CM II

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•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


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