family systems and social–ecological therapies as well as the implications of these approaches for training and practice in rehabilitation health.

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.

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.

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.

This chapter discusses the importance of optimal nutrition through the first year of life and explains the necessity of vaccinations for this patient population. It applies the knowledge gained into practice to provide families with information to promote safety for the infant after discharge home. This will include car seat safety, safe sleep practices, smoke and drug exposure, as well as infection control. The birth of an infant is an exciting time for families. As health care providers, it is the responsibility to provide accurate, up-to-date information to promote the healthy growth and development of the infant and family unit. The American Academy of Pediatrics (AAP) recommends the use of child safety seats for all newborns, infants, and children. Exposure to tobacco smoke during pregnancy, at delivery, and after delivery may have lifelong effects on infants. The chapter presents case studies to assure parents to care for their baby.

Turning relationships with health care providers into social support sounds great for all aspects of medicine. There is no harm in using social support and humor together. A close look at the research on immune function, allergies, erectile dysfunction, and longevity reveals some promise for laughter’s health benefits. Nevertheless, throwing away antibiotics in favor of animation is ill advised. In addition, a blithe, nonchalant attitude about symptoms of sickness might lead people to avoid health professionals, making illness worse. White blood cells of various types play an integral role in the battle against illness. Most experiments on humor and health focus on these indices by sampling a test tube full of blood or spit. Finding out the exact number of antibodies in human fluids is not a kitchen-sink exercise. Nevertheless, researchers put together as much data as possible on shoestring budgets.

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.

“If some is good, more must be better”. This colloquialism captures a common feeling that can pervade many aspects of our lives, childbearing certainly among them. To understand why iatrogenic multifetal pregnancies are so common, it is essential to consider how the processes involved in reproduction. The ways they are manipulated by those who would assist infertile patients in navigating them, and understood by those patients themselves, shape the decision making process of both care providers and patients. Responding to concerns about the quality of treatment available and about patient access to information about treatments’ effectiveness, in 1992, the US Congress passed the Fertility Clinic Success Rate and Certification Act (FCSRCA), mandating that all clinics performing assisted reproductive technologies (ART) to provide data annually for all ART procedures performed to the Centers for Disease Control and Prevention (CDC) in a standardized manner.

This chapter addresses the key principles of sport, exercise, and performance psychology. It reflects the broadening of sport psychology studies to encompass more widespread human performance research. The most well-established model explaining factors likely to increase the chance of injury is Williams and Andersen’s Stress-Injury Model. They proposed that a history of stress, insufficient coping resources, and personality characteristics, all of which increase the stress response, increase susceptibility to injury. Integrated model of response to sport injury is intended to demonstrate the dynamic and complicated nature of the injury and rehabilitation experience. Most athletic trainers are educated on the body, thus they know how to identify the injury, treat the body part, and create a rehabilitation program to initiate recovery and return to play; however, they also spend a great deal of time with injured athletes and are privy to their frustrations. This connection between injured athlete/performer and health care provider is significant as research has found better adherence to rehabilitation programs when athletes believe their health care professional cares about their well-being.

This chapter addresses the key principles of sport, exercise, and performance psychology. It reflects the broadening of sport psychology studies to encompass more widespread human performance research. The chapter provides several suggestions to injured individuals related to goal setting, using social support, and managing the mood by thinking positively, focusing on what one can control, and even laughing. As future health care professionals, coaches, sport and exercise psychologists, or even parents, it is important to understand the possible negative ramifications of injury while simultaneously understanding that there are steps people can take to minimize their chances of getting injured and steps to improve their well-being during the injury process. Delays in recovery suggest the importance of delaying day after competition practices to minimize chances of injury due to physical fatigue, slower cognitive function, and suppression of lower body power.

Support for persons with intellectual and developmental disabilities (I/DD) is a lifelong proposition for families. The activities of support are integral to their lives and part of their identities. As a community, people aspire to a network of formal support providers working in concert and collaboration to provide for the health, education, employment, and general well-being of the person with I/DD. This chapter addresses the strengths, needs, and lives of families of persons with I/DD and considers how these variables affect client/family relationship and partnership with rehabilitation counselors (RCs). From the counseling perspective, a working alliance always begins with an appreciation of the person, and family, in his or her environment. For families of a person with I/DD, this will require a thorough understanding of developmental disabilities, issues affecting family participation, environment resources, and considerations for RCs.

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.

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.

This chapter shows some opening remarks for mental health professionals (MHPs) and trainees who are new to doing cognitive behavioral therapy (CBT) and positive psychology (PP) treatments with kids suffering from an internalizing disorder. It reviews the parental lunacy concept and presents some overview comments regarding positive ethics and multiculturalism. MHPs need to know how to heal pain as well as how to promote joy and meaning in kids, teens, and their families. Ethics should focus not only on how a few psychologists harm patients but also on how all psychologists can do better at helping them. This view of ethics is called positive or active ethics. Kid clinicians operating predominantly from a perspective of maximizing understanding, healing, and happiness can be filled with a sense of purpose, flow, and self-efficacy. Minority youth are treated differently than Caucasian youth when interacting both with traditional mental health systems.

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.

This chapter reviews theories that are particularly useful in explaining child maltreatment: biological, social-relational, neurobiological, psychodynamic, learning, and cognitive theories. Biologically based theories addresses children’s physical development, and social–relationally based theories addresses interaction between children and their parents, is highly useful for understanding and intervening in child abuse, particularly with young children. Neurobiological theories focus on children’s brain development as influenced by traumatic events, particularly child maltreatment. Child Abuse Prevention and Treatment Act (CAPTA) defined child abuse and neglect and established mandatory reporting policies. Child neglect is failing to provide for a child’s basic needs, including physical, educational, emotional needs, or medical care. CAPTA categorizes child maltreatment as physical abuse, sexual abuse, emotional abuse, or neglect. Social workers, other health care professionals, and laypersons have the responsibility of not only understanding the past but also making changes for a better future.

This chapter defines emerging disabilities; explores medical, psychosocial, and vocational implications of emerging disabilities that distinguish them from traditional disabilities; and provides demographic characteristics of individuals who are most vulnerable to acquiring emerging disabilities. It examines some social and environmental trends that have contributed to the development of emerging patterns and types of disabilities including advances in medicine and assistive technology, globalization, climate change, poverty, violence and trauma, the aging American populace, and disability legislation. Psychological and physical trauma from warfare, violent crime, intimate partner violence, and youth violence can result in permanent physical, cognitive, and psychiatric disabilities. Diagnostic uncertainties, misdiagnoses, and skepticism on the part of medical providers are frequently associated with emerging disabilities. Women also represent a population that is at an increased risk of acquiring emerging disabilities and chronic illnesses. Rehabilitation systems are still not fully prepared to address the multifaceted needs of individuals with emerging disabilities.

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.

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.

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.