AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman
Transcription
AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman
AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates Center for Professional Education Program Guide Fall/Winter 2016 1 AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates Center for Professional Education ADVISORY BOARD Clayton Ciha President & CEO, AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates Steve Hunter, LCSW, LMFT Director, Business Development, AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates Jason Washburn, PhD, ABPP Director, Center for Evidence-Based Practice, AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates; Director of Education and Clinical Training, Northwestern University Medical Center Arthur Freeman, EdD, ScD, ABPP Director, Clinical Psychology Doctoral Degree Program, Midwestern University Dave J. Norton, PhD, LMFT Founder and Executive Director, Centennial Counseling Welcome to our 2016 Fall/Winter Professional Education Guide On behalf of AMITA Health Alexian Brothers Behavioral Health Hospital, we want to thank you for your continued support of our professional education series. Because of you, we are one of the premier destinations in the Midwest for continuing education credits in seven different disciplines. We value the relationships we have created with all of you the last several years and look forward to a great new season of learning. The Center for Professional Education will continue to provide CEU learning for all mental health disciplines including school professionals (CPDUs) and addiction specialists (CADC/IAODAPCA). Our article by Dr. Jason Washburn addresses the important topic of Violence: Assessing Risk for Mental Health Practitioners. We are thrilled to have special presenter David Sheff joining us in January to discuss Overcoming Addiction and Ending America’s Greatest Tragedy. David has written two New York Times bestselling books including the memoir Beautiful Boy: A Father’s Journey Through His Son’s Addiction. I am pleased to announce the return of Bill O’Hanlon presenting, Resolving Trauma Without Drama. Bill is ranked as one of the best presenters in the country and does only a small handful of live workshops. For those who need cultural competence CEUs, we have Mark Sanders discussing spiritualty and psychotherapy. Dr. Ronald Potter-Efron is making a return appearance to present his material on Healing Toxic and Hidden Anger. Dr. Rachel Lofton will present a workshop on Sexuality and Intimacy with Autism Spectrum Clients. Counseling transgender youth in schools and agencies, one of the most important topics facing mental health professionals and school staff, will be addressed with Dr. Toni Tollerud and Matt Liberatore. Finally, we are proud to present our second edition of Honoring Our Veterans on November 16, 2016. This workshop, in honor of our Veterans, will feature three phenomenal speakers and be offered FREE of charge. As always, we look forward to being your best value in the market for CEU training. I look forward to seeing you at our upcoming fall events. Thanks for your partnership. Please see the latest updates on workshops and trainings at: AMITAhealth.org/BehavioralMedicine/AB/Professionals Sincerely, Steven Hunter, LCSW, LMFT Director of the Center for Professional Education Director of Business Development 2 Center for Professional Education: Fall/Winter 2016 Program Registration Information Registration Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) If fees apply, you may pay by credit card online or over the phone. If your organization is mailing a check (payable to ABBHH) for your participation, please make sure the check is mailed to: AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates Center for Professional Education c/o Steve Hunter, LCSW, LMFT 1650 Moon Lake Blvd. Hoffman Estates, IL 60169 Check-in and networking begins 30 minutes prior to each program. Earn one (1) CEU credit for reading the article: Assessing Risk for Violence By Jason Washburn, PhD, ABPP Pages 4-11 1 Fall/Winter 2016 Training Calendar At-A-Glance DATE TOPIC # Sept. 16 Current Mental Health Trends and Strategies for Children and Adolescents Madelyn “Mandy” Burbank, LCSW Patrick B. McGrath, PhD Jackie Rhew, LCPC, CADC Sarah Briley, EdD, CADC Kelly Demers, PsyD 12 Sept. 20 Hypersexuality and Dementia: Causes, Behaviors and Treatment Options Sachin Bhalerao, MD 13 Sept. 23 Counseling Transgender Youth in Schools and Agencies: What We Need to Know as Advocates Toni Tollerud, PhD, LCPC, NCC, NCS, ACS Matt Liberatore, MA, LCPC 14 Sept. 30 What’s the Latest in ADHD? Strategies and Medication Amy Davis, PhD Tricia McKinney, PsyD Michael Feld, MD 15 Oct. 7 Resolving Trauma Without Drama: New, Brief, Respectful and Effective Approaches to Treating PTSD Bill O’Hanlon, MS 16 Oct. 14 Sexuality & Intimacy in Autism Spectrum Disorder: Rights and Risks Rachel Lofton, PhD 17 Oct. 15 LCPC Supervision Series: Workshop 1: Effective Strategies in Supervision Toni Tollerud, PhD, LCPC, NCC, NCS, ACS 26 Oct. 28 Healing Toxic and Hidden Anger: Treatment for Passive-Aggressive, Chronically Angry and Impulsively Angry Clients Ronald Potter-Efron, PhD, LICSW, CADC III 18 Oct. 29 LCPC Supervision Series Workshop 2: Advanced Supervision Issues: Psychological Stress, Resistance and Impairment Toni Tollerud, PhD, LCPC, NCC, NCS, ACS 26 Nov. 11 Cultural Competence: Integrating Spirituality and Psychotherapy Mark Sanders, LCSW 19 Nov. 12 LCPC Supervision Series Workshop 3: Peer, Triadic, Group and Supervision: Effective Strategies Toni Tollerud, PhD, LCPC, NCC, NCS, ACS 26 Nov. 16 Honoring Our Veterans: Issues and Challenges Joseph E. Troiani, PhD, CADC Patrick B. McGrath, PhD David Cosio, PhD 20 Dec. 2 When Talk Isn’t Enough: Expressive Therapy for Emotional Disorders Linda Cao-Baker, LCPC, BC-DMT Elizabeth Muckley, LCPC, RDT-BCT Victoria Storm, BC-MT Rita Guertin, LPC, ATR 22 Dec. 9 Violence: Assessment of Risk For Mental Health Practitioners Jason Washburn, PhD, ABPP 23 Jan. 26 Overcoming Addiction and Ending America’s David Sheff, author 24 Greatest Tragedy 2 PRESENTER Fall/Winter 2016 Webinars Calendar At-A-Glance DATE TOPIC PRESENTER # All of our programs are intended for healthcare-related professionals. In some cases, such as our intensive advanced degrees may be required. Sept. 20 training A Primercourses, on Violence Risk Assessment Jason Washburn, PhD, ABPP 27 Oct. 20 Technology and Teen Dating Violence Madelyn “Mandy” Burbank, LCSW 27 Nov. 10 Non-Suicidal Self-Injury: It’s Not Just Cutting Denise Styer, PsyD 27 Dec. 6 Petitions for Involuntary Admission: Colleen Caron, RN Don Mitckess, LCPC, CRADC 27 Older Adult and Other Special Populations Continuing Education Information CEU Grouping A B C D E F G LSW/LCSW, LPC/LCPC, LMFT IAODAPCA (CADC) Psychologists CPDU (School Personnel) Nursing Dietitians Nursing Home Administrators Licensed Social Workers/Licensed Clinical Social Workers Approved provider through the Illinois Department of Financial and Professional Regulation #159.000944 Licensed Professional Counselors/Licensed Clinical Professional Counselors Approved provider through the Illinois Department of Financial and Professional Regulation #159.000944* *According to IDFPR Professional Counselors/ Administrative Code Section 1375.200 C.1.R, CEUs for LSW/LCSW are reciprocal for LPC/LCPC Licensed Marriage and Family Therapists Approved provider through the Illinois Department of Financial and Professional Regulation #168.000166 CADC/IAODAPCA For selected programs, we apply for IAODAPCA Credits. Check each program description for reference to those credits. Psychologists Approved provider through the Illinois Department of Financial and Professional Regulation #268.000021 School Personnel/Continuing Professional Development Unit For select programs, we will apply for CPDU credits. Check each program description for reference to these credits. Approved provider through the Illinois State Board of Education #080916103644232 Nurses Approved provider through the Illinois Department of Financial and Professional Regulation #236.000058 Dietitians For select training programs, we will apply for Illinois Dietetic Association CEUs. Check each program description for these credits. Nursing Home Administrators Approved provider through the Illinois Department of Financial and Professional Regulation #139.000233 Illinois Department of Financial and Professional Regulation require that participants attend the entire workshop to receive full credit. AMITA Health recognizes that our attendees may arrive late or need to leave early. We will be happy to provide you an amended certificate based on actual hours in attendance. 3 FEATURE ARTICLE Assessing Risk for Violence Mental Illness and Violence Violence is often paired with mental illness in popular culture and the minds of the public. It appears increasingly common for mental illness to be the first reason to be professed for a horrific act of Jason Washburn violence.1 Numerous politicians and PhD, ABPP media pundits have been quick to blame mental illness for violence.2 Public opinion general supports a connection between mental illness and violence.3 After the shooting at the Sandy Hook Elementary School in Newtown in 2012, a public opinion poll found that 45.6% of respondents indicated that they agreed that people with serious mental illness are, “by far, more dangerous than the general population”.4 In specific situations, mental illness likely contributes to violent behavior. This connection between mental illness and violent behavior is legally recognized in what is commonly called the “insanity defense.” John Hinckley Jr., soon to be released, was famously found not guilty by reason of insanity for the attempted assassination of President Ronald Reagan in 1981. Although the Hinckley verdict resulted in legal reform that made the insanity defense more difficult, the connection between mental illness and crime remains in legal and public minds. 4 There is some evidence supporting a link between mental illness and violence. Several studies suggest that people with severe mental illness, such as schizophrenia, bipolar disorder, and major depression, are at a greater risk for violence. For example, in a total population study in Sweden, depression was associated with a three-fold increase in violence, even after controlling for sociodemographic factors.5 A meta-analysis of 20 studies that included over 18,000 people found an increased risk of violence among those with schizophrenia and psychosis. In particular, when compared to the general population, schizophrenia and psychosis was associated with a 19.5 greater odds of committing homicide.6 Mental health professionals (MHPs) are likely to encounter clients who are at risk for violence, and even to be victims of violence.7 For example, a meta-analytic study of nearly 24,000 patients across 35 different studies found that approximately 17% of patients engaged in at least one violent act while on an inpatient unit.8 Patients on forensic psychiatric units are likely to be the most at risk for violence. One study found that aggression from forensic inpatients was nearly universal; 99% of staff reported verbal conflict with patients and 70% reported being assaulted in the prior year.9 Violence against mental health professionals received national attention in 2010 with the murder of a psychiatric technician, Donna Gross, by a forensic patient at Napa State Hospital. EARN ONE (1) CEU CREDIT FOR TAKING THE QUIZ AT THE END OF THIS ARTICLE. Yet the association of mental illness and violence is more complex than this horrible incident or the findings from these studies suggest. In the meta-analysis discussed above, only one in 300 people with schizophrenia had committed homicide, a rate similar to that of people with substance abuse without schizophrenia.6 In another study, 8.4% of people with bipolar disorder were found to have committed a violent crime, more than double the rate in the general population (3.5%). Yet, after controlling for other non-psychiatric risk factors for violence, there was no increased risk of violence specifically for bipolar disorder.10 To be clear, the vast majority of people with mental illness do not engage in violent behavior.11 For example, national data indicate that only 5% of the 120,000 gun deaths between 2001 and 2010 were committed by people with mental illnesses.2 Even when people with severe mental illness are violent, the violent behavior is typically not directly related to their mental illness. For example, only a small subgroup of people with severe mental illness appears to be at risk, and typically only during critical times, such as shortly after a psychiatric hospitalization.11 Further, a recent study of inpatients with histories of repeated violence found that psychosis only preceded 12% of their violent behavior.12 For most people with mental illness, their risk for violence is increased by the same factors that increase risk for violence among people without mental illness.13 It is also important to underscore that people with severe mental illness are much more likely to be victims of violence, either from others or by hurting themselves. One study found people with severe mental illness were 11 times more likely to be victims of violence than those without mental illness.14 Indeed, across the nation, suicide accounts for more than half of the deaths associated with guns.11 In summary, the mere presence of mental illness may tell us very little about risk for violence. Instead, mental health professionals must determine the relevance of mental illness in understanding violence risk.13, 15 Clinical Approaches to Assessing Risk for Violence Right or wrong, violence and mental illness is connected in the mind of the public. As a result, MHPs are often approached when there is a concern or question about violence. The typical approach to understanding risk for violence is to conduct a risk assessment. But what is a risk assessment? Although the answer to this question can vary, at a general level, a risk assessment involves a process in which factors that are expected to increase risk are evaluated with the goal of determining the probability that a certain outcome will occur.16 In my professional experience, clinical assessments of violence risk often looks very similar to suicide risk assessments. I’ve found that mental health professionals are likely to ask a variety of questions to obtain evidence of homicidal ideation, with a particular focus on understanding the level of detail of those plans, the means or ability to carry out those intended plans, and the client’s intent to carry out those plans. I’ve also found, however, that every MHP handles a violence risk assessment in different ways. Approaches to violence risk assessment typically vary because a MHP’s prior training, experience, and ultimately her or his “gut” feelings also vary. One MHP may focus on one set of factors as relevant to violence risk, while another MHP focuses on a completely different set of factors. Even when MHPs assess for similar factors, it is unlikely they will place the same weight or importance on each of the specific factors. Assuming two MHPs could develop high reliability in their assessment of violence risk, it is unclear if their assessments would even be valid. By relying on intuition, prior clinical experience, or their memory of important factors from the research literature, reliance on clinical judgment often involves the use of irrelevant or even incorrect risk factors, as well as a failure to attend to the most critical factors. Indeed, despite evidence to the contrary, there is a tendency for clinical judgment 5 FEATURE ARTICLE, continued to overweight symptoms of mental disorders in violence risk assessment,17 and often overestimate risk in general.18 What about clinical expertise? Unfortunately, even clinical experience or “expertise” appears to add little to the accuracy of clinical judgment.17 The major problem with developing accurate clinical expertise is that most MHPs have nothing on which to judge the accuracy of their risk assessment decisions. In contrast to research studies, in which participants are followed-up to determine if they’ve become aggressive, MHPs often don’t get to follow-up on the clients that they assess for risk.17 Indeed, in many cases, the results of the assessment may fully preclude the likelihood of an accurate follow-up of the client’s risk. For example, the client may be sent to an inpatient unit where risk for violence is contained and managed. It is impossible to know, however, if a patient that is sent to the inpatient unit was or was not actually going to be violent outside of the inpatient unit. Further, expertise of a specific client, such as a therapist who has been treating a specific client for many years, may actually interfere with the assessment of violence risk. MHPs are less likely to make accurate predictions if they are more familiar with the client.19 In summary, assessment of violence risk through clinical judgment raises grave concerns with reliability and accuracy.20 Because of the high stakes involved in the assessment of violence risk, it is critical for the assessment to be as accurate as possible. Accuracy involves being both sensitive (i.e., identifying those clients who are truly at risk), as well as specific (i.e., identifying those clients who are truly not at risk) in risk assessment).21 MHPs often fear a false negative situation, in which the assessor concludes that a client is at low risk when the client is actually at high risk for violent behavior. Yet a false positive is also problematic: concluding that a client is at high risk when the client is actually at low risk can result in unnecessary treatment, stigmatization, and restrictive interventions that may actually interfere with a client’s recovery.22 Fortunately, several decades of research have resulted in the development of increasingly sophisticated tools for MHPs who find themselves in the position of needing to conduct a violence assessment. Actuarial Assessments At the opposite end of clinical judgment is the actuarial approach to violence risk assessment. What is actuarial assessment? Actuarial assessment is a process for determining, combining, and differentially weighing a set of previously identified factors to obtain an understanding of the likelihood or probability that an event will occur in the future.23 There is an entire profession in the business world, specifically in the insurance industry that is devoted to actuarial assessment. These actuaries, as they Fortunately, several decades of research have resulted in the development of increasingly sophisticated tools for mental health professionals who find themselves in the position of needing to conduct a violence assessment. 6 are called, are tasked with understanding the financial implication of uncertainty, using mathematical and statistical models combined with financial theories to determine the risk associated with future events.24 Although there are many differences Although there are many differences between clinical and actuarial assessments of violence risk, the most important difference is with the method used to determine what factors to focus on in the assessment. In contrast to clinical judgment, which can vary from MHP to MHP – and even from patient to patient within the same MHP – actuarial assessments rely on a predetermined, fixed, and clearly articulated procedure for evaluating, weighing, and combining information to determine risk.25 An MHP using an actuarial assessment will use it in very similar, if not nearly exactly way as another MHP, and each assessment process will be the same across all clients being assessed. important difference is with the method A defining feature of actuarial approaches to violence assessment is that they are based on findings from the empirical literature. For example, in constructing the Violence Risk Appraisal Guide (VRAG) to identify mentally disordered offenders at risk for violent recidivism, the test developers started with over 50 different predictor variables. Like most actuarial violence risk assessments,26 the developers examined sociodemographic factors, childhood and adult adjustment, criminal history, characteristics of the initial offense, and psychological variables in the development of the VRAG. The large number of initial predictors was identified from the prior research, from clinicians, and from theories of violent behavior. The developers then followed 618 mentally disordered offenders over an average of 81.5 months to determine who engaged in violent recidivism. Use various analytic strategies, the authors found that 12 items were most predictive of violent recidivism. Yet, these items were not all equally predictive. As such, the developers weighted the tiems based on the rate of recidivism associated with that item. For example, using 5% increments as a guide, the item “never married” was weighted at +1 because offenders who were never married recidivated at a 7% greater rate. In contrast, being married was weighted at -2 because married offenders recidivated at a 10% lower rate than the rate of all offenders combined.27 The actuarial approach has numerous advantages over clinical judgment. First, the actuarial approach relies on actual evidence to identify the items that are critical to violence risk assessment. In clinical judgment, it is unclear if the factors being used have an empirical basis, and even more so, if they actually improve prediction. For inclusion in an actuarial assessment tool, the items between clinical and actuarial assessments of violence risk, the most used to determine what factors to focus on in the assessment. must not only be associated with later violent behavior, but also improve upon the prediction of later violent behavior.17 Indeed, while many factors are associated with violent behavior, only a handful of factors actually improve the prediction of later violence, above and beyond the other variables. Second, actuarial approaches provide a clear and evidence-based way to combine risk factors. Conscious or not, clinical assessment of violence risk also involves this step: MHPs determine what factors are particularly relevant or important to determining risk for a specific client. In other words, the MHP is applying different “weights” to different factors in their assessment. In clinical assessment, however, the application of weights is idiosyncratic to the MHP and may or may not be based on any evidence, either clinical or empirical. Indeed, an MHP may not even be aware that they are weighing one factor more than another in their determination of violence risk; it may happen at an intuitive or “gut” level.17 In contrast, actuarial assessments apply weights in a pre-determined, analytic fashion to determine risk. When conducted correctly, actuarial assessments remove the subjectivity and variation involved in a clinical judgment, taking the guesswork out of risk assessment.23 Third, an actuarial assessment like the VRAG can also provide a probabilistic conclusion that is very difficult, if not impossible to obtain with clinical judgment. Clinical judgment often results in categorization of risk into broad categories, such as low, medium, and high; however, categorizing specific clients into these broad ranges is often idiosyncratic to the specific MHP.18 Using the samples on which the actuarial assessment was created, an MHP can identify the number of people who engage in violent recidivism within a particular range of scores on the actuarial tool. With the application of item weighting, the VRAG provides a score from -26 to +38, which can be further divided into nine risk categories. Take, for example, a client who scores a 10 on the VRAG. At a general level, a score of 10 could correspond to a clinical 7 FEATURE ARTICLE, continued of violence risk. That isn’t the case. In reality, most MHP have rejected actuarial tools for assessing risk.17 At best, MHPs use one or more actuarial assessment as part of a larger clinical assessment. Even among forensic mental health evaluators, the available evidence suggests that the VRAG is used sparingly: only 18% of evaluators reported using the VRAG on their last two assessments of violence risk.29 Despite their appeal, MHPs, and even other researchers are concerned with the limitations of actuarial assessments.30 For example, one of the features that makes actuarial risk assessments attractive is the provision of seemingly highly specific and accurate risk estimates.23 The prior example determined a 44% change of violent re-offense within the next seven years, which sounds very specific and very impressive. Yet, it is important to remember that this estimate is based on a group of people who happened to have the same score at the client; it says nothing specifically about the client’s actual risk. Some have argued that the analytics involved in determining these risk estimates, specifically the large margins of error that accompany these estimates, make the application of group-based statistics to individuals an imprecise and uncertain practice.25,31 Indeed, actuarial Despite their appeal, mental health professionals, and even other researchers are concerned with the limitations of actuarial assessments.30 8 judgment of “medium” risk. With an actuarial assessment like the VRAG, however, it is possible to determine a more specific risk for violent recidivism. Using the VRAG normative database, the MHP can conclude that the client falls within Risk Category 6. Only 28% of offenders from the normative sample scored higher than this client on the VRAG. More specifically, because 44% of offenders in Risk Category 6 had a violent offense within an average of 7 years, the MHP can conclude that the risk for violent recidivism is 44%.28 As such, an actuarial assessment allows the MHP to provide not only a broad risk categorization, but also a specific risk level with an empirically-based estimate of risk for violent recidivism. Fourth, actuarial assessment appears to be superior to unaided clinical judgment.19 Based on several metaanalytic studies, actuarial assessments improve the accuracy of violent risk assessment by an average of a 13% over unaided clinical judgment.18,19 By another estimate, given 1,000 predictions of violence, actuarial assessments of violence correctly identify 90 more clients than clinical judgment.19 There is also some evidence that actuarial risks assessments are becoming more accurate over time as researchers identify better predictors, improve the reliability of those predictors, and determine improve how they combine and weigh those predictors.17 Given these findings, it seems reasonable to assume that nearly every MHP is using actuarial tools for assessment Weighting is also typically conducted differently in SPJ than in actuarial assessments. Instead of standard and empirically-driven weights for items, the weighting of different factors in SPJ approaches is often left to the MHP, who determines which items are most relevant (i.e., more weight) for the specific individual.30 As such, while the SPJ approach requires the MHP to determine the presence of a risk factor, it is up to the MHP to determine the relevance of that risk factor for the particular individual. assessments and statistical algorithms for determining risk are, by their very nature, unable to understand all of the unique characteristics and circumstances of a given individual or circumstance.24 Instead, some have argued that probability estimates of risk for future violence should be abandoned, and we should instead use more flexible approach that is grounded in the scientific literature, but allows for consideration of information beyond the specific items on an actuarial tool.24 A Blended Approach to Violence Risk Assessment: Structured Professional Judgment Concerns with actuarial assessment have led to approaches that blend the science of actuarial approaches with the flexibility and comprehensiveness of clinical judgment. These approaches, broadly referred to as Structured Professional Judgment (SPJ), are intended to guide an MHP towards a decision on violent risk, allowing greater flexibility and individualization of the assessment to the specific client.25 SPJ tools share several features. Consistent with actuarial approaches, the items are determined a priori; that is, there is a standard set of risk factors that are used to evaluate all individuals. In contrast to actuarial approaches, however, SPJ measures select items using a logical or rational approach, rather than a purely empirical approach.30 While authors of SPJ tools rely on the empirical literature to determine the items to include in their measures, the items they select come from multiple studies with varying levels of scientific rigor. Some SPJ tools also include items that may have clinical appeal, but limited empirical support, or even allow the MHP to write in their own risk factors. This approach to item selection allows for a more comprehensive set of items to be included in SPJ measures than actuarial assessments, while also making sure that MHPs assess for a standard set of items. Further, unlike actuarial approaches which typically rely on historical factors that do not change, SPJ assessments integrate dynamic and potentially malleable factors into their assessments. For example, dynamic risk factors, such as impulsiveness, anger, negative mood, psychosis, antisocial attitudes, substance use, interpersonal relationships, and treatment variables (therapeutic alliance, adherence), not only provide valuable information that may influence more immediate risk for violence, but also opportunities to specify treatment/ management targets.32 By including dynamic factors, SPJ approaches are more useful for determining treatment targets and managing risk in a clinical context.33 Consistent with the focus on dynamic risk factors, SPJ approaches tend to estimate risk over shorter periods of time. For example, while the VRAG provides estimates for 7 to 10 years later, some forms of SPJ recommend reassessment every 3 months, or even earlier if the risk factors are not adequately addressed through treatment or management.34 Finally, rather than specific probability estimates, as is provided with actuarial assessments, SPJ approaches typically categorize individuals into broad risk levels, such as low, moderate, and high. When combined with a focus on malleable factors, the SPJ approaches allow MHPs to not only identify broad risk categories, but also specific factors that could be used to reduce risk. A common example of the SPJ approach to violence risk assessment is the Historical Clinical Risk Management-20 (HCR-20).15 The HCR-20, now in its third version, provides guidance to MHPs in assessing the presence of 20 historical, clinical, and risk management items. The historical scale includes some of the same static factors found in actuarial assessments, such as violence history and early maladjustment. The clinical scale, however, includes factors not found in actuarial assessments, such as insight, attitudes, impulsivity, active symptoms of mental disorders, and treatment response. Finally, the risk management items address social support and destabilizing influences, feasibility of management 9 FEATURE ARTICLE, continued plans, and compliance with treatment/management plans. The HCR-20 manual provides detailed guidance for how to evaluate each item. The MHP not only determines the presence of a risk factor, but also the relevance of the factor for the specific individual being evaluated. For example, while substance abuse may be rated as present for an individual who smokes marijuana, the individual may have never been violent while high, and therefore the factor may not be relevant.35 There is substantial debate about the comparative efficacy of actuarial versus SPJ approaches to violence risk assessment.30 It seems, however, that the SPJ approach is likely as valid as the actuarial approach. A recent meta-analysis indicates that the HCR-20 performs as well as actuarial assessments, like the VRAG.36 Across six different violence assessment tools, actuarial and SPJ approaches were found to have similar predictive validities. Indeed, the tool with the greatest predictive validity of violence, the the Structured Assessment of Violence Risk in Youth,37 uses an SPJ approach. actually rely on the total scores.17 By allowing greater flexibility in the SPJ approach, MHPs may feel free to take additional liberties in selecting or modifying factors, so much so that the SPJ approach begins to look like unstructured clinical judgment.19 Although MHPs may be tempted to consider other factors or modify the factors that are included in an SPJ, there is little data to support that combining actuarial measures with other measures improves predictive accuracy.38 Third, as mental health professionals, it is always temping to overweight symptoms of mental disorders, increasing the likelihood of false positives with a mentally ill population. Recommendations for Practice Some researchers, such as the developers of the VRAG, argue that MHPs should use a purely actuarial approach to violence risk assessment, with no discretion given to MHPs for modifying or adding to the assessment.23,25 Indeed, there is no evidence that the modification of numerical risk scores by clinical intuition does anything to improve the accuracy of violence risk assessment.27 Yet, such a hard line may not be fully necessary. SPJ approaches, when done correctly, appear to perform similarly to actuarial approaches.39 It is also important to acknowledge that while the science of violence assessment has improved dramatically over the last two decades, there is still much to discover. For example, a recent meta-analysis suggests that the scientific literature may be biased by the authors’ investment in the tools they’ve created. Specifically, the studies that were authored by the developer of the tool under evaluation had predictive validities that were two times higher than the studies authored by independent investigators.36 Taking all of these findings together, the jury remains out about the best approach to take in violence risk assessment. Much like actuarial approaches, however, there are limits to the SPJ approach.17 First, not all factors included in SPJ tools are actually based in the scientific literature. Even worse, some SPJ measures include factors that have been shown not to increase risk, such as the severity of prior violence or psychotic symptoms. Second, while total scores from SPJ measures appear to perform as well as many actuarial methods,37 it is not clear that MHPs 10 The lack of consensus in violence risk assessment is reflected in the practices of MHPs. In a survey of forensic mental health evaluators reporting on their two most recent violence risk assessments, 89% used at least one structured risk assessment tool, with an average of 3.98 tools per evaluator. Of note, 110 different structured risk assessment tools were used.29 Most evaluators used multiple methods in their assessments, including an interview (99%), record reviews from the justice (95%), mental health (91%), and educational (26%) systems, professional (55%) and non-professional (27%) collateral reviews, additional observations of the examinee (26%), biological tests (12%), and visits to places relevant to the examinee or risk of violence (7%). Although most evaluators used structured assessments of some kind, the most common reason for not using them was because they trusted their clinical judgment.29 As such, even among professionals who do forensic work as their livelihood, there is great variability, and most evaluators rely on multiple measurements to conduct risk assessments. So what is the best approach to assessing for violence risk? There seems to be enough evidence to suggest that unstructured clinical judgments should be avoided in favor of either actuarial or structured professional judgment tools. Beyond that, Douglas et al. (2014) recommends a six step process.30 First, gather as much relevant information from as many sources as possible, especially about past violent behavior. Sources of information can include record reviews, as well as interviews with the client, victims, witnesses, and collaterals. Second, identify the presence of risk factors and, third, determine the relevance of those risk factors for your client. The second and third step of this process are particularly amenable to the use of actuarial and SPJ tools. Fourth, the MHP must go beyond just categorizing risk or providing a specific estimate of risk; the MHP must consider the specific scenarios by which violence is most likely to occur. The MHP should consider scenarios in which the client repeats any past violence, as well as a best-case (i.e., desists violence) and worst-case (i.e., most serious likely violence) scenarios, and finally, an evolution of the violence trajectory in a different or alternative direction. Fifth, develop plans to mediate or reduce the risk for violence in the four scenarios. Finally, the MHP should document and communicate the risk. In all of these approaches, it is important to acknowledge that clinical skill and judgment is still required, even with actuarial assessment. Indeed, understanding how to gather and categorize information, even for actuarial assessment, is task left best to MHPs; however, MHPs must be careful to exercise their judgment and skill, as best as possible, within the tools available.17 See references on page 28. Earn a CEU Credit Did You Read the Article? To obtain one (1) CEU Credit (groups A, C and E), please submit your answers to these questions here: www.surveymonkey.com/r/assessingviolence QUESTIONS: 1. Most gun deaths are committed by people who suffer from mental illness. True False 2. Mental health practitioners are less likely to make accurate predictions if they are more familiar with a client. True False 3. Violence Risk Appraisal Guide (VRAG) is used to identify offenders at risk for violent recidivism. True 4 False Across different violence assessment tools, actuarial and SPJ approaches were found to have similar predictive validities. True False 11 Current Mental Health Trends and Strategies for Children and Adolescents Program Agenda Friday, September 16, 2016 9 am – 1 pm Location NIU Conference Center, Hoffman Estates Campus 5555 Trillium Blvd., Hoffman Estates, IL 60192 CEUs Offered: 4.0 Groups: A, B, C, D, E Cost: FREE Includes program materials, continuing education and continental breakfast Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am Description This workshop will feature experts from a variety of programs who will address current and trending issues with children and adolescents. Program Objectives Participants will: • Learn current mental health trends for children and adolescents • Define strategies to intervene in these diagnostic areas • Examine family dynamics in each diagnostic area 12 Update on Teen Dating Violence Madelyn “Mandy” Burbank, LCSW, Clinical Navigator AMITA Violence Prevention Services Phobias and Panic in Children and Adolescents Patrick B. McGrath, PhD, Assistant Vice President AMITA Health Foglia Family Residential Treatment Center Strategies and Updates for School Anxiety Jackie Rhew, LCPC, CADC, Clinical Liaison AMITA Health Alexian Brothers Behavioral Health Hospital Current Trends and Strategies in Adolescent Substance Abuse Sarah Briley, EdD, CADC, AMITA Health Alexian Brothers Behavioral Health Hospital Stella Wilson, LCSW, Clinical Coordinator, Youth Addictions AMITA Health Alexian Brothers Behavioral Health Hospital Strategies for Working with ASD Population Kelly Demers, PsyD, Psychologist AMITA Health Autism Spectrum & Developmental Disorders Resource Center Approaches to Working with Dysregulated Adolescents Denise Styer, PsyD, Clinical Director AMITA Health Center for Eating Disorders School Transition Planning Jackie Rhew, LCPC, CADC, Clinical Liaison AMITA Health Alexian Brothers Behavioral Health Hospital Kristen Poniatowski, LCSW, School Liaison AMITA Health Alexian Brothers Behavioral Health Hospital Hypersexuality and Dementia: Causes, Behaviors and Treatment Options A Joint Event with the Northern Illinois Coalition for Mental Health and Aging Tuesday, September 20, 2016 10 am — noon Faculty Sachin Bhalerao, MD Medical Director, Older Adult Inpatient AMITA Health Behavioral Medicine Institute Location Bridges of Poplar Creek Country Club 1400 Poplar Creek Dr. Hoffman Estates, IL 60169 CEUs Offered: 3.0 Groups: A, B, E, G Cost: $20 Includes program materials, continuing education and continental breakfast Description Sexually inappropriate behavior in the Dementia population is quite a common and challenging behavioral issue often encountered in long-term care and hospital settings. Our goal is to educate and provide a better understanding of these behaviors and provide both pharmacological and non-pharmacological treatment strategies to better serve our patients and empower us to address the behavioral challenges they may present. Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 9:30 am Program Objectives Participants will: • Learn what constitutes sexually inappropriate behavior • Discuss the pathophysiology of inappropriate sexual behavior • Discuss the treatment and management of sexually inappropriate behavior • Discuss novel therapeutic agents • Discuss ethical issues associated with these kinds of behaviors 13 Counseling Transgender Youth in Schools and Agencies: What We Need to Know as Advocates Friday, September 23, 2016 9 am – 3 pm Guest Faculty & Faculty Toni Tollerud, PhD, LCPC, NCC, NCS, ACS Distinguished Teaching Professor Department of Counseling, Northern Illinois University Matt Liberatore MA,LCPC Assistant Principal and Director of Student Services John Hersey High School Yumi Terajima, PsyD Therapist, AMITA Health Center for Self-Injury Outpatient Program Location NIU Conference Center, Hoffman Estates Campus 5555 Trillium Blvd., Hoffman Estates, IL 60192 CEUs Offered: 5.0 Groups: A, B, C, D, E Cost: $40 Includes program materials, continuing education, continental breakfast and snacks Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am Program Objectives Participants will: • Review legal, ethical and social justice issues • Discuss the key developmental factors, social and emotional barriers • Learn skills and strategies to enhance safety and wellness safety and wellness concerns 14 Description The increase of children and adolescents who are coming out as transgender and gender-expansive, requires counselors and educators to become strong and intentional advocates for these youth. This workshop will address basic information about transgender and gender-expansive youth, the challenges they face, and how professionals can intervene to help contribute to a safe and healthy environment. It will review school policies, Title IX, state and national legislation, medical diagnosis, and other legal and ethical concerns regarding this population. While exploring the social and emotional concerns that these youth face in their schools, families, communities, and peer groups. Guest Faculty Bios Dr. Toni R. Tollerud is a professor in the Department of Counseling, Adult and Higher Education at Northern Illinois University (NIU). She is an accomplished counselor educator and consults all over the state on issues related to supervision, career development, and school counseling. Matt Liberatore is currently the Assistant Principal for Student Services at John Hersey High School located in District 214. Throughout his time working in education, Matt has quickly become a top advocate and ally to the LGBTQIA community within the education field. In the past five years, Matt has presented on “how to create a gender-diverse safe environment to district, high schools, and Student Services professionals. What’s the Latest on ADHD? Neurobiology, Strategies and Medication Friday, September 30, 2016 9 am – 1 pm Faculty Michael Feld, MD Community Liaison Psychiatrist AMITA Health Alexian Brothers Behavioral Health Hospital Amy Davis, PhD Pediatric Neuropsychologist AMITA Health Alexian Brothers Neuroscience Institute Brian Van Meurs, PhD Pediatric Neuropsychologist Fellow AMITA Health Alexian Brothers Neuroscience Institute Tricia McKinney, PsyD Psychologist/Therapist AMITA Health Alexian Brothers Behavioral Health Hospital Location Description This workshop will highlight updates in three major areas in the diagnosis and treatment of ADHD. Areas of focus will be neurobiology, medication and strategies for working with this population. Following the presentations, participants will have an opportunity to ask questions during a panel discussion. Program Objectives NIU Conference Center Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 Participants will: CEUs Offered: 4.0 • Synthesize strategies for working with ADHD children, adolescents and young adults Groups: A, B, C, D, E Cost: $30 Includes program materials, continuing education and continental breakfast • Learn to identify the neurobiology of ADHD to further understand etiology • Learn to identify new medications and understand the benefits of these medications Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am 15 Resolving Trauma Without Drama: New, Brief, Respectful and Effective Approaches to Treating Post-Traumatic Stress Disorder Friday, October 7, 2016 9 am – 4 pm Guest Faculty Bill O’Hanlon, MS, LMFT Author, Psychotherapist Location NIU Conference Center, Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 CEUs Offered: 5.0 Groups: A, B, C, D, E Cost: $50 Includes program materials, continuing education, continental breakfast and snacks Reserve a Seat People with post-traumatic stress commonly suffer for years and develop a variety of troubling and often crippling problems. This workshop will detail a philosophy and methods of working briefly and effectively with people who have been traumatized. An array of new methods has shown that previous conceptions and methods of working with trauma are unnecessarily longterm and re-traumatizing, rather than creating a sense of possibilities. Participants will leave equipped with new tools and ideas to work briefly, effectively and respectfully with even severe and long-standing trauma. Bill is a dynamic speaker whose humor and engagement with the audience makes his presentations fun and enlivening. Program Objectives Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Participants will: Check-in begins at 8:30 am • Learn three methods of creating hopeful futures for trauma survivors Guest Faculty Bio • Learn to design therapeutic rituals Bill O’Hanlon, MS, LMFT, is an inspirational, professional speaker and prolific author (over 30 books so far!), who helps motivate people and organizations to determine what they are meant to be doing and to remove the barriers to succeeding at those goals. Originally trained as a psychotherapist, Bill became known for his collaborative, respectful approach, irreverent humor, storytelling, clear and accessible presentation style and his infectious enthusiasm for whatever he is doing. He teaches seminars, leads trainings, writes books, coaches people and offers websites, podcasts, blogs, web-based courses and teleclasses. 16 Description • Learn four rapid methods for resolving trauma Sexuality and Intimacy in Autism Spectrum Disorder: Rights and Risks Friday, October 14, 2016 9 am – 1 pm Description Intimate relationships and sex are important parts of the human experience, but both require complex social skills that may present a challenge to people on the spectrum. Individuals with ASD are at increased risk of sexual victimization and may also be at increased risk of problematic sexual behaviors. This presentation will discuss the core features of ASD that contribute to challenges in intimate relationships and sexuality and describe the ways in which sexuality education can promote healthy sexuality. Specific teaching tips and content areas to address will be discussed. Program Objectives Participants will: • Describe key content areas of sexuality education for people with ASD • Note core features of ASD that can make intimate relationships and sexuality challenging • Learn to identify three strategies for effective sexuality education instruction Guest Faculty Bio Dr. Rachel Lofton is the Clinical Director for the AARTS Center. She is also on faculty in the psychiatry departments at both Rush University Medical Center and the Yale School of Medicine. Dr. Lofton specializes in evaluations, consultation and interventions for children and adults with Autism Spectrum Disorder (ASD) and other social challenges. She has an extensive background in educational, behavioral and social intervention approaches for individuals with ASD. Guest Faculty Rachel Lofton, PhD Faculty Rush University Medical Center and Yale University Faculty Lunch Panel Shubhrajan Wadyal, MD Service Line Director AMITA Health Alexian Brothers Behavioral Health Hospital Maria Bellantuono, MA, LCPC, NCC Clinical Director AMITA Health Alexian Brothers Autism Spectrum Disorders Resource Center Amy Davis, PhD, ABPP Pediatric Neuropsychologist, AMITA Health Neuroscience Institute Location NIU Conference Center Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 CEUs Offered: 3.0 Groups: A, B, C, D, E Cost: $45 Includes program materials, continuing education continental breakfast, and lunch Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am 17 Toxic and Hidden Anger: Approaches for Passive-Aggressive, Chronically Angry and Impulsively Angry Clients Description Friday, October 29, 2016 9 am – 4 pm Guest Faculty Ronald Potter-Efron, PhD, LICSW, CADC III Author Location NIU Conference Center, Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 CEUs Offered: 5.0 Groups: A, B, C, E Cost: $50 Includes program materials, continuing education, and continental breakfast Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am Program Objectives Participants will: • Help clients comprehend the interactions between anxiety and anger in their lives • Identify separate and distinct forms of anger • Provide treatment interventions for each of these forms of anger 18 This workshop is a rare opportunity to participate in a seminar lead by the international anger expert, Dr. Ronald Potter-Efron. Dr. Potter-Efron will present a brand new and powerful workshop full of practical techniques ready to use immediately. This program will provide an in-depth look at the issue we’ve all faced but haven’t always recognized: hidden, chronic and passiveaggressive anger. When people don’t express their views and feel compelled to conceal their true beliefs, and emotions, behaving in ways that don’t match what they honestly think, there can be serious physical and psychological results for everyone involved. Dr. Potter-Efron will also provide many useful and practical interventions for use with a wide range of clients with other anger problems including clients whose chronic anger has become habitual, people with impulsive anger issues, and individuals whose deep distrust of others fuels their anger. Guest Faculty Bio Dr. Ronald Potter-Efron is the author of 20 books on anger and relationship communication – exploring the key factors that lead to passiveaggression and other forms of toxic anger. Dr. Potter-Efron has studied for almost 30 years the wide variety of ways that problematic anger is displayed. His knowledge of these often subtle differences in angry behavior, and the corresponding cognitive distortions that justify problematic anger, has enabled him to develop individualized treatment approaches that better meet the widely varied needs of clients. He is the author of Letting Go of Anger and Healing the Angry Brain. Cultural Competence: Integrating Spirituality and Psychology Guest Faculty Mark Sanders, LCSW, CADC Lecturer University of Chicago Location NIU Conference Center, Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 Friday, November 11, 2016 9 am – noon CEUs Offered: 3.0 Groups: A, B, C, E Meets state licensure requirement for cultural competence Description Includes program materials, panel, networking, and continental breakfast Two-thirds of Americans surveyed say they would prefer to work with a therapist who has a spiritual foundation. This interactive, skill-building workshop focuses on strategies to integrate spirituality and psychotherapy. Topics include: Reserve a Seat • Differences between religion and spirituality Cost: $30 Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am Guest Faculty Bio Mark Sanders, LCSW, CADC, is an international speaker in the addictions and mental health fields whose presentations have reached thousands throughout the U.S., Europe, Canada, and the Caribbean Islands. He is the co-author of Recovery Management and author of Relationship Detox: How to Have Healthy Relationships in Recovery, and Slipping through the Cracks: Intervention Strategies for Clients with Multiple Addiction and Disorders. Sanders had two stories published in the New York Times best-selling book series, Chicken Soup for the Soul. He is also a lecturer at the University of Chicago. • Integrating religion and spirituality with traditional counseling approaches • Ethics and spirituality • Issues of diversity in spirituality • Addressing religious addictions in psychotherapy Program Objectives Participants will: • Understand differences of religion and spirituality • Synthesize strategies for integrating spirituality into counseling • Learn how to conduct a spiritual assessment • Utilize and understand strategies for addressing religious addictions in counseling 19 Honoring Our Veterans: Issues and Challenges A Joint Event with the Illinois Psychological Association (IPA) Military Section Descriptions & Program Objectives Friday, November 20, 2016 9 am – 1 pm Guest Faculty & Faculty Joseph E. Troiani, PhD, CADC Core Clinical Psychology Faculty Adler University Veterans Today Joseph E. Troiani, PhD, CADC NIU Conference Center Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 Historically, our military veterans have experienced social exclusion within our society. As a group, their rates of suicide, homelessness, unemployment, engagement in the criminal justice system, physical health, mental health, and substance abuse problems are significantly higher than the non-veteran population. We have to look no further than the largest veteran population, veterans from the Vietnam War, who were marginalized often the minute they stepped off the plane following their tours of duty. Veterans of that war, as well as the veterans of this, the fifteenth year of what is now being referred to as the “long war,” continue to experience alienation and disenfranchisement. CEUs Offered: 4.0 Participants will: Patrick B. McGrath, PhD, Assistant Vice President AMITA Health Behavioral Medicine Institute Foglia Family Foundation Residential Treatment Center David Cosio, PhD, Psychologist, Anesthesiology/Pain Clinic Jesse Brown VA Medical Center Location Groups: A, B, C, E Other: Military, Veterans and family member Cost: Free Includes program materials, continuing education and continental breakfast Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8 am 20 Honoring Our Veterans is a conference for professionals, active military, veterans and their families. Joseph E. Troiani, PhD, CADC; Patrick B. Mcgrath, PhD and David Cosio, PhD will present a follow-up to last year’s soldout Veterans Conference to address new issues and treatments for our warrior/veteran population. • Understand the demographics of the current veterans population in Illinois • Examine the reported rates of behavioral health issues with the veteran’s population • Know the experience of having served in the military. • Identify the full spectrum of related traumas and injuries • Discuss the impact of ongoing conflicts on those currently serving, those who have served, and their families IPA and AMITA Health Alexian Brothers Behavioral Health Hospital are co-sponsoring this event to highlight the needs of the military and veteran communities for Veterans Day. This conference is for professionals, active military, veterans and their families. Putting Chronic Pain Management into Veterans’ Hands David Cosio, PhD Beyond Nightmares and Flashbacks Patrick B. McGrath, PhD Post-traumatic stress (PTS) is no longer a hidden problem for veterans and there are now active attempts to engage veterans in getting help. But its impact goes beyond the veteran – their families, friends, occupations, and academics can also be affected by PTS. We will discuss the far-reaching effects of PTS and what treatment providers need to do to help veterans and their families. Participants will: • Understand the impact of PTS on veterans and their families • Discuss the specific areas of impact • Synthesize treatment approaches to PTS Dr. David Cosio will share basic principles for relief and prevention, provide education about conventional interventions, and introduce services offering non-pharmacological and alternative interventions for the relief of pain and promotion of self-management strategies. The goal of this seminar is to empower therapists who work with veterans who suffer from chronic pain. Participants will leave the seminar being able to create a comprehensive pain management plan for their clients. Participants will: • Explain the current state of pain management in the U.S. • Describe the multi-dispensary approach to pain management • Learn how to create a comprehensive pain management plan • List the five key coping skills to have more success when working with veterans suffering from chronic pain 21 When Talk Isn’t Enough: Expressive Therapy for Emotional Disorders Description Friday, December 2, 2016 9 am – 4 pm Faculty Linda Cao-Baker, LCPC, BC-DMT Clinical Director of Expressive Therapy Services AMITA Health Alexian Brothers Behavioral Health Hospital Elizabeth Muckley, LCPC, RDT-BCT Expressive Therapist AMITA Health Alexian Brothers Behavioral Health Hospital Victoria Storm, BC-MT Expressive Therapist AMITA Health Alexian Brothers Behavioral Health Hospital Rita Guertin, LPC, ATR Expressive Therapist AMITA Health Alexian Brothers Behavioral Health Hospital Location Bridges of Poplar Creek Country Club 1400 Poplar Creek Dr. Hoffman Estates, IL 60169 CEUs Offered: 6.0 Groups: A, B, C, D, E Cost: $50 Includes program materials, continuing education, continental breakfast and afternoon beverages Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am 22 This workshop will present a neuroscience-based theoretical framework of expressive therapy and clinical intervention methods from four disciplines (dance movement therapy, drama therapy, art therapy and music therapy) as applied to emotional disorders. All intervention techniques will be presented with case studies and experiential practice, focusing on specific symptoms, process of application and the how/why of change. In this intensive training, you will learn actionoriented, and creative expressive therapeutic skills to apply in the 1:1 setting. Participants will be able to help clients to develop their expressive vocabulary, embody motivation, strengthen self-regulation, increase cognitive reappraisal skills, and restructure behavior. Program Objectives Participants will: • Acquire key concepts of theoretical framework of expressive therapy in working with emotional disorders • Learn intervention skills of therapeutic movement dialogue treating poor body image, lacking of motivation, mood swings and psychosomatic symptoms • Acquire intervention techniques of music therapy treating self-injury, suicidal thought, lacking of tolerance • Identify intervention techniques of drama therapy treating social phobia, impulsivity, and negative thought frame Violence: Assessment of Risk for Mental Health Practitioners Friday, December 9, 2016 9 am –noon Description This presentation reviews approaches to assessing for risk of harm to others. Although people with mental illness are much more likely to be victims than perpetrators of violence, mental health professionals invariably encounter situations in which it is necessary to assess for risk of harm to others. Through a review of the evidence base and best practices, this presentation will provide mental health professionals with an appreciation of the science of violence prediction, the benefits and limits of various approaches to violence risk assessment, and an overview of approaches and available tools for violence assessment. Program Objectives Participants will: • Understand the capacity of mental health professionals to assess for violence risk • Become familiar with various approaches to the assessment of violence risk • Identify various tools for violence risk and their benefits and limitations Faculty Jason Washburn, PhD, ABPP Director, Center for Evidence Based Practice AMITA Health Alexian Brothers Behavioral Health Hospital Director of Education and Clinical Training, Northwestern University Medical Center Location NIU Conference Center Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 CEUs Offered: 3.0 Groups: A, B, C, D, E Cost: $30 Includes program materials, continuing education and continental breakfast Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am Faculty Bio Jason Washburn is the Director of the Center for Evidence-Based Practice at AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates. He is a licensed psychologist and a board-certified specialist in clinical child and adolescent psychology. He is also an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine where he directs the PhD program in Clinical Psychology. 23 Overcoming Addiction and Ending America’s Greatest Tragedy Description: In the Presenter’s Own Words Thursday, January 26, 2017 9 am – noon Guest Faculty David Sheff Author Faculty Gregory Teas, MD Chief Medical Officer AMITA Health Behavioral Medicine Institute Sarah Briley, EdD, CADC Clinical Director, Center for Addiction Medicine AMITA Health Alexian Brothers Behavioral Health Hospital Irfan Syed, MD Medical Director, Center for Addiction Medicine AMITA Health Alexian Brothers Behavioral Health Hospital Location NIU Conference Center Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 CEUs Offered: 3.0 Groups: A, B, C, D, E Cost: $30 Includes program materials, continuing education, continental breakfast and panel Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Check-in begins at 8:30 am 24 I know first-hand the pain and terror that comes from drug use – our own or a loved one’s. When he was a teenager my son became addicted and almost died. I learned the hard way that addiction is America’s greatest challenge – it impacts every other societal problem you can name. We’ve ignored it because it has been our great shame. We’ve viewed drug use as a problem of morals and character, rather than what it is: a health issue. A health crisis. But we’ve ignored it at our peril. There are far too many parents like me – desperately trying to save the lives of their children. And there are far, far too many suffering even more – they’ve lost their children or other loved ones. Drugs are now killing more people in our nation than any other non-natural cause – more than anything except cancer and heart disease. A person is dying every 19 minutes. We are in the midst of an epidemic, and have been blindsided, but as a nation we’re beginning to wake up to the fact that our efforts to prevent drug use and cure addiction have failed. And in addition, we’re learning that though we’re not preventing it, substance abuse is preventable, and though we’re not effectively treating it, addiction is treatable. We can change the course we’re on, but only when we reject the status quo. We must acknowledge that we’ve been looking at the nation’s drug problem in the wrong way. We’ve focused on drugs, but we must instead focus on why people use them. When we do, we learn how to successfully prevent people from using drugs in the first place; slow or stop use once it’s begun, and save those who become addicted. When we accept the new paradigm based on the understanding that addiction is a disease that’s preventable and treatable, and when we adopt new proven prevention and treatment strategies, we will make our cities safer, help families stay together, help our children grow up healthier, and save countless lives. Participants will interact with experts Gregory Teas, MD, Sarah Briley, EdD, CADC and Ifran Syed, MD during the last hour of the workshop. Coming Spring 2017 Program Objectives Participants will: • Define addiction as a national crisis in need of change • Learn prevention and treatment for substance abuse • Discuss treatment options with a panel of experts Guest Faculty Bio David Sheff is an American author of the New York Times best-selling books Clean: Overcoming Addiction and Ending America’s Greatest Tragedy and Beautiful Boy: A Father’s Journey Through His Son’s Addiction. In 2009, Sheff was included in the Time Magazine Time 100, The World’s Most Influential People, and Beautiful Boy was named the best nonfiction book of the year by Entertainment Weekly. The book also won the Barnes & Noble “Discover Great New Writers Award” for nonfiction and was an Amazon Best Book of the Year (2008). Beautiful Boy was based on Sheff’s article, “My Addicted Son,” that first appeared in the New York Times Magazine. The article won an award for “Outstanding Contribution to Advancing the Understanding of Addictions” from the American Psychological Association. Sheff, a journalist, has written for The New York Times, Rolling Stone, Playboy, Wired, Fortune, and National Public Radio’s “All Things Considered.” His interview subjects have included John Lennon, Frank Zappa, Steve Jobs, Ai Weiwei, Keith Haring, David Hockney, Jack Nicholson, Ted Taylor, Carl Sagan, Betty Friedan, Barney Frank, Fareed Zakaria, and many others. AMITA Health Behavioral Medicine Institute is excited to announce the opening of a brand new residential treatment center in Elk Grove Village, IL. The Foglia Family Foundation Residential Treatment Center will specialize in the treatment of Anxiety, ObsessiveCompulsive Disorder and Addictions, for adults ages 18 and up. · 24-hour supervision · Latest approaches in evidence-based treatments · Cutting-edge technological interventions such as Virtual Reality treatment for PTSD, phobias, addictions and more · Individualized treatment plans · Specialized therapy groups including Mindfulness, Pain Management, Cognitive Behavioral Therapy, Relapse Prevention, Forgiveness/12-Step, Hoarding, Perfectionism, Nutrition and Victim/Survivor The Foglia Family Foundation Residential Treatment Center will also provide specialty treatment options to populations such as Millenials, Veterans and Professionals. For more information on the Foglia Family Foundation Residential Treatment Center, please contact Scott Naples at [email protected] or 847.230.3581. AMITAhealth.org/BehavioralMedicine/AB/RTC 25 LCPC Supervision Series: Keys to Successful Clinical Supervision Training Workshop 1, October 15 Effective Strategies in Supervision Workshop 1: Saturday, October 15, 2016 Workshop 2: Saturday, October 29, 2016 Workshop 3: Saturday, November 12, 2016 This workshop covers the basic strategies necessary to be an effective supervisor and to engage in the supervision process. Specific topics include: • What is supervision? 8:30 am – 3 pm Guest Faculty Toni Tollerud, PhD, LCPC, NCC, NCS, ACS Distinguished Teaching Professor Department of Counseling Northern Illinois University Location NIU Conference Center Hoffman Estates Campus 5555 Trillium Blvd. Hoffman Estates, IL 60192 CEUs Offered: 18.0 Groups: A, B, C, E Cost: $180 Includes program materials, continuing education, continental breakfast, lunch and snacks Reserve a Seat Register online at AMITAhealth.org/BehavioralMedicine/AB/Register or call 1.855.MyAMITA (692.6482) Attendees are welcomed to register for workshops on an individual basis if necessary. Each workshop offers 6.0 CEUs. Check-in begins at 8 am 26 • Differences in settings, roles, expectations, and evaluation • Roles of effective supervisors • Expectations of supervisor/supervisee • Selecting a preferred style for supervision and understanding of the discrimination model as a starting point • The supervisor as learner in the discrimination model • Effective planning for the supervision session • The art and importance of process in supervision • Ethical concerns and vignettes pertinent for the beginning supervisor Guest Faculty Bio Dr. Tollerud is a professor in the Department of Counseling, Adult and Higher Education at Northern Illinois University. She received a Presidential Teaching Professorship Award in 2008. In her 25 years at NIU, she has coordinated and served as Director of Internship and the School Counseling Program. She is an accomplished counselor educator and consults all over the state on issues related to supervision, career development, and school counseling. Workshop 2, October 29 Advanced Supervision Issues: Psychological Stress, Resistance and Impairment This workshop deals with more advanced issues that arise in the supervisory relationship including: • Dealing with difficult supervisees • Prevention strategies to avoid difficulties • Due process procedures in supervision •Impairment • Supervision/supervisee burnout Webinar Learning Series Online learning through AMITA Health Alexian Brothers Center for Professional Education is available for your convenience. Each webinar will be offered on the specified date from noon – 1 pm. One (1) CEU credit will be awarded upon completion of webinar for groups A and C. Webinar programs are FREE OF CHARGE! Registration is required. Register online at AMITAhealth.org/BehavioralMedicine/ AB/Register • Transference and countertransference Opportunities to apply concepts learned will be experienced through viewing videos of sessions. Workshop 3, November 12 Peer, Triadic, Group and Supervision: Effective Strategies This workshop offers insightful supervision information utilizing approaches other than the traditional two-person, face-to-face approach. It will explore the following: • Differences between consultation and supervision • Group supervision • Leadership styles in doing group supervision • Triadic supervision, the reflective approach model • Peer supervision • Ethical and legal issues surrounding these approaches A Primer on Violence Risk Assessment September 20, 2016 Jason Washburn, PhD, ABPP Technology and Teen Dating Violence October 20, 2016 Madelyn “Mandy” Burbank, LCSW Non-Suicidal Self-Injury: It’s Not Just Cutting November 10, 2016 Denise Styer, PsyD Petitions for Involuntary Admission: Older Adult and Other Special Populations December 6, 2016 Colleen Caron, RN Don Mitckess, LCPC, CRADC Opportunities to apply these concepts learned will be experienced through both live and video-taped exercises. 27 FEATURE ARTICLE, continued References from article on page 4: 1. Robillard JM, Illes J. A link in the ink: mental illness and criminal responsibility in the media. Journal of Ethics in Mental Health. 2011;6:1-7. 2. Metzl JM, MacLeish KT. Mental illness, mass shootings, and the politics of American firearms. Am J Public Health. 2015;105(2):240-249. 3. Swanson JW, McGinty EE, Fazel S, Mays VM. Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol. 2015;25(5):366-376. 4. Barry CL, McGinty EE, Vernick JS, Webster DW. After Newtown--public opinion on gun policy and mental illness. N Engl J Med. 2013;368(12):1077-1081. 5. Fazel S, Wolf A, Chang Z, Larsson H, Goodwin GM, Lichtenstein P. Depression and violence: a Swedish population study. Lancet Psychiatry. 2015;2(3):224-232. 6. Fazel S, Gulati G, Linsell L, Geddes JR, Grann M. Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 2009;6(8):e1000120. 7. Winer JP, Halgin RP. Assessing and Responding to Threats of Targeted Violence by Adolescents: A Guide for Counselors. Journal of Mental Health Counseling. 2016;38(3):248-262. 8. Iozzino L, Ferrari C, Large M, Nielssen O, de Girolamo G. Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(6):e0128536. 9. Kelly EL, Subica AM, Fulginiti A, Brekke JS, Novaco RW. A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital. J Adv Nurs. 2015;71(5):1110-1122. 10. Fazel S, Lichtenstein P, Grann M, Goodwin GM, Langstrom N. Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review. Arch Gen Psychiatry. 2010;67(9):931-938. 11. McGinty EE, Frattaroli S, Appelbaum PS, et al. Using research evidence to reframe the policy debate around mental illness and guns: process and recommendations. Am J Public Health. 2014;104(11):e22-26. 12. Skeem J, Kennealy P, Monahan J, Peterson J, Appelbaum PS. Psychosis Uncommonly and Inconsistently Precedes Violence Among High-Risk Individuals. Clinical Psychological Science. 2016;4(1):40-49. 13. Elbogen EB, Dennis PA, Johnson SC. Beyond Mental Illness: Targeting Stronger and More Direct Pathways to 28 Violence. Clinical Psychological Science. 2016:Advance online publication. 14. Teplin LA, McClelland GM, Abram KM, Weiner DA. Crime victimization in adults with severe mental illness: comparison with the National Crime Victimization Survey. Arch Gen Psychiatry. 2005;62(8):911-921. 15. Douglas KS, Hart SD, Webster CD, Belfrage H. HCR-20 (Version 3): Assessing Risk for Violence2013, Burnaby, BC, Canada. 16. Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ. Coming to terms with the terms of risk. Arch Gen Psychiatry. 1997;54(4):337-343. 17. Hilton NZ, Harris GT, Rice ME. Sixty-Six Years of Research on the Clinical Versus Actuarial Prediction of Violence. The Counseling Psychologist. 2006;34(3):400-409. 18. Oleson JC, VanBenschoten SW, Robinson CR, Lowenkamp CT. 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