National Social Work Ebook Continuing Education

This interactive National Social Work Ebook contains 15 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.

Social Work Continuing Education

Elite Learning

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ELITELEARNING.COM/BOOK Complete this book online with book code: SWUS1524 15-hour Continuing Education Package $74.95


Chapter 1: Cultural Humility for Behavioral Health Professionals [6 Contact Hours] 1 The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and mental healthcare professionals to use when working with diverse patients in a culturally humble manner. Chapter 2: Clinical Neuropsychology: Applications in Practice, 3rd Edition [2 Contact Hours] 41

This intermediate course will provide information about the origins of the field of clinical neuropsychology, how clinical neuropsychologists are trained, the functional organization of the brain, what happens during a typical neuropsychological evaluation, multicultural considerations, how and when to make a referral to a neuropsychologist, how to read a neuropsychological report, and detailed examples of common referral questions to neuropsychologists for child, adult, and geriatric patients. Chapter 3: Professional Ethics and Law [4 Contact Hours] In practicing a profession, three interrelated but distinct areas come into play: professional values, ethics, and the law. Although all three areas are related to one another, sometimes they can conflict with one another. Sometimes, also, values can conflict with other values, as can ethics. When ethics conflict, an ethical dilemma results. When professional values conflict with professional ethics, the organized and generally agreed-upon framework of an ethical code is vital. When ethics and the law collide, it may be necessary to consult the relevant professional organization. The American Medical Association, for example, has become involved when the law required that a physician be present at an execution. The AMA code of ethics explicitly forbids physicians from participating in capital punishment (Henry, 2018). This intermediate course is intended to provide healthcare professionals such as social workers with an overview of how professional values, ethics, and the law come into play in mental health practice. Chapter 4: Suicide Risk in Adults: Assessment and Intervention, 2nd Edition [3 Contact Hours]


94 The purpose of this course is to assist clinicians in understanding factors that contribute to suicidal behavior, conducting comprehensive suicide risk assessments, and engaging patients in brief, empirically-supported interventions to reduce risk of death. This course meets an increasing demand of many mental health professionals seeking information about working with suicidal clients and conducting empirically-supported suicide risk assessments. This intermediate-level course is designed for social workers, mental health counselors, marriage and family therapists, educators, community-based program administrators, providers, and psychologists. The course will cover major risk factors, demographics and warning signs for suicidal behavior, as well as provide guidance on clinical risk assessment and options for intervention. Although the information presented here is useful to many mental health providers, no continuing education course can provide all the information that may be required in working with each individual who comes for help. It is therefore important that mental health providers consult knowledgeable colleagues, review the most recent articles and books on the topic of suicide, read and understand the risk-management practices of their agency, and maintain awareness of applicable local and state laws concerning the management and referral of suicidal persons. References and resources for those interested in pursuing further education on this topic are provided at the end of the course.

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.



Book Code: SWUS1524


What are the requirements for license renewal? License Expires

Contact Hours and Mandatory Subjects

Varies depending on state.

See state requirement chart on the following pages.

How much will it cost?



Chapter 1: Cultural Humility for Behavorial Health Professionals


$54.00 SWUS06CH

Chapter 2: Clinical Neuropsychology: Applications In Practice, 3rd Edition


$18.00 SWUS02CN

Chapter 3: Professional Ethics and Law


$32.00 SWUS04PE

Chapter 4: Suicide Risk in Adults: Assessment and Intervention, 2nd Edition


$27.00 SWUS03SR $74.95 SWUS1524

Best Value - Save $56.05 - All 15 Hours


How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you an approved provider? Colibri Healthcare, LLC (formerly Elite Professional Education, LLC), Provider Number 1147, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 5/5/2023 – 5/5/2026. Illinois Department of Financial and Professional Regulation (Social Work Sponsor #159.001485). Florida Board of Social Workers, and Ohio Counselor, Social Worker And Marriage And Family Therapist Board – (Provider #50-4007), New York State Education Department Continuing Education Provider #SW-0004. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at Work you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at, or call us toll free at 1-866-653-2119, Monday - Friday 9:00 am - 6:00 pm, EST.


Book Code: SWUS1524


How to complete this book for CE credit

Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must complete online, provide your customer information and complete the evaluation. Read the instructions below to receive credit and your certificate of completion.

Scan this QR code to complete your CE now!

Fastest way to receive your certificate of completion

Online Please read these instructions before proceeding. IF YOU’RE COMPLETING ALL COURSES IN THIS BOOK: • Go to and enter code SWUS1524 in the book code box, then click GO . • If you already have an account created, sign in with your username and password. If you don’t have an account, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey. IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to and enter code that corresponds to the course below, then click GO . • Each course will need to be completed individually.

Course Name

Course Code

All 15 Hours in the book


Cultural Humility for Behavioral Health Professionals


Clinical Neuropsychology: Applications In Practice, 3rd Edition


Professional Ethics and Law


Suicide Risk in Adults: Assessment and Intervention, 2nd Edition




Book Code: SWUS1524

How Many Continuing Education Hours do I Need? NOTE: CE Rules can change. Always check your state board for the most up-to-date information.






30 40


3 hours in ethics; 3 hours in clinical (if licensee has a clinical designation). 6 hours in substance abuse education; 6 hours in cross-cultural education, of which three hours include issues relating to Alaska Natives; 3 hours in professional ethics; and 3 hours in teletherapy practice. 3 hours in behavioral health ethics or mental health law; 3 hours in cultural competency and diversity.






Arkansas California

30 36

15 36

3 hours of ethics.

6 hours of laws and ethics each renewal; 7 hours of HIV/AIDS (required first renewal only); 3 hours of Telehealth (one time requirement for renewals after 7/1/2023). Marriage and Family Therapy (6 hours) per BPC section 4999.20 *Only required for the following LPCCs – otherwise course is not required: • LPCCs who choose to assess or treat couples or families. • LPCCs supervising an MFT trainee or Associate MFT. • LPCCs supervising an LPCC or Associate PCC gaining experience with couples or families.


40 15

20 10



1 hour on cultural competency; 2 hours mental health conditions common to veterans and family members of veterans, including (1) determining whether a patient is a veteran or family member of a veteran, (2) screening for conditions such as post-traumatic stress disorder, risk of suicide, depression and grief, and (3) suicide prevention training (first renewal and once every six years thereafter).


40 40

40 40

6 hours in ethics; 1 hour in mandatory reporting.

District of Columbia

6 hours in ethics, 2 hours in LGBTQ, 2 hours in COVID CEs, 4 hours in relevant topics designated as D.C. Health Public Health Priorities. In person CEUs waived for 2023 renewal. 2 hours Preventing Medical Errors in Behavioral Health (each renewal); 3 hours Ethics & Boundaries in Psychotherapy - or - 3 hours Teletherapy (each renewal); 2 hours Domestic Violence (required every third renewal); 3 hours Florida Laws and Rules (required every third renewal); Supervisors: 4 hours Qualified Supervision Training (every third renewal). 5 hours of ethics relating to professional counseling, social work, marriage or family therapy (must be in an interactive format: live or synchronous). 15 hours have to relate to specialty/profession.







Idaho Illinois

20 30

20 15

1 hour of ethics.

3 hours of ethics; 3 hours of cultural competency, 1 hour of sexual harassment prevention; 1 hour of implicit bias. At least 20 hours of Category I Continuing Education and 2 hours of Category I Ethics Continuing Education.





27 40 30

27 40 30

3 hours in ethics.


3 hours in ethics; 6 hours related to the diagnosis and treatment of mental disorders. 3 hours of ethics; 6 hours of suicide assessment, treatment and management (every six years); 3 hours in domestic violence and elder abuse; 1.5 hours in pediatric abusive head trauma (every six years); 3 hour supervision course for supervisors. 3 hours in ethics; 10 hours in diagnosis and treatment (LCSW); 3 hours in clinical supervision if designated a supervisor. 4 hours in ethics (6 hours for conditional licensees); 12 hours in family and intimate partner violence (one time requirement). 3 hours in ethics and professional conduct, including boundary issues, or pertaining to the standards of practice and laws governing the profession of social work in Maryland; 3 hours in supervision if a supervisor.




10 (limit waived through 8/31/2023)








Book Code: SWUS1524









2 hours in anti-racism with a focus on oppression; 1 hour in anti- discrimination; 2 hour Board-approved training in domestic and sexual violence (one time requirement).

Minnesota Mississippi

40 40

20 20

1 hours in ethics; 4 hours in cultural responsiveness.

4 hours of ethics; 2 hours of cultural diversity/multicultural issues/cultural competency awareness; 1 hour in mandated reporting for all client populations. 3 hours of ethics; 2 hours of suicide assessment, referral, treatment, and management; 3 hours in explicit or implicit bias, diversity, inclusion, or cultural awareness/ competency/humility.




Montana Nebraska

20 32 30

20 20 30

2 hours related to suicide prevention. 2 hours of mental health ethics.


2 hours in suicide prevention and awareness; 2 hours in cultural competency, diversity, equality and inclusion; 4 hours in ethics (LCSW and LISW require 36 CE hours).

New Hampshire

40 40

20 40

6 hours of ethics and 3 hours of suicide prevention (Category A).

New Jersey*

5 hours of ethics; 3 hours of social and cultural competence; 1 hour of prescription opioid drugs* *Not all courses contained in this book are approved for New Jersey. New Jersey accepts courses that are approved by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) programs, these courses can be found online at:

New Mexico

30 36 40 30 30 16

30 12 20 10 30

6 hours in cultural awareness.

New York

3 hours in appropriate professional boundaries.

North Carolina North Dakota

4 hours of ethics.

2 hours of ethics; LPCCs require an additional 10 clinical hours.


3 hour of ethics; 3 hours of supervision training for supervising professional counselors. 3 hours of ethics; 3 hours of supervision for supervisors. *Oklahoma does not accept NBCC approval for Counselor continuing education credit. 6 hours of ethics (4 hours LMSW, 3 hours RBSW); 6 hours of cultural competency (4 hours LMSW, 3 hours RBSW); 2 hours of suicide risk assessment, training and management (all). 3 hours in ethics; 2 hours in state-approved child abuse recognition and reporting; 1 hour in suicide prevention.




40 - LCSW 30 - LMSW 20 - RBSW

40 - LCSW 30 - LMSW 20 - RBSW




Rhode Island South Carolina

30 40


3 hours in ethics; 3 hours in cross-cultural practice.


Supervisor must complete 10 hours of supervision oriented continuing education during every two-year licensure period.

South Dakota

30 15

30 10



3 hours of ethics; 2 hours of Board-approved suicide prevention (every 4 years); 1 hour rules and regulations of the Board. 6 hours of ethics (completion of Texas jurisprudence exam will count as 1 hour of continuing education in counselor ethics); 1 hour of human trafficking prevention; 6 hours of supervision if licensee has supervisor status; 3 hours in cultural diversity or competency.





40 20 15 36


6 hours of ethics; 2 hours of suicide prevention.

Vermont Virginia


1.5 hours in ethics.

15 26

3 hours in ethics or the standards of practice or laws.


6 hours of professional ethics; 6 hours of training in suicide assessment, treatment and management. The training must be repeated once every six years. 3 hours of ethics and 2 hours must be specific to veterans and family members of veterans; 3 hours of supervision of clinical counseling if have supervisor status. 4 hours of ethics and professional boundaries (must be in an interactive format: live or synchronous).

West Virginia







45 3 hours of ethics; 3 hours of suicide assessment or intervention. NOTE: CE Rules can change. Always check your state board for the most up-to-date information. 45



Book Code: SWUS1524

Chapter 1: Cultural Humility for Behavioral Health Professionals 6 CE Hours

Release Date: July 10, 2023 Expire Date: July 10, 2027 Upon successful completion of this course, continuing education hours will be awarded as follows: Social Workers and Psychologists: 6 Hours Professional Counselors: 6 Hours

Faculty Author :

the past sixteen years. She is a Fulbright Fellow in Global Health and has been featured in The Washington Post, The Wall Street Journal, CNBC, NBC, ABC news, WebMD, and USA Today. Dr. Jameca Woody Cooper has no significant financial or other conflicts of interest pertaining to this course. objectives as a method to enhance individualized learning and material retention. ● Provide required personal information and payment information. ● Complete the mandatory Course Evaluation. ● Print your Certificate of Completion. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Dr. Jameca Woody Cooper is a Counseling psychologist, educator, entrepreneur, author, and civic leader. Dr. Jameca holds a master’s and Ph.D. in Counseling Psychology from the University of Missouri Columbia. Her company, Emergence Psychological Services, has served the Saint Louis community for How to receive credit ● Read the entire course online or in print. ● Depending on your state requirements you will be asked to complete: ○ A mandatory test (a passing score of 75 percent is required). Test questions link content to learning Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative Disclosures Resolution of conflict of interest

to diagnostic and treatment options of a specific patient’s medical condition.

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Learning objectives After completing this course, the learner will be able to: Š Describe dimensions of diversity in the United States (U.S.).

Š Explain cultural humility as an essential part of counseling, including core components and key considerations. Š Describe the role of societal and institutional accountability within the counseling context. Š Differentiate cultural humility and multicultural competency. Š Illustrate the different elements of cultural humility. Š Examine the cultural variables that impact help-seeking.

Š Identify factors that can interfere with the counseling relationship between a clinician and clients of diverse cultural backgrounds, including issues related to oppression, privilege, and marginalization. Course overview The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists

and mental healthcare professionals to use when working with diverse patients in a culturally humble manner.


The American population is highly diverse. In the upcoming years, the U.S. will continue to increase in diversity. The U.S. Census Bureau projects that by 2050 the U.S. population will look different. Estimates say that Hispanic, Asian, and African American populations will grow (Culverhouse College of Business, 2019). “In 2020, 33.8 million people reported being more than one race, more than a threefold increase from 2010, when 9 million people, or 2.9% of the population, identified that way.” (Quarshie & Slack, 2021). Professionals engaged in counseling must become increasingly self-aware. They must understand how their unique individual experiences influence their worldviews and values and how

the unique personal experiences of their clients influence each client’s worldviews and values. Further, various ethnic and racial groups may have diverse beliefs, social structures, interactional patterns, and expectations. There are various types of diversity, including age, economic class, sexuality, gender identification, and disability. Because of these factors, counselors should cultivate cultural humility skills. Counselors who practice cultural humility use four intersecting elements of ongoing self-reflection, self-critique, lifelong learning, and a commitment to advocacy and institutional change to guide their work with clients (Hook et al., 2013; Ratts et al., 2015). The cultural humility framework recognizes the concepts of power, privilege, and oppression and, thus, calls on counselors to be agents for change and

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Book Code: SWUS1524

promoters of social justice (Ratts et al., 2015). Counselors with humility can be “other-focused” and accurately view themselves, their values, and their biases (Davis et al., 2013). These qualities allow counselors to practice as partners with clients from various ethnic and racial backgrounds and other dimensions of diversity. Culturally humble counselors can recognize their own beliefs and values and act as allies with clients working toward positive personal and more considerable societal change (Hook et al., 2013). It helps develop cultural humility that counselors understand the sociopolitical landscape in the U.S. concerning issues of race, immigration/refugee status, disability, sexual orientation, gender identification, and socioeconomic class (Ratts et al., 2015). The 2016 presidential election has revealed the continued deep divisions within our country regarding attitudes toward racial and ethnic diversity, disability, sexual orientation, and gender identification. The Southern Poverty Law Center (2016) has reported an increase in incidents of both harassment and intimidation during and after the election. These incidents have been perpetrated against various minority groups, including African Americans, immigrants, and the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) population, Jewish individuals, and Muslims (Miller & Werner-Winslow, 2016). In the U.S., there are significant economic, health, education, employment, and housing disparities based on minority status (Agency for Healthcare Quality and Research [AHQR], 2015; Orfield, Frankenburg, & Siegel-Hawley, 2016; Proctor, Semega, & Kollar, 2016; Turner et al., 2013). Minority status, as used in

this course, pertains to race and ethnicity and belonging to any marginalized group, such as having a disability; identifying as transgender, lesbian, gay, or bisexual; ascribing to a minority religion; and so on. Social disparities in access to resources and experiencing acts of racism and discrimination can lead to higher stress and a higher risk of developing mental health issues. Despite an increased need for services, clients with marginalized identities have less access to quality mental health services (AHQR, 2015, 2016). This highlights the ethical responsibility of counselors to develop multicultural and social justice counseling competencies to work with clients effectively. Cultural humility in counseling goes beyond counselors knowing specific cultural and minority groups with whom they work. It is a way of practicing counseling that requires counselors to be aware of how their own culturally embedded ideals, beliefs, and prejudices affect their interactions with diverse clients (Hook et al., 2013). This requires counselors to reflect on themselves and their interactions continually and critically with clients. Through reflection, counselors can improve interactions with clients through honest appraisals of how their personal biases and deficits play into each counseling session and each relationship, allowing them to address power imbalances within the counseling relationships and institutional levels. This intermediate-level course presents an introduction to cultural humility and offers tools for practitioners. It offers mental health counselors, marriage and family therapists, and psychologist’s tools to use in working with diverse clients in a culturally humble manner.


What is cultural humility? Cultural humility is defined as having an open-minded attitude when learning about the elements of other cultures (MasterClass, 2022). Cultural humility is going beyond the regular diversity training and being intentional about learning about different cultures instead of relying on one’s own reading or study. It is not enough to think about our values, beliefs, and social position in today’s context. To practice true cultural humility, a person must also be aware of and sensitive to historical realities like legacies of violence and oppression against certain groups of people. According to Tervalon and Murray-Garcia (1998), cultural humility is defined as a “process that requires humility as individuals continually engage in self- reflection and self-critique as lifelong learners and reflective practitioners.” Tervalon and Murray-Garcia represent cultural humility as a lifelong commitment to self-evaluation and self- critique, balancing power, and advocacy. When practitioners commit to lifelong self-evaluation, this implies a position of humility and willingness to learn, even when learning may be difficult or uncomfortable. Balancing of power suggests a respectful partnership with patients and families that values their self-knowledge and lived experiences alongside our expertise in our field. Finally, advocacy involves individuals moving beyond the interpersonal to impact larger (i.e., institutional, structural) systems. Figure 1 shows the different components of cultural humility defined by Tervalon and Murray-Garcia.

Figure 1. The Five Rs of Cultural Humility

Note . Adapted from “Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education,” by Tervalon, M., et al.,1998. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.

Book Code: SWUS1524

Page 2


Diversity is a multidimensional concept that refers to many aspects of an individual that combine to comprise an overall sense of self. The U.S. continues growing and becoming a country where all cultural groups are represented. The past several censuses have shown increased racial and ethnic diversity among the U.S. population. The latest Census Bureau estimates indicate that nearly 4 of 10 Americans identify with a race or ethnic group other than White and suggest that 2010 to 2020 will be the first in the nation’s history in which the White population declined in numbers. In 2019, most of the nation’s population under 16 identified as a racial or ethnic minority. This group, Latino or Hispanic and Black individuals, comprise nearly 40% of the population (Frey, 2020). Moreover, diversity occurs within a cultural and social context where variances within the general population are treated differently based on society’s social, political, and cultural constructs. Some dimensions of diversity include race, socioeconomic class, gender, sexual orientation (i.e., identifying as lesbian, gay, bisexual, transgender, queer/ questioning [LGBTQ]), gender identification (i.e., identifying as transgender), and disability. Although this is not an exhaustive list of all elements of individual diversity, it does address many prominent diversities dimensions an individual may have and determine where that individual falls within the societal hierarchy. Dimensions of diversity also empower some members of society while oppressing and marginalizing other members of society (Sue & Sue, 2016). Counselors need to understand the effects of diversity on a client in multiple domains, including a client’s mental health and well-being. In some instances, a client’s identity constructs may be a source of great strength, and in other contexts, they may contribute to increased stress. For example, on a micro level, simply being different increases the threat of victimization and bullying (Tippett & Wolke, 2014). When individuals differ from the majority group, a concept referred to as “person–group dissimilarity” (Juvonen & Galvan, 2009, p. 300), they are at risk of victimization. For instance, being the only individual in a school, workplace, or community group who possesses a particular trait increases the risk of victimization, Race and Ethnicity Race is a human-invented, shorthand term used to describe and categorize people into various social groups based on characteristics like skin color, physical features, and genetic heredity. Cultural humility is essential as it relates to diversity. People think diversity in the U.S. and automatically only associate diversity with racial or ethnic differences. In 2020, the White population is still the majority race in the U.S. representing 59.7% of the U.S. population (Frey, 2022).

regardless of the trait (e.g., race, religion, socioeconomic status, LGBTQ, appearance). Children with special needs and physical disabilities are consistently at an increased risk of victimization (Fegert et al., 2020). Adults who are members of a minority group suffer from higher rates of bullying (Lewis, Giga, & Hoel, 2011). Some minority workers have been shown to endure a bullying rate that is two to three times higher than that of their nonminority coworkers (Lewis et al., 2011). Namie, Christensen, and Phillips (2014) found that Hispanic Americans, African Americans, and Asian Americans all experienced higher rates of workplace bullying, both witnessing and targeting, than White Americans and that their group rates were each higher than the national average. As in school settings, differences of any type increase a person’s risk of being bullied or experiencing other forms of victimization. For decades, “social psychologists have repeatedly demonstrated that individuals who do not belong to the group are devalued.” They are more likely to be used as scapegoats in the workplace (Zapf & Einarsen, 2011, p. 188). Being isolated, bullied, or oppressed can negatively impact your mental health. Bullying and mental health are closely related. Victims of teenage bullying tend to go through severe emotional trauma. They often feel helpless, lonely, bitter, isolated, angry, frustrated, vulnerable, and anxious. Victims of depression from bullying often carry the after-effects deep into adulthood. They might have ongoing self-esteem issues, continue struggling to form lasting relationships, and start avoiding social interaction as much as possible. They often also find it difficult to trust others, impacting their personal and career relationships. Likewise, adult victims of workplace bullying, or community oppression, will show signs of severe stress (Warszewska-Makuch, 2020). In a study examining the effects of workplace bullying, findings reveal perceived bullying was associated with mental health problems, including psychological distress, depression, and burnout, and physical health problems, including insomnia and headache (Lever et al., 2019). They show that bullied staff took more sick leave. As such, the context of a client’s diversity elements may directly affect the client’s reasons for presenting to counseling in the first place. However, numbers in that demographic in the U.S. have been dropping since 1950 and will continue to go down. By 2030, estimates state that White people will have dropped to 55.8% of the population, and Hispanic peoples will have grown to 21.1%. The percentage of Black and Asian American peoples will also increase significantly. Also, between now and 2030, White people as a proportion of the population will get smaller, and the minority race groups will all keep getting bigger (Frey, 2022). See Figure 2.

Figure 2. United States Growing Diversity 2010-2020

Note . Adapted from Frey, W. H. (2022). According to new census data, the nation diversifies even faster than predicted. ( research/new-census-data-shows-the-nation-is-diversifying-even-faster-than-predicted/)..

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Book Code: SWUS1524

Immigration The U.S. is a nation of immigrants. In the past decade, there has been increasing attention focused on immigrants and refugees in this country. While the racial, ethnic, and immigrant diversity within American society is often cited as one of its greatest strengths, it has also been a challenge for America and for Americans in terms of fully accepting and embracing the broad array of immigrant groups that have become American. Since 1965, the number of immigrants in the U.S. has quadrupled (Budiman, 2020). Individuals from all different parts of the world desire to immigrate to the U.S. in search of increased opportunities. Immigration can be a hazardous, long, and dramatic process. Thus, many immigrants will have various experiences of loss, adjustment, and abuse (Budiman, 2020). Historically, every new immigrant group has experienced various degrees of prejudicial and discriminatory treatment and exclusion from mainstream society. However, the experience of many European (e.g., Irish, Italian, German) immigrants was one of initial discrimination followed by swift acculturation and assimilation, likely aided by the physical appearance and language similarities to those of earlier settlers (Brown & Bean, 2006). Asian and Latina/o immigrants have experienced prejudicial treatment due to readily identifiable physical and language differences. Historical evidence of mistreatment is well documented, with perhaps one of the most egregious examples being the internment of Japanese Americans during World War II (Nagata, Kim, & Nguyen, 2015). Americans often think of the journey of voluntary immigration of the many ethnic groups that come to America to build a “better” life. However, many immigrants arrive in this country due to war, famine, and natural disasters (Bunch, 2016; Coates, 2014). For instance, the legacy of the forced immigration of enslaved Black Americans is often overlooked. Black Americans endured 250 years of enslavement followed by 60 years of “separate but equal” status and continuing racist practices in our education, housing, health, and criminal justice systems (Bunch, 2016; Coates, 2014). Black Americans’ systemic and continuous oppression is a direct legacy of this forced immigration and has resulted in enduring educational, health, and wealth disparities (Bunch, 2016; Coates, 2014). Culture plays an extremely relevant role in counseling and psychotherapy. Immigration is a dominant event in a person’s life, shaping and distorting everything that comes before and after. Changing countries results in unique challenges at any age. Neighborhood relationships are particularly critical for new immigrants because many aspects of the new environment can be disorienting (Bunch, 2016; Coates, 2014). Living in ethnic communities protects immigrants from cultural isolation and benefits their initial psychological adjustment. However, pressure to assimilate may be strong outside their ethnic group, resulting in discrimination and its negative consequences. Within immigrant and refugee communities, collectivist cultural backgrounds prevail. The experience of psychological illness is often attributed to culture-specific or religious phenomena or both. Thus, in many immigrants or refugee cultures, conditions or disease are not considered positioned in the body or mind alone but may be seen as drawing on physical, supernatural, and moral realms (Sue & Sue, 2016). Mental illness may be understood heavily by ancestors and spirits rather than internal emotional factors. This creates an exciting position that workers need to both acknowledge and respect. While practitioners do not need to agree with or practice these beliefs, providers are expected to withhold judgment and support clients and their values. Even immigrants who have lived in the U.S. for a long time and who appear to have adopted the American lifestyle may maintain strong identification with, and hold the values of, their culture of origin (Korngold, 2009). Integrating the social and cultural values, ideas, beliefs, and behavioral patterns of the culture of origin with those of the new culture may lead to acculturation stresses. These stresses can cause or

increase mental health difficulties, such as anxiety, depression, post-traumatic stress disorder (PTSD), substance abuse, suicidal ideation, and others (Korngold, 2009). Acculturation involves changes in many aspects of immigrants’ lives, such as language, cultural identity, attitudes and values, ethnic pride, types of food and music preferred, media use, social and ethnic relations, cultural familiarity, and social customs (Korngold, 2009). Acculturation may occur in stages, with immigrants learning the new language first, followed by gradual participation in the new culture (Korngold, 2009). While some settings, such as workplaces or schools, are predominantly culturally American, others, such as an immigrant’s ethnic neighborhood and home environment, predominantly comprise the heritage culture (Korngold, 2009). Many immigrants and refugees are also unaware that there are professionals, such as counselors, who can help them navigate this strange new landscape (Korngold, 2009). Those who work with these populations say that as part of the cultural diversity that the counseling profession has embraced, counselors have a responsibility to help immigrants and refugees with everyday challenges associated with community, school, work, health care, and other systems. Therefore, as a mental health professional, you must adopt an open mind regarding the immigration experiences the individuals have. Challenges Immigrant communities encounter many challenges, including discrimination, such as being told to “go back to your own country,” language difficulties as many immigrants do not speak English upon their arrival, lower access to healthcare due to lower-paying jobs without benefits, and visa issues as some immigrants are undocumented, among many others (NAMI, 2019). There is also the added challenge of isolation from the larger national community. Many immigrant families live close to their immigrant community, which may reinforce a sense of separation (NAMI, 2019). Coping with these challenges can lead to mental health issues or mental illness, particularly for those with a pre-existing biological vulnerability to a mental illness. Common stereotypes of immigrants that they are less educated, more blue-collar, and more conservative can adversely impact mental health (NAMI, 2019). To avoid these perceptions, immigrants may feel a need to disassociate from their immigrant community. This may lead to a loss of network support, a risk factor for mental health issues (NAMI, 2019). Immigrants may not feel accepted in the U.S. Finding their “tribe” and developing an identity could be a long and challenging process, complicated and troublesome for mental health. A sense of belonging can be critical to good mental health. A lack of cultural competency and confidence is also a challenge for immigrants. Many immigrants and refugees report that when they have discussed their cultural upbringing and experiences with practitioners, they have been minimized, misunderstood, and dismissed (NAMI, 2019). The challenges are even more significant for those who cannot speak when and when they see a doctor or therapist; expressing emotions in their nonnative language can be challenging (NAMI, 2019). Translation can help, but a therapist might provide a more robust understanding of cultural context to help a patient. Different dialects can also complicate translation. Many immigrants are far less likely to seek treatment or trust a healthcare provider due to a lack of cultural understanding and competency. Cultural competence involves learning and maturation processes related to children’s inborn unique capacity to adapt to various social and cultural circumstances, including bi- and multicultural contexts. By mentally switching between different cultural codes (scripts or schemas), they accommodate their behaviors to the demands of the context. Counselors’ understanding of the differential treatment of current and past immigrant groups based on their ethnic, racial, religious, and linguistic backgrounds is paramount to their

Book Code: SWUS1524

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knowledge of their clients. How individuals and groups are treated from a sociopolitical (macro) level and a daily individual interactional level (micro) affects their views and understanding of the world in which they live. From a person-in-environment perspective, individuals act upon the environment, and the environment acts and reacts to the individual. Thus, while individuals help shape the environment around them, the environment also shapes the individual (Zastrow, Kirst-Ashman, & Hessenauer, 2019). A demographic breakdown of the diversity in the U.S. is provided in Table 1. This breakdown may help counselors better conceptualize clients’ diverse experiences. Table 1 summarizes the U.S. population by race/ethnicity. Table 1: U.S. Population by Ethnicity and Race: 2020 Race/Ethnicity Percentage White 57.8% Hispanic 18.7% Black 12.4% Asian 6% Note : Adapted from US Census: US sees unprecedented multiracial growth, the decline in the White population for first time in history. USA TODAY. politics/2021/08/12/how-2020-census-change-how-we-look-america- what-expect/5493043001/ Poverty The percentage of individuals living in poverty in the U.S. is 13.5% (Proctor et al., 2016). However, poverty is not equally distributed throughout the American population. Women, children, and racial and ethnic minorities experience poverty more often than men, working adults, and White people; individuals with disabilities experience poverty more often than those without current disabilities (Institute on Disability, 2016; Proctor et al., 2016; Tucker & Lowell, 2016; U.S. Census Bureau, 2015). The unequal distribution of poverty across the population reflects the disparities in opportunities these populations experience throughout their lives. Some examples of the difference in opportunities include a disproportionate number of racial and ethnic minorities living in low-income neighborhoods and experiencing insufficient educational opportunities, as well as women continuing to earn less than men (the most current data concludes that women earn 81 cents for every dollar men earn; Bureau of Labor Statistics, 2016; Mode, Evans, & Zonderman, 2016). Research shows that the poverty rate in the U.S. is increasing. Healthcare professionals must be aware of data relating to poverty and work to decrease the growing problem of poverty. Poverty is closely connected with poorer mental health in societies across the world (Ridley et al., 2020). Poverty is associated with volatile income and expenditures. Poverty can strain a person’s physical and mental health. Many low-income people work long hours to pay bills and provide for their families. This lifestyle can impose immense stress and reduce a person’s cognitive ability. The resulting worries and uncertainty can exacerbate mental health. Ridley et al. (2020) examine the connection between poverty and mental illness. They note that poor mental health can result from the fear and reality of poverty. “The anticipation of economic shocks, not just their occurrence, may cause mental illness. People living in poverty face substantial uncertainty and income volatility and juggle what are, in effect, complex nancial portfolios, often without access to formal insurance… Sustained long-run exposure to stress from managing this volatility may threaten mental health.” Ridley concludes that mental illness could increase a person’s risk of poverty, for example, “by capturing attention, causing excessive rumination and distorting people’s memories and beliefs about their abilities.” Depression, they suggest, may cause people to

Clinicians must be careful not to make sweeping generalizations regarding any population. For instance, Latin American immigrants (the most significant number of immigrants in 2010) come from many countries: 29.3% from Mexico, 7.6% from other Central American countries, and 9.3% from the Caribbean Islands (U.S. Census Bureau, 2012). Further, clients are influenced by various factors, including the level of acculturation (to be discussed later), immigration experience, experiences with discrimination, and ability to speak English. Therefore, clinicians must ask clients about their personal experiences and significant life events. Some cultural generalizations may help clinicians increase their knowledge of specific cultures and enhance their understanding of a portion of clients’ differing experiences. However, this is not intended to shift the clinician’s focus away from developing a better understanding of the dynamics of race, immigration, and other facets of diversity within the current social, economic, and political environment of the U.S. Clinicians are better prepared to understand and understand and help the natural climate in which their diverse clients live and that climate’s role in accommodating or marginalizing them. Moreover, it will be better for counselors to help their clients if they understand how they are accommodated and marginalized by American culture. Race, ethnicity, and immigration status are a few facets of diversity affecting clients. Diversity includes socioeconomic status, disability, sexual orientation, religion, and gender identification. These facets of diversity can serve as dimensions that marginalize and oppress individuals. have diminished belief in their abilities, while anxiety may cause someone to be more risk-averse in the labor market. Women in Poverty More women than men are living in poverty in the U.S. Men who have migrated for employment or to avoid conscripted military work often have left women behind. Migrating across hundreds of miles and rugged terrain is not feasible for women and children. Basic information about women in poverty includes the following (Bleiweis et al., 2020): ● Of the 38.1 million people living in poverty in 2018, 56%, or 21.4 million, were women. ● Nearly 10 million women live in deep poverty, falling below 50% of the federal poverty line. ● The highest poverty rates are experienced by Native American Indian or Alaska Native (AIAN) women, Black women, and Latinas. About one in four AIAN women live in poverty. This is the highest poverty rate among women or men of any racial or ethnic group. ● Unmarried mothers have higher poverty rates than married women, with or without children, and unmarried women without children. Nearly 25% of unmarried mothers live below the poverty line. ● Women with disabilities are more likely to live in poverty than both men with disabilities and persons without disabilities. Women with disabilities have a poverty rate of 22.9%, compared to 17.9% for men with disabilities and 11.4% for women without disabilities. Reasons Why Women Live in Poverty. The impact of sexism and racism on society limits women’s employment opportunities. Some of the causes of poverty in women include the following issues. Occupational Segregation into Low-Paying Jobs. Women are disproportionately represented in certain occupations, especially low-paying jobs. This is due, in part, to the perception of gender roles that assume women’s work is low-skilled and undervalued. This is especially true for women of color (Bleiweis et al., 2020). Lack of Work-Family Policies. Issues such as insufficient paid family and medical and earned sick leave impact women’s ability to manage work and caregiving. Childcare is expensive and sometimes hard to access.

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Book Code: SWUS1524

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