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Making a referral for a client for other services seems fairly easy. The complicated part on this is when the counselor feels that the client may benefit from a different therapist, or the client has reached the end of sessions for what they were being seen for. I remember when my daughter was seeing a counselor and they had reached a point where it was time for her to move to a different therapist, it was hard on her, and she had some setbacks. She didn't get along with the new therapist and stopped going for a while until we found someone she got along with. This worries me with clients I am working with.

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Bear in mind that being referred may lead to the client experiencing difficult emotions: be ready to explain your decision and reasons clearly and calmly, pointing out what you feel the client will gain from the referral. You can also help the client work through their reaction.

Before raising the topic with the client, consider whether this may key into any other issues they have - for example, attachment difficulties, or struggles with loss or rejection - and be ready to link these themes to how they experience being referred.

If there is a waiting list for the service to which you are referring the client, you may wish to offer the client some ' holding sessions ' during this time, so that they are not left unsupported during this gap.

Even though you are not able to help them fully with their issue (hence the need to refer), your ability and willingness to accompany them as they wait, offering them the core conditions to support them during this time, could be invaluable to them.

It is also important to allow yourself time to reflect on and process your experience of referring the client, ensuring that your professional decision to do so does not lead to feelings of incompetence (sometimes known as 'imposter syndrome').

You may also feel emotions in yourself relating to loss, or to how the client reacted when you raised the topic of referral. This is a good opportunity for reflection and personal development, so enhancing your own self-awareness and growth.

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Referrals in Counselling * Counselling Tutor

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Referrals in Counselling Definition Feltham and Dryden (1993: 157) define 'referral' as 'directing someone to a counsellor or alternative source of treatment'. Clients may be referred inwards to a counsellor (by, for example, a GP or another counsellor) or be referred onwards by a counsellor (to another professional helper better suited to helping the client).

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Being aware of cultural competence is very important.  You have to be careful not to impose your own values and beliefs on others. Listening and getting to know your clients is key to have a successful counseling relationship. This will teach you how to interact with the client and understand where they are coming from.

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I enjoyed this assignment. I like when assignments give me hands on experience. I was nervous about it but excited. I found it a little challenging highlighting the different issues. There were some that could be more than one. Figuring out how to address the issues without sounding unprofessional. Or saying things like you need to do this or that. I didn't think that wording would be that difficult but it is. My oldest is in a complicated relationship and she was sharing some stuff with me and I found myself pausing and thinking how I was going to word my response so that I wouldn't offend her or make her feel uncomfortable. I actually find myself doing this a lot since I started taking classes.

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-by Timothy J Lyons

Crises are opportunities. Crisis is a time when the person in crisis is most susceptible to influence from targeted assistance from a crisis worker. In many behavioral modifications and Cognitive behavioral therapies, the crisis is a key factor used to assist the client to come through the other side of the situation so that the person in crisis stabilizes in a more adaptive level of functioning. According to leading cognitive behavioral regimens, the perception of the precipitating event is a crucial factor in the crisis. This is where the ABC Model of Crisis intervention comes into play

The subjective view, that the person in crisis holds, is the key to any interventions on the part of the helper or crisis worker. It is the starting point of the ABC model of Crisis intervention is a standard modus operandi which comes from the cognitive disputation model of cognitive behavior therapies. It is also the focus of contextual behavioral models. The context in which we view an event or the perception that we have of it is the one area that can be changed. It is the one area that can be disputed so that a crisis can be stabilized.

ABC Model of Crisis intervention

ABC Model of Crisis intervention is supported by scientific methods with evidenced based practices. They are used to treat crisis situations, change behaviors, and reduce suicidal ideation. These practices use the reframing of perception of events (thoughts about the event) to help. By helping a person to change the way that they see the event, a human services crisis worker can do the work of crisis intervention in a short amount of time. An example that many may be familiar with is at the loss of younger loved one (crisis), wherein one might ask themselves why this had to happen and why were they taken away when they were so young, it's not fair! (perception) and the crisis begins with resistance of acceptance.

With the help of the ABC Model of Crisis intervention, the crisis worker can help the person suffering from the crisis. It can change that viewpoint or accept it by reframing. The helper may have to go with age old maxims like life must go on. They are in a better place. We just don't know what god has planned or even that person just might be needed some place else.

Any one of these are valid reframing (cognitive disputation) techniques. These could assist in changing the way that the viewer sees that event. The ABC Model of Crisis intervention can help move a person from one perception which can cause great pain like, "it's not fair" to another thought which may reduce crisis situation levels (the pain will probably still be there but the person can function again) like, "although it does not seem fair, how am I to question life and its plans, there may be something bigger involved here."

This ABC Model of Crisis intervention may seem simplistic or even unreal. During a crisis, when a person needs help as quickly as possible, a rewrite of their perception is crucial. It can help that person to cope. The intervention may not completely alleviate the situation. It might just bring the levels of crisis down enough so that it can be managed. The person receiving the intervention can be helped to begin functioning again.

References

Kanel, K. (2015). A Guide to Crisis Intervention (5 ed.). Belmont, CA. Brooks/Cole.

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ABC Model of Crisis Intervention - Psychology Info

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by Timothy J Lyons Crises are opportunities. Crisis is a time when the person in crisis is most susceptible to influence from targeted assistance from a crisis worker. In many behavioral modifications and Cognitive behavioral therapies, the crisis is a key factor used to assist the client to come through the other side of the situation so that the person in crisis stabilizes in a more adaptive level of functioning.

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Crisis Prevention and Threat Group Assignment

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Crisis Prevention and Threat Group Assignment

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Human Trafficking was the group project I participated in. I loved working with my group. They were both very knowledgeable and we worked together well. I've been fascinated to learn more about trafficking. This assignment just piqued my interest even more. I got to work with a survivor of sex trafficking. During that time I learned that victims of trafficking stop maturing at the age that they begin being trafficked. This was interesting to me because it was true with this survivor. She had began being trafficked at the age of 16 and thats exactly how she acted. I plan to do more research on this.

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Open Access

Collection Review

Collection Review Collection Review articles synthesize in narrative form the best available evidence on a topic. Submission of Collection Review articles is by invitation only, and they are only published as part of a PLOS Collection as agreed in advance by the PLOS Medicine Editors.
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Cathy Zimmerman,

Ligia Kiss

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Citation: Zimmerman C, Kiss L (2017) Human trafficking and exploitation: A global health concern. PLoS Med 14(11): e1002437. https://doi.org/10.1371/journal.pmed.1002437

Published: November 22, 2017

Copyright: © 2017 Zimmerman, Kiss. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was supported by UKaid from the Department for International Development, grant number PO 5732. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: MOU, Memorandum of Understanding; PPE, personal protective equipment

Provenance: Commissioned; part of a Collection; externally peer reviewed

Summary points

Labor migration is an economic and social mobility strategy that benefits millions of people around the world, yet human trafficking and the exploitation of low-wage workers is pervasive.

The negative health consequences of human trafficking-and labor exploitation more generally-are sufficiently prevalent and damaging that they comprise a public health problem of global magnitude.

Human trafficking and labor exploitation are substantial health determinants that need to be treated as preventable, drawing on public health intervention approaches that target the underlying drivers of exploitation before the harm occurs.

Exploitative practices are commonly sustained by business models that rely on disposable labor, labyrinthine supply chains, and usurious labor intermediaries alongside weakening labor governance and protections, and underpinned by deepening social and economic divisions.

Initiatives to address human trafficking require targeted actions to prevent the drivers of exploitation across each stage of the labor migration cycle to stop the types of harm that can lead to generational cycles of disability and disenfranchisement.

Introduction

While migration within and across national borders has been an economic and social mobility strategy that has benefited millions of people around the world, there is growing recognition that labor exploitation of migrant workers has become a problem of global proportions. Human trafficking and other forms of extreme exploitation, including forced labor and forced marriage, now collectively under the terminological umbrella "modern slavery," are reported to affect an estimated 40.3 million people globally, with 29.4 million considered to be in situations of forced labor [ 1]. PLOS is launching a collection of essays and research articles on "Human Trafficking, Exploitation and Health" to increase awareness of the problem and to urge health and nonhealth professionals alike to engage in international and local responses to protect the health of individuals and populations affected by trafficking.

Human trafficking is a multidimensional human rights violation that centers on the act of exploitation. The United Nations defines trafficking in persons as "the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation" [ 2]. The elements of coercion, exploitation, and harm link human trafficking with other forms of modern slavery, forced labor and forced marriage.

In this introduction to the Collection on Human Trafficking, Exploitation and Health, we describe the magnitude of the problem, discuss the complex characteristics of trafficking, indicate the harm and associated health burden of trafficking, and offer a public health policy framework to guide robust responses to trafficking. Ultimately, however, in this introductory paper, we assert that human trafficking is a global health concern. That is, the health consequences of human trafficking are so widespread and severe that it should be addressed as a public health problem of global magnitude. Furthermore, because human trafficking has pervasive global health implications, we propose that these abuses-and perhaps labor exploitation more generally-be treated as preventable.

The dimensions of human trafficking and global health implications

Early discussions about trafficking in persons focused almost solely on sex trafficking of women and girls and drew primarily on law enforcement responses. But human trafficking is now understood more broadly to occur in a wide array of low- or no-wage hazardous labor. In fact, the contemporary amalgam of mobility and low-wage labor fosters many opportunities for labor exploitation. Men, women, and children are trafficked for various purposes, including domestic servitude, agricultural and plantation work, commercial fishing, textiles, factory labor, construction, mining, and forced sex work as well as bride trafficking and petty crime [ 3- 5]. These types of abusive work situations are especially viable in low- and middle-income countries [ 6] where low-cost labor is in high demand and where informal and precarious employment proliferates and labor governance is weak [ 7, 8]. A substantial proportion of human trafficking occurs within the same country, although international trafficking has received greater global attention [ 6].

The exploitation that is at the heart of trafficking comprises different forms of abuse, such as extensive hours, poor pay, extortionate debt, physical confinement, serious occupational hazards, violence, and threats. These forms of abuse occur across a spectrum at varying levels of severity. And, importantly, the impact of exploitation on the health and wellbeing of a person who has been trafficked depends on the combination of types and severity of the acts she or he suffers ( Fig 1).

Harmful in what ways and to whom

There is growing evidence on the wide-ranging health consequences of human trafficking. A systematic review on health and human trafficking found that survivors experienced multiple forms of abuse, numerous sector-specific occupational hazards, and dangerous living conditions [ 9] and suffered a range of poor health consequences. Among trafficking surviors in Southeast Asia, nearly half (48%) reported physical or sexual abuse and 22% sustained severe injuries, including lost limbs, and reported symptoms indicative of depression and anxiety disorders [ 10]. At the same time, however, there has been limited evidence on the social, financial, and legal harm suffered by trafficked persons-which often have further implications for ill health.

Reports on human trafficking regularly highlight that child workers, minorities, and irregular migrants are at particular risk of more extreme forms of exploitation. Over half of the world's 215 million young workers are estimated to be in hazardous sectors including forced sex work and forced street begging [ 11]. Ethnic minority and highly marginalized populations are known to work in some of the most exploitative and damaging sectors, such as leather tanning, mining, and stone quarry work [ 12]. Irregular or illegal migration status can be used to threaten and coerce workers. Poor language skills can prevent migrant workers from understanding and negotiating employment terms and enagaging in job training, and, importantly, it can hinder their understanding of local rights and assistance resources [ 13, 14]. Human trafficking also frequently manifests in highly gendered ways [ 1]. For example, women and girls are commonly trafficked for sexual exploitation, forced marriage, and domestic work [ 1, 4], while males appear to be more vulnerable to trafficking into various armed conflicts, and men in Southeast Asia are more likely than women to be recruited for commercial fishing, sometimes referred to as "sea slavery" [ 15, 16]. Government can play a role in restricting migration, such as Nepal's migration bans affecting younger prospective female migrants [ 17], or can promote migration through, for example, the Bangladeshi government's Memorandum of Understanding (MOU), which subsidizes recruitment fees for females migrating to numerous Gulf States [ 18].

The public health burden of human trafficking and labor exploitation

Prevention: A public health approach

Recent epidemiological shifts away from infectious diseases towards noncommunicable diseases [ 24] has led to growing knowledge about the influence of socioeconomic and cultural determinants in mortality and morbidity patterns. This has resulted in increased recognition of the effect of precarious employment, multiple forms of marginalization, and legal and entitlement structures in individual and population health [ 14]. Addressing these structural determinants is at the core of effective prevention efforts for many public health problems. Extreme exploitation, like other complex social phenomena, such as violence against women or substance misuse, has multiple and interacting causes and effects [ 25, 26]. Labor exploitation can be seen as a health determinant and preventable social problem and benefit from public health prevention approaches that target the harm before it occurs [ 27]. A prevention lens directs us to consider the interaction of multiple factors that protect or put individuals and populations at risk of labor exploitation and to seek potential mechanisms to minimize these risks or enhance protection. It also suggests that we examine how various dimensions of exploitation might contribute to aspects of harm among different populations. Moreover, from this vantage point, we might reflect somewhat provocatively on the striking similarities between the harm sustained by people who are officially identified as "trafficking victims" versus migrant workers in the same sectors [ 19].

A public health policy framework to address human trafficking, exploitation, and health

To prevent the exploitation of aspiring labor migrants, evidence is urgently needed on the determinants of exploitation and factors that promote safe migration and decent work. Moreover, theoretical or policy frameworks are required to look specifically at the ways that individual, group, and structural factors (including economic, social, legal, and policy-related aspects) influence exploitation and health along a migration trajectory, which can guide our search for evidence to inform interventions [ 28- 31].

Fig 2 depicts factors associated with labor exploitation across a migration process, dimensions of exploitation, and various dimensions of harm. It is worth noting, however, that while structurally driven social, economic, and gendered power imbalances underpin exploitation more generally, they often manifest differently between different forms of exploitation. For example, there are critical distinctions between various types of labor trafficking and sex trafficking versus conflict-related trafficking. In many low-wage production sectors, for instance, exploitative practices are sustained by business models that rely on labyrinthine supply chains, myriad labor intermediaries, and high demand for inexpensive and disposable labor. It is not coincidental that exploitation of workers has occurred alongside the diminishing power and density of trade unions and shrinking freedom of association and collective bargaining [ 32]. These interactions are exacerbated by weak labor governance [ 33] that fails to protect workers from production processes frequently fueled by demands for low-cost goods and services-despite international conventions to protect workers [ 34]. The framework in Fig 2 depicts a process of complex, cumulative causation of potential harm throughout a migration cycle. It highlights interactions between macrolevel structural factors (e.g., global, national, social, etc., systems and institutions) that influence the persistence of trafficking and harm among individuals in communities (microlevels). And, while not explicit, this conceptualization also acknowledges the role of inequalities such as age, gender, nationality, ethnicity, and class [ 35] to each individual's vulnerability to exploitation [ 36].

Importantly, this framework conceptualizes exploitation as a potentially preventable cause of harm [ 41]. This perspective incorporates forms of harm beyond physical, psychological, and occupational health problems and includes social, financial, and legal harm and further suggests that the damage from exploitation can transmit across generations.

The discussion that follows focuses primarily on trafficking of labor migrants and exploitation, but the core features underpinning exploitation, power, control, and abuse, are applicable to other forms of human trafficking (forced sex work, forced marriage, for armed conflict).

Predeparture

Most migrants leave home in search of a better life for themselves and their family, sometimes inspired by income disparities between neighboring migrant and nonmigrant households. The effects of climate change on local production, market-driven land exhaustion, humanitarian crises, and weak social assistance have each contributed in different ways to distress migration [ 42]. Local livelihood challenges have pushed millions of individuals away from their homes towards income opportunities that are often difficult to refuse or in which conditions are nonnegotiable-including situations of human trafficking [ 43]. To reduce people's vulnerability to extreme forms of exploitation, the international community has made substantial investments in community-based awareness raising and migration knowledge building [ 44]. These efforts are often based on the premise that, if individuals were more informed about migrating for work, they would be less susceptible to being exploited. However, there remains little evidence to demonstrate that human trafficking is caused by information deficits among prospective migrants or about the positive effects of premigration awareness interventions [ 45].

People may be at greater risk of entering potentially exploitative arrangements when they are compelled to make urgent migration decisions, such as when confronted by humanitarian crises such as armed conflict, environmental disasters (tsunamis, flooding, earthquake), organized and gang violence (e.g., Northern Triangle of Honduras, Guatemala, El Salvador), or personal crises such as family illness or death [ 46- 48]. Household debt can push people to accept extortionate job placement or employment terms and conditions-and, conversely, people may take out loans at difficult repayment rates to fund their migration [ 49]. For example, 91% of Bangladeshi migrants reported multiple migration-related debts, including labor brokers' fees [ 50]. Social support and job assistance schemes [ 51], where available, can mitigate distress migration but are sometimes perceived as inadequate to overcome financial pressures, long-term poverty, or to secure financial self-sufficiency [ 52].

Return

Because there has been limited theoretical work conducted on labor exploitation and harm, this broad framework is meant to help guide future intervention research and prevention strategies. However, each of the categories and variables proposed must be understood within differing historical and socioeconomic contexts and the reigning political climate that might, for instance, fuel discriminatory public discourse on migrants and migrant workers.

Discussion

Slavery and its like have existed for millennia; so have social and economic inequalities. Through the declaration of the 2030 Sustainable Development Goals, the international community has promised that efforts will be dedicated to reducing poverty, ensuring healthy lives, and, most encouragingly, promoting decent work. This brings us back to the proposition we posed initially: human trafficking should be considered a global health concern. First, in terms of prevalence, when compared with other well-recognised global health problems such as the approximately 35 million people infected with HIV or the 1 million girls under age 15 who give birth every year [ 60, 61], human trafficking seems to deserve similar attention, with current estimates at approximately 40.3 million people [ 1]. Next, when considering harm, findings from studies around the world indicate consistently that most trafficked people experience violence and hazardous, exhausting work, and few emerge without longer-term, sometimes disabling, physical and psychological damage [ 54].

To date, there has been very limited engagement by the global health community in the dialogue on or responses to trafficking. Similarly, those working to address "modern slavery" have given little attention to the health impact of trafficking. So, how does one bring these communities together? As the first medical journal collection on human trafficking, exploitation, and health, the PLOS collection offers a good start towards gaining greater attention from the health sector. Providing evidence alongside expert commentary, this collection points to the range of clinical specialties and policy considerations required to address human trafficking as a global health determinant. Similarly, initiatives to tackle modern slavery, forced labor, and human trafficking need to make the links between human trafficking and health by working more closely with the health sector [ 62]. For both communities, a public health approach that treats the harm from exploitation as preventable will help foster interventions on the large scale that is needed. We urgently need to know more about the health burden posed by exploitative, low-wage, and hazardous labor, and, most importantly, the associated risk factors, especially in Asia and Africa-locations where some of the most exploitative labor occurs [ 63]. This is the type of evidentiary groundwork that was laid to address complex social problems such as intimate partner violence and that is now included in many routine health surveys and the international calculation of the Global Burden of Disease [ 25, 64]. Importantly, to intervene in effective and efficient ways, evidence is also needed on the determinants of human trafficking and on who is most affected and in what ways so that precious funds for intervetions are well targeted. The ecological framework introduced in this paper might serve as a starting point to direct research to investigate key structural, social, and individual drivers of exploitation.

Moreover, a public health approach to prevent human trafficking should simultaneously generate greater attention to its less recognized sibling, labor exploitation. That is, initiatives to address human trafficking will benefit from including actions to prevent exploitation and harm among low-wage laborers, more broadly-in what is often known as 3D work: dirty, dangerous, and demeaning. A dialogue is needed about how much and in what ways low-wage workers are currently exploited and about the ways that work-related hazards might harm individuals, including by disabling parents, who may then be forced to send their children to work-perhaps producing a generational cycle of disability and disenfranchisement.

In an era in which the value of human labor appears to be systematically degraded and political rhetoric further marginalizes already disregarded migrants and disadvantaged workers, now is a propitious moment to launch, in earnest, global health actions to tackle endemic labor exploitation.

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Human trafficking and exploitation: A global health concern

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In this collection review, Cathy Zimmerman and colleague introduce the PLOS Medicine Collection on Human Trafficking, Exploitation and Health, laying out the magnitude of the global trafficking problem and offering a public health policy framework to guide responses to trafficking.

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This assignment was really interesting to me.  learning about the different crisis situations and the different responses people have. This training helped me realize that there is always a helper in every crisis situation. That one person that is able to deal with what is going on in that moment right after the crisis. They can be used to comfort or provide assistance to the crisis response team. I don't know how I would react in a crisis situation even though between me and my husband I'm the calmer one when it comes to disaster.

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As part of the National Child Traumatic Stress Network (NCTSN), the Learning Center for Child and Adolescent Trauma offers Free Online Education with:

300+ FREE CE certificates

50+ speakers

200+ online webinars

90,000+ members

Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery. Both PFA and SPR were developed by the National Center for PTSD and the National Child Traumatic Stress Network, as well as other individuals involved in coordinating and participating in disaster response and recovery.

PFA and SPR intervention strategies are intended for use with children, adolescents, parents and caretakers, families, and adults who are survivors or witnesses exposed to disaster or terrorism. PFA and SPR can also be provided to first responders and other disaster relief workers.

While grounded in the same foundations of disaster response and recovery, there are several differences between PFA and SPR.

Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery. Both PFA and SPR were developed by the National Center for PTSD and the National Child Traumatic Stress Network, as well as other individuals involved in coordinating and participating in disaster response and recovery.

PFA and SPR intervention strategies are intended for use with children, adolescents, parents and caretakers, families, and adults who are survivors or witnesses exposed to disaster or terrorism. PFA and SPR can also be provided to first responders and other disaster relief workers.

While grounded in the same foundations of disaster response and recovery, there are several differences between PFA and SPR.

Psychological First Aid (PFA) Online is 5-hour interactive online course that helps participants learn the core actions of PFA and describes ways to apply them in different post-disaster scenarios and with different survivor needs. This course also covers provider well-being before, during, and after disasters. This course is relevant for new providers who are wanting to be oriented to PFA, as well as for seasoned practitioners who want a review of the PFA concepts.
This 5-hour interactive online training offers certificate of completion with 5 CEs upon completion.

Skills for Psychological Recovery (SPR) is a 5-hour interactive course designed for providers to help survivors gain skills to manage distress and cope with post-disaster stress and adversity. This course is for individuals who want to learn about using SPR, learning the goals and rationale of each core skill, delivering SPR, and supporting survivors in the aftermath of a disaster or traumatic event.
This 5-hour interactive online training offers certificate of completion with 5 CEs upon completion.

Los Primeros Auxilios Psicológicos constituyen un enfoque modular basado en la evidencia y cuyo objetivo es ayudar a niños, adolescentes, adultos y familias a afrontar las consecuencias inmediatas de desastres o actos de terrorismo. En este curso en línea, Rosaura Orengo-Aguayo, PhD, ha adaptado el entrenamiento de PFA en un formato de 3 horas, en Español. Luego de ver este curso en línea, los participantes recibirán 3 créditos de educación continua.

Destrezas para la Recuperación Psicológica (SPR por sus siglas en inglés) es un curso de 3.5 horas diseñado para que los proveedores ayuden a los sobrevivientes a adquirir destrezas para manejar la angustia y afrontar el estrés y la adversidad luego de un desastre. Este curso es para personas que desean aprender sobre el uso de SPR, conocer los objetivos y la justificación para cada destreza básica, brindar SPR y brindar apoyo a los sobrevivientes después de un desastre o evento traumático. Luego de ver este curso en línea, los participantes recibirán 3.5 créditos de educación continua.

Skip Contact Us

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learn: psychological first aid (pfa) and skills for psychological recovery (spr)

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Learn: Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR)

# data[].attributes.attachment_link.description
As part of the National Child Traumatic Stress Network (NCTSN), the Learning Center for Child and Adolescent Trauma offers Free Online Education with: 300+ FREE CE certificates 50+ speakers 200+ online webinars 90,000+ members Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery.

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This unit has been my favorite so far.  One because this is what I want to focus on as a counselor.  Two because I love watching documentaries.  I have to be honest, there were very few on the list that were given that I had not seen before. I literally binged watched the Trials of Gabriel Fernandez when it came out on Netflix. I feel like the jobs I've held have made me more passionate to want to focus on helping clients address the trauma they have been through so that they can move forward to heal. The ACEs is such a powerful tool and can help identify past traumas and current issues. It gives you a better perspective of what you are working with.

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Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them.

Adverse Childhood Experiences (ACEs) Prevention Strategy Plan [3 MB, 20 Pages]
This resource outlines CDC's specific goals and objectives for ACEs prevention and response. The goals and objectives aim to prevent ACEs before they happen, identify those who have experienced ACEs, and respond using trauma-informed approaches in order to create the conditions for strong, thriving families and communities where all children and youth are free from harm and all people can achieve lifelong health and wellbeing.

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Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them. Adverse Childhood Experiences (ACEs) Prevention Strategy Plan [3 MB, 20 Pages] This resource outlines CDC's specific goals and objectives for ACEs prevention and response.

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Unit 1 Section 2 Reference for Mental Health Disorders

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Unit 1 Section 2 Reference for Mental Health Disorders

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The research done for this assignment was very informative and a little overwhelming.  I'd love to dive deeper into some of the websites I sited in the template.  There was just so much information.  I learned a lot and read a lot and understood some of the mental health illnesses.  I find it a little intimidating and overwhelming.  Having personal experience working with and trying to help someone close to me to cope with a mental illness and being unsuccessful is why I feel this way.  It was helpful to know where to refer clients too and who else to involve in a treatment plan.  I look forward to learning more coping mechanisms for working with mental health clients.

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National Institute of Mental Health (NIMH)

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Mental illnesses are common in the United States. It is estimated that more than one in five U.S. adults live with a mental illness (57.8 million in 2021). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe. Two broad categories can be used to describe these conditions: Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses all recognized mental illnesses. SMI is a smaller and more severe subset of AMI. Additional information on mental illnesses can be found on the NIMH Health Topics Pages.

Definitions

The data presented here are from the 2021 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA). For inclusion in NSDUH prevalence estimates, mental illnesses include those that are diagnosable currently or within the past year; of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); and, exclude developmental and substance use disorders.

Any Mental Illness

Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below).

Serious Mental Illness

Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.

Prevalence of Any Mental Illness (AMI)

Figure 1 shows the past year prevalence of AMI among U.S. adults.

In 2021, there were an estimated 57.8 million adults aged 18 or older in the United States with AMI. This number represented 22.8% of all U.S. adults.

The prevalence of AMI was higher among females (27.2%) than males (18.1%).

Young adults aged 18-25 years had the highest prevalence of AMI (33.7%) compared to adults aged 26-49 years (28.1%) and aged 50 and older (15.0%).

The prevalence of AMI was highest among the adults reporting two or more races (34.9%), followed by American Indian / Alaskan Native (AI/AN) adults (26.6%). The prevalence of AMI was lowest among Asian adults (16.4%).

Figure 1

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native

Mental Health Services - AMI

Figure 2 presents data on mental health services (including virtual services) received within the past year by U.S. adults aged 18 or older with any mental illness (AMI). NSDUH defines mental health services as having received inpatient treatment/counseling or outpatient treatment/counseling, or having used prescription medication for problems with emotions, nerves, or mental health.

In 2021, among the 57.8 million adults with AMI, 26.5 million (47.2%) received mental health services in the past year.

More females with AMI (51.7%) received mental health services than males with AMI (40.0%).

The percentage of young adults aged 18-25 years with AMI who received mental health services (44.6%) was lower than adults with AMI aged 26-49 years (48.1%) and aged 50 and older (47.4%).

Figure 2

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. Note: Estimates for Native Hawaiian / Other Pacific Islander and, American Indian / Alaskan Native groups are not reported in the above figure due to low precision of data collection in 2021.

Prevalence of Serious Mental Illness (SMI)

Figure 3 shows the past year prevalence of SMI among U.S. adults.

In 2021, there were an estimated 14.1 million adults aged 18 or older in the United States with SMI. This number represented 5.5% of all U.S. adults.

The prevalence of SMI was higher among females (7.0%) than males (4.0%).

Young adults aged 18-25 years had the highest prevalence of SMI (11.4%) compared to adults aged 26-49 years (7.1%) and aged 50 and older (2.5%).

The prevalence of SMI was highest among AI/AN adults (9.3%), followed by adults reporting two or more races (8.2%). The prevalence of SMI was lowest among Asian adults (2.8%).

Figure 3

* Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native.

Mental Health Services - SMI

Figure 4 presents data on mental health services received within the past year by U.S. adults 18 or older with serious mental illness (SMI). The NSDUH defines mental health services as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health.

In 2021, among the 14.1 million adults with SMI, 9.1 million (65.4%) received mental health treatment in the past year.

More females with SMI (67.6%) received mental health treatment than males with SMI (61.3%).

The percentage of young adults aged 18-25 years with SMI who received mental health treatment (57.9%) was lower than adults with SMI aged 26-49 years (67.0%) and aged 50 and older (71.0%).

Figure 4

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. Note: Estimates for Asian, Native Hawaiian / Other Pacific Islander, and American Indian / Alaskan Native groups are not reported in the above figure due to low precision.

Prevalence of Any Mental Disorder Among Adolescents

Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement (NCS-A), Figure 5 shows lifetime prevalence of any mental disorder among U.S. adolescents aged 13-18.¹

An estimated 49.5% of adolescents had any mental disorder.

Of adolescents with any mental disorder, an estimated 22.2% had severe impairment and/or distress. DSM-IV based criteria were used to determine severity level.

Figure 5

Data Sources

1. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043

2. Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report .

Statistical Methods and Measurement Caveats

National Survey on Drug Use and Health (NSDUH)

Diagnostic Assessment:

The NSDUH AMI and SMI estimates were generated from a prediction model created from clinical interview data collected on a subset of adult NSDUH respondents who completed an adapted (past 12 month) version of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (Research Version, Non-patient Edition) (SCID-I/NP; First, Spitzer, Gibbon, & Williams, 2002), and was differentiated by level of functional impairment based on the Global Assessment of Functioning Scale (GAF; Endicott, Spitzer, Fleiss, & Cohen, 1976).

The assessment included diagnostic modules assessing the following: mood, anxiety, eating, impulse control, substance use, adjustment disorders, and a psychotic symptoms screen.

The assessment did not contain diagnostic modules assessing the following: adult attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, schizophrenia or other psychotic disorders (although the assessment included a psychotic symptom screen).

People who only have disorders that are not included in these diagnostic modules may not be adequately detected. However, there are known patterns of high comorbidities among mental disorders; these patterns increase the likelihood that people who meet AMI and/or SMI criteria were detected by the study, as they may also have one or more of the disorders assessed in the SCID-I/NP.

Population:

The entirety of NSDUH respondents for the AMI and SMI estimates were the civilian, non-institutionalized population aged 18 years old or older residing within the United States.

The survey covered residents of households (persons living in houses/townhouses, apartments, condominiums; civilians living in housing on military bases, etc.) and persons in non-institutional group quarters (e.g., shelters, rooming/boarding houses, college dormitories, migratory workers' camps, and halfway houses).

The survey did not cover persons who, for the entire year, had no fixed address (e.g., homeless and/or transient persons not in shelters); were on active military duty; or who resided in institutional group quarters (e.g., correctional facilities, nursing homes, mental institutions, long-term hospitals).

Some people in these excluded categories had AMI and/or SMI, but were not accounted for in the NSDUH AMI and/or SMI estimates.

Data regarding sex of the respondent was assessed using male and female categories only. Gender identity information was not collected in the survey.

Survey Non-response:

In 2021, 53.0% of the selected NSDUH sample of people 18 or older did not complete the interview. This rate of non-response is higher than in previous years. Please see the Background on the 2021 NSDUH and the COVID-19 Pandemic section below for more information.

Reasons for non-response to interviewing include the following: refusal to participate (30.1%); respondent unavailable or never at home (18.8%); and other reasons such as physical/mental incompetence or language barriers (4.2%).

People with mental illness may disproportionately fall into these non-response categories. While NSDUH weighting includes non-response adjustments to reduce bias, these adjustments may not fully account for differential non-response by mental illness status.

Data Suppression:

For some groups, data are not reported due to low precision. Data may be suppressed in the above charts if the data do not meet acceptable ranges for prevalence estimates, standard error estimates, and sample size.

Background on the 2021 NSDUH and the COVID-19 Pandemic:

Data collection methods for the 2021 NSDUH changed in several ways because of the COVID-19 pandemic: the 2021 NSDUH continued the use of multimode data collection procedures (both in-person and virtual data collection) that were first implemented in the fourth quarter of the 2020 NSDUH. Overall, 54.6% of interviews were completed via the web, and 45.4% were completed in person. In 2021, the weighted response rates for household screening and for interviewing were 22.2% and 46.2%, respectively, for an overall response rate of 10.3% for people aged 12 or older.

Given the use of multimode data collection procedures throughout the entirety of the collection year and the rate of non-response, comparison of estimates from the 2021 NSDUH with those from prior years must be made with caution.

Please see the 2021 National Survey on Drug Use and Health Methodological Summary and Definitions report for further information on how these data were collected and calculated.

National Comorbidity Survey Adolescent Supplement (NCS-A)

Diagnostic Assessment and Population:

The NCS-A was carried out under a cooperative agreement sponsored by NIMH to meet a request from Congress to provide national data on the prevalence and correlates of mental disorders among U.S. youth. The NCS-A was a nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the adult U.S. National Comorbidity Survey Replication and 9,244 adolescent students selected from a nationally representative sample of 320 schools. The survey was fielded between February 2001 and January 2004. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Survey Non-response:

The overall adolescent non-response rate was 24.4%. This is made up of non-response rates of 14.1% in the household sample, 18.2% in the un-blinded school sample, and 77.7% in the blinded school sample. Non-response was largely due to refusal (21.3%), which in the household and un-blinded school samples came largely from parents rather than adolescents (72.3% and 81.0%, respectively). The refusals in the blinded school sample, in comparison, came almost entirely (98.1%) from parents failing to return the signed consent postcard.

For more information, see PMID: 19507169 and the NIMH NCS-A study page.

Last Updated: March 2023

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An overview of statistics for mental illnesses. Mental illnesses are common in the United States. One in six U.S. adults lives with a mental illness (43.4 million in 2015). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe.

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Unit 1 Section 1 Reflection for Introduction and Assessing Prior Knowledge

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Unit 1 Section 1 Reflection for Introduction and Assessing Prior Knowledge

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I enjoyed getting to know and read all the posts in this assignment. I learned that there is still so much to learn.  It's definitely important to have colleagues and/or a support group to consult with in this field.  I was surprised to know that so many classmates are barely beginning their journey in this field of study.  I love that everyone is passionate in their own way and directions with obtaining this degree.  For so long, specifically in my community, there has been a huge need for counselors.  I'm eager to do more research of my own and learn from my classmates what they interpret in this class.

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The American Counseling Association Center for Practice, Policy, and Research is responsible for providing access to, and interpretation of, the American Counseling Association Code of Ethics. This web page provides ACA members and members of the public with the necessary tools to ensure compliance with the ethical standards of the counseling profession.

Although ethics and risk management are related, ACA does not offer risk management services such as advice to minimize risk in the event of lawsuits and/or criminal charges. ACA believes that whenever questions arise, counselors should consult with a lawyer licensed in the jurisdiction in which they practice. More information is offered in the Risk Management section below.

The 2014 update to the ACA Code of Ethics is the first edition that covers the ethics of using social media with clients. This edition also presents new or expanded guidelines on distance counseling, confidentiality, extending boundaries, multiculturalism and diversity, the use of technology, record keeping, diagnosis, end-of life care, the selection of interventions, and preventing the imposition of counselor personal values,

View the 2014 ACA Code of Ethics (PDF)

The 2014 ACA Code of Ethics is also available:

To cite the ACA Code of Ethics as a resource for an academic work, use the following:

American Counseling Association. (2014). ACA code of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf

To view previous editions of the Codes of Ethics, visit our Ethics Archive.

The American Counseling Association is pleased to help members with inquiries on ethical practice, career counseling and advice regarding the profession.

Please kindly note that this service is not designed to function as a real time hotline. Inquiries are prioritized, and the ACA standard practice is to respond within three business days of receipt.

Please send an email request to consult@counseling.org to schedule a consultation.

Thank you in advance for your patience.

The ACA Ethics Committee is responsible for processing complaints of alleged violations of the ACA Code of Ethics. To file a complaint against a counselor who is an active ACA member, please review the Policies and Procedures for Processing Complaints of Ethical Violations. After reviewing the Policies and Procedures for Processing Complaints of Ethical Violations, begin the complaint process by sending an email to ethics@counseling.org

Although ethics and risk management are related, the American Counseling Association no longer offers risk management services such as advice to minimize risk in the event of lawsuits and/or criminal charges.

Risk management is a very complex area. ACA believes that, whenever questions arise, counselors should consult with a lawyer licensed in the jurisdiction in which they practice.

One resource, recommended by Anne Marie "Nancy" Wheeler, former ACA Risk Management Consultant, is Martindale.com, an online legal portal that can be used to search for attorneys. ACA has no affiliation with Martindale and does not endorse the attorneys listed on the company's website. Be certain to verify the credentials and past work of all prospective legal advisers.

In addition, professional counselors should use all of the services available to them through their liability insurance provider. In the event of a licensure complaint or professional liability incident or notice of complaint, ACA members insured through HPSO should call 800-982-9491, or go to hpso.com for more information.

To view previous risk management columns by Anne Marie "Nancy" Wheeler, J.D., as well as other resources, visit the ACA Risk Management page.

Each month, experts in ethics explore real-world issues in Counseling Today through the lens of the 2014 ACA Code of Ethics. Visit our Ethics Update page to access past columns.

Difficult situations can arise in any counseling setting, and when they do, counselors "are expected to engage in a carefully considered ethical decision-making process," as recommended by the 2014 ACA Code of Ethics.

Holly Forester-Miller, PhD, and Thomas E. Davis, PhD, collaborated with the American Counseling Association to publish a white paper titled "Practitioner's Guide to Ethical Decision Making" (2016). For more information and to read the white paper, visit the ACA Ethical Decision-Making page.

There are many ways to engage with and/or learn about the 2014 ACA Code of Ethics. Visit the Code of Ethics Resources page to find out more.

If you are looking for resources related to previous editions of the Codes of Ethics visit our Ethics Archive.

ACA offers a number of resources, including consultation, regarding licensure. Visit the ACA Licensure Requirements page for more information. To request a consultation about licensure, email acacareers@counseling.org.

The Graduate Student Ethics Awards, with separate categories for master's degree and doctoral degree students, reward the exceptional and demonstrable understanding of the ACA Code of Ethics.

To read the statement, click here.

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The American Counseling Association Center for Practice, Policy, and Research is responsible for providing access to, and interpretation of, the American Counseling Association Code of Ethics . This web page provides ACA members and members of the public with the necessary tools to ensure compliance with the ethical standards of the counseling profession.