Course 8K - Harm Reduction Strategies & Challenges with Co-Occurring HIV, SUD, and Mental Disorders

This Continuing Education course is sponsored online by CEU By Net, LLC. The course is an expansion of the shorter Course 1K, to which we have added Chapters 1, 2, and 3 extracted from the larger document written and copyrighted by SAMHSA, published in the public domain in 2020 with a forward updated in May 2021 by the U.S. Department of Health and Human Services,

This continuing education course earns 8 CEUs for TCBAP-TCB-TAAP, California CAADE and CADTP, NAADAC, IC&RC, Florida Certification Board (FCB), Florida and Texas Mental Health Boards, and CE Broker. Also earns 6 credit hours for NBCC and California BBS. EACC Approval for 8.0 PDHs in Domains I, II, III - expires June 30, 2024

Based upon these credentials, 8 course credits are accepted by MOST MENTAL HEALTH and ADDICTION licensing boards nationwide.

This CE course contains 4 of the 5 chapters of the SAMHSA document entitled 'Prevention and Treatment of HIV Among People Living with Substance Use and/or Mental Disorders' -- published by SAMHSA in the public domain in 2020 with a May 2021 forward by Elinore F. McCance-Katz, MD, Ph.D., Assistant Secretary for Mental Health and Substance Use, U.S. Department of Health and Human Services. The document is the result of a collaboration of expert panels of federal, state, and non-governmental participants who provided input for each of the chapters in the document. Panel members include accomplished scientists, researchers, service providers, community administrators, federal and state policymakers, and people with lived experience.

Compared to Course 1K, this Course 8K presents a more extensive examination of current approaches and challenges encountered in the prevention and treatment of HIV in people living with co-occurring SUD and/or SMI or SED. The course also presents current evidence of the effectiveness of programs and strategies used to treat and prevent HIV among people with co-occurring behavioral health disorders.

The course includes practical information from currently operating treatment and prevention programs, to consider when selecting and implementing your own programs and practices.

The emphasis in the design of the three research-validated programs is upon PREVENTION and TREATMENT of HIV, HARM REDUCTION in people who use and inject drugs, and improvement of overall mental and physical health in clients with HIV and co-occurring disorders through psychosocial programming.

The three model programs feature practices to increase adherence and uptake of viral suppression and preventative drugs, including pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), syringe exchange programs (SEP), Contingency Management (CM), Patient Navigation (PN), and linkage and retention.

We have extracted the extensive list of references for all of these chapters, and placed them at the end of the course as attachments with active inks to the referenced documents. You can review and download any of this reference material for use now and in the future. You will not be tested on the reference documents but they provide valuable added perspective to the course material and resources which you can use in your program or practice now and in the future.

The document is the result of a collaboration of expert panels of federal, state, and non-governmental participants who provided input for each of the chapters in the document. Panel members include accomplished scientists, researchers, service providers, community administrators, federal and state policymakers, and people with lived experience


. The Goals of This Course:

1. Learn the details of three research-validated service delivery models in diverse settings in which HIV can be effectively prevented and treated in persons living with HIV and concurrent SUD and/ or Mental Illness.

2. Learn effective approaches with various populations to encourage uptake and consistent compliance with (a) Pre-Exposure Prophylaxis (PrEP - prevention of HIV when exposed to the virus), and (b) Post-Exposure Prophylaxis (PEP), and (c) suppression of the HIV virus in those who have contracted HIV (ART - Antiretroviral Therapy)..

3. Understand the roles of both Biomedical Intervention and Psychosocial Intervention in the prevention and treatment of HIV in persons with concurrent behavioral health disorders (SUD and mental illness).

4. Learn how Syringe Exchange programs are successfully integrated within communities and the most effective approach to implementation with persons with concurrent behavioral health disorders.

5. Learn the role of Peer Health Navigation (PHN) and Contingency Management (CM) in achieving behavioral and biomedical targets, including transgender women of color who are at risk for or have HIV and concurrent behavioral health disorders.

6. Know why it is critical that programs primarily serving people with serious mental illness and SUD (a) assess their clients for HIV risk, (b) conduct HIV testing, and (c) provide medically and behaviorally integrated HIV prevention and treatment services to address their complex needs.

7. Understand the errors in the design of HIV programs which result in unsuccessful or reduced HIV viral suppression -- particularly with those living with a concurrent diagnosis of SUD and/or Mental Illness.

8. Understand that the model HIV treatment and prevention programs presented in this course must be modified as needed, to meet the needs and living circumstances of the local population.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Guide 1 - Course 8K

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Guide 2 - Course 8K

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Guide 3 - Course 8K

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Course 1K - Introduction to Effective Harm-Reduction Strategies for Prevention and Treatment of HIV in Persons with Co-Occurring Behavioral Health Disorders

This short Continuing Education course is sponsored online by CEU By Net, LLC. The course content is written and copyrighted by SAMHSA, published in the public domain in 2020 with a forward updated in May 2021. SAMHSA presents current, research-validated strategies for the prevention and treatment of persons who are living with HIV concurrent with SUD and/or Mental Disorders, with an emphasis on HARM REDUCTION. The course materials examine three currently operating community-based programs that utilize emerging and best practices for working with this population and identify the challenges and strategies for implementation.

The three model programs utilize client-centered, harm-reduction approaches in diverse settings that have demonstrated effectiveness in treating persons with concurrent HIV and Substance Use and/or Mental Disorders, as well as prevention of HIV in this vulnerable behavioral health population. The strategies described are part of a comprehensive HIV program.

The programs feature practices to increase uptake and improve adherence to pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), syringe exchange programs (SEP), Contingency Management (CM), Patient Navigation (PN), and linkage and retention.

This continuing education course earns 1.75 CEUs for TCBAP-TCB-TAAP and Texas BHEC, California CAADE and CADTP, NAADAC, IC&RC, and Florida Certification Board (FCB), Florida Mental Health Board, and CE Broker. Earns 1.25 credit hours for NBCC and California BBS. EACC 2 PDHs Domain I, III expires June 30, 2024

Based upon these credentials, the course credits are accepted by MOST MENTAL HEALTH and ADDICTION licensing boards nationwide.

This CE course contains Chapter 4 of the larger SAMHSA document entitled 'Prevention and Treatment of HIV Among People Living with Substance Use and/or Mental Disorders' -- published by SAMHSA in the public domain in 2020 with a May 2021 forward by Elinore F. McCance-Katz, MD, Ph.D., Assistant Secretary for Mental Health and Substance Use, U.S. Department of Health and Human Services.

The document is the result of a collaboration of expert panels of federal, state, and non-governmental participants who provided input for each of the chapters in the document. Panel members include accomplished scientists, researchers, service providers, community administrators, federal and state policymakers, and people with lived experience

The Goals of This Course:

1. Learn the details of three research-validated service delivery models in diverse settings in which HIV can be effectively prevented and treated in persons living with HIV and concurrent SUD and/ or Mental Disorder.

2. Learn the effective approach to encouraging uptake and consistent compliance with Pre-Exposure Prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in various populations.

3. Understand the roles of both BIOMEDICAL Intervention and PSYCHOSOCIAL Intervention in the prevention and treatment of HIV in persons with concurrent behavioral health disorders, supporting wellness, employment, and sustained functionality.

4. Learn how Syringe Exchange programs are successfully integrated within communities and the most effective approach to implementation with persons with concurrent behavioral health disorders.

5. Learn the role of Peer Health Navigation (PHN) and Contingency Management (CM) in achieving behavioral and biomedical targets in transgender women of color who are at risk for or have HIV and concurrent behavioral health disorders.

6. Know why it is critical that programs primarily serving people with serious behavioral health disorders assess their clients for HIV risk, conduct HIV testing, and provide integrated HIV prevention and treatment services to address their complex needs.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Guide for Course 1K

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Course 2H - HIV and AOD Issues with Adolescents and Families

This course is sponsored by CEU By Net and earns 2 Clock Hours of credit for multiple State Boards including Florida CE Broker, Texas BHEC, TCBAP-TCB-TAAP, IC&RC, NAADAC, California CADTP and CCADE, Florida Certification Board. EACC 2 PDHs Domain II, III expires June 30, 2024 The course also awards 1.75 CA BBS Hours and 1.75 NBCC Credit hours. Based upon these credentials, the course is accepted by most state boards for multiple licenses.

Note: This course has two study guides. You must complete the quiz for both study guides to obtain your CE Certificate.

Save the publications AND the quizzes to your computer, and read the materials off-line if you choose. Enroll in the course ONLY if you decide to take the quizzes and download your certificate. The quizzes must be taken ONLINE.

YOU PAY ONLY TO TAKE THE QUIZZES and to obtain your INSTANTLY DOWNLOADED CERTIFICATE.

Take a quick look at the QUIZZES if you like. (Click the little plus + sign below the GOALS at the end of this overview, and then scroll down to find the quiz link.) Our approach to quiz development makes reading through online publications and completing the quiz 'do-able'. We accept PAYPAL and any regular credit or debit card.

The first Study Guide in Course 2H pertains specifically to adolescents and young adults who are HIV-infected or coping with AIDS. The GOALS for the first section of the course involve the following: :

1. Know how to identify HIV-infected adolescents who are at risk for substance use

2. Learn effective approaches to communication with HIV infected adolescents about substance use.

3. Know how to screen and assess for substance use disorders (SUDs) in HIV-infected adolescents

4. Know how to implement appropriate substance use interventions for use with HIV infected adolescents, and how to make referrals for additional treatment and social intervention as needed.


The second Study Guide in Course 2D focuses upon HIV/AIDS in the context of the FAMILY. This module provides guidance for the following GOALS:

1. Know some approaches for effectively communicating HIV status within the family

2. Understand the issues pertaining to arrangement of future care of children in the HIV infected household.

3. Understand the impact of substance use by the parent in an HIV/AIDS household, including the resulting impairment and complication of family dynamics.

4. Know how to recognize and manage abuse and neglect in HIV-affected families.

5. Pertaining to DOMESTIC VIOLENCE in HIV-affected families: Know the indicators, the assessment approach, some appropriate intervention techniques, and some special treatment planning issues when the HIV patient is the PERPETRATOR vs. when he or she is the VICTIM.


The course is appropriate for AOD-SA-CD Counselors, Pastoral Counselors, Rehab Specialists, LMFTs, LPCs and other licensed counselors, Social Workers, and other treatment providers.

The publication on adolescents is AUTHORED, COPYRIGHTED, AND PUBLISHED in the public domain by the New York State Department of Health AIDS Institute's Office of the Medical Director, in collaboration with The Johns Hopkins University, Division of Infectious Diseases. The AIDS Institute's Clinical Guidelines Program directly oversees the development, publication, dissemination and implementation of clinical practice guidelines addressing the management of adults, adolescents, and children with HIV infection.

The publication on HIV and the Family is AUTHORED, COPYRIGHTED, AND PUBLISHED by the same entity - the AIDS Institute's Office of the Medical Director, in collaboration with The Johns Hopkins University, Division of Infectious Diseases.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Study Guide 1 - Substance Use and Dependence Among HIV-Infected Adolescents and Young Adults

For the focus and goals of this module, see the overview section above. Say the authors of this sponsored course: "For the purpose of these guidelines, the term adolescents refers to both adolescents and young adults, 13 to 24 years of age. The use and abuse of alcohol and other mood-altering substances can be particularly problematic for both adult and adolescent HIV-infected patients. However, substance use patterns are different between adolescents and adults. "Screening, assessment, and treatment of substance use in adolescents require unique considerations, including the following: • Social factors, particularly strong peer influences, have a significant impact on adolescent substance use. • Experimentation with substances, especially with alcohol, is common among adolescents and is often considered normative behavior. • HIV-infected adolescents presenting for treatment typically demonstrate a high degree of co-occurring mental health symptoms or prior mental health diagnoses, which frequently precede the onset of problem substance use." Click here to view this study material. Click here to view and print the quiz you will take for this material.

Study Guide 2 - Family Issues for Patients with HIV/AIDS

To review the focus and goals of this module, see the course overview above. Say the authors of this sponsored course: "As more women of childbearing age become HIV infected, HIV/AIDS increasingly becomes a disease that involves the family. Primary care practitioners working with HIV-infected parents should, therefore, be aware of the needs of their patients’ families, as the burden of HIV infection becomes much greater when children are involved. "By providing treatment and solutions for common problems found in HIV-affected families, primary care practitioners help ease the pressure on these patients. Family members of an HIV-infected person also may face particular difficulties. When confronted with the knowledge of a person’s illness or lifestyle, family members can become confused or angry. If not addressed, these emotions can be turned against the HIV-infected person. "Children who are infected must cope with and adapt to their own chronic and perhaps terminal illness. They often lack the emotional maturity that can help adults, yet they still must try to deal with the psychological effects that the disease can have on them and their families. Similarly, children who live with an HIV-infected family member must bear the psychological impact of this situation. The impact can be especially traumatic if the infected family member is the child’s parent or sibling." YOU MUST CLICK THE BLUE 'CLICK HERE' LINK BELOW to view Study Guide 2 for free, for this section of the course. Click here to view this study material. Click here to view and print the quiz you will take for this material.

Course 8T - Human Trafficking of Adolescents in America

CEU By Net, LLC sponsors this online course, 'Human Trafficking of Adolescents in America' - NOW RE-APPROVED by Texas HHSC for the required certificate through August 9, 2025.

The course earns 8 credit hours (CEUs) that you can apply to multiple continuing education categories including SUD and mental health Assessment, Cultural Awareness; Federal and State Laws and Rules; Ethics, Crisis Intervention and Trauma-Informed Care; LGBTQ youth; interagency and community coordination; abuse, neglect, exploitation, and more.

The course earns 8 CEUs for Texas, Florida, and most other states nationwide for mental health and addiction licenses and certifications, and 8 hours for NAADAC and IC&RC. Earns 8 PDHs for EACC-EAPA, re-approved May 1, 2023. Earns 5.5 credit hours for NBCC and California BBS (and applies to your required 6 hours of Laws and Ethics for BBS).


This course presents an ethical, sensitive, and culturally appropriate approach to identifying, assessing, and assisting minors who are victims of Human Trafficking, including coordination with local and Federal Law Enforcement in the prosecution of trafficking perpetrators.

The course material includes a printable, downloadable prototype assessment for use with trafficking victims, which is important in securing interagency services for survivors and successful prosecution of perpetrators. The course also explains the Federal laws applying to the trafficking of minors vs. adults and clarifies common misunderstandings about what constitutes 'trafficking.'


The GOALS of this course:

1. Learn the focus, approach, and achievements of the US Department of Justice and its partner organizations in the National Strategy to Combat Human Trafficking.

2. Understand the Federal laws and legal definitions of Human Trafficking for both minors and adults as defined in the Trafficking Victims Protection Act (TVPA); know how to recognize the various forms of sex and labor trafficking to which victims are submitted which violate their Human Rights; and understand the volitional difference between Human Trafficking and Prostitution in Adults.

3. Learn a research-based ETHICAL and CULTURALLY AWARE approach to assisting adolescent victims of Human Trafficking with the development of personal safety strategies and methods of escape from the perpetrator.

4. Become familiar with the ethically formulated Trafficking Assessment content which is required for the successful prosecution of human trafficking perpetrators, including victim-centered language and questions, awareness of trauma-sensitive dynamics, sensitivity to safety issues, and respect for the victim's right to PRIVACY and CONFIDENTIALITY.

5. Understand the ETHICAL ISSUES and PROFESSIONAL CHALLENGES involved when working with the law enforcement team—i.e., the inherent limitations placed on CLIENT CONFIDENTIALITY, to successfully prosecute the perpetrator; and the need for both the credentialed staff and the unlicensed staff to maintain compliance with the rules for SCOPE of PRACTICE.

6. Know the characteristics and methods of Human Trafficking perpetrators and the diverse settings in which they operate, violating the FEDERAL LAW in the United States and the HUMAN RIGHTS of the victim.

7. Understand the typical etiology of how Human Trafficking exploitation and abuse occur in the lives of homeless and runaway youth, and the reasons why escape is difficult or impossible without Trauma-Informed assistance and interagency coordination between law enforcement and behavioral health professionals.

8. Understand the role of drugs, alcohol, homelessness, and survival sex in the deprivation of human rights which is characteristic of Human Trafficking.

9. Know an ethical way to work with trafficking victims to develop a safety plan at various stages in the human trafficking situation – while a victim is in the situation, during the process of leaving, and once the victim has left – and how to ensure safety for staff within the program.

10. Recognize the impact of the COVID-19 Pandemic upon resources for homeless and runaway adolescents who are targets of Human Trafficking perpetrators.


AUTHORS, PUBLISHERS: The material in this manual is published and copyrighted in the public domain by the U.S. Department of Justice, U.S. Department of Health and Human Services, SAMHSA, U.S. Office of Victims of Crime, Homeland Security, The Polaris Project, and Family & Youth Services Bureau - Runaway and Homeless Youth Training & Technical Assistance Center - National Safe Place Network.

APPROVALS:

NBCC, California BBS (including Laws and Ethics), Texas Mental Health licensing boards, Texas TCBAP-TCB-TAAP, California CAADE and CADTP, NAADAC, IC&RC, Florida Certification Board (FCB), Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Earns 8 PDHs in Domain 3 for EACC-EAPA approved Dec 22, 2021. Based on these approvals, the course is approved by most mental health and addiction licensing boards.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Guide 1_Course 8T_Human Trafficking of Adolescents in America

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Guide 2_Course 8T_Human Trafficking of Adolescents in America

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Guide 3_Course 8T_Human Trafficking of Adolescents in America

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Course 2F - Personality Disorders in Patients With HIV/AIDS and SUD

This course is sponsored by CEU By Net and earns 2 Clock Hours of credit for multiple State Boards including Florida, Texas, TCBAP-TAAP, IC&RC, NAADAC, California CCADE and CADTP, and Florida Certification Board. EACC 2 PDHs Domain III expires June 30, 2024. It also awards 1.5 CA BBS Hours, and 1.5 NBCC Hours. Based upon these credentials, course is accepted by most state boards for multiple licenses.

Note:

This online course focuses upon ASSESSMENT AND THERAPEUTIC INTERVENTION WITH individuals who have HIV/AIDS and a CONCURRENT PERSONALITY DISORDER. .

The course is appropriate for AOD-SA-CD Counselors, Rehab Specialists, LPCs and other licensed counselors, Social Workers, and other treatment providers who work with or wish to work with persons with HIV-AIDS.

This publication is authored and published in the public domain by the AIDS Institute's Office of the Medical Director, in collaboration with the Johns Hopkins University, Division of Infectious Diseases. The AIDS Institute's Clinical Guidelines Program directly oversees the development, publication, dissemination and implementation of clinical practice guidelines addressing the management of adults, adolescents, and children with HIV infection.

About this publication, quoting the authors: "Patients with personality disorders often present challenging therapeutic situations ... Personality disorders among patients infected with HIV are associated with a higher rate of depression, maladaptive coping, and other psychiatric symptoms .... This chapter focuses on the fixed patterns of behavior and interpersonal relationships that characterize personality disorders, particularly the ways in which these behaviors impact medical care. Because interaction with others can be challenging for patients with personality disorders, they may be averse to medical treatment. Patients with personality disorders may want care but may not know how to accept it. .... Clinicians can interact with these patients effectively with a plan that focuses on support between the patient and the care team."

There is an addendum to this publication which we have included as part of the course, which provides very specific instruction on how to detect, assess, and manage the potential for suicide and violence in personality disordered individuals with HIV-AIDS. The authors are clear that the potential for violence toward others in those with a dual diagnosis of HIV-AIDS and a Personality Disorder is far greater than the risk presented by HIV-AIDS patients who do_not have a Personality Disorder. For additional information about the study materials - and to READ the online article and to PREVIEW AND PRINT a copy of the online quiz - JUST CLICK THE + SIGN BELOW THE 'GOALS' for this Summary Guideline, below.


THIS COURSE is a 'QUIZ ONLY' course. The material for this course - and the quiz which we have developed to assess mastery of the materials - may be accessed FOR FREE on the internet, by clicking a link on our site. After reviewing the materials free of charge, you may enroll in the course for free with an Annual Subscription [or if you don't have a subscription, pay the $18 course fee]. Then take the online quiz and complete the Feedback Form to obtain your instant-download certificate.

We suggest that you print a paper copy of the quiz and mark your answers as you read through the materials. Then, when you are ready to take the online quiz, just take a couple of minutes to transfer your answers from the paper copy to the screen.

THE GOALS of This Summary Guidelines:

1. Learn how to recognize disordered personality and behavioral traits and their impact upon the treatment process and the environment which surrounds the individual.

2. Learn that antisocial and borderline personality disorders are the two most prevalent personality disorders among substance-using patients, and that those with borderline and antisocial personality disorders are more likely to participate in sexual and needle-sharing risk behaviors.

3. Know how to differentiate those who are suffering the effects of domestic violence, or the limitations of intellectual capacity, from those with Personality Disorders.

4. Understand why the diagnosis of a specific personality disorder may not be as important as identifying and focusing on specific personality TRAITS and CO-OCCURRING disorders including SUD that make treatment planning and provision of health care and other support services difficult..

5. Know that the professional's principal objective should be to help affected individuals to maximize health-oriented behaviors.

6. Recognize the specific personality types: Odd or Eccentric Individuals, Dramatic, Emotional, or Erratic, and Anxious or Fearful -- and how to work with them.

7. Understand the need for a structured approach: Although long-term intensive, individual psychotherapy is necessary for fundamental, lasting change in patients' personalities, briefer interventions may help patients modify their maladaptive behaviors.

8. Know how to detect, assess, and manage the potential for suicide and violence in personality disordered individuals with HIV-AIDS.

Note: You are free to read, download, save, and print the Study Guide(s) and Quiz(zes) for this Course, before deciding to enroll in the course. These course materials are public domain, and CEU By Net is sponsoring the course for CE Credit. You may STUDY THIS COURSE and the quiz AT NO CHARGE. You may enroll in the course at any time. You must take the quiz ONLINE, by logging into your My Home Page , clicking on the course you want to complete, completing the quiz or quizzes required, and submitting the Feedback Form. You will then instantly receive your course completion certificate! For more information on this course - and to see a COPY of the online quiz - click the '+' symbols, below:

Course 2F - Personality Disorders in Patients With HIV/AIDS and SUD

The following areas are addressed in this very practical, to the point publication - which emphasizes strategic teamwork and clinical consistency to effectively manage difficult clients/patients in an HIV/AIDS clinic setting: I. INTRODUCTION: Key Point: HIV-infected patients who present with maladaptive personality traits and behaviors may have other causative or co-occurring medical, mental health, SUD, and/or social disorders that require intervention. In addition, some patients with severe personality disorders may have styles of interaction that could foster conflict among patients, clinicians, and other staff. A team approach that relies on supportive, effective communication among everyone involved in the patient’s treatment is essential. II. DEFINITION OF PERSONALITY DISORDERS III. DIFFERENTIAL DIAGNOSIS FOR PERSONALITY DISORDERS A. Patients Who Are Victims of Domestic Violence B. Patients With Low or Borderline Intelligence IV. MANAGEMENT OF PATIENTS WITH PERSONALITY DISORDERS: Key Point: The diagnosis of a specific personality disorder may not be as important as identifying and focusing on specific personality traits and co-occurring disorders that make treatment planning and provision of health care difficult, such as SUD. The medical staff’s principal objective should be to help patients maximize health-oriented behaviors. A. General Approach to Patients With Personality Disorders 1. Effective Communication 2. Interdisciplinary Team 3. Developing a Treatment Plan 4. Educating Support Staff B. Approach to Specific Patient Types 1. Odd or Eccentric Patients 2. Dramatic, Emotional, or Erratic Patients 3. Anxious or Fearful Patients C. Structured Approach to Treatment of Personality Disorders - Key Point: Although long-term intensive, individual psychotherapy is necessary for fundamental, lasting change in patients’ personalities, briefer psychotherapies may help patients modify their maladaptive behaviors. Treatment for SUD is oftentimes necessary, in that antisocial and borderline personality disorders are the two most prevalent personality disorders among substance-using patients REFERENCES FURTHER READING ADDITIONAL RESOURCES Click here to view this study material. Click here to view and print the quiz you will take for this material.

Course 2D - The Ethics of Advance Directives: Assisting Clients and Families with Preferences for End of Life Care Including Those with HIV-AIDS

This course is sponsored by CEU by Net and is approved and/or pre-approved or automatically approved for 2 credit hours by multiple State Boards including Texas and Florida, TCBAP (Texas Certification Board) and TAAP, IC&RC, NAADAC, Florida Certification Board, and California CCADE and CADTP. EACC - 2 PDHs Domain III expires June 30, 2024. The course also awards 1.25 CA BBS Hours and 1.25 NBCC Hours.

This research-based study is published by the federal Agency for Healthcare Research and Quality (AHRQ), an agency of the US Department of Health and Human Services, and is written by Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S., and Ronda Hughes, Ph.D..

The course is both an ETHICS course and a COUNSELING INTERVENTION course and is appropriate for professionals who are working with [or may encounter] cancer patients, HIV-AIDS patients, stroke patients, terminally ill children, those who are in intractable pain, and others for whom End of Life care is an Issue. Say the authors, "Predicting what treatments patients will want at the end of life is complicated by the patient’s age, the nature of the illness, the ability of medicine to sustain life, and the emotions which patients and families endure."

Counseling dying or gravely ill or at-risk people and their families regarding their decisions for End of Life Care (Advance Directives) is fraught with both ETHICAL and INTERVENTION issues. Such counseling assistance is a delicate matter and can be difficult for counselors to carry out without inadvertently inserting their own biases into the intervention. This course teaches a 5-step research-based method to avoid such conflicts.

This 5-step counseling approach is also appropriate for working with clients who have chronic diseases such as cancer, kidney failure, CHF, and HIV/AIDS -- where there is considerable uncertainty about when death is likely to occur, but which is nevertheless a complex issue which may exacerbate co-occurring disorders including SUDs.

The main issue in working with people who are seriously ill is, how far do you want medical personnel to go, to delay death? HIV-AIDS patients differed significantly from other ill patients, in several areas. There are also circumstances in which the reaction of the patient to discussing such issues varies significantly, depending upon the specific stage or type of illness and age of the individual - including the reaction of terminally ill children.

The research therefore calls upon Behavioral Health and other medical professionals to tailor the approach according to the illness and the situation, i.e., HIV-AIDS vs Cancer vs Stroke vs. Alzheimer's .... and impending death vs. uncertainty of when death will occur.

The approach is, accordingly, a 'KNOWLEDGE FRAMEWORK’ and a 'GUIDELINE' for working with individuals with differing medical issues and life circumstances including HIV-AIDS -- and to do this work ethically. The research included discussion with patients with various medical conditions which they could face when he or she nears the end of life, including severe intractable pain, disabling stroke, permanent coma, mental deterioration, etc.. The patients were then asked to indicate which of these circumstances they would consider worse than death, i.e., under which conditions they would NOT want measures to be taken to prolong life. HIV-AIDS patients differed significantly from other ill patients in not wanting to prolong life under these circumstances.

This course is also helpful for those providers who work with HEALTHY individuals who work in life-threatening situations including MILITARY deployment to war zones, police officers, firemen, SWAT teams, undercover agents and other such at-risk occupations.


GOALS OF THIS COURSE:

1. Learn the terms pertaining to individuals' and surrogates' LEGAL RIGHT to make 'End of Life' care decisions.

2. Based upon the extensive research which produced this document, become aware of the need for clearer documentation and communication of patients' and surrogates' preferences for End of Life Care within the clinical record and in the direct communication provided to the treating physician and other caretakers.

3. Understand the THERAPEUTIC BENEFITS and the ETHICS of engaging in discussions about ‘end of life preferences‘ with applicable clients and their partners, spouses, families or surrogates (representatives).

4. Know that discussion and decisions about Advance Directives are important at multiple stages of proximity to death -- whether death is potentially imminent (as with late-stage AIDS patients and other critically ill people), or when the individual is adjusting to a diagnosis of serious illness which may ultimately result in death including HIV and cancer, or when preparing for high-risk medical procedures, or when coming to terms with the risk of critical injury in high-risk employment (military, law enforcement, etc.).

5. Based upon the extensive research presented in this document, learn that the choices for End of Life Care vary significantly, depending upon the specific type of life-threatening illness or circumstance -- such as the prevalent desire of those with HIV/AIDS to limit or rule out medical interventions to prolong life, vs. the preference of those with a different illness or life threatening situation to extend life through direct medical intervention.

6. Learn a five-part, research-supported PROCESS for structuring discussions about End of Life preferences, which inherently supports our ETHICAL RESPONSIBILITY for assuring the welfare and legal rights of the client.


This publication is dated 2003. However, the AHRQ considers this document to be nevertheless highly relevant to the subject at hand, when compared to other documents available within their research library and available elsewhere on the internet. This article is listed 3rd on the list of 261 AHRQ publications on this topic when most recently reviewed.

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Course 2D - The Ethics of Advance Directives: Assisting with Preferences for End of Life Care Including Those with HIV-AIDS

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