HSC4134 Exam 3 (Emotional Health & Counseling)

Basis of Health Counseling

Help clients maintain those behaviors that promote health and prevent illness or change those behaviors that inhibit the healing process and contribute to illness

Ethical Relativism

The theory that holds that morality is relative to the norms of one's culture

Study all of Motivational Interviewing Part 1 PowerPoint

What is motivational interviewing

Contemplation

-"Getting ready" -Individuals are intending to change but not immediately Aware of the pros and cons of changing

Pre-Contemplation

-"Not ready" -Not yet considering or intending to change in the foreseeable future or is unwilling/unable to change -Person may be characterized by other theories as resistant, unmotivated, or not ready for help

Confrontation

-A "supportive challenge" -Viewed as a gentle means of "going with" clients by seeking their help in clarifying any discrepancies, incongruities, or mixed messages in their stories

Licensure

-A legal process controlled by individual states. -Involves passing a law at the state level that controls the practice or title of an occupation. -Practicing without a license is considered "breaking the law." -This is why it is extremely important that you never refer to using health counseling skills as counseling. We are not licensed counselors. Other terms - coaches, educators, etc. -Currently no professional license in the 50 states to practice health education (Hawaii started the process in 2013-14, but I haven't heard an update). -Licensures are not always reciprocal between states. -"provide health counseling "- not described as "counselors"

Health Counseling

-A psycho-educational process that revolves around two primary functions: (1) Helping clients understand & cope with the feelings & emotions associated with their health problem, (2) Helping clients develop & adhere to therapeutic regimens -a form of health education: describes various approaches & methods for assisting individuals to reduce or prevent the progression of disease processes as well as to improve health status & functioning

Health Belief Model (HBM)

-A psychological model that attempts to explain and predict health behaviors by focusing on the attitudes and beliefs of individuals -Developed in response to the failure of a free tuberculosis screening program offered in the 1950's -Originally only 4 perceptions, cues to action and self efficacy (1988) added later -Explains behavior from the perspective of cues to actions, self-efficacy, and four perceptions (Perceived susceptibility, Perceived severity (seriousness, Perceived benefits, Perceived barriers)

Ethical Dilemma

-A situation that forces a person to make a decision that involves breaking some ethical norm or contradicting some ethical value -Involves making a decision between two or more possible actions where any one of the actions can be justified as being the right decision

Focusing on the Narrative

-A subtle influencing skill that helps clients open their minds to different ways of viewing their problems. Seven major focal points: (1) Individual focus, (2) Problem focus (3) Family focus, (4) Other individual focus, (5) Mutuality focus, (6) Helper focus, (7) Cultural/environmental context focus

Ethics

-A system by which one determines whether an action is moral or immoral -A system of values that guides behavior in relationships among people in accordance with certain social roles -Morality: a code of conduct that acts to guide behavior -Moral judgments: Judgments concerned with what an individual or group believes to be the right or proper behavior in a given situation

Certification

-A voluntary process through which recognition is granted to individuals who meet certain predetermined qualifications (educational requirements, experiential requirements, passing a certification exam) -A term used to denote recognition of one's professional credentials and experience by a recognized certifying body board, center or commission -Available for many professions -CHES (granted by NCHEC) and MCHES

Social Cognitive Theory

-AKA "Social Learning Theory" (Albert Bandura) -Behavior results from interaction of the individual, the environment and the behavior itself. -Reciprocal Determinism: A change in one factor leads to changes in all of them.

Transtheoretical Model

-AKA "Stages of Change" Model -Explains that people go through six stages on their way to changing behavior -The time a person can stay in each stage is variable but the tasks required to move to the next stage are not -Criticism: does not capture everything regarding physical activity (motivation to change)

Clarify Client Role

-Active participant

Primary Prevention

-Activities designed to reduce the likelihood of person developing the health problem -focus on prevention -Examples: (1) wash hands, flu shot to prevent the flu (2) Exercise and reduce sugars to prevent diabetes (3) Abstinence, wearing a condom, to prevent std's (3) Brush teeth, less sugar, to prevent cavities (4) Do not smoke to prevent stroke

Secondary Prevention

-Activities targeting early detection & prompt treatment -focus on detection -Examples: (1) getting tested for std's (2) Getting checked for cavities (3) Mammogram (4)Pap smear (5) Get checked for blood clots or symptoms to see if they have stroke

Tertiary Prevention

-Activities that limit disability & premature death of persons who have had the health problem for a while & are dealing with the complications associated with it -Examples: (1) eat healthy if they have diabetes (2) speech therapy if they had a stroke

Attending Skills

-Attending means "paying attention to" -Also known as listening skills -Designed to get clients to start talking and tell you their stories -Visuals, Verbals, Vocals, Body Language

Ethical Principles

-Autonomy -Justice -Non-maleficence -Beneficence -Fidelity -Promise-keeping -Honesty -Truthfulness -Privacy -Confidentiality -Respect

Behavior Change Theories

-Basic premise: All behavior is learned.(Classical conditioning, Operant conditioning) -We can unlearn unwanted behaviors, and relearn new, more desirable behaviors. -Health Belief Model -Social Cognitive Theory -Transtheoretical (Stages of Change) Model -Social-Ecological Model

Perceived Susceptibility

-Belief about the risk of developing or contracting a condition

Perceived Severity (Seriousness)

-Belief about the seriousness of the consequences of the behavior

Setting Goals & Measurable Objectives

-Best to use goals set by professional associations & public health organization as the starting point -Ask clients for additional goals they have & try to incorporate (May require referral to other professionals) -Goals must be clear & attainable -Objectives should be measurable (Basically will answer the question, "who will do how much of what & by when?")

Purpose of Introductory Skills

-Build a foundation for trust and sharing -Establish human connection and set the tone for acceptance and nonjudgmentalism -The environment is important—both physical & psychological elements (1)Safety:nothing on the floor, access to the door (2) Comfort: lighting and temp (3) Confidentiality: close the door, don't talk about patients with other ppl, don't leave info out (4) Reliability: be on time for appointments so patients don't wait (5) Respect: respect for individual, client, confidentiality, profession

Affirming

-Builds rapport and demonstrate empathy -Is not the same as praise -Centers on the client and not the helper -"You did very good job of....." rather than "I'm so proud of you for...."

Closed (Yes/No) Questions

-Can be answered with a simple yes or no. -Can be useful...verify facts -When overused can quickly end a dialogue

Individual level SEM

-Characteristics of an individual that influence behavior change -gender, age, racial/ethnic identity, sexual orientation, knowledge, economic status, literacy, religious identity, etc.

Attending Mistakes

-Clock watching -Daydreaming -Showing obvious signs of boredom -Becoming easily distracted -Allowing interruptions -Prejudging the person

Eliciting & Reflecting Meaning

-Concerned with helping clients uncover their most deeply held thoughts & feelings about their health problems. -used to help clients interpret their stories & determine what they mean to them

Ethical Conduct

-Conducting oneself in a manner consistent with acceptable principles of right and wrong (community, country, profession, etc.)

Visuals

-Culturally-appropriate eye contact: (1) Look into the person's eyes but do not stare (blink, soften your gaze, relax your forehead and eyebrows) (2) More critical when the other person is talking than when you are (3) Occasionally break eye contact (combine this with non-verbal feedback)

Information, Directives, & Instruction

-Form the heart of health counseling & distinguish it from more generic counseling. -The goal of health counseling is to teach clients & students how to manage, cure or cope with their health problem. -Health counselors must teach clients & students how to prevent recurrences, reinfections, & re-injuries.

Interpersonal Level of SEM

-Formal and informal social networks and social support systems that can influence individual behaviors -family, friends, peers, co-workers, religious networks, customs or tradition

Social Ecological Model (SEM)

-Framework for understanding the multifaceted and interactive effects of personal and environmental factors that determine behaviors -Five hierarchical levels: Individual, Interpersonal, Community, Organizational, Policy/enabling environment

Autonomy

-Free to decide one's own course of action -the right of an individual to make his or her own independent decisions

Characteristics of Health Counseling

-Generally, short term & task oriented -Starts & ends with a specific health problem -Focuses on the emotional issues surrounding a specific health issue -Each health problem has a unique set of educational & emotional directives -not therapy or -Cuts across a variety of disciplines -Is not distinguished by a recognized professional credential or specialty -Can be performed in a variety of setting and by a array of professionals (licensed professionals, nurses, psychologists, physicians, wellness coaches, physical therapists, health educators)

Goal of Health Counseling

-Help all clients understand and work through their feelings and emotions surrounding their health problems so they can... (1) help develop and adhere to their therapeutic regimens, (2) gain more control over their illnesses, and (3) improve health status/get better

Summarizing

-Help keep helper 'on the same page' -Can be demonstrated in three (3) variations: 1. A collective summary: Recalls a series of related interrelated items as they accumulate 2. A linking summary: Reflects back on what the client has said and links it to something else from a prior conversation 3. A transitional summary: Is wrap up a task or session or announce a shift to something new

Six Key Elements of Introductory Skills

-Human Contact -Smile -Exchanging Names -Explanation of Helper Role -Clarification of Client Role -Transition to the Client's Story

Exchange of Names

-Identify yourself by name and job title -Easy to combine with smiling & shaking hands

Action

-Individuals actively involved in taking steps to change -Typically overt and observable -The busiest stage, where individuals have to work the hardest

Termination

-Individuals are confident they will not return back to old behavior

Preparation

-Individuals are intending to take immediate action -Pros outweigh the cons

Policy/Enabling Environment Level of SEM

-Local, state, and national laws and policies -Healthy People 2020 goals, Clinical, program policies or recommendations of recognized bodies, professional organizations & professional associations (e.g., USPSTF, AAP), Clinical, program policies of federal programs (CDC, CDC, NIH)

Minimal Encouragers

-Minimal amount of feedback necessary to encourage client to keep talking -Can be nonverbal or verbal & can be used independently or together

Non-maleficence

-Non-harming or imposing the least amount of harm to reach a beneficial outcome

Core Interviewing Skills

-OARS -Skills that can be used by interviewers to help move clients through the process of change 1. Open questions 2. Affirming 3. Reflecting 4. Summarizing

Organizational Level of SEM

-Organizations and social institutions with rules and regulations that affect how, or how well services are provided -Medicare and Medicaid, State/local health departments, Health clinics, Professional organizations & associations, Health plans, insurance companies

Psycho-educational

-Psycho: mental-deals with feelings and emotions -Educational: knowledge- provide information and skills

Community Level of SEM

-Relationships among organizations, institutions, and informational networks -Community-based organizations, Schools, Support groups, Research institutions, Media, Neighborhoods, Community leaders, Businesses, Transportation

Reflective Statement

-Repeating back what is said with a spirit of warmth and empathy -respond with a statement rather than a question to avoid the risk of evoking defensiveness (Pg. 53) -A statement to double check whether you have understood what the client said—gotten it right -A way of letting the client know you are listening Opens/keeps the door open for further elaboration by the client -Can vary in depth from simple to complex -Generally, should not be longer in length than the client's statement

Interpretation of Meaning & Reframing

-Separate but used together -Interpretation of meaning: (1)includes counselor's perspective on the meaning of the client's stories, (2) draws from personal life experiences, clinical experience & theoretical framework -Reframing: helper presents different version of clients' stories for them to consider

Cues to Action

-Signals or reminders that prompt people to do something -Smoking examples: (1) Seeing healthy lungs vs tar covered lungs (2) Having a grandchild (3) Getting a call for a reminder of an appointment (especially for older ppl)

Maintenance

-Stage in which people are free of the old behavior -Do not have to work as hard as in the action stage but must be prepared to cope with common causes of relapse

Logical Consequences

-The outcomes that occur as a result of following directives & instructions -Two sets: (1)What helpers expect to happen (2)What clients expect to occur

Perceived Barriers

-The perception that the behavior change will be ineffective -Barriers must be identified, addressed and removed, if possible, for new behavior to be adopted. Examples: (1) don't take flu shot because dislike needles, (2) don't want to take chemo because it makes me weak and my hair fall out, (3) transportation, cost, (4) don't want to stop smoking because I do not want to gain weight

Sick Role Behavior

-The things people do or do not do from the time they are diagnosed with a condition to the time they are cured or their condition is in a maintenance stage. -Can be part of either secondary or tertiary prevention -Example: (1) diabetes-->take insulin (secondary or tertiary (2) Sti-->take medication (secondary) then back to prevention once disease is gone (tertiary)

Illness Behavior

-The things people do or do not do from the time they suspect that they might be exposed to, infected with, or have developed a disease to the time they are diagnosed. -the intent is to halt progression/spread through identification and treatment -related to secondary prevention -Example: Told that you have been in contact with someone who has an STI- from the time being told may immediately go and get diagnosed or try to treat illness (health educator would encourage person to get tested): the things you do before being diagnosed

Health Behavior

-The things people do or do not do to promote their health and prevent disease: (1)Adopting health-enhancing behaviors, (2) Stopping health-risk behaviors -Focus is on primary prevention -Example: stop smoking to prevent lung cancer

Smile

-Universal sign of friendliness & approachability

Transition to the client's story

-Use open-ended statement linked to client's needs, goals, story -Important to know why the client has come to see the helper -"Can you tell me what brings you here today?"

Forced-Choice Questions

-Valuable but limit clients' range of options for responding -Clients who are scattered & abstract in their decision making

Verbals

-Verbal following: (1) Literally means "following client" (2) goal is to keep dialog going--with client, not helper leading (3) Follow their words (pick up where they left off) (4) Do not move to your own agenda

Vocals

-Vocal tone: (1)Adapt to their vocal tone when possible (pace, tone, intensity) (2)Avoid note taking (unless notes are needed)

Examples of Open Questions

-What do you do to protect yourself from pregnancy or STIs including HIV? -What has worked in the past? -How would you feel if you found out you were pregnant (or HIV positive)? -What kinds of problems have you had with taking your medication?

Legal Issues in Counseling

-issues are related to laws governing the practice of counseling. -most are passed & enforced at the state level -licensure standards are set by state professional boards -States have different standards of care and laws -Has to do with anything requiring a license to do (certification and accreditation are not these type of issues)

Information

-minimal necessary to follow their therapeutic regimen -two commons mistakes made by health educators: (1) giving too much information, (2) giving the wrong type of information

Three Levels of Prevention that Health Counseling Targets

-primary, secondary, tertiary -some overlap

Ethical Issues in Counseling

-related to practice standards

Body Language-Open/approachable

-squarely facing person, relaxed but not slouching, engaged but not threatening, hands unclenched, arms unfolded

Self-Efficacy

-the extent to which people believe they are capable of performing the behaviors -Confidence in one's ability to take action

Beneficence

-the obligation to do good -demonstrating kindness and helping others

Accreditation

-the process of public recognition granted to colleges or universities that offer specialized programs of study related to obtaining a credential or license -Looked at when becoming accredited: Faculty, students (meeting learning objectives and outcomes), professors (have correct degrees and qualifications to be teaching in program), and classrooms

Directives

-the things clients & students need to do to get better -the instructions that clients & students need to follow to meet the objectives that relate to the goals of their therapeutic plan

In health counseling, health educators use instructions for the following purposes

-to teach clients & students how to take medications -to encourage clients & students to keep logs, journals, & diaries -to teach clients & students how to perform exercises & rehabilitative procedures -to encourage clients & students to engage in risk-reduction activities -to help clients & students self-monitor their behavior.

4 main Categories of discrepancies (Confrontation)

1. Thoughts/beliefs & actions: know that condoms are very effective in preventing STI's but has STI because they don't wear condoms 2. Feelings / actions 3.Thoughts/beliefs & feelings 4. Versions of the story or parts of the story: : "I have only been with only one partner" later in the conversation: "I cheated on my partner" - feelings deals with emotions -thoughts deal with cognitive/knowledge

Open Questions

Purpose: -Explore, clarify and gain an understanding of client's feelings, thoughts, belief, and behaviors -Gather information -client does mot of the talking -Help client make an informed decision

Values

-Describes what is important in a person's life -Qualities or standards that govern the behavior person -Act as the foundation for principles -The foundation to a person's character, attitude, etc. -Used to make decisions about what is right and what is wrong

Feedback & Self-Disclosure

-Feedback: Entails giving objective information about how the client is behaving -Self-disclosure: The intentional disclosing of helpers personal information as part of their effort to connect with clients in a deeper, more humanistic way-->goal is to increase openness between the helper & the client/student

Explain Your Role & the Nature of Health Counseling

-Helper (Health Educator), help you understand the process & meet your goals, etc.

Major Influencing Skills

1. Confrontation 2. Feedback & Self-Disclosure 3. Focusing the Narrative 4. Eliciting & Reflecting Meaning 5. Interpretation & Reframing 6. Information, Directives, & Instructions 7. Logical Consequences

Verbal Minimal Encouragers

1. Minimal verbal utterances: -"ummm" -"uh huh" 2. Key word(s) -the most important word(s) in the sentence -can be either cognitive or affective 3.Mirroring: -Restating (repeating) the client's exact words while mimicking the body posture -can be verbal and nonverbal

Nonverbal Minimal Encouragers

1. Overall relaxed open body posture 2. Facial expressions: -culturally appropriate eye contact -smiling -arching of Eyebrows -head nods 3. Hand gestures: -Roll hands to indicate "continue"

Stages in Transtheoretical Model

1. Precontemplation: No recognition or need for or interest in change 2. Contemplation: Thinking about changing 3. Preparation: Planning for change 4. Action: Adopting new habits 5. Maintenance: Ongoing practice of new, healthier behavior

Human Contact

-A firm handshake: Used by both men & women, An accepted gesture of warmth & approachability, Understood as a sign of respect & greeting, Variations

Justice

-The obligation to be fair in the distribution of benefits and risks

Perceived Benefits

-Whether stopping an old behavior or adopting a new one, the change must be viewed as being beneficial or advantageous -Benefits must outweigh barriers in terms of significance.

Therapeutic Regimen

-a routine that promotes health and healing -examples in health counseling: (1) someone who has difficulty taking medication- health counselor may help set alarm on their phone (2) Someone who needs a medication they cannot afford- health counselor may by a resource to help lower price or contact someone who can make it free

Body Language-Closed/not approachable

-not squared, tense, forward leaning or slouching, distant, hands clenched, arms folded