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
Want Elite Learning’s best offer? See inside front cover
ELITELEARNING.COM/BOOK Complete this book online with book code: SWUS1524B 15-hour Continuing Education Package $75.00
WHAT’S INSIDE
Chapter 1: Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition [1 CE Hour] Description of current state: The key risk periods for substance use disorders (SUD) occur during life transitions, such as adolescence. This means that substance use assessment and intervention is especially critical for the adolescent population. The emphasis for this basic-level course is on helping healthcare professionals to effectively assess adolescents for substance use disorders and intervene effectively with
1
adolescents who are dealing with such disorders. Chapter 2: Cultural Humility in Behavioral Health [3 CE Hours]
14
The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and other behavioral healthcare professionals to use when working with patients from diverse backgrounds in a culturally humble manner. Chapter 3: Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards [3 CE Hours] This basic-level course will help practitioners approach documentation in a way that is guided not solely by what is mandated, but by what is mutually beneficial to all stakeholders in the documentation process: The practitioner, the agency, the funding source, and – most of all – the clients. Chapter 4: Managing Professional Boundaries
35
59
[3 CE Hours] This course is intended for healthcare professionals who provide care to clients/patients. The course discusses professional standards and principles for providing safe ethical care, how those standards are reflected in clinical boundaries, common boundary dilemmas faced by clinicians, and how to apply a decision-making model to navigate boundary situations. Chapter 5: Pain Assessment and Management [2 CE Hours] 80 The purpose of this basic-level course is to elaborate on the definition of pain and its perception, factors hampering pain management, assessment of a client for pain, and interventions to improve function in clients with pain. The goal is to provide evidence-based practices that the health professional can use when working with clients who have pain. Chapter 6: Suicide Risk in Adults: Assessment and Intervention, 2nd Edition [3 CE Hours] 97 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.
©2024: 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.
i
SOCIAL WORK CONTINUING EDUCATION
Book Code: SWUS1524B
FREQUENTLY ASKED QUESTIONS
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?
CE HOURS PRICE COURSE CODE
COURSE TITLE
Chapter 1: Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition 1
$9.00 SWUS01AD
Chapter 2: Cultural Humility in Behavioral Health
3
$27.00 SWUS03BH
Chapter 3: Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards
3
$27.00 SWUS03ET
Chapter 4: Managing Professional Boundaries
3
$27.00 SWUS03PB
Chapter 5: Pain Assessment and Management
2
$18.00 SWUS02PA
Chapter 6: Suicide Risk in Adults: Assessment and Intervention, 2nd Edition
3
$27.00 SWUS03SR
Best Value - Save $60.00 - All 15 Hours
15 $75.00 SWUS1524B
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. Social workers completing this course receive 15 total credits including 9 clinical, 3 cultural competence, and 3 ethics continuing education credits. 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 EliteLearning.com/Social 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 office@elitelearning.com, or call us toll free at 1-866-653-2119, Monday - Friday 9:00 am - 6:00 pm, Saturday 10:00 am - 4:00 pm EST.
ii
Book Code: SWUS1524B
SOCIAL WORK CONTINUING EDUCATION
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 EliteLearning.com/Book and enter code SWUS1524B 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 EliteLearning.com/Book and enter code that corresponds to the course below, then click GO . • Each course will need to be completed individually.
SWUS1524B
Course Name
Course Code SWUS1524B
All 15 Hours in the book
Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition
SWUS01AD
Cultural Humility in Behavioral Health
SWUS03BH
Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards
SWUS03ET
Managing Professional Boundaries
SWUS03PB
Pain Assessment and Management
SWUS02PA
Suicide Risk in Adults: Assessment and Intervention, 2nd Edition
SWUS03SR
iii
SOCIAL WORK CONTINUING EDUCATION
Book Code: SWUS1524B
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.
HOURS REQUIRED
HOURS ALLOWED BY HOME-STUDY
STATE
MANDATORY
Alabama
30 45
20 45
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; 3 hours in teletherapy practice; 3 hours in suicide education. 3 hours in behavioral health ethics or mental health law; 3 hours in cultural competency and diversity; 3 hours of Arizona Statutes/Regulations Tutorial on the Board website.
Alaska
Arizona
30
30
Arkansas California
30 36
15 36
3 hours of ethics.
6 hours of laws and ethics (every renewal; 7 hours of HIV/AIDS (first renewal only); 6 hours suicide risk assessment and intervention (one-time requirement); and 3 hours in telehealth (one-time requirement).
Colorado
40 15
40 10
None.
Connecticut
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).
Delaware
40 40
40 12
6 hours in ethics, 1 hour in mandatory reporting.
District of Columbia
6 hours in ethics (must be done face-to-face, no online courses accepted); 2 hours in LGBTQ; 4 hours in relevant topics designated as D.C. Health Public Health Priorities. 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.
Florida
30
30
Georgia
35
10
Idaho Illinois
20 30
20 30
1 hour of ethics.
3 hours of ethics; 3 hours of cultural competency; 1 hour of sexual harassment prevention, 1 hour of implicit bias; 1 hour in Alzheimer disease and other dementias (if licensee provides health care services to patients 26 years of age and older); 1 hour of DCFS Mandated Reporter Training, within 3 months of initial licensure and at least every 3 years thereafter.
Indiana
40
40
At least 20 hours of Category I Continuing Education and 2 hours of Category I Ethics Continuing Education.
Iowa
27 40 30
27 40 30
3 hours in ethics.
Kansas
3 hours in ethics; 6 hours related to the diagnosis and treatment of mental disorders. 3 hours of board-approved Kentucky Code of Ethical Conduct; 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.
Kentucky
Louisiana
20
10
Maine
25
10
Maryland
40
20
iv
Book Code: SWUS1524B
SOCIAL WORK CONTINUING EDUCATION
HOURS REQUIRED
HOURS ALLOWED BY HOME-STUDY
STATE
MANDATORY
Massachusetts
30
30
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
2 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.
Missouri
30
15
Montana Nebraska
20 32 30
20 32 30
2 hours related to suicide prevention. 4 hours of mental health ethics.
Nevada
2 hours in suicide prevention and awareness; 6 hours in cultural 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: https://www.elitelearning.com/social-work/new-jersey/
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.
Ohio
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.
Oklahoma
8
Oregon
40 - LCSW 30 - LMSW 20 - RBSW
40 - LCSW 30 - LMSW 20 - RBSW
Pennsylvania
30
30
Rhode Island South Carolina
30 40
8
3 hours in ethics; 3 hours in cross-cultural practice.
40
Supervisor must complete 10 hours of supervision oriented continuing education during every two-year licensure period.
South Dakota
30 30
30 20
None.
Tennessee
6 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.
Texas
30
30
Utah
40 20 15
15
6 hours of ethics; 2 hours of suicide prevention.
Vermont Virginia
5
1.5 hours in ethics.
15
3 hours in ethics or the standards of practice or laws (LCSWs are required 30 hours with 6 hours in ethics). 6 hours of professional ethics; 6 hours of training in suicide assessment, treatment and management. The training must be repeated once every six years. 1 hour 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).
Washington
36
26
West Virginia
30
10
Wisconsin
30
26
Wyoming
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
v
SOCIAL WORK CONTINUING EDUCATION
Book Code: SWUS1524B
Chapter 1: Adolescent Substance Use Disorders for Healthcare Professionals, 2nd edition 1 CE Hour Release Date: October 9, 2023 Expire Date: October 9, 2027 Upon successful completion of this course, continuing education hours will be awarded as follows: ● Social Workers and Psychologists: 1 Hour ● Professional Counselors: 1 Hour
Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 5/5/2023 - 5/5/2026. Social workers completing this course receive 1 clinical continuing education credit. focusing on children and adolescents, then mostly on adults and the elderly. In 2014, Ms. Pozzetto obtained her LICSW, and after a few years in management, in 2020, opened a private practice. During her career Ms. Pozzetto has specialized in trauma work, dissociative disorders, mood disorders, and end-of-life issues. Simona Pozzetto, LICSW has no significant financial or other conflicts of interest pertaining to this course.
Colibri Healthcare, LLC, Provider 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.
Faculty Author :
Simona Pozzetto, LICSW was born and raised in Italy, where she obtained her bachelor's degree in psychology. After moving to Massachusetts, Ms. Pozzetto achieved her MSW and completed the Certificate Program in Jewish Communal and Clinical Social Work at Simmons College and Hebrew College in 2003. Ms. Pozzetto worked in community mental health clinics and long-term care facilities as a clinical therapist, initially How to receive credit ● Read the entire course online or in print. ● Answer the final examination questions at the end of the course. ○ A passing grade of 75% is required. Test questions link content to learning objectives as a method to enhance individualized learning and material retention. 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
● Provide required personal information and payment information.
● Complete the 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.
to diagnostic and treatment options of a specific patient’s medical condition.
©2024: 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
Upon completion of this course, the learner should be able to: Discuss the incidence and prevalence of substance use disorders. Explain the process of assessing adolescents for potential substance use disorders. Implicit in Healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider
Identify coexisting morbidities that occur with SUD. Describe the continuum of care for adolescents dealing with SUD. Discuss the various treatment options for SUD.
might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes
Page 1
Book Code: SWUS1524B
EliteLearning.com/Social-Work
INTRODUCTION
Research shows that key risk periods for SUD occur during life transitions, such as adolescence. The psychological development of adolescence focuses on socialization. Peer pressure can be especially intense. If peers are using substances, the adolescent may feel obligated to also use substances to “belong” and make/keep friends (Meadows-Oliver, 2019).
Problem behavior in early adolescence may identify a subset of youth who are at an especially high and generalized risk for developing adult psychopathology. Therefore, substance use assessment and intervention are particularly critical for adolescents. To be comprehensive, treatments should encompass the physical, mental, emotional, social, cultural, cognitive, and behavioral aspects of the adolescent (National Institute on Drug Abuse, 2020).
INCIDENCE AND PREVALENCE
The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the wellness of millions of Americans. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2019 National Survey on Drug Use Alcohol Abuse of alcohol is quite prevalent in the U.S. Data show that (SAMHSA, 2021a): ● About 139.7 million Americans 12 years of age or older were past month alcohol users; 65.8 million people were binge drinkers in the past month; and 16 million were heavy drinkers in the past month. ● ●About 2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank during that period. ● About 14.5 million people 12 years of age or older have had an alcohol use disorder. ● Excessive alcohol use can lead to risk-taking behavior such as driving while impaired. In fact, research shows that every day, 29 people in the U.S. die in motor vehicle crashes that involve an alcohol-impaired driver. ● Excessive alcohol use can increase the risk of stroke, liver cirrhosis, alcoholic hepatitis, and cancer. Healthcare Professional Consideration: Since the onslaught of COVID-19, social isolation, unemployment, restricted community events, and family distancing have all created stresses that have increased the abuse of alcohol and other substances. Electronic Cigarette (E-Cigarette) According to data from the Centers for Disease Control and Prevention’s (CDC) 2020 National Youth Tobacco Survey (CDC, 2020), use of e-cigarettes declined from 2019 to 2020 among both middle and high school students. This is a reversal of previous trends. E-cigarettes contain nicotine and various other chemicals. This means that their use is especially unsafe for youth, young adults, and pregnant women (CDC, 2020). Opioids An average of 128 Americans die every day from an opioid overdose (CDC, 2021a). Data concerning opioid use indicates the following (SAMHSA, 2021a). ● There were 10.1 million people age 12 or older who misused opioids in 2020. Most of these people misused prescription pain relievers. Marijuana According to 2019 data (SAMHSA, 2021a): ● An estimated 48.2 million Americans 12 years of age or older (17.5% of the population) used marijuana in the past year. Emerging Trends in Substance Misuse Several troubling emerging trends have also been identified by SAMHSA. These include the following (SAMHSA, 2021a). ● Methamphetamine: In 2019, almost 2 million people had used methamphetamine in the past year. An estimated
and Health reports that about 19.3 million people 18 years of age and older had a substance use disorder in the past year (SAMHSA, 2021a). Key findings from SAMHSA’s 2019 survey include the following (SAMHSA, 2021a). Tobacco Data from the 2019 SAMHSA report shows that 58.1 million people were tobacco users in the past month. Additionally, 45.9 million people age 12 or older in 2019 were cigarette smokers in the past month (SAMHSA, 2021a). Tobacco use is the leading cause of preventable death. It often results in lung cancer, respiratory disorders, heart disease, and stroke. An estimated 480,000 deaths in the U.S. are related to cigarette smoking every year (SAMHSA, 2021a). Children raised in households with smokers are at increased risk of asthma and respiratory illnesses. Individuals who work in restaurants, bars, or offices where secondhand smoke is a hazard are also at risk of the consequences of smoke inhalation. Evidence-Based Practice Research indicates that more than 16 million Americans are living with a disease caused by smoking cigarettes (SAMHSA, 2021a). Healthcare professionals must be alert to the impact of smoking tobacco and work to help patients stop using tobacco products or, just as importantly, to prevent their use in the first place. Healthcare Professional Consideration: The CDC (2021b) reports that 99% of e-cigarettes sold in the U.S. contain nicotine. Furthermore, some e-cigarette labels fail to disclose that the product contains nicotine. Some are marketed as containing 0% nicotine but, in fact, have been found to contain nicotine. ● An estimated 1.6 million people age 12 or older had an opioid use disorder. ● An average of 128 Americans die every day from an opioid overdose. ● About 745,000 people used heroin during 2020. ● Opioid use, specifically injection drug use, is a risk factor for contracting HIV, hepatitis B, and hepatitis C. ● About 4.8 million people 12 years of age or older had a marijuana use disorder in the past year. ● Research indicates that marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term. 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to percentages in 2015 and 2018. Overdose death rates involving methamphetamine quadrupled from 2011 to 2017.
EliteLearning.com/Social-Work
Book Code: SWUS1524B
Page 2
The frequent use of methamphetamine is linked to mood disturbances, hallucinations, and paranoia. ● Cocaine: In 2019, about 5.5 million people 12 years of age or older were past users of cocaine. Overdose deaths involving cocaine increased by 33% from 2016 to 2017. In the short term, the use of cocaine can cause an elevation in blood pressure, restlessness, and irritability. In the long term, severe
medical complications such as heart attacks and seizures can occur. ● Kratom: In 2019, approximately 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia. Its leaves can have psychotropic effects by affecting opioid brain receptors. It is currently not regulated and can cause nausea, pruritis, seizures, and hallucinations. (National Academies of Sciences, Engineering, and Medicine, 2019). Assessment of the adolescent depends on understanding the development of four domains: Physical, cognitive, social, and emotional. Consideration of these domains should be part of the assessment process.
ASSESSMENT OF THE ADOLESCENT
Adolescents make up almost 25% of the overall U.S. population. The period of adolescence begins with the onset of puberty and ends in the mid-20s. It is a critical time of development during which primary areas of the brain mature. Adolescence is a period during which the adolescent forms new relationships with peers and adults and explores the possibilities of future adulthood Physical Domain/Development Physical development consists of physical maturation, including changes in the muscles, bones, and organ systems. Physical development generally comprises sensory development (the organ systems underlying the senses and perception), motor development (the actions of the muscles), and nervous system development (the coordination of both perception and Cognitive Domain Cognitive development is sometimes referred to as intellectual or mental development. Cognitive activities include thinking, perception, memory, reasoning, concept development, problem solving, and abstract thinking. According to Knoll and colleagues (2016), most early adolescents still think predominantly in concrete terms. They relate information and experiences to what they currently know and find it difficult to think about the future or other concepts to which they have never been exposed. The ability to think abstractly—to project into the future and Social Domain Social development includes the adolescent’s interactions with other people and their involvement in social groups. The earliest social task is attachment, and the presence or absence of effective parental attachment is a strong predictor of the health and resilience of the child. Developing relationships with adults and peers, assuming a moral system, and eventually assuming a productive role in society are all social tasks (Cooke et al., 2016). While each of these four developmental domains can be examined individually, it is misleading to suggest that development occurs separately in each of the four domains. Development in any domain affects—and is affected by— development in each of the other domains. The developmental milestones of adolescence include puberty (drastic maturing of physical and sexual self), a shift from parents to peer groups as the primary influence, and growing independence in thoughts and actions (Meadows-Oliver, 2019). Even though middle-stage adolescents typically have developed intellectually to a degree comparable to adults, their erroneous beliefs and perceptions often contribute to high-risk behaviors Emotional Domain Adolescents typically experience more frequent high-intensity emotions and fewer low-intensity emotions compared to adults. Adolescents begin to assert their independence and interact less with parents and family and more with peers. Family conflict also increases during this stage of life. The intensity and fluctuations of various emotions contribute to the risk of developing emotional stress and mental health disorders. General characteristics of emotional development of the adolescent encompass the following issues (Meadows-Oliver, 2019). ● Early adolescence: The young teenager begins to develop interest in the opposite sex. However, the peer group is typically composed of same-sex friends.
DOMAINS
movement). In adolescence, puberty marks intense physical as well as sexual awareness and related social imperatives (Cleveland Clinic, 2018; National Academies of Sciences, Engineering, and Medicine, 2019). Hormonal and body image changes may also affect adolescent behavior.
to understand intangible concepts—develops as adolescence progresses. The fact that most early adolescents cannot think abstractly has important implications for program planning and necessitates different program approaches from those that would be created for older adolescents. For example, drug prevention programs that ask early adolescents to picture what future opportunities would be lost by using substances would be an ineffective strategy with young people. that can include experimenting with drugs, breaking laws, and engaging in frivolous or dangerous sexual encounters (such as sex without protecting against sexually transmitted infections and/or pregnancy). Also during these times, life events such as family problems of divorce, separation, and drug abuse can further impact the experiences and behaviors of the adolescent (Meadows-Oliver, 2019). Healthcare Professional Consideration: When assessing adolescents, it is critical to consider the pubertal development of transgender and gender-nonconforming youth. Individuals who are gender nonconforming may identify as transgender, genderqueer, gender fluid, gender expansive, or nonbinary. Puberty for this population can be especially stressful. The development of secondary sexual characteristics that do not correlate with an adolescent’s gender identity can be overwhelming and intense (National Academies of Sciences, Engineering, and Medicine, 2019). ● Middle adolescence: Self-assurance increases. Independence in making decisions is valued. Of critical importance is conformity with the adolescent’s peer group. The peer group has more influence and leverage compared to parents and other family members. The middle stage adolescent often questions parental and other adult authority, which can lead to rebellion and undesirable behaviors. Risk-taking behaviors, such as substance use and engaging in activities that are dangerous (e.g., driving very fast with a disregard for safety) may appear, especially if the peer group encourages such behaviors.
Page 3
Book Code: SWUS1524B
EliteLearning.com/Social-Work
● Late adolescence: During late adolescence, rebellion typically diminishes. As a young adult, there is a sense of self and preparation for establishing and meeting life Assessment Screening Tools Youth who are using substances, whether or not they are using addictively, tend to be guarded about the subject and are likely to share accurate information only if they trust that the healthcare professional genuinely cares about their well-being. A nonjudgmental attitude is critical when building a therapeutic relationship with youth. The following evidence-based assessment tools are frequently used with adolescents who are using substances. ● The Problem-Oriented Screening Instrument for Teenagers (POSIT) is a 139-item, self-administered, holistic tool for use with 12- to 19-year-old adolescents. It is composed of yes/ no questions under the following 10 subscales: Substance Use and Abuse; Physical Health Status; Mental Health Status; Family Relations; Peer Relations; Educational Status; Vocational Status; Social Skills; Leisure and Recreation; and Aggressive Behavior and Delinquency. The POSIT is appropriate for adolescents with at least a fourth- to fifth-grade reading level and can be completed in 20 to 30 minutes. No special training is required to administer the tool. One of the advantages of POSIT lies in its comprehensiveness; while the POSIT is recommended especially for evaluating adolescent substance use and abuse problems, the screening results can identify potential problems in various areas. Such comprehensiveness may help mental health professionals make better referrals for further assessment or necessary services based on the patient’s particular needs. Those wanting to use the POSIT may do so without training or permission and at no charge (Alcohol and Drug Abuse Institute [ADAI], n.d.). A computerized administration and scoring version of the POSIT has been developed by PowerTrain, Inc., in Landover, Maryland. This version is designed to reduce administration and scoring time. This computerized tool automatically prepares a summary bar graph that compares individual scores with normative cut-points. This summary may be printed out and used to initiate a discussion between the adolescent and provider (ADAI, n.d.). ● The Drug Use Screening Inventory (revised; DUSI-R) is a 150-item, multidimensional instrument created to assess the severity of an adolescent’s problems in areas such as Multidimensional Assessment Data Assessment data provide the material for an evaluation of the adolescent’s weaknesses, strengths, problems, and needs. This information should be used to create a treatment plan. All assessments and treatment plans must be evaluated regularly throughout the course of treatment. ● Some areas that should be addressed in the assessment process include the following (Meadows-Oliver, 2019; Videbeck, 2020). ● Complete medical and psychiatric health history ● Psychological and emotional functioning ● Mental status examination ● History of chemical use or abuse ● Chief complaint ● Treatment history for mental and physical conditions ● Psychological tests ● Age ● Assigned gender, gender identity, and sexual orientation ● Family background and functioning ● Cultural identification ● Education and work history ● Socioeconomic status ● Legal involvement history ● Community resources ● Strengths, weaknesses, problems, and needs
goals. Although specific commitments to a particular role or career may not be made, the young adult is exploring and determining what such commitments might be.
substance abuse, psychiatric disorders, social functioning, family systems, peer relationships, and leisure activities. The screening not only assesses for drug and alcohol problems but can also help with comprehensive treatment planning (eINSIGHT, n.d.). ● The Substance Abuse Subtle Screening Inventory for Adolescents (SASSI-A2) is a 67-item instrument validated for the assessment of both substance dependence and substance abuse among adolescents. The unique aspect of this tool is that it includes both direct questions and more subtle questions to reduce defensiveness and extract more accurate responses. This instrument is available from the SASSI Institute at www.sassi.com (SASSI, n.d.). ● The Screening to Brief Intervention (S2BI) and Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) are screening tools launched by the National Institute on Drug Abuse (2019a). These tools are brief and available online. They are designed to help healthcare professionals swiftly and easily introduce brief, evidence-based screenings into their clinical practices. Adolescents are asked about frequency of substance use within the past year, and the results are triaged into one of three levels of SUD: No reported use, lower risk, and higher risk. The BSTAD and S2BI can be administered in less than 2 minutes and are scientifically validated in adolescent samples. Both tools can be either self-administered or provider administered using a tablet or computer. In addition to risk scores, healthcare professionals receive information about the implications of results, recommended actions, and additional resources compiled via subject matter expert consensus. Healthcare Professional Consideration: It is important to note that it is unwise for a healthcare professional to rely solely on data from screening tool diagnoses and treatment plans. It is best to supplement information obtained through standardized instruments with other assessment data, such as psychosocial assessments, mental status examinations, collateral reports (from family, peers, teachers, therapists, physicians, probation officers, or clergy, if indicated), and direct observation. ● History of sexual, physical, and/or emotional abuse (as victim and/or perpetrator) ● History of traumatic events ● Behavioral definitions of problems related to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), criteria (APA, 2013). Drug screening may also be implicated in cases related to criminal activity, legal jeopardy, and/or physical and/or emotional abuse. If patients are implicated in the juvenile court system, they must be given a thorough evaluation for substance use problems, physical disorders, mental disorders, school performance, sexual abuse accounts, and other comorbid conditions. It is difficult to achieve successful outcomes with an adolescent under these circumstances unless they are removed from their pathological environment. Immediate intervention is critical when working with youth who are involved in the juvenile court system (Guerrero et al., 2015). Healthcare Professional Consideration: It is imperative for assessment to incorporate physical, cognitive, social, and emotional domain indicators. Without consideration of all facets of an adolescent’s life, a complete and useful assessment cannot be conducted
EliteLearning.com/Social-Work
Book Code: SWUS1524B
Page 4
COEXISTING DISORDERS IN AN ADOLESCENT PATIENT WITH A SUBSTANCE USE DISORDER Many adolescents who present for substance use treatment may also have other diagnoses, such as conduct disorder, anxiety disorders, trauma- and stressor-related disorders, bipolar and related disorders, depressive disorders, attention-deficit/ hyperactivity disorder, or oppositional defiant disorder. For example, many substance-using adolescents exhibit symptoms of bipolar and related disorders; substance use may represent these adolescents’ attempt to self-medicate for their symptoms. The high prevalence rates for co-occurring diagnoses in adolescents have led some researchers to note that dually diagnosed adolescents are not a special subpopulation but are instead the norm (Yoshimasu et al., 2016). Thus, an important aspect of working with adolescents relates to the diagnosis of coexisting disorders.
Physical Illnesses Several physical illnesses are public health concerns for both patients and healthcare professionals in SUD treatment programs. These include HIV, AIDS, and viral hepatitis. HIV infection prevention and reduced infection rates are central goals in SUD treatment programs. Research indicates that HIV testing and risk-reduction interventions are linked to cessation or reduction of drug use as well as associated high-risk behaviors, such as unsafe sex (SAMHSA, 2020). HIV/AIDS HIV can be contracted when someone comes into contact with the body fluids of an infected person. Having unprotected sex and sharing needles when participating in injection drug use are examples of methods of HIV transmission. If women are infected and are not treated, they can pass HIV to their infants during pregnancy, delivery, and lactation. Alcohol and drug misuse can exacerbate symptoms of HIV (SAMHSA, 2020). Evidence-Based Practice In 2019 in the U.S., people who injected drugs accounted for 7% (2,508) of the 36,801 new HIV diagnoses. Men who injected drugs accounted for 4% (1,397) of the new HIV diagnoses. Women who injected drugs accounted for 3% (1,111) of the new HIV diagnoses (CDC, 2021c). Mental Health Disorders Many people who have SUD are also diagnosed with mental health disorders, and people with mental health disorders may also be diagnosed with SUD. Various national population surveys show that approximately 50% of persons with a mental health disorder also have a SUD and vice versa. There are few studies on comorbidity in the youth population. However, available data indicate that over 60% of adolescents in community-based SUD programs also meet the diagnostic criteria for a mental health disorder. Around one in four people with serious mental illness also have SUD (National Institute on Drug Abuse, 2020). Some of the most common mental health disorders that coexist with SUD include the following (National Institute on Drug
Hepatitis The three key strains of viral hepatitis infection are hepatitis A, hepatitis B, and hepatitis C. Vaccines are available for hepatitis A and hepatitis B. Currently, there is no vaccine available for hepatitis C. The primary source of hepatitis C infection in the U.S. is injection drug use. Injection drug use is a significant risk factor for contracting and spreading hepatitis C (SAMHSA, 2020). Although most hepatitis C infections occur via exposure to blood from unsafe injection practices and drug use, there are additional major causes, including unsafe healthcare practices, unscreened blood transfusions, and sexual practices that lead to blood exposure (World Health Organization [WHO], 2019 As people use intoxicating substances on a regular basis, their bodies typically adjust to the substance. This means that they need to take more and more of the substance to get the desired “high.” Using substances via intake methods that deliver more of the substance to the brain swiftly soon occurs. Injecting is one way to accomplish the desired rapidity of delivery. Individuals who get to this point of substance use without treatment are more likely to share needles and contract hepatitis C (American Addiction Centers, 2019). consistent with a developmental stage or an episode of another disorder. However, it should be noted that personality disorder features that are present in adolescents usually do not remain into adulthood. Therefore, to diagnose an adolescent (or anyone younger than age 18) with a personality disorder, the symptoms must have been in existence for at least one year (APA, 2013). This criterion rules out a significant number of young people. There is one important exception to diagnosing adolescents with a personality disorder: Antisocial personality disorder. A diagnosis of antisocial personality disorder cannot be made in adolescents because the definition of this disorder includes the existence of dysfunctional behavior that begins in childhood or early adolescence (must contain some of the criteria for conduct disorder before age 15). All other personality disorders can, theoretically, be diagnosed in adolescents, but personality disorders are seldom diagnosed in young people. Of course, if the adolescent has symptoms that meet the diagnostic criteria for such a disorder, then this diagnosis should be given (APA, 2013). Many mental health providers are reluctant to definitively diagnose an adolescent for fear of labeling a situational reaction or transient developmental issue without long-term evaluation. Healthcare Professional Consideration: During an adolescent’s transition to young adulthood (18–25 years of age), if they have comorbid disorders, they need coordinated support to cope with life’s challenges and achieve maximum states of wellness (National Institute on Drug Abuse, 2020). Development is also associated with other risk factors such as genetic influence, psychosocial experiences, and/or general environmental factors (National Institute on Drug Abuse, 2020). Some research findings show that mental health disorders may precede SUD. Thus, early diagnosis and treatment of mental health disorders may help to decrease comorbidity.
Abuse, 2020; SAMHSA, 2020). ● Anxiety and mood disorders ● Schizophrenia ● Bipolar disorder ● Major depressive disorder ● Conduct disorders ● Posttraumatic stress disorder (PTSD) ● Attention-deficit/hyperactivity disorder (ADHD)
● Borderline personality disorder ● Antisocial personality disorder
Many youth present with a dual diagnosis of substance use disorder and a personality disorder. An accurate diagnosis of personality disorder can be made for older adolescents if the symptoms are pervasive and persistent, and the behavior is not Timing of Drug Use During adolescence, the brain continues to develop. In fact, functions such as decision-making and impulse control are among the last to mature. These functions are critical to making mature decisions and are lacking, to some extent, in younger adolescents. Therefore, early drug use is a very strong risk factor for the later development of mental health disorders.
Page 5
Book Code: SWUS1524B
EliteLearning.com/Social-Work
Other findings suggest that young adolescents develop internalizing disorders, or disorders that are grounded in distress emotions such as depression and anxiety, before developing SUD (National Institute on Drug Abuse, 2020). Research findings indicate that untreated ADHD in youth increases the risk for SUD. Healthcare professionals must identify whether these young people have received effective ADHD treatment and what treatment initiatives have been implemented (National Institute on Drug Abuse, 2020).
Treatment of childhood ADHD often includes the administration of stimulant medications such as amphetamine. This is a matter of concern, since prescribed stimulant medications have addictive potential. Research findings are not consistent regarding this treatment. Some studies suggest that AHDH medications do not increase the risk of SUD among children. It is essential that when stimulant medications are prescribed, healthcare professionals teach patients and families about the chronic nature of ADHD and the risk for SUD (National Institute on Drug Abuse, 2020).
CONTINUUM OF CARE
It is important to incorporate a continuum of care for SUD in adolescents if treatment is to be effective. The care continuum begins with prevention and education; involves outreach for adolescents who are more difficult to reach; and occurs across various care settings, including outpatient, inpatient, residential and therapeutic communities, and halfway houses.
Healthcare Professional Consideration: Acute inpatient detoxification is the first step in the treatment and recovery process. Detoxification is not considered to be a treatment itself. Acute inpatient care settings can provide medications that can help to suppress withdrawal symptoms during detoxification. It is important to note that persons who do not receive further treatment after detoxification (e.g., via therapeutic communities or halfway houses) usually resume their substance use (National Institute on Drug Abuse, 2019b). should start with young children to create awareness of SUD and its consequences. Preventive conservations can facilitate communication and, ideally, the making of wise decisions about substance use (Addiction Center, 2021). Education regarding substance use and SUD is also an important preventive strategy. Educational programs are designed to teach social, personal, and drug resistance techniques that adolescents can apply to their own lives. Early intervention and counseling for adolescents at high risk and/or who are dealing with dysfunctional home environments and displaying problematic behavior may be especially important to prevention (Addiction Center, 2021). Most programs are targeted at children and adolescents because these are the ages when most people initiate use of alcohol and other drugs. Effective substance use prevention programs target protective factors related to child and adolescent substance abuse, including parental investment in the individual, social competence, self-regulation, and school bonding and academic achievement (Scheier, 2015). are team-based processes designed to meet specific needs (Merced County Behavioral Services, 2021). Healthcare Professional Consideration: For adolescents who have run away from home or who are unhoused, outreach and case management is the initial treatment of choice. Adolescents living on the street are subject to such dangerous problems as prostitution, substance abuse or dependence, and shoplifting. Workers must help their youthful clients overcome the obstacles that prevent them from obtaining needed services. They must concentrate on building a trusting relationship that will help them persuade the adolescents to accept counseling and treatment for substance abuse or dependence. Rules and guidelines vary among halfway houses. When moving into a halfway house, residents agree to abide by its rules and guidelines. Examples of some common rules and guidelines include that the resident must (The Recovery Village, 2021): ● Stay sober ● Avoid all drug and alcohol substances ● Agree to random drug testing ● Contribute to the house by doing designated chores ● Not fight or commit violent acts toward other residents or staff
Prevention Prevention of SUD is of critical importance. Adolescents are in the process of developing their identities, likes, and dislikes, and thinking about what the future may hold for them as they grow into young adulthood. If young adolescents begin to experiment with drugs to acquire or keep friends, they may put themselves at risk for a potentially life-threatening habit or addiction In 2018, there were 27 million students in 8th to 12th grade who used an illicit drug. In the same year, 29.3% of this population used illicit drugs and suffered a depressive episode. An estimated 18.7% of 8th to 12th graders drank alcohol in the last month of 2018, and 12% of those adolescents participated in binge drinking (Addiction Center, 2021). Prevention of SUD can begin at home. Open dialogue between parents (or other adults to whom they are close) and adolescents is critical to the prevention of SUD. These conversations Outreach Community outreach programs are standard ways for groups such as social service agencies and healthcare agencies to identify a community need and provide services to the people who need them. These people are often disadvantaged and/ or not able to access needed services (American Student Dental Association [ASDA], 2022 (Addiction Center, 2021). Evidence-Based Practice Outreach workers must establish a trusting relationship with adolescents to steer them into treatment. The various treatment facilities include therapeutic communities, outpatient clinics, and 12-step groups. Some large cities have halfway houses designed specifically to treat substance abusing or dependent adolescents. Outreach workers (sometimes referred to as case managers) do not work in isolation. Effective outreach programs Halfway Houses Halfway houses are transitional living facilities for people who are in recovery for drug and/or alcohol addiction. Halfway houses are designed for individuals who have gone through a treatment program for addiction, particularly those who find the thought of returning home overwhelming because of a dysfunctional environment or lack of a strong support system. The purpose of a halfway house is to offer support to those who are new to recovery and committed to living without addiction. Such settings are ideal for people who have already gone through medical detox and have completed an inpatient or outpatient treatment program (The Recovery Village, 2021).
EliteLearning.com/Social-Work
Book Code: SWUS1524B
Page 6
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108 Page 109 Page 110 Page 111 Page 112 Page 113 Page 114 Page 115 Page 116 Page 117 Page 118 Page 119 Page 120 Page 121 Page 122 Page 123 Page 124 Page 125 Page 126 Page 127 Page 128 Page 129Powered by FlippingBook