Mental & Physical Assessment

Transcription

1 Mental & Physical Assessment Leslie Korn, PhD, MPH LMHC, ACS, RPP, NTP, NCBTMB Copyright Dr. Leslie Korn, 2018

2 Integrative Assessment Physical, Mental, Emotional & Spiritual Self Integrative Assessment Physical, Mental, Emotional & Spiritual Narrative Physical Health History Trauma /ACE History Pain Digestion & Elimination History Nutritional Status/Dietary practices Medications, Supplements/ Herbs Addictions Self Medication Behaviors Attitudes & Beliefs Exercise Detoxification Behaviors Experiences with clinicians Circadian & Ultradian Rhythm 4

3 Physical Health History Major Health Concerns/ Past and Current Family Medical History Beliefs/Lifestyle/ Genetics (e.g APOE test) Surgeries Accidents Please refer to the intake form that I use. It is also found in my book Nutrition Essentials for Mental Health Take some time to fill out The Food Mood Diary 5

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6 Prevalence of ACE by Category for Participants Completing the ACE Module on the 2010 BRFSS ACE category Women Men Total Percent (N=32,539) Percent (N=21,245) Percent (N=21,245) ABUSE Emotional Abuse 34.1% 35.9% 35.0% Physical Abuse 15.8% 15.9% 15.9% Sexual Abuse 15.2% 6.4% 10.9% HOUSEHOLD CHALLENGES Intimate Partner Violence 15.6% 14.2% 14.9% Household Substance Abuse 27.2% 22.9% 25.1% Household Mental Illness 19.3% 13.3% 16.3% Parental Separation or Divorce 23.1% 22.5% 22.8% Incarcerated Household Member 5.2% 6.2% 5.7% The prevalence estimates reported are from Washington, DC and ten states (HI, ME, NE, NV, OH, PA, UT, VT, WA and WI) who included the ACE module on the 2010 BRFSS (n=53,784).

7 Trauma / ACE History Complex relationships between traumatic exposures & Dissociative disorders: pain, substance abuse, eating disorders Auto-Immune Sleep (fibromyalgia) Gastrointestinal Chronic inflammatory response depression self medication Trauma in early family life can affect attitudes towards mealtime, food choices, and the ability to engage in nutritional self care. 13 Pain Visual Analogue Scale unidimensional measure of pain intensity See handout: Body Pain Visual Analogue Assessment

8 Nutritional Assessment is PsychoEducation Educate the client about the nutritional basis for her / his symptoms Connect mental health symptoms with physical symptoms / condition Bridge health experiences & symptoms of the past with those in the present Identify where food-related behaviors may be an effort to reestablish balance in the system Identify some alternatives to current behaviors that will bring positive, lasting results Provide hope for methods that can reduce any current side effects Identify three nutritional goals to begin the change process 15 Digestion and Elimination History

9 Nutritional Status / Dietary Practices Explore the meaning of food Food gathering & preparation History of family & diet, mealtimes Breastfeeding, antibiotics, etc. 17 Mindful Eating Chewing food until it is liquid Put the fork down between each bite A relaxed state to aid digestion The HapiFork biofeedback mindfulness Eating slowly reduces GERD, increases satiety reduces intake

10 Mindfulness Raisin Exercise Hold a raisin and observe it as though you are the first person to ever touch a raisin and you are investigating for the first time. See the raisin in all of its detail; observe every part of it the wrinkles, the way the light shines on it. Touch the raisin and explore the texture & sensation See handout for complete exercise. Do this exercise and then introduce your clients to the exercise. Initial Exploratory Dietary Questions How many of my meals are you preparing? How many meals a week are fast food? How are you preparing your meals? Which foods make you feel great? Which foods make you feel poorly? Do you use foods to alter your consciousness? What foods do you like but don t often prepare? Who are your allies for change in the family? Who are your allies for change among my friends? 20

11 Assessment: Begin to Reframe Shame-Based Statements Client 1: I just have no willpower when it comes to donuts. If I see them at work on the break table, I just gobble them up. I have always been bad that way. Therapist: Donuts are designed with so much sugar and flour that they act like drugs. No wonder you & many people find it hard to turn down donuts. It is not about willpower. Let s strategize some nutritional support that will satisfy. 21 Reframe Shame-Based Statements Client 2: I went to my friend s birthday party and she offered me a platter, and I ate two pastries, and now I have ruined everything I was working toward. Therapist: You have not ruined everything you are working toward. You have had a brief setback, but there s nothing keeping you from your goals. It s hard to say no at a birthday party. Did you feel you would standout or offend your host if you said no thank you? How about if we role play and plan for next time so you decide what it is you need & want for yourself. 22

12 Nutritional / Dietary Intake History The Korn Food/Mood Diary Exercise: Fill out the Korn Food/ Mood diary for 3 days and conduct your own review. 23

13 Food Diary and Clinician Checklist The Client fills out for 3 consecutive days Clinicians reviews with the client using the checklist Look for time of food intake, timing between food intake, protein sources Sugar & caffeine intake Protein stabilizes mood Hydration Identify healthy behaviors and unhealthy ones; explain how to make improvements & healthy substitutions. 25

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18 Medications & Supplements / Herbs Databases to explore interactions among drugs/nutrients/herbs Drug/ Nutrients: Integrative Therapeutics Checker Natural Medicines Comprehensive Database (subscription) cs=&s=nd Drug Interaction Checker PDR for Herbal Medicines (Book) Herb, Nutrient, & Drug Interactions, Mitchell Stargrove (Book) 35 Exploring Attitudes about Medications What are your beliefs and concerns about medications OTC, Prescription, Supplements, Herbs Explore preferences for how medications/supplements are absorbed (pills, capsules, powders, liquid, extracts etc.) 36

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21 Lifestyle: Exercise & Movement Copyright,Leslie E. Korn,

22 Explore Spirituality & Religion Is spirituality important to you? Is your spirituality something you want to incorporate into our work together beliefs about health & wellness What are your social supports: friends, family (2 & 4 footed/winged etc) Do you have a religions practice or affiliation you want to incorporate in our work together; if so lets explore 43 Summary Conduct an assessment that explores physical mental emotional & spiritual story Physical health history & narrative reveals mental health; this is bi directional in effect Assessment as Psycho Education Reduce shame based statements Mindfulness & Eating Nutritional Assessment: The Food Mood Diary & Comprehensive Self Reporting: Drugs/Nutrients/Herbs interactions Detoxification History Lifestyle Factors Spirituality

23 Thank you! drlesliekorn.com