CM II
•Empathic listening •Engagement- building trust •Empowerment- sharing responsibility •Encouragement- supportive feedback to help them learn new ways of coping and viewing the world •Evaluation- monitor progress, successes, setbacks and make sure that the goals remain mutual
Individual Supportive Counseling Intervention Strategies
Associated features of Mania:
Inflated self-esteem or grandiosity, Diminished need for sleep, Severe insomnia - Difficulty falling asleep, Pressured speech, flight of ideas, distractibility, Increase in goal-directed activity, Increase in psychomotor agitation, 9.Poor judgment, inappropriate irritability, impulsiveness and inappropriate social behaviors that may be intrusive and demanding, Poor judgment, inappropriate irritability, impulsiveness and inappropriate social behaviors that may be intrusive and demanding
the nine basic emotions
Joy, Surprise, sadness, anger, contempt, shame, fear, guilt and disgust
A consumer is looking for a job. He is concerned about losing his disability income and wants help in understanding his options. A practitioner can help by doing which of the following?
Make an appointment with the local vocational rehabilitation office, attend the appointment with them so you can learn about employment options
Choose the best reason to modify a person's rehabilitation plan.
Recovery is an ongoing process. The person is constantly developing new strengths/skills and reducing deficits. Plans need to be modified to accommodate these changes
The strengths model can enhance the sense of power felt by the case manager and the client by
Reducing conflict and creating a partnership, Seeing possibilities in the community, Increasing outcomes and a sense of satisfaction
compulsions
Repetitive behaviors or mental acts that are performed to prevent or reduce anxiety.
•Teaching/educating on skills needed to function effectively •Skills taught should correspond to the assessment and treatment plan •Utilize educational principles - will review later •Prompting/coaching positive feedback •Integrate teaching/learning principles
Skills Training Intervention Strategies
Inappropriate affect for schizophrenia
Smiling, laughing, or other facial expressions displayed at times when it is not required. (No Appropriate stimulus.)
Spiritual Wellness can be described as
The ability to establish peace and harmony in our lives.
Occupational Wellness can be described as
The ability to get personal fulfillment from our jobs or our chosen career fields while still maintaining balance in our lives.
Physical Wellness can be described as
The ability to maintain a healthy quality of life that allows us to get through our daily activities without undue fatigue or physical stress.
what is environmental wellness
The ability to recognize our own responsibility for the quality of the air, the water and the land that surrounds us. The ability to make a positive impact on the quality of our environment, be it our homes, our communities or our planet contributes to our Environmental Wellness.
Social Wellness can be described as
The ability to relate to and connect with other people in our world.
the ultimate goal of recovery
The establishment or re-establishment of normal roles in the community, The development of a personal support network, and An increased quality of life.
what is confidentiality
The ethical principle or legal right that a physician or other health professional will hold to keep secret all information relating to a patient; unless the patient gives consent permitting disclosure.
what is privacy
The freedom from unauthorized intrusion: state of being let alone and able to keep certain personal matters to oneself.
What are negative impacts of stigma? ( MODULE 2)
The loss of rightful life opportunities (such as housing and competitive employment), The reaction of the criminal justice system (those showing signs of their mental illness are more likely to get arrested than those who are not), Diminished self-esteem; self- efficacy and confidence, Accessing services
what is wellness
The quality or state of being healthy in body and mind esp as the result of deliberate effort, An approach to healthcare that emphasizes preventing illness and prolonging life, as opposed to emphasizing treatment diseases
Before entering the helping profession, a competent practitioner must consider
Their initial motive for entering a helping profession, Personal biases that may influence the development of relationships, Personal values that may affect the services provided
why is it important for a CM to know about life domains
These are the areas that your consumers will need assistance with to have a better quality of life income/housing), live in the community and have meaningful relationships.
Six strength assessment process
Thorough, Detailed and Specific, ongoing process, conversational manner, active listening, evolve at consumers rate, should occur in the community
What is the most important reason to get input from the person with whom you are working as you begin the process of goal setting?
To recognize that the person is their own expert in what works and what is needed
Collaboration and partnership require
Trust, an honest exchange of accurate information, and flexibility
what can intellectual wellness do for us
When we we're able to recognize our creative abilities and to find ways to expand our knowledge and skills, we start to feel good about ourselves, we're more encouraged to want to try something new, to venture off in a new direction and take on challenges we'd otherwise avoid
what happens when you don't have financial wellness
When you're poor and don't have enough money to properly care for yourself and your family, you aren't able to realize the financial dimension of wellness.
Running Deer dreams of weaving rugs like his ancestors' tradition. How can he accomplish his goal?
While participating in a design class at the local college, he can visit relatives to learn about traditional weaving styles
What are the four A's to consider when developing resources for the client?
Who will your primary target audience (i.e. adults with Serous Mental Illness, children with Serious Emotional Disturbance, adult or children with substance use disorders, etc.)? What is their learning style (visual, auditory)? If a group, what are the similarities and differences between learners (i.e. age, gender, developmental, anything that might impact learning)? What are the values, beliefs, motivations and interests of the learner(s)?
Does shame inhibit men or women more when they want to receive case management services? Why?
women; issues to due with society
What is the difference between ethics and values?
ethics are that branch of philosophy dealing with values relating to human conduct
the E in ADDIE
evaluate and final stage, an ongoing phase each time the instruction is presented, this allows you to determine if the instruction developed was effective
consider what the indicator of success is and how you can best determine if your instruction met the desired results.
evaluation phase
Beneficence remember "beneficial"
everything we do is beneficial to our clients
Individuals with psychiatric disabilities are as complex and diverse a group as the population in general and all of them will have difficulty performing in every life domain
false
The main concern with client and the goals on their personal plan is modifying their behavior & compliance
false
The three characteristics of public and self- stigma , are stereotype, prejudice, and acceptance.
false
what is burnout
fatigue, frustration, or lack of interest that results from prolonged stress
what are informal support
friends and family members, community
1 in 5 youth aged 13-18 experience
•a severe mental disorder at some point during their life.
what are competencies
•include skills, abilities, aptitudes, proficiencies, knowledge faculties and talents.
public stigma
when the general population endorses the prejudice toward mental illness; discriminates against them; prevents them from attaining such community integration goals as obtaining a good-paying job or living in comfortable housing.
self-stigma
when the individual with mental illness internalizes the prejudice and suffers diminished self-esteem and self-efficacy which undermines the person's sense of personal empowerment.
auditory hallucinations
(e.g. hearing voices or some other sound) are most common type of hallucination in schizophrenia.
what is enabling
(normalization) has more positive like characteristics.
Steps to self-care and awareness
Examine your values, build yourself up, Learn to relax, exercise regularly, Eat sensibly, Avoid chemical solutions, Take control of your life
What are the domains of the strengths assessment?
Executing, Influencing, Relationship Building and Strategic Thinking.
duty to protect privacy
HIPPA and it was established to help people keep their insurance before it was to protect client info.
You're working with a woman who has struggled with symptoms of the "evil eye" all her life. She is in crisis right now. How would you help her?
Help her identify what has worked in the past to relieve the uncomfortable feelings and support her to use those tools
A consumer lives with their parents and a supervised apartment becomes available. They ask the practitioner to find out if they can move into that apartment. The practitioner proceeds by
Identifying all housing options that may meet their needs
cognitive impairments for schizophrenia
Impaired attention and memory, Confusion, Difficulty concentrating and easily distracted, Inability to transfer information from one situation to another, Impairment of logic, problem solving and ability to do abstract thinking
Are there other terms for the words case manager? What are they?
boss, director, foreman, foreperson, forewoman, head, overseer, superintendent, supervisor, taskmaster, taskmistress
How many sessions does it take complete the strengths assessment.
one
eight dimensions of wellness
Emotional, environmental, financial, intellectual, occupational, physical, social, spiritual
The American Disability Act (ADA) is divided into five (5) titles. Which of the following are included?
Employment, Telecommunications, Public Accommodations
what are the five functions of Strength Model
1.Engagement and relationship 2.Strengths assessment 3.Personal planning 4.Resource acquisition 5.Collective and continuous collaboration and graduated disengagement
what are the negative symptoms for schizophrenia
2.Loss of functioning, Emotional flatness or lack of expressiveness, An inability to start and follow through with activities, Speech that is brief and lacks content, Lack of pleasure or interest in life, Difficulties with social cues
what is the recovery rate of schizoprenia
60%
what is the recovery of major depression
65%-80%
longitudinal research studies have showed recovery rates with SMI is
68%
what is the recovery with addiction treatment
70%
what is the recovery of bipolar
80%
mood
A long term emotional state that is either positive or negative and is less specific than.
What is a hallucination?
A person experiences something that doesn't really exist (except in their mind). Visual, Auditory, Olfactory (Smells), Gustatory (Taste), Tactile (Feeling)
A CM II demonstrates the following competencies (professional)
Acquire knowledge and skills, Facilitate informed decision, Emphasize choices, Provide practical and meaningful activities, advocate, Promote the effectiveness of psychiatric rehabilitation with colleagues and the service delivery system, maintain personal wellness, Take intentional personal action to support recovery, seek input and feedback, Recognize one's own role during conflict in order to facilitate resolution
an example of life domain
Activities of daily living, Performance of social roles, Performance of cultural roles, Performance of occupational roles
2 types of social relationships
Affiliative and functional
what is a skill
An ability acquired by systematic effort to do something well. Skills may be physical, intellectual, emotional or social (behavioral
What is deficit orientation?
An approach that tends to focus on needs and problems in people or helping people avoid risks associated with negative outcomes. These risk- based interventions do not sustain change
What are best practices in family interventions?
Appreciate the family as a core for healing and recovery, Appreciate the families emotional struggles and experiences, Sustain open communication and include them in the multidisciplinary team
What is a delusion
Are considered inaccurate beliefs held by an individual, (typically with a mental illness), regardless of logical evidence disproving the belief.
some critical skills for children
Asking for help, Completing homework independently, Conversing with classmates, Sharing anxious feelings with teacher and family, Waiting for a turn in class
A female consumer is upset about her roommate always borrowing her clothes without asking. She is pacing and shouting. How should you react?
Assess the situation by talking to her to help de-escalate the crisis
what are the primary service function of rehabilitation services?
skill practice and curriculum based education
Assist persons with psychiatric disabilities to identify personal priorities, preferences, strengths and interests, perform holistic assessments across multiple life domains, Collaborate with persons with psychiatric disabilities to help them identify their individual preferences in dealing with crises, Collaborate with persons with psychiatric disabilities to write goals with specific action steps in order to develop effective treatment/rehabilitation/recovery plans, Identify opportunities that empower persons with psychiatric disabilities transition from professional provider service so natural community supports
Assessment, planning and outcomes
Become familiar with ABCs of support and self-care strategies (WELLNESS SLIDES)
Awareness- Of our needs Limits of our physical and emotional resources Balance- Between activities, work, play and rest Connection- To oneself, others, and something larger
What is cultural competency?
Capacity to function effectively as an individual and an organization within the context of multicultural beliefs, behaviors, and presented by consumers and their communities.
What is spirit breaking behavior?
Chastising, Being rude, Imposing one's own standard, Attributing everything to MI/SA, Restricting Choice, Making generalization, Making decisions for person, Telling person what they are not ready for
What are some things that are opposite of stigma
Community integration and Personal empowerment
informed choices
Competent practitioners should have a basic knowledge of evidence based practices and the policies and laws that impact a consumers benefits so they assist the consumer with making ___________.
critical skills for adults
Conversing with neighbors, Managing Anger, Improving hygiene, Managing Time, Planning a balanced/nutritious meal, Cooking a simple meal, Managing money
Use outreach techniques, Teach communication skills, Provide interventions for change, Develop relapse prevention strategies, Utilize group formats to engage persons with psychiatric disabilities in a wide range of activities, De‐escalate crises, modify environments, Use motivational enhancement and readiness development strategies to initiate and sustain the recovery process, Encourage persons, provide education on issues related to psychiatric conditions, Provide best‐practice procedures, treatments, and approaches
DOMAIN V. Interventions for Goal Achievement
Intervene to stop stigma, oppression, discrimination, and prejudice, Advocate for better access to public services and resources, Advocate for needed regulatory policies related to persons with psychiatric disabilities, Advocate for system integration among public resources and community resources, Advocate for system changes, Advocate civil rights and protections as well as human rights and protection, Assist persons with psychiatric disabilities in their use of other service systems to meet their personal goals, Develop leaders among persons with psychiatric disabilities
DOMAIN VI. System Competencies
Engage and include persons with psychiatric disabilities from all the diverse backgrounds, Identify one's own culturally learned assumptions to promote culturally competent collaborative relationships, Assess cultural factors to ensure culturally competent diagnoses, goals, planning, and rehabilitative interventions, Conduct all rehabilitation activities in the preferred language and communication style, Remove institutional barriers that sustain stigma, oppression, discrimination, add prejudice in order to provide culturally competent service, •Teach persons with psychiatric disabilities and their natural support systems the skills to recognize and overcome cultural barriers, Receive input and provide feedback to persons with psychiatric disabilities and their natural support systems
DOMAIN VII. Diversity & Cultural Competency
What is hope inducing behavior?
Demonstrating care & kindness, communicating belief, Supporting person's decision, Normalizing experience, Pointing out achievement, Offering support to reduce fear, Acknowledging goals are person's goals
associated features of depression
Depressed mood most of the day and nearly everyday, Feelings of hopelessness, pessimism, guilt, worthlessness, helplessness nearly everyday, Diminished interest or pleasure in almost all activities, Fatigue or loss of energy nearly everyday, Psychomotor agitation or retardation almost daily, insomnia or hypersomnia, Difficulty thinking, remembering, concentrating, making decisions nearly everyday, Significant appetite loss, weight loss or weight gain, 1Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders & chronic pain
the first D in ADDIE stands for
Design and second phase, this consists of learning objectives, assessment instruments, exercise, content, subject matter analysis, lesson planning and media selection.
A CM II demonstrates the following competencies (community integration)
Develop linkages with a wide range of community resources, Promote the use of natural supports, Challenge situations in the community, Provide information on alternatives and complementary supports
what is defined as recovery?
No current medications,, Working, Relating well to family and friends, Integrated into the community, and Behaving in a way that one would not be able to detect that the person had ever been hospitalized for any kind of psychiatric problem
What are the core principles of psychiatric rehab?
People have the capacity to learn and grow, People are to be treated with dignity and respect
mood disorders
bipolar, major depression
a thought disorder is
a disturbance in the thought process that is most narrowly defined as disorganized thinking with altered associations
1 in 25 adults in the US experiences
a serious mental illness in a given year
schizophrenia is considered
a thought disorder with a constellation of signs and symptoms that may cause an individual to have a decline in interpersonal relationships, work, education or self-care.
Some individuals with a psychiatric disability may have difficulty attaining important life goals and functioning effectively in one or more life domains such as
activities of daily living and performance of social, cultural and occupational roles without assistance.
instruction should be designed to
address the skill area in a way that will translate to consumers daily life
What are the four A's?
adequacy, availability, accessibility, accommodation
18.1% of adults in the US experienced __
an anxiety disorder
Resilience means
an inner capacity that when nurtured, facilitated, & supported by others empowers children, youth, and families to successfully meet life's challenges with a sense of self-determination, mastery, hope, and well being
What are the Phases of ADDIE?
analyze, design, development, implement, evaluate
A in ADDIE
analyze, the first phase, the needs of what the learners are required to know after participating in the instruction, and the context in which the instruction will be facilitated
What type of disorder is OCD
anxiety disorder
what are formal supports
anyone who is helping in a professional setting i.e. CM and therapists,
What are staff turnover rates in mental health? (WELLNESS MODULE)
approximately 25%-50% per year
serious mental illness is defined as
as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities..
What are the essential functions of case management?
assist people recover, reclaim & transform their lives
You notice that a co-worker seems to favor some individuals over others and is not consistent in his actions. By doing this, he may be violating all of the following ethical principles except:
autonomy
Psychiatric rehabilitation activities/techniques are designed to provide the person with the opportunity to
become informed about the illness, assess what is needed to recover, choose rehabilitation goal(s), and plan for and obtain the experiences needed to develop the skills to achieve recovery
2.6% of adults in the US live with
bipolar disorder
What is the purpose of self-disclosure?
can be a means of building rapport with clients, which is essential to the counseling relationship.
anxiety disorders
characterized by the apprehensive anticipation of future danger or misfortune
10.2 million adults have been diagnosed with
co-occuring disorder
Emphasizes the development of thinking skills and processes as a means to enhance learning. The objective is to allow learners to become strategic, self-reliant, flexible, and productive in their learning endeavors
cognitive strategies
what are individualized strengths
competencies and confidence
a set of specific objects, symbols, or events which are grouped together on the basis of shared characteristics and which can be referenced by a particular name or symbol
concept learning
When discussing a client's case in group supervision what should be discussed?
confidentiality
•Stabilize emergency situations •Decrease stressors •Mobilize resources/supports to prevent hospitalizations •Improve their functioning above pre-crisis level
crisis diversion strategies
Rehabilitation services are education based services which generally involve two (2) primary functions
curriculum based education and skill practice
What are the symptoms for depression
deepened state of sadness, melancholy, hopelessness
symptoms of panic disorders
derealization, depersonalization, panic attacks
how can you challenge self-stigma
disclosure and change cognitive schemas
what are ways to practice competance
education, training, experience and supervision
what is compassion fatigue
emotional distress or lack of interest that results from the constant demand of caring for others
The engagement relationship should be a partnership that consists of...
empowerment
Community integration and "normalization" would promote a(n) __________ niche
enabling
The initial meetings with the person where the purpose is to create a trusting and reciprocal relationship between practitioner and the client as a basis for working together and begin the developing a collaborative helping partnership.
engagement and relationship
What are the seven core helping functions of the Strengths Model?
engagement, assessment, treatment planning, implementation, therapy, monitoring, and graduated disengagement
niches are defined as
environmental habitat of a person
what are resources
environmental strength
What is active listening?
giving undivided attention to a speaker in a genuine effort to understand the speaker's point of view
What are the positive symptoms for schizophrenia
hallucinations, delusions, disorganized speech, catatonic behavior
What is an overlapping relationship
has NO significant authority or emotional relationship.
What is a dual relationship
has significant authority or emotional relationship with their client.
The practice of psychiatric rehabilitation, is comprised of three strategies
helping persons identify goals, helping persons plan strategies and acquire necessary skills to reach and maintain desired goals and helping persons develop necessary supports to maintain those goals.
What type of relationship should case managers have when working with consumers?
helping relationship
The 10 fundamental components of recovery include
holistic, self-directed, non linear
According to Resilience and Recovery, Focal Point, Summer 2005, which of the following make it more likely that a young person will be able to "bounce back" from adversity
hope and connectedness
Principles of recovery are
hope, personal control and responsibility, connectedness, discovery, active sense of self
duty to warn
if targeting someone to harm
the I in ADDIE,
implement and the fourth phase where you will carry forward the instruction you have designed
What are the symptoms for mania
increased state of excitement, expansiveness and/or irritability
Know what people first language means.
is a form of politically correct language aiming to avoid perceived and subconscious dehumanization when discussing people with disabilities. We want to remind that they are people first and the illness is second
Why is the case management service plan important in the strengths model?
it is important for goal planning
basic ethical principles
justice, fidelity, veracity
When do most serious mental illnesses begin
late adolescence to early adulthood
when does schizophrenia typically begin
late adolescence to early adulthood and unlikely after age 45
5.A result of individuals that have had service providers do everything for them or the belief that they can't do anything correctly is often referred to as __________.
learned helplessness
who establishes ethical principles
licensure and laws
What does helping mean in the strengths model?
looking at the strengths in their personality, talent, support and aspirations
6.9% of adults in the US had at least one _____ in the past year
major depressive episode
Dual Relationships refers to having a personal relationship as well as a professional relations
meaning client and a friend
autonomy is "freedom of choice"
meaning that the client is the director of their recovery and everything we help with is solely their choice.)
Fidelity is "faithfulness"
meaning we keep our word and follow through on what we say
Non-maleficence is "do no harm"
meaning we will never do anything that will cause harm to our client's and/or recovery
1 in 5 adults in the U.S. experiences
mental illness in a given year
•The five factors that contribute to and manifest the oppressive life of people with psychiatric disabilities inhabit
mentalism, poverty, fear, professional practice, structure of the mental health service system
what is entrapping
more negative like characteristics
What are the big 9
needs assessment, service plan, referral, linking, advocacy, follow-up, monitoring, outreach, crisis diversion
Phrases containing "everyone will" or "all will have" are never right because
no two people are alike and everyone's recovery look different
1.Refraining from engaging in any behavior that would cause harm is which of the following basic ethical principles?
non-maleficence
Onset of bipolar
occurs prior to the age of 35. It usually begins in late adolescence or early adulthood.
What is a strengths based practice?
paradigm shift because it is a better alternative than being preoccupied with the negative aspects of people and society - more concerned with achievement than with solving problems; with thriving more than just surviving, with dreaming and hoping rather than just coping, and with triumph instead of just trauma.
obsessions
persistent ideas, thoughts, or impulses that are unwanted and inappropriate, causing marked distress
The creation of a mutual agenda for work between the person and the case manager focused on achieving the goals that the person has set
personal planning
What are the stages of change?
precontemplation, contemplation, determination, action, maintenance, relapse
what are the four considerations during the analysis phase
primary target, leaning style, values/beliefs/interests, similar and differences between learners
the ability to combine previously learned principles, procedures, declarative knowledge, and cognitive strategies in a unique way within a domain of content to solve previously unencountered problems
problem solving
. What is personal planning?
process of creating an action plan based on awareness, values, reflection, goal-setting and planning for personal development within the context of a career, education, relationship or for self-improvement
What are the principles of the strengths based model?
promoting the use of informal supportive networks; offering assertive community involvement by case managers; and emphasizing the relationship between the client and case manager
how can you challenge public stigma
protest, education, contact
promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives
psychiatric rehabilitation
involve skills that are physical by nature.
psychomotor
what are the critical elements in a helping relationship
purposeful, reciprocal, genuine, trusting, empowering
what are techniques of active listening
reframing, clarification, paraphrasing
what is the concept of confidence
related to power, influence, belief in one's self and self efficacy.
what are environmental strengths?
resources, formal and informal support, opportunities
What does ROPES stand for
review, overview, presentation, exercise, summary
Social functioning is a multifaceted concept that can best be understood several life domains
role functioning, social relationships, self-care and independent living skills, leisure and recreational activities and community integration
1% of adults in the US live with ____
schizophrenia
five most prevalent serious mental illnesses
schizophrenia, bipolar, major depression, panic disorder, OCD
what is counter transference
service provider's repressed feelings through identification with the emotions/experiences/problems of the client
The focus of Interventions in psychiatric rehabilitation
setting priorities; setting short-term and long- term goals and planning and implementation of the interventions
The personal/recovery plan is developed based on the consumer's goals and the primary source of information and guidance should come from the
strengths assessment
20.2% million adults in the US experiences
substance use disorder
implementation phase
successfully putting your instruction into use in the contexts for which they are intended
What is evidenced based
supported employment, assertive community, integrated dual disorders treatment, psychosocial education, illness management and recovery
what does recovery not mean
symptom free
Does case management tailor to the needs of each person or focus on general needs of everyone?
tailor to the needs of the individual
what is emotional wellness
the ability to understand your own feelings, accept your limitations, and achieve emotional stability
is the phase in which you take the general training parameters identified in the Analysis Phase and use them to create a well developed outline for instruction
the design phase
What does the strengths model provide for people?
the focus is on strengths not deficits
the strength based assessment is used as
the primary source for information and guidance.
the first D in ADDIE
the second phase, design and this consists of learning objective
What is the purpose of the functional assessment in rehabilitation services?
to identify skill learning needs
Why is the strengths perspective good to use with substance abusers?
to remind them the positives in their lives
Deficit oriented systems may cause individuals to internalize negative images and only identify themselves only by their illness
true
HIPPA was established to protect individuals from losing health coverage when changing employees
true
Self- stigma is when the individual with mental illness internalizes the prejudice and suffers diminished self- esteem and self- efficacy which undermines the person's sense of personal empowerment.
true
shared decision making
true partnership in which the consumer's choices are honored and by creating an environment of trust, choice, and individuality can thrive.
What does hope inducing mean?
using positive interactions
duty to report
usually when you see someone is being abused, child, elderly etc
Name the different types of communication.
verbal and nonverbal
Justice refers to "fairness"
we are always fair with the clients
Veracity is "truthfulness"
we are always honest
What are informed choices?
when a person is given options to choose from several diagnostic tests or treatments, knowing the details, benefits, risks and expected outcome of each
