Chapter 2  Healthcare Delivery Systems

Assignment : (1) page assignment in a word document, Times New Roman Times in a font size of 12.

What would be your recommendation to improve the US healthcare system? What barriers are there to making the changes you recommend? What would you recommend overcoming these barriers?

Discuss how social, economic, and technological factors impact healthcare delivery.

Assignment 2: 1) page assignment in a word document, Times New Roman Times in a font size of 12.

Real World Case 2.1

What events in Steve’s life created a downward spiral into homelessness? Which events are related to social needs and which could healthcare have addressed?

What were some of the barriers Steve faced in accessing healthcare?

Why do you think the emergency department was the first place Steve thought to go for care? How might the emergency department improve care for patients like Steve?

What public health programs would be of the best utilization for Steve?

Real World Case 2.1

Steve is a 35-year-old, single male who lived in a one-­bedroom apartment in a safe neighborhood. Steve worked as a maintenance technician for a local mill. Steve’s job provided health insurance and he rarely needed to use it. Steve smoked half a pack of cigarettes each day and drank socially a few times a month.

One afternoon, Steve’s company notified him that it was laying off more than one hundred ­employees, including him. Though he was devastated about losing his job, Steve was grateful that he had some savings that he could use for rent and other bills, in addition to the unemployment checks he would receive for a few months. For the next six months, Steve searched aggressively for a job but was unable to find one. With his savings depleted, he was not able to make ends meet, and he was evicted from his apartment. His self-esteem plummeted and he became depressed.

Steve stayed with various family members and friends and was able to pick up some odd jobs to make some money. However, his drinking and anger got worse and his hosts asked him to leave. When he ran out of people to call, he started sleeping at the park. One night when Steve was drunk, he fell and cut his shin. The injury became red and filled with pus. Steve was embarrassed about his situation and didn’t want anyone to see him. But when he developed a fever and pain, he decided to walk to the nearest emergency department. He saw a provider who diagnosed him with cellulitis, a common but potentially serious bacterial skin infection, and gave him a copy of the patient instructions that read “discharge to home” and a prescription for antibiotics. Steve could not afford the entire prescription, but he was able to purchase half the tablets.

Steve began staying at a shelter. Each morning he had to leave the shelter by 6 am, and he walked the streets during the day and panhandled for money to buy alcohol. One day two men jumped Steve, kicked him repeatedly, and stole his backpack. A bystander called 911 and he was taken to the same emergency department where he had sought treatment for the shin injury. Again, the providers didn’t screen him for homelessness, and he was discharged back to “home.”

A few days later, an outreach team from a local nonprofit organization introduced themselves to Steve and asked if he was ok. He did not engage in conversation with them. They offered him a sandwich, a drink, and a blanket, which he took without making eye contact. The outreach team visited him over the next several days and noticed his shortness of breath and the cut on his leg.

After a couple of weeks, Steve began to trust the outreach team and agreed to go to the organization’s medical clinic. The clinic provided primary care and behavioral health services through scheduled and walk-in appointments. Steve said the providers there treated him like a real person. He was able to have regular appointments with a therapist and began working on his depression and substance abuse. A year later, his health has improved. He is sober and working with a case manager to find housing.

Assignment 3: (1) page assignment in a word document, Times New Roman Times in a font size of 12.

Real World Case 2.2

1. How is this situation complicated by not having all of the facilities linked into a common EHR?

2. Whom would the HIM director have to work with to make an EMPI project successful?

3. What are the advantages to all facilities of having a shared health record number

Real-World Case 2.2

A municipal medical center in a city of 100,000 residents decided that they needed to diversify if they were going to survive the ups and downs of the economy. The board of directors met with the chief of the medical staff to determine the best course of action. They mutually decided to emphasize a cradle-to-grave approach by acquiring a few select physician practices and a local nursing home, starting a home health agency, and creating a hospice unit within the medical center. The board then decided to link all new acquisitions to the medical center’s existing electronic health record (EHR) but ran into a problem with patient identification for health record purposes. The issue was that the same patient may have been or was going to be in multiple facilities within the new enterprise. However, at each of the present facilities (physician office, medical center, and nursing home), the same patient would have different health record numbers. A plan for an enterprise health record number was needed. The medical center administration decided to bring in the health information management director of the medical center to provide expertise and experience in resolving the problem.

Chapter 8 A Values-Based, Multicultural Approach to Career Counseling and Advocacy

Things to Remember

The process and techniques used in a culturally sensitive approach to career counseling

The cultural values of the major racial and ethnic groups in the United States

The advocacy process and the risks involved

That religious values may influence the career choice making process

In a sense, this entire book to this point has been to a large extent about values and multiculturalism. Specifically, in Chapter 2 I outlined how professional organizations have established ethical prohibitions against not taking race, ethnicity, and culture into consideration in counseling and psychological practice. In the discussions about each of the theories, I have included suggested multicultural adaptations, both in the theories themselves and in their applications. I have also pointed out that Holland (1997) theorized that his six personality types include both interests and values, that TWA (Dawis, 2002) and its adaptation on O*NET place values at the center of the theory and its applications, and that Super not only saw values as important in career development, but he and Nevill produced the Values Scale (Super & Nevill, 1996) to help measure work values. However, not one of the aforementioned theories or its application includes cultural values, in spite of evidence that suggests that they are an important variable in the career development of African Americans, Asian Americans, Native Americans, and Latina individuals and groups (Fouad & Kantamneni, 2013).

In the years leading up to my initial statement about the importance of cultural values in career development and counseling, I read and rejected several ideas about how best to tackle the issue. I happened to be involved with a report of a group of English consultants who helped an African government design a health care intervention that failed miserably. The now-forgotten authors concluded that the first step in their process should have been to assess the values of the people who were to be helped and only then to design the intervention. The report of the failed consultation and the extensive work of the Association for Multicultural Counseling and Development on the need for cultural competence oriented my thinking to differences and similarities in cultural values.

In 1988, I embarked on a crash course in work and human values by reading literally dozens of research articles about values. Some of those articles discussed the differences in values in various cultures, including the impact those values had on the decision-making process, work satisfaction, and so forth. I also discovered that some people in the field of communications had focused on variations of communication styles based on differences in cultural values. This chapter is the culmination of a long process of discovery aimed at ascertaining how effective, sensitive career counseling can be offered in a cross-cultural context.

In Chapter 1, I cited Blustein and his colleagues (Blustein, McWhirter, & Perry, 2005), who had called for a change in the paradigms that guide the work of career development specialists, partially because of its cultural roots in Eurocentric thinking and partially because the current models do not include advocacy for racial, cultural, ethnic, and sexual minorities. In this chapter, a multicultural approach to career counseling is presented, based largely on my (2002) values-based theory and its updates in this book. The objective of this presentation is to provide a detailed, comprehensive approach to career counseling, defined as a process aimed at facilitating career development and one that may involve choosing, entering, adjusting to, or advancing in a career. Along with Brooks (Brown & Brooks, 1991), I defined career problems as undecidedness growing out of too little information; indecisiveness growing out of choice anxiety; unsatisfactory work performance; incongruence between the person and the work role; and incongruence between the work roles and other life roles, such as family or leisure.

I want to point out that the approach discussed here does not rule out borrowing ideas from other theories. For example, I often use Bandura’s ideas about self-efficacy and appraisals to help my clients understand their motivation or, more likely, their lack of motivation. This presentation is followed by a section focused on helping students and others build their own approaches to career counseling.

Implicit in many discussions on multiculturalism, and its extension to counseling, is the message that white counselors need to learn about the cultures of ethnic and racial minorities, persons who are disabled, and persons who are gay, lesbian, bisexual, and transgendered and apply this knowledge to counseling. Consider the very real possibility of a lesbian counselor entering her office one day to find a white, Christian male who believes that homosexuality is a sin and freely expresses that view with everyone. One possibility is for the counselor to refer the client to another professional if she finds his views so repugnant that she cannot maintain her objectivity. The other is to try to understand his worldview, develop a working relationship with him, and proceed to help him with his career problem. The point here is a simple one: In a diverse culture such as ours, all counselors, regardless of race, ethnicity, or worldview, need a multicultural approach to career counseling.

As was illustrated in earlier chapters, the mechanics of career counseling, including approaches to the relationship and assessment, vary based on the theory being applied. Gysbers, Heppner, and Johnston (2003) developed a taxonomy of tasks that occur within career counseling simultaneously with the process of developing a working alliance. These tasks include identifying the presenting problem; structuring the counseling relationship; developing a counselor–client bond; gathering information about the client, including information about personal and contextual restraints; goal setting; intervention selection; action taking; and evaluation of outcomes. As will be shown later, the multicultural counseling model outlined in this chapter accepts most of these ideas regarding the structure of career counseling with minor changes.

Foundation of the Values-Based Approach

There are three aspects of culture. Universal dimension refers to the similarities among all groups. General cultural dimension refers to the characteristics of a particular group and typically refers to ethnicity, the group’s common history, values, language, customs, religion, and politics. There are more than 200 national entities and 5,000 languages in the world. These broad groups can be broken down into countless subgroups. It is impossible for career counselors to study all of the cultures and subcultures of the world, although it is possible for counselors in the United States to learn about what are termed the cultural generalizations of the major cultural groups in this country. The third aspect of culture is the personal dimension, which is reflected in the individual’s worldview and is based on the extent to which the general cultural values and worldview have been adopted by the individual. The process by which this occurs is called enculturation, and the result is racial/ethnic identity development, a continuous process that results in a worldview.

An individual’s worldview is the basis for his or her perception of reality (Ivey, D’Andrea, Ivey, & Simek-Morgan, 2009). Cultural generalization—that is, the assumption that the individual’s characteristics resemble those of the broader group—is stereotyping and must be avoided (Ho, 1995). Skin color, dress, ethnicity, religious beliefs, customs, or traditions honored are not proxies for personal culture.

As was discussed in Chapter 6, there are two broad philosophical bases for our theories and approaches: logical positivism and postmodernism. Ivey and his colleagues (2009) adopted a postmodern underpinning for their general approach to multicultural counseling, because it accommodates a “multiplicity of points of views” (p. 7). In fact, postmodernism accommodates an infinite number of points of view, because each person is perceived as having a unique worldview. Not surprisingly, given the relative perspective of postmodernism, there are no guiding truths, because truth is unknowable. Because there are no guiding truths, values are situational, not universal. It was this valueless perspective that led Prilleltensky (1997) to reject postmodernism as a philosophical basis for the practice of psychology.

The assertion here is that career counseling should proceed based on the client’s worldview, which is primarily based on the client’s cultural values unless those value collide with the laws of the dominant culture. If advocacy is incorporated into the career counseling process, then it should also be based on the client’s values. However, career counselors may also engage in advocacy aimed at legislative, community, and/or organizational change outside of the career counseling process based on their own values system.

Recently, I was confronted with a situation in which a young Chinese American high school student was being kept out of school to work in the family restaurant. Her parents believed that their action was perfectly congruent with their worldview, but their behavior was in conflict with the laws of the state of North Carolina. Career counseling cannot be a value-free enterprise. For example, if I take the relativity perspective on values in postmodern approaches into a career counseling session with an unacculturated American Indian male and help him build a career plan based on his worldview, then the plan must be implemented in a culture dominated by a totally different worldview. I may advocate for the client with prospective employers, but I may also find myself interpreting the employer’s values and helping the client continue to prize his own views while adapting to those in the workplace so that he can find meaningful employment.

Student Success Story

Jeannine was excited to be back in school. It had been over 20 years since she dropped out of

college to start her family. She was also excited to graduate as soon as she could so she could get

the promotion her manager promised her once she graduates. The pay increase would help a

lot…and she was ready for a new challenge at work.

Half way through her first class, her excitement started to wane a bit. She started to realize

working full time, taking care of her family, and going to school was no easy task. The online

learning environment was also new to her and presented some unexpected challenges.

As the weeks went on, she started to get more and more behind and her work was not to the level

she expected of herself. Jeannine started to wonder if online education was really for her.

The more she thought about the challenges she was experiencing and the possibility of dropping

out the more she remembered her goal to graduate and receive her bachelor’s degree. She had

waited for over two decades to accomplish this goal…she wasn’t going to let it slip away now.

Jeannine sat down and wrote out all the problems she was facing. She made a list of problems

along with possible solutions to each problem. She thought about how she had power to make

changes and take control of her situation. She had started to feel helpless when the problems

piled up, but after she made the list, she realized she had the ability to control the situation.

The first thing Jeannine did was call her academic counselor. She told her counselor all the

things she was struggling with. Jeannine got some great advice on how to manage her time better

and how to navigate the online learning environment. Her counselor also made her feel like she

wasn’t alone and wasn’t the only person who was struggling. This really boosted her confidence.

With this advice Jeannine wrote out a schedule which indicated all the times she would sit down

and focus on school. She made specific times to check and post in the discussion forum. She also

made sure to review and start all the assignments early in the week so they wouldn’t creep up on

her and have to be completed in a rush. Doing these things took a lot of pressure off of Jeannine

and she started doing better on her assignments because she was no longer procrastinating.

Next Jeannine asked her teenage daughter to teach her how to use the online learning tools

better. Jeannine was not “tech savvy” and she felt kind of intimidated by the online learning

environment…she was just afraid she would break it if she did something “wrong.” Her daughter

sat down with her for an hour on a few different occasions just to play around with the online

tools so Jeannine could feel more comfortable. She soon found that she understood how to find

things and navigate efficiently. Jeannine’s fears for using the tools quickly went away and she

was figuring things out for herself in no time. She just needed a little more time and practice.

Initially Jeannine also struggled with her writing skills. She hadn’t written an academic paper in

years and had forgotten a lot of the intricacies. She started to take some extra time and review

some of the tutorials and resources in the online student resources section of her online

classroom. There she practiced her writing skills and made sure to implement the things she

learned into her actual assignments. She noticed that her writing started to improve. She was

articulating her ideas much more clearly and writing became less of a chore. She was really

starting to get control of this “being a student” thing.

By the end of her first class, Jeannine was more excited than ever to be a college student. She

still had some struggles, but she was overcoming them…she knew she would just keep on

improving over time and would eventually reach her goal of being a college graduate.

Jeannine learned that despite the obstacles she faced, she could still take control and do specific

things to overcome them

QUESTION

Instructions

You will build upon the work you did for the previously in order to complete this final draft of your forensic examination. You will add information, the most significant of which will be a diagnostic and opinion section. Your work from the previous two, in addition to the additional info that comes later, should be included in this one. Include the following in your response:

Introductory Remarks, Informed Consent, Background Information

· Briefly describe the fictional evaluee’s social, educational, occupational, substance use, medical, and psychiatric history.

· Include mock collateral information obtained during the course of the evaluation.

1. Mental Status Examination

· Using a formal mini-mental-status exam, describe your mock client’s performance on domains such as orientation, immediate recall, attention and calculation, recall, language, judgment, ability to abstract, and intelligence.    Interview Questions,  Test Battery,   Diagnosis

· Provide a thorough DSM-5 diagnosis for your mock client.

1. Opinion

· Provide a defensible forensic opinion that relates to the legal question asked.

· Justify your opinion.

This should fulfill the following objectives:  A forensic evaluation appropriate to the age and gender of the fictional evaluee.

A description of the evaluee’s relevant history and personal characteristics.

An explanation of all aspects of informed consent pertaining to this evaluation.

A description of the fictional evaluee’s performance on a formal mini-mental-status exam.

A thorough DSM-5 diagnosis for the fictional evaluee.

A justification of a forensic opinion addressing the legal question asked.

communication that is scholarly, professional, and consistent with expectations for members of the psychological professions.

Discussion 2: Attentional and Interpretive Bias

Think back to the period of time following the attacks on New York’s World Trade Center on September 11, 2001. If you happened to travel by airplane during that time, did you experience a higher degree of anxiety than you might normally have? If you did not fly during that period, imagine how flying might have felt in terms of anxiety levels.

How might anxiety affect the way that you and your fellow passengers view one another within the context of a situation involving such attacks? Do you think that you would pay more attention to other travelers? Might certain behaviors seem more suspicious? These are examples of attentional and interpretive bias. These examples demonstrate how mood can affect memory and learning.

For this Discussion, consider additional examples of effects of mood on memory and learning. Consider how anxiety or depression can influence attentional and interpretive bias.

With these thoughts in mind:

By Day 4

Post two ways mood might affect memory and learning and explain how. Explain one way that anxiety or depression can influence attentional and interpretive bias. Provide examples to support your response. Justify your response using the Learning Resources and current literature.