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A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency

A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency. Alya Reeve, MD, MPH University Of New Mexico Health Sciences Center Professor of Psychiatry, Neurology & Pediatrics PI, Continuum of Care. Date: 8-28-2012. “ Clinical Assessment:

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A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency

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  1. A.M.B.E.R. clinicAlbuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency Alya Reeve, MD, MPH University Of New Mexico Health Sciences Center Professor of Psychiatry, Neurology & Pediatrics PI, Continuum of Care

  2. Date: 8-28-2012 “Clinical Assessment: Techniques, Strategies, Adaptations”

  3. Techniques • Arrange schedules to minimize rushing. • Get independent sources of information. • Listen to ALL the information. • spoken, unspoken • alliances

  4. Techniques • Create alliance by reducing nonverbal threats • Positioning in the room • Angle of interactions • Answer questions; explain procedures or steps • Involve patient in discussion & consent process • Make sure no one is rendering patient invisible

  5. Techniques • Do not have to do everything in one day! • Develop desensitization plans for procedural anxiety. • Record signs and symptoms without diagnostic categorization. • Permits re-examination of hypotheses

  6. Strategies • Create atmosphere in which patient will reveal their understandings. • Safe environment • Respecting confidentiality • Use patient’s communication of symptoms or distress more than support staff articulation(s).

  7. Strategies • Keep record system for reference • Note sources of information, corroboration • Consider environmental, emotional, physiological factors contributing to behavior and intention • Assume the person is alive

  8. Adaptations • For procedures: • Desensitize in stepwise fashion • Introduce people as is feasible; allow the patient to control the rate of exposure • If routine exam you will gain a lot by taking even a year to gain trust • Create opportunities to observe the action or behavior of interest

  9. Adaptations • Atypical presentations of common diagnoses • Aggression may be masking depression • Pain is most frequent cause of changed behavior and altered sleep • Nonverbal communication • Inability to follow commands for AIMS

  10. Adaptations • Observe the patient’s response to other people talking about their interactions, talking for the patient. • Accept questions as a way to make you real in the patient’s world • Use the multi-axial system of diagnosis

  11. Putting it together • Have to take a little time • Synthesize information, observations, expectations… • Bio-psycho-social; holistic approach

  12. Clinical Assessment • There has to be a purpose to clinical examination • What does this report answer, to whom? • Are medications warranted? • Is psychotherapy available?

  13. Communication • Information has to go to the team providing supports. • Written report; oral report • Psychological support is needed by everyone on the team

  14. Communication • New findings, or new complications should be disseminated • Team members need to challenge each other to develop and maintain best practices.

  15. Innsbruck, Austria Railroad Station 2006

  16. Next presentation: 9-17-2012 “Psychopharmacology – first of a series” resources and back issues can be found at Continuum of Care website: http://som.unm.edu/coc/Training/powerpointnew.html

  17. CME/CEU • x

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