NCMHCE Exam Review Podcast Assessment Part 2 Brought to you by Counselor Toolbox Podcast and AllCEUs.com Counselor Continuing Education where you can get Unlimited on demand CEUs for $59 or unlimited live webinars for $40

Objectives ~ Define assessment ~ Review acronyms to help you remember what to look for when assessing for a problem. What is Assessment ~ Assessment is the process of gathering, analyzing and integrating information into a comprehensive picture that describes ~ The nature, frequency, intensity and duration of the client’s problems ~ The roles the client, significant others and the environment/community play in the current issues ~ The functioning of the client and significant others ~ Client motivation to address presenting issues ~ Resources needed to resolve problems and effectively participate in treatment. Presenting Issue ~ Represents the problems that are foremost in the client’s mind ~ Denial of any problems may also provide information into client insight, judgement and motivation Evaluating the presenting issue ~ When did it begin? ~ What makes it worse? Better? ~ How often does it occur and to what intensity? ~ If the client is reporting multiple symptoms, assess the above for each and identify which symptom presented first. ~ What are the antecedents of (triggers/precipitants) the problem? ~ How do you feel when the problem occurs? What are you thinking? ~ Describe what happens right after the problem (reinforcers), habitual responses. Stressors ~ What stressors are occurring and what is their frequency, intensity and duration? ~ How does the client deal with the stressors? ~ Are the stressors impacting the course of the presenting problem? Emotional Range ~ Emotional control (dysregulation or flattening) can impact the client’s health, relationships and functioning at work or school. ~ People who avoid dealing with emotions may develop depression, anger or anxiety ~ People who experience dysregulation may also develop depression, anger or anxiety ~ Trauma-induced changes in emotional range may also impact the client’s ability to function ~ Remember that affect is the current, transient state. Always assess affect. Mood Disorders ~ When the client presents with mood symptoms, inquire about ~ Previous episodes of the same symptoms ~ How he or she has dealt with them before ~ If there was a previous episode, was there full remission?

Depression ~ What to look for ~ Anhedonia ~ Dysphoria ~ Sleep changes ~ Appetite changes ~ Changes in psychomotor behavior ~ Reduction in libido ~ Reduced energy ~ Nonverbals indicating any of the above

~ Highly self-critical ~ Cognitive distortions ~ Hopelessness/pessimism ~ Irritability ~ Guilt/shame ~ Difficulty concentrating ~ Withdrawal from relationships

Depression Mnemonic A SAD FACES ~ A = Appetite (Weight Change) ~ S = Sleep (Insomnia / Hypersomnia) ~ A = Anhedonia ~ D = Dysphoria ~ F = Fatigue ~ A = Agitation / Retardation ~ C = Concentration Diminished ~ E = Esteem (Low) / Guilt ~ S = Suicide / Thoughts of Death

Mania ~ What to look for ~ Elevated mood ~ Grandiosity ~ Irritability/aggression ~ Pressured speech ~ Flight of ideas ~ Restlessness ~ Hypersexuality ~ Impulsivity

~ Limited insight ~ Poor concentration ~ Impatience ~ Gregariousness ~ Provocativeness

Mania Mnemonic DIG FAST ~ Distractibility ~ Indiscretion ~ Grandiosity ~ Flight of ideas ~ Activity increase ~ Sleep deficit ~ Talkativeness Anxiety ~ What to look for ~ Irritability/edginess ~ Uneasiness/worry ~ Panic ~ Hypervigilance ~ Psychomotor agitation/Nervous habits ~ Nonverbals indicative of worry

~ Ruminating ~ Persistent worrying about a variety of things ~ Difficulty concentrating ~ Withdrawal from relationships ~ Highly critical of self ~ Sleep problems ~ Clinginess/dependency Anxiety Mnemonic: Worry WARTS ~ Worry

~ Worn out ~ Absentminded ~ Restless ~ Touchy ~ Sleepless PTSD ~ What to look for: ~ Exposure to a traumatic event ~ Re-Experiencing (Dreams, memories, flashbacks) ~ Avoidance of reminders ~ Negative thoughts or feelings that began or worsened after the trauma and/or difficulty experiencing positive emotions ~ Trauma related arousal and reactivity PTSD ~ Disinterest in usual activities ~ Re-experience ~ Event preceding symptoms ~ Avoidance ~ Month or more of symptoms ~ Sympathetic arousal Substance Abuse – SAD CLIPS ~ Signs of intoxication or withdrawal ~ Slowed reflexes ~ Aroma of drugs ~ Difficulty concentrating

~ Confusion ~ Lowered inhibitions ~ Impaired Coordination ~ Pupils ~ Slurred speech

Physical Symptoms – CLASSED ~ Is the client under a doctors care? If so why? ~ If there are obvious long-standing physical/developmental issues, how have they impacted the client? ~ Convulsions or seizures ~ Libido ~ Appetite ~ Sleep ~ Sex hormones ~ Energy ~ Dizziness or fainting ~ Describe childhood health

Medical Referral- EAT LOADS ~ Eating Disorder ~ AIDS/HIV ~ Tuburculosis

~ Long standing depression ~ Ongoing physical complaint (chest pain, dizziness, abdominal pain, chronic cough, fatigue) ~ Abrupt personality or behavioral change ~ Delirium/Dementia ~ Substance abuse

Test Taking Tip ~ Everything in the NCMHCE has one clear diagnosis and assumes a mutual respect between client and counselors. Thus, the test is measuring for ideal questions and treatments, even if those might not be appropriate or applicable in some real-world situations. ~ In reading the initial scenario, focus on the symptoms and all components of the question. ~ Does the question indicate the client is grieving and withdrawn? Then you would look for remedies that target that area such as support groups ~ Consider whether the information that is being requested is actually beneficial and whether it will narrow down the diagnosis. Asking too many questions will lower your score ~ Gather support FOR your diagnosis NOT to rule out other things.