Gary Tik Toks with Mike and Mike. He's back. That miss being over here reacting to weird stuff. Hey, Dory, where's Nemo? I ate him. What?  Oh, right. Oh, wait. Yo, is this going to be the sequel? This is the sequel, right? The third one, bro. Oh, the third one. You made me do this, Dory. Don't worry. Nemo, find you. Bro, what is going on? This is not the Nemo I remember. Father? Father? Nemo, you're alive.  She was pregnant, Dad. She was pregnant with your children. Dude, and he killed her. All that matters is you will be with me forever, Nemo. Oh, he was whispering it. Whoa! He's inside of me. Freeze! Yo, that... What do you see, Mr. Clown Fish? Looks like my son Nemo. Do you remember our affirmations? Nemo is food, not friend. This is so dark. That concludes your psychiatric appointment, Mr. Clown Fish. You are beyond salvation and we put to death. Enjoy life while you can, Nemo. I'll be with you. Bro! You don't got to watch this, kid. Bro, they lost him into a mine. Damn. He never really was funny.  Hey, yo, that's got to fire. What? I didn't have a gas sign.  Is that like the trailer to a game or something? It's not a dirty zombie, but like penguins. That's pretty cool. It looks cool, like animation. Like it looks... Oh! Oh, he got the bear. No. I forgot his little... He forgot the names of the little guy, man. That was sick. Grimmit 2000, okay.  Oh, is that where you mess with his face? I used to make his mustache all big, you know. Eyes all big. As if his mustache isn't already big enough. Bro, what the heck? I came through the pipes. What came through the pipes? Homeless people or something? Oh my God, Mario. He let himself go. He looked like a 50-year-old plumber, bro. That was Don Mario right there. There's Don Luigi right there. Oh, but they came through the pipes. I think we just died, bro. What is that, like a dead body? Is that the pipe? Yeah, I think that's the pipe they came through. And it's an abnormally huge-licking pipe. And it's peaceful, though. It is peaceful. Oh, what? What? Yo, what are we watching right now? Hey, he brought the liver back. Nice. Oh, dude, look at my cat, bro. Are they cat rats? Oh, they're from New York, bro. So they're probably breeding with the rats. Well, the New York rats? They're like the side of the cats. For real. Oh, the tail.  They're cute, but the rat tail makes it like... Yeah, the tail is a tail. The ears are cute. They're like a hybrid, bro. This is weird. If they had, like, furry tails, they would be better. Yeah. Wouldn't make them more athletic since, like, rats are, like, fast, like, twisted. Yeah, I mean, they'll probably be in the, like, hybrid. Because, like, New York rats? They'll square up with anybody, bro. They'll square up with Tim's on. Is that Bill, not the science guy? He let the science get to him. He injected something into himself. Bro, what is this? This is so weird. I want to, like, poke at it, but I can't. This keeps going, huh? This is so strange. Oh, his eyeballs about to pop out, bro. That would be even more disturbing if it does. Come out! It's, like, right there, but it doesn't want to pop out, man. Oh, so this is just... This keeps going forever, huh? Imagine, like, our skin was like that, like, it would just be like that the entire time. This is so weird. We did it all times? Yeah. Oh, it's floating away. What? Woofoo-doofoo. That's as weird as the name was, man. Friend. Exposed Earth. Are they like erasers or something? Oh, erasers or, like... I don't know. Bro, why is he yanking on us? Oh! Yeah, that caused a lot of pain. Hey, I need to have a sense of humor. What, are they, like, tofu? Maybe. Oh, in the back room. He was about to get consumed by the bigger tofu. I didn't know what it was. Was it spider pepper? Spider pepper into the, into the what? To the... Zickleverse. I was bit by a radioactive spider. And the last year, I've been the one and only spider pepper. Hey, hey, hopefully the pepper people don't go after you again, bro. It's copyright strike, bro. Oh, yeah, we got a copy strike. These pepper people... It was Hasbro, dude. They're coming after me. Hey, this guy's dope, though. Yeah, it is. Strike? Pepper's gonna get shrek, man.  Yeah, this one was dope. You haven't watched it, you could watch it, man. Yeah, I haven't watched it. He's here. He's here. What did I say? Property of Thomas. It's like a sequel following up another video. Yeah, I probably watched the other one. That's dangerous! He's strong, bro. Who's strong, bro? There's that old man's strength right there. Yes! Oh, he's like a friend of mine. Remember me? He came out all sad, dude. Oh, no. Yes! Oh, I thought you too, man. Yeah. Damn it. Look at the actual video's fire. Oh, dude, this is real life, bro. Sonic in real life? Oh, my God. Yeah, you look very real. I think I'm in another dimension. Oh, God. Oh, Sonic here, too. Yeah, I feel like I'm in a dump. Mike Murcia. Murcia. Heck nah, I'm sharing my grandma's face. That's what happens when you leave your grandma at the retirement home, bro, and you don't check up on her. Yeah, don't leave your grandma's at the retirement home. Make sure to visit your grandma, man. Is this a gas station worker on Fentanyl? Bro, what happened to his face? They're facing out like nervousness. Yeah, it just dropped yesterday. Dude, his mouth, what the? Oh, oh, we're at the ferry. It just blew up. Damn. Oh, no. I just deleted it. Wow. Oh, bro, they landed right under her face. Mom! There's something in the hairline. I need to do that. You're in a real car. She raced her for snitching, bro. What the heck? Hey, man. That's what you need.  Now I remember why I stopped watching these, man. I always go home. Then I start having nightmares. Got to hold my pillow real tight. Oh, man. Do you want to say anything, brother? Go subscribe and like and comment and subscribe again. You heard him.


That's me! I've recently moved to Sheffield, come up from London and delighted to be back in the north. At the end of the presentation, I'm going to come back to 3 questions I'd like to ask you this morning. Firstly, what do you like having done for you? Secondly, what do you like doing with others? Thirdly, what do you like doing by yourself? Take a moment, take those in and jot them down if you like. I'll be calling out for a bit of audience participation later, and we'll talk about those. So, what I'm going to talk about today, the obligatory, who I am, what I'm interested in, how I think we're going about designing new services or magic, as I'm calling it now, how our tools can limit us in that, and how I think we need to find ways to do less doing to people and more doing with people, which probably explains my relationship with the co-op. So, as you heard, I originally spent the last sort of five or six years very involved with a good friend of mine, Ivo, getting something called Good Gym, up and running all across the UK. The premise of Good Gym is that traditional gyms are totally bonkers. You often will go to some dark basement somewhere, start running nowhere on this treadmill, or we're still lifting things in the corner of a room that really don't seem to need lifting. And so, the idea was that all this latent energy could be put to much, much better use.  That will often take the form of weekly group runs where groups will gather, 20 or so people run to perhaps a local school, paint a classroom, we'd bed at a care home. This is actually down in London, lots of turning manure at city farms, always a popular task. And then also what we'll do is we'll pair up individual runners with isolated older people, the coaches, because it's those people that provide the motivation to get out each week and do a run. So, that was Good Gym. I'm pleased to say it's running now. We're up to about 30 or so areas across the UK and it continues to grow. So, I think it's kind of interesting seeing how people want to arrange themselves in new ways. But most recently I've joined co-op, co-op digital, platinum sponsor, which may explain my being here. What do we do? Well, the co-op has been around a while. 1844, these are the Rochedale pioneers, all came together. And of course being back in 1844, this means that we're six years older than California. I'm proud to say six years older than the valley. And actually what's exciting is I think we've been an innovator for most of that time. These are some of the first retailer to have scales in the stores, the first self-service stores, and various other bits and pieces. And these were all tackling quite serious needs at the time or inequalities. The first retailer to have scales in stores were because people were being ripped off with weights and measures. Business owners would be cutting flour with chalk or sawdust in a bid to raise profits. So, yeah, always a history of tackling the inequalities that we saw people coming together to try and do that. And we're not afraid to be radical, so based on principles of open membership and democratic control. And I think this is a quote by Catarina Fake, and it's a wonderful quote. I think she says you can tell what companies' values are by what they focus on and what they take the time to build. So it's all well and good saying we are this thing, but when you look at what these companies are doing, I think that's really a reflection of what their ambition is and what their values are. So we're starting to ask what do you get if you have membership cooperation on the internet? What are the future digital services where cooperation is a competitive advantage? This is the team I work with, a lovely bunch of folk. And we've been exploring a huge range of areas because I think any modern service now, I think, would probably involve elements of cooperation. So we've been running little experiments to look at where we might move, whether that's in energy, community energy organisations, or the grid, the complete shift that's going to happen there. Obviously high streets changing care, connected devices, some of the stuff in the homes, privacy and data, and a little bit around ensuring things too. So sometimes we use design sprints to explore what these services could be. So I'm curious, people in the room who might identify as designers, perhaps? Okay, a couple. A few people who are sort of design-based, mostly technologists, then it sounds like. So let's see how much of this is familiar. But the way we've been approaching things is we've built prototypes to test our assumptions and put them in front of real people to learn what works and what doesn't and what to do next. So perhaps as hackers, it's a similar thing, right? You sort of make something quickly to get it out there and look at how it responds and judge what to do next. And I think that's the thing now. We can do this with software. We can build things incredibly fast. It can be sort of smoking mirrors to some extent and see the impact it has. That's the kind of approach we take. So to give you an example, we have an electrical supplier called Electrical, and they saw how people were getting ripped off renting washing machines. You might be familiar with people like Brighthouse on the high street. And it turns out to be incredibly expensive. I've got my opinions on this sort of thing, but essentially, you know, if you're struggling financially, you could rent a washing machine. When you start to get out of debt, perhaps you then start to get sold other things. I can only pay for it in store. I'm not quite sure. Yeah, I sort of take issue with these sorts of organisations, and I think there might be interesting new ways to tackle that. So we started to wonder whether people would sign up for a subscription service for washing and quickly put together a website called Washify. So for £4 a week, you'd get a washing machine. Should it break, repairs within two days, and we could tie in with a regular delivery of laundry liquid or something. Subscription services are pervasive in music or film, and I think we'll start seeing more of this sort of thing. So it was a way to test this. And we thought there might be three potential markets, landlords, people who don't have the cash to buy machines up front and people who are constantly moving around a lot. So we started trying to research with landlords and put an ad out in Landlord Zone, a riveting reed, but it does reach 120,000 landlords. So there, it's just a case of fairly nondescript average just offering some time to speak to them. And we invited them to have a look at a website that we'd made about this proposition. Watch them sign up. Ask them how they manage their flats, and they're more about that dynamic, as people never rented a flat out, so I don't really know a lot about that. Next door, we'd be observing them and taking notes on what we're learning. So there it is at the end of the prototype. We're all very excited. Will people sign up for a subscription service for their washing?  As it happens, a broken washing machine is a fantastic excuse to go and snoop around your property and check, you know, is it being kept as you thought? Or you've probably got a network of tradespeople in the area that you use to manage these things. So, yeah, our first idea completely bombed. But we were still sort of exploring this further, so we were putting ads out on both Facebook and Google and started printing flyers and hit the streets with the flyers to talk to people. That was out and around Salford, I think. And the Facebook ads and flyers didn't attract anyone.  It was speaking to people, trying to collar them. It's a hard job. But the Google ads, in fact, really, really worked, worked really well. And I realised it was quite simply, you're reaching someone at the point when they're searching for something. So we wanted to find out a little bit more about that. I added a chat box to the web page and you've probably seen these sorts of things in the bottom corner of web pages that pop up when people start to check you're okay. But for us, it was a really good opportunity to speak to people immediately at that point and learn a lot more about them. And what we realised is that we were starting to reach people at precisely the time where, like, their washing machine's broken, they've got a pile of dirty washing on the floor, it's starting to smell a bit. It opens up all sorts of other ideas. So if you wanted to build a service around this, you probably the first thing you might do is provide a voucher to get it quickly to a local dry cleaners or something. But, yeah, I guess it's just trying to show how we can quickly build this sort of magic these days. It was interesting listening a bit more to the sort of connected devices I taught that Caroline gave last. And I think I come at it from a slightly different angle because I'm familiar with, like, want to cry and all of the botnet attacks that are happening at the moment. And it doesn't seem to be a month that we can go without seeing all of these insecure devices being turned to malicious use. And people just aren't familiar with what's going on, I think, in their homes. It is just magic. And I was curious, could the co-op help people to understand and take control of these devices? So to do that, another experiment we ran, we launched, well, we came up with the concept of this idea called co-op scout. And I'll show you a complicated technical diagram of how that works. So scout connects to your broadband router and effectively connect all your devices to scout. And in turn, it would be able to monitor the network for both sort of, I guess it would be checking exploits and posts out there and being able to update you should you be updating your software on these things because often most people plug things in and just leave it. So, again, we recruited six participants that we knew had different devices in the home, so we screened for them up front and asked quite extensive lists of all their software. And then they came into the lab setting and we were able to present them with a kind of mock-up of their home on a phone. So you can see this is how a dashboard might look in the Samsung TV, something that's going on. And you can see it can send the audio data to a third party called Nuance. So anything in the home is being recorded and transmitted insecurely. And you can sort of say, well, I'm not quite comfortable with this and we could show them how to disable it, actually take the TV offline and worry I'm kind of interested in maybe with co-op. You know, join a few thousand other people lobbying to change this. Remarkably, everyone's like, holy, there's no idea. Oh, I'm okay with it. And I was just like, well, no one wanted to take their tellies offline. But there was something in this idea, this is something rumbling away that we're not comfortable with it. And maybe if there's another kind of action we might be able to take on that. So that was interesting. These design experiments are all done in just a few weeks. So I suppose it's also about just trying to learn quite quickly in these ways. But I think the tools and the approaches we take do limit us in this. So I think it's all well and good there for products or services that are predominantly transactions in some sense. But I think where I get particularly interested in is how we might use software and magic to help people form new forms of relationships with one another. So what if we were going to try and design ways that people may trust one another? We worked with the insurance part of the business. And they came to us basically saying insurance is totally broken, both fingers in the ears and that no one trusts anyone anymore, which is bizarre given the whole industry seems to be built upon something like that. So insurance companies don't trust claimants. They put in fake claims. In turn it drives up prices. We all bonify claims can't do it. And then all the other parts of the regulators don't trust the insurance company. So it's a real pickle. And I think in part it's because it doesn't really look like this anymore, which is Lloyd's coffee shop of London and it's people of a mutual interest of trading, shipbuilders and the like looking out and trying to forecast what's going to happen. So we were curious whether the co-op could help people come together to ensure the things that matter to them in a, I suppose, a more local sense, a community insuring itself and built another prototype. This one again will somehow get the links out so people can have a look around at this stuff. But protect together was a way that perhaps a group of people might sort of say we'll ride bikes for a monthly subscription. We're ensuring one another's bikes and should something happen we'll draw on that. Whoops, sorry. Again, so this time we brought people who lived in a particular block together and spent a day looking in a lab at what they thought about this sort of proposition. And of course everyone says yeah, I'll put the money in and trust my neighbours and all these sorts of things. But really I think what I completely started to see was we were going about testing this in all the wrong way because I think we're still in this transaction form where we might present scenarios and things but we'd slipped into this state where we were asking people what they would do and not really able to observe what they'd actually do. And we needed to find a way to test those new kinds of relationships. And I think we sort of see hints of this. This is Monazoi, one of the... It's not really a start-up anymore but one of the banks, online banks. And they're investing heavily in the UI and the experience of the banking app because they recognise trust is incredibly important there and what it's doing is it's meaning but I think what it's doing is it's sort of meaning that yes, I trust Monazoi, I trust them as the bank. And it made me think well, we sort of have it happening a bit. This is Airbnb. The way to rent holiday accommodation. And here you can see we've got... on the listings, we'll often have profiles or feedback ratings. This is Mo's flat. And he's had 14 ratings. And it's kind of interesting but on the other hand, it's a bit like I was looking for a spanner last night on that, Amazon. And I found it stark that we're sort of reducing these potential relationships almost to transactions now. This will go and stay in someone's house and then I'm assessing it in the same way I might a particular spanner in a list of things. And you could contrast that with something like couch surfing which was a sort of predecessor to all of this where on a profile page here it drills into a lot more detail about a particular individual whether it's their education or ethnicity or beliefs or religion or maybe it's where they've been or the ambitions of where they want to go but we can kind of forge different types of relationships there. And it's important here. I'm not talking about sort of nostalgia but I think so there are certain things that these new digital services that we're seeing that are doing incredibly well but I think it's recognising that in doing that the sort of professionalisation or the transaction is these things, we're losing things the ability to create these new forms of relationship. And so to bring it back to the co-op we print members' opinions on wine and beer rather than those five star ratings which I thought was quite interesting and we have a group of... we can call out to members to participate in different ways and so there was a sort of taste-taste testing experiment and in turn in the local store then the reviews went onto the bottles and it was incredibly successful and incredibly engaging and I think this is interesting but let's be honest it's just labels and sort of in some respects it's the surface I think of where we might be able to get to. So ultimately I'm still grappling with how we do less of these things to people and more try and find ways of using technology to work with people. And it was really stark, it struck me it's not just about the things we build but how we might interact with one another. So back in March a colleague and I went to the Internet Freedom Festival which is an incredibly interesting week. There we were able to meet with human rights workers, lawyers, technologists, activists from all over the world fighting for human rights in countries where democracy was under threat. Some of them are travelling under pseudonyms so it's where really their themselves would be in a lot of trouble should it be known that they're participating in these sorts of things. And at the same time then I logged on to check work email and was mandated to go and perform my information security basics. And it was the Solarius Flash Game like who still makes flash games where the information theft dragged the boat of information security and go fishing for secure parcels. This is totally bonkers.  I turned to my colleague and I was like, this is absurd. We have to react to this in some way. And of course we could have done a monzo on it and made it flashy and slick and this could be delivered in a different way but instead we came back and we decided to throw a crypto party. And I don't know if anyone's been to a crypto party before but essentially it's a way to celebrate and play with the kinds of cryptographic technologies that are out there. So we made passwords using dice so picking up half a dozen dice, rolling them and then you use them to look up words on these big long sheets of dictionary paper and of course it's more secure because you've not used a computer to generate that password by bringing it into the physical. And it gets people talking about what is a secure password. So it's a way of phishing for random letters. We played with Signal which is an open source piece of software by Wisponet, what's that used but essentially with it being open source in theory is more, well it's less likely to have been tampered with. It's less likely to be backdoors into these sorts of things. And then used Tor and showed how you could visit Google and it might spit it out in Chinese or in Russian or something because you're kind of bouncing through proxies. And so I think personally I think encryption and anonymity is for everyone and that our privacy is incredibly important and that's why we party with crypto. So I suppose the point with this is it was much more about trying to find ways to work with the organisation rather than feel like I was having something done to me. So I think we can sort of explore those concepts a bit more. But it gets complicated. So this is the design sprint that Google will present. There's a five day process to get something in front of users really, really quickly and this is what we tend to follow a lot. But when you're moving away from products and services with a very clear transaction and you're thinking about relationships which are built on trust or social constructs it gets quite confusing and quite messy. So I'm starting to ask the question what happens when this agile way of building software isn't about websites anymore and I think it can feel really overwhelming. And how do you use agile to build new types of relationships? And I think what I'm starting to see is it becomes about how you design the invite or the follow up or like the merchandise, the badges and things. These things all become incredibly important to creating the community that understands the vision the activities and the language that we use. So one little example at Good Gym as I say we call the older people the coaches and it seems quite insignificant I suppose but bearing in mind this is Sheila and for most of the other interactions she had in her life she was the care receiver whether it was a district nurse coming in or a social services worker so for a moment to be the coach where she's responsible for Kevin and his well-being and his fitness I think it can really transform how we think of ourselves so the language we use in this services and the magic we're building I think it's really important that digital is still very much there but it's there to enable new types of relationships and not just transactions So that's a little bit of a summary a whistle stop tour of this concept of why cooperation I think is even more important today some of what we're trying to do with carp digital look at what happens when you bring what is the role of the carp in the 21st century amongst the Amazons and the Googles and the Facebooks So back to those three questions I asked you at the start to have a think about what you like having done for you what you like doing with others and what you like doing by yourself but rather now than ask for individuals I think what we'll do is we'll just turn to someone next to us and spend a minute or two just sharing reflections on a couple of those things so you can get to know each other a little bit differently Excellent, thank you So Sorry, I'm not going to call for responses back now but hopefully I mean look as soon as people are able to work with one another it's so much richer if I'd have put the call out to you and I think we'd have had this weird silence and a couple of people would have tentatively volunteered something I'll look forward to hearing some of that in the break and so just to pull it back together I guess I'm worried that the world is becoming dominated by these sorts of transactional consumer services maybe they're getting dressed up in these fancy new technologies but essentially it's market share capital and sort of VT return and I think that often in the name of trying to do things for people we inadvertently end up doing things to them and all of their ethics and the values that are getting built into these pieces of software are often coming from a very very slim narrow view of the world so our next challenge I think is to design new ways for people to work with one another both in building and scaling this stuff but participating within it thank you


Welcome to the Addiction Counselor Exam Review. This presentation is part of the Addiction Counselor Certification Training. Go to https.www.allceus.com. slash certificate-tracks to learn more about our specialty certificates starting at $149. Hi everybody and welcome to the assessment review for the Addiction Counselor Certification Exam. We're going to be talking about, guess what? Assessment. And a lot of this is geared to be basically just a primer, a review, a CliffsNotes version. If you are feeling weak on the assessment process, it is really important that you go back and you review assessment courses either that you've taken or you can review some of the assessment courses that are in our Addiction Counselor Certification Training Track. So there are 12 steps to assessment. Engage. So as soon as you meet somebody, you're not going to have rapport, so you've got to develop rapport.  So-and-So and, you know, nice to meet you, John Smith. Let's go. Where do you live? And start filling out forms right away. Take time to get to know them. Look them in the eye. Talk to them for a minute. It doesn't have to be a huge conversation for an hour. But when people feel like numbers, they're not going to engage.  Get authorizations and gather information from collateral sources, probation officers, family members, whatever you think you can get collateral information. Another good source is from other treatment providers that are either currently working or have worked with the client in the past. Patients for co-occurring disorders determine the severity of mental and substance use disorders. So you may have somebody who has a moderate alcohol dependence issue, but they have got really significant clinical depression. So, you know, you're going to be dealing with those differently. Obviously, we need to make sure that we help them get stabilized and you want to make the appropriate placement recommendation based on the client's needs. Determine the appropriate level of care. Generally we use the ACAM to do this. Sometimes you may use the LOCUS, which is another patient placement guide that can help you determine where a client is best served. Determine their diagnoses and generally there's more than one. So you want to look for mental health issues. You want to look for substance issues. You want to look for poly substance issues. You want to look for issues that may not be in the DSM. You know, you're looking for other psychosocial issues that may be contributing to the problem like domestic violence or lack of housing. Determine disability and functional impairment. So how bad is this? On a scale of, you know, one to not really bad, I could see you once a week outpatient and not a problem. To five, the patient needs to be in 24-hour medically monitored residential care in the hospital. You know, you've got, and the ACAM breaks it up really nice for you. You're going to determine where they need to be. How much is it impacting their ability to work, their ability to do activities of daily living, their ability to form fulfilling relationships, their ability to have a rich and meaningful life. And that's what we mean by disability and functional impairment. How much is it impairing them, keeping them from reaching their full abilities and having a rich and meaningful life? Identify their strengths and supports because we're going to build off of these. What have they done up until now to survive? What things work for them when they're feeling depressed, when they're wanting to use? Identify cultural and linguistic needs and supports. If they're, talk with them about their culture and whether they want to involve any faith healers or if there are any cultural practices that they think are important to their recovery process. If you need an interpreter, obviously you're going to take care of that now. And be careful about jargon that you use, try not to use any, and colloquialisms or local phrases that you may use that they may interpret differently. So be sensitive to a person's culture and background and meet those needs as needed. Identify additional problem areas such as medical, housing, and education. Determine their readiness for change for each problem. And I've said it before, I'll say it again and I'll probably say it many times after this. People may have an addiction issue. They may have a depression issue. They may have a PTSD issue and a diabetes issue. Okay. So they've got four different issues going on. With their depression, they may be really ready to make that go away because they are tired of being depressed and there is really not much of an upside to being depressed. It's painful. So they're ready to work on that. The addiction, they may not be able to envision themselves as being a non-drinker, never drinking again or never using again, or they may not be ready to give that up because smoking a joint is the only thing that helps them relax right now. So they may not be motivated to change that problem or make huge changes in that problem. So you need to determine their readiness for change for each identified problem area and then start to plan treatment. This is when you figure out, okay, where are they going to go and what kinds of services are they going to need and what do I need to link them to. So screening determines the possible presence of an issue. Assessment is a much more in-depth interview and it's an ongoing process. It's not something that you do for an hour at the beginning and then you never do again. You're going to assess clients every time they come into your office. You're going to assess clients a lot the first three or four times you see them because they're not going to think to tell you everything in the intake and you're not going to think to ask about everything. You're going to learn more about them and as you learn more about them, it may change their treatment plan a little bit. Assessment determines the nature and severity of the problems, develops specific treatment recommendations and surveys clients strengths and resources for addressing life issues. So when we're talking about strengths and resources, we're talking about what do you have going for you. Let's look at social support. Do you have people who can help you out? People who you can lean on? Financial support. What kinds of financial resources do you have for childcare or treatment or maybe taking some time off from work? We're looking not only at strengths the way they've coped with these problems before and things they have inside them that can help them succeed at being happy and healthy, but we're also looking at what resources they have personally as well as what resources can they tap into. Maybe they don't have enough money to hire a nanny to come in to help them with their three children. But maybe their church offers drop-in childcare or maybe there's a church that they don't even belong to that is willing to let them drop their kids off at the church's drop-in childcare. So we want to identify not only what resources the client personally has, but what resources are in the community that the client can access to help them address their life domains or issues in their different life domains. A lot of law schools offer free clinics. So if the client has issues with child custody or a divorce or bankruptcy or any kind of stuff like that, they may be able to get pro bono help at a free law clinic. Some attorneys do pro bono work. So contact your local bar association and find out if there are attorneys in your area that can help your client. So this is the way you find out things. Local boards to find out, local dental boards to find out if there are any free dental clinics. Contact the United Way information and referral. They know about a lot of programs that are out there that can help people get medications, eyeglasses, childcare, housing, assistance paying for electric bills is limitless. So United Way 211 is a great, great resource. The substance abuse assessment focuses on historical and situational factors contributing to or triggering use. Now remember substance abuse doesn't necessarily just have to be drugs.  Yes, you know, they're not all in the DSM, but we do want to look at those addictive behaviors because addictive behaviors can cause changes in brain chemistry, can cause that dopamine rush that throws the neurochemicals out of whack, similar to what some drugs do. So it's important to recognize any behavioral addictive behaviors as well as chemical ones. Look at their patterns of use. Have they used, do they use consistently? Are they a binge user? Do they use when they're stressed? Has their use increased over the past five years? Showing that they're developing a tolerance. Have they started combining substances or combining a substance with an activity in order to get that rush that they're looking for? Identify common signs and symptoms of use. You're going to be administering the cage screening or the audit. You also may be looking for your basic checklist. Have you engaged in the behavior for longer than intended? Have you spent more money on this than intended? Have you spent more time engaging in, recovering from, or planning to use than intended? Have you given up important psychosocial activities in order to use, you know, that whole list of things that indicates that the person has a substance use disorder? And we're going to talk about the consequences of use.  You know, let's look at those seminaries at least. It examines the context in which the disorders manifest. So somebody may not be using all the time or may not be depressed all the time. So what are the contexts in which this gets worse? It explores the reciprocal interactions of family and or marital life on the problem. Social support and interpersonal functioning on the problem. Their physical health needs, if somebody's got fibromyalgia, for example, then when their fibro is acting up and they're in a lot of pain, their addiction or their depression may also get worse in order to, as a result of the fibromyalgia. So we want to look at the physical health needs include in their adequate sleep and proper nutrition, spirituality, how does that impact their disorder? Does it give them hope? Or does it make them feel ashamed? Employment, financial issues and legal issues and any other issues which may impact treatment. How do they impact this disorder and their, the client's ability and willingness to participate in treatment? We also want to look at gender, cultural and linguistic issues. Some cultures are not comfortable with group treatment. Some cultures feel the family should be intimately involved in treatment. Other cultures, not so much. Sometimes gender specific programs are more helpful and appropriate than mixed programs. So you want to talk about, you know, how would you feel if you were in a group that had men and women in it? Look at their readiness for change and how that impacts their willingness to participate in treatment. Their relapse risk, again for every single problem issue, not just substances, but their relapse risk for depression, their relapse risk for fibromyalgia or, you know, any physical issues. Recovery support, who out there can they rely on that provides good support for them in recovery when they are not actually in treatment. Any special life circumstances that may impact their ability to participate in treatment, such as being a single parent. Single parents not only often have a hard time affording additional child care, but child care can flake out. Sometimes single parents can't afford to take time off from work because there's nobody else bringing in money so they've got to work. So we want to talk about any barriers or obstacles to full participation and engagement in treatment and also look at medical conditions. If they've got some sort of medical condition that makes it difficult for them to sit for long periods of time or they're having insomnia, you know, sleep apnea is one that can really zap somebody's energy and make it more difficult for them to participate in treatment. So once you've looked at all the reciprocal interactions and you've tried to figure out and identify any potential barriers and how to overcome them, you've identified all the strengths the client is bringing to the table that you've got to work with and you've identified any resources that the client has or that are in the community that can be used to deal with these barriers and enhance treatment engagement. When you move on to providing treatment or we'll talk now about providing treatment based on the client's perception of his problems and this is going to coincide with motivation. If a client doesn't feel that their substance use is really all that bad, they may not be ready to work on it yet. So what's the client's perception of how bad this problem is? What goals does the client wish to accomplish and what strengths does the client think he or she has? So we're going to start talking about these and I'm going to say what is it that you want to accomplish in treatment and a lot of times our goals can be similar. They may not be the same. When I work with clients who are involuntary, they may not be wanting to give up smoking marijuana for example, but they want to get off probation. I'd love to see them quit smoking marijuana, but I also want to see them get off probation. In order to get off probation, they have to quit smoking marijuana. So hey, I will help them reach their goal of getting off probation, which my goal gets accomplished in the process and all the better. But if you encourage clients to work towards goals that are meaningful to them, they will be more motivated and engaged. So the forms that we're going to use, you want to get collateral information, you want to talk with the client, you want to use standardized interviews in some cases. Standardized interviews limit the interviewer to a script. It requires limited training and it collects the same information on all clients. It's kind of like when you go to the doctor's office and they start asking you about different health conditions you've had, they're just checking boxes. Standard interviews allow you to ask probing questions and require some additional training or knowledge to know what follow-up questions to ask. So if you ask a client whether they've ever been exposed to a traumatic event and they say yes, you have to know what the appropriate next question is that can probe, you know, tell me a little bit about the nature of that traumatic incident. The other thing that you can use and that can be really helpful are self-administered tests and questionnaires. They require some motivation and reading on the client's part, but they are nice because the client can do them at home before they come in. And clients tend to be more open on self-administered tests when they're checking things off as opposed to looking you in the eye and telling you something that they may find more embarrassing or shameful or they may think that you're going to judge them for what they did or what they think or whatever. So self-administered tests can be really helpful additions to the clinical picture. Standardized instruments, when you're using them, have reliability. That means if you are using an instrument that says it measures depression, we know it actually measures depressive symptoms. And well, that's validity, sorry, it validly measures it. And then reliability means if you give somebody that assessment today and you give that somebody that assessment tomorrow, it's going to give you somewhere similar in the results. It may not be exactly the same because 24 hours have passed, but it's going to be really diagram close if it's not exactly the same. That's called test-retest reliability. And you want to make sure that standardized instruments you're using do have test-retest reliability and what's called inter-rater reliability. So if I'm going to give an assessment to John Smith, I come up with these answers in this scoring and this clinical picture. And my friend Sally, who works two offices down, administers the same instrument to John Smith, she should get a very similar clinical picture if not the same as I did. That's called inter-rater reliability. So we both see the same thing when we administer this test. That would be like an example that comes up a lot is when you observe clients in natural settings. So we'll use kids for an example here. Our inter-rater reliability would be to identify how many times Johnny acts out. That's not really well-defined. So how I define acting out may be very different than how Sally defines acting out. So I may end up with 17 hash marks and she may end up with three. That's very poor inter-rater reliability because we saw two different things because we were defining things differently. So test-retest. If you give the client the same test within a very short period of time, it should give you the same result. And inter-rater reliability. If two people are administering the test, it should give the similar result to both people. Sources of information with written consent, of course, personal reports, reports from family, reports from other professionals or prior treatment experiences. For employment history, criminal records, and any available drug tests. Collateral information gathered should be confirmed to the extent possible to make sure it's actually valid. An accurate assessment requires the coherent integration of multiple sources of information to avoid over or under estimation of the problem. And when you're hearing it only from the client, it's hard to get a real picture on is it as bad as the client is saying or is it is not bad. A lot of times clients, especially with substance abuse, clients will minimize their problems and minimize the issue. So it sounds like there's no problem. And then when we hear from collateral sources, we realize that they were grossly underestimating the extent to the problem. So you want to get information. When I have clients come in for an assessment for probation and parole, I always have them bring their criminal history. And if they don't bring it, then we look it up before we get started because I want to see not only how many times they've been convicted of drug charges, but also how many times they have been arrested for drug charges because that gives me a little bit more to go on when I'm looking to identify whether they're experiencing, quote, repeated problems in one or more life areas as a result of the addictive behavior. Drug testing is part of the initial assessment in substance use disorder treatment. We want to get a baseline to figure out what you're using, how much is in your system. It's used to identify drugs to make the most appropriate treatment recommendations. Alcohol and benzodiazepine withdrawal can be life threatening. So if I have somebody who tests positive for either one of those, I'm obviously going to make a referral to either a medical doctor who may want to do ambulatory detox or a detox unit. But I am not going to say, well, you need to dry out first and just send them on their merry way. Likewise, there may be certain drugs that people are on that they cannot be admitted to a treatment center for. The treatment center I used to work at, we didn't admit anyone who was on benzodiazepines. So if they were on them and they were not willing to detox from them or it was clinically contraindicated, then we had to refer them somewhere else. You want to use drug testing to screen to prevent adverse effects of prescribed medications. You don't want to be taking something that increases serotonin levels and then also taking an SSRI and then like a stimulant and an SSRI because you could precipitate a serotonin crisis. So we want to know what's in there. We don't want somebody taking prescription benzodiazepines prescribed by a physician while they're also abusing opiates because those are both depressants and they could lead to respiratory failure. We need to know what's in the person's system. It's a component of the treatment plan. Drug testing helps keep people doing the next right thing if they know that they could be drug tested at any time. It's a way to monitor the use of substances and compliance with medications. Now obviously your on-site drug tests are not going to tell you what the levels of Zoloft are in somebody's system or whatever. But if you send it off to the lab, then you'll get a mass spec report back and you'll be able to tell whether their psychotropic medications or any other medications that they're on for that matter are staying stable or if they're wonky. And you'll also be able to see if levels of certain drugs are declining. For example, marijuana takes a long time to go out of the system. So a lot of times people are admitted to treatment when they still test positive for marijuana and what we want to see is that THC level declining over a period of a couple of weeks. Drug testing is a method to assess the effectiveness of treatment. If they're able to stay clean and not test positive, then we're doing something to help them stay clean. I mean, something is working here. And it's a method to document abstinence for legal matters, disability issues or custody issues, you know, any of the legal stuff. Drug testing cannot replace an assessment to diagnose a substance use disorder though. We need to look and see what consequences the substance use is having. We need to make sure they meet the criteria for the DSM diagnosis of substance use disorder. And just having a drug in your system doesn't make you meet that criteria. Drug testing can accurately reveal drugs in the system. So if a client says, oh, I never used that, and drug test says they did, you know, mass spectrometry is not, you know, there's a very, very, very small margin of error. Yes, you can retest it. I've never had a mass spec report turn up wrong or incorrect in 20 years. Time frame for detection is limited though. So for some substances, it's 24 hours. For other substances, it's three days. But you need to get that in there, which is why random testing is so important. It is dependable for identifying frequent users, but less accurate for infrequent or binge users. So if Tom is an alcoholic and he binge uses, you know, one weekend every five or six weeks, the only time he's going to test positive is after one of those weekends. And if you're seeing him for 12 weeks, that means you only have two windows of opportunity there. Another method for testing that is out there and available are sweat patches. And they stay on the arm for 14 days. They are relatively unable to be adulterated. So people can't, you know, scam the system, so to speak. And they give you a picture of the person's levels of different drugs over a longer period of time. They can sometimes get, what's the word I'm looking for corrupted, you know, if something gets on them that makes it an invalid test. That you have much less ability for the client to just eliminate a particular drug so it doesn't show cocaine or something like they can try to do in some of the urine screens. Breathalyzers are usually only valid for a couple of hours. Once the substance is out of your system, once your body is metabolized, a breathalyzer ain't going to work. Urine may be helpful for up to a month depending on the drug. You can do onsite, which are your cups. Now a lot of onsite tests have okay accuracy rates. They have about a 30% depending on the company you go with and how well your people administer the tests. About a 30% failure rate, which means it can either be a false positive so it turns shows that there's something in their system when there really isn't or a false negative, which the drug test doesn't show anything being in their system when there really is. So you have to remember that they're only about 65, 70% accurate, but it's a good starting place and the drug cups usually only run between 450 and 8 bucks a pop. We're sending it to the lab runs anywhere from $45 to $80 or more depending on how many different panels you have run. So if you have a client and you administer onsite drug tests, that gives you a general idea about how they're doing. And if there's a question about it, you can send it to the lab. And then it's recommended that like every third or fourth screen you send to the lab anyway just to make sure that it's not showing a false negative. False chromatograph can also be used in order to identify specifically what's in the urine. Saliva will identify what the person has used within the past day. Sweat and hair can be used. Drug patterns, it shows drug patterns over time, especially hair. As the hair grows out, it will show give a better idea of what was used during time because our hair grows really slowly. So you can get quite a bit of information from a strand of hair. It can't discriminate from recent and past drug use though. So we don't have a way of saying this person used yesterday versus a month ago because the hair grows really slow. And it's not able to identify use within the past three to eight days. Now that's true for hair, for sweat. They like to leave the patch on for a full 14 days so your accuracy is a little lower if you pull it off sooner. But it does give you a 14-day snapshot of what's going on with the person. And then blood can be used and withdrawn. If the substance is still in the person's system, then it can show up in blood. Another thing you need to do during assessment is a risk assessment. One of the most important functions of both screening and assessment is to identify any risks for relapse, acute medical conditions. If they look like they're getting ready to stroke out or they start slurring their words, they're detoxing from alcohol, it may mean that they need to have thiamine in order to prevent brain damage. So we want to look for anything that may indicate a medical or psychiatric crisis that requires an immediate referral to detox, CSU, which is the crisis stabilization unit or the emergency room. We want to assess for intoxication, substance toxicity. Sometimes people will overdose and we want to make sure we identify that. I've had clients use before because they wanted to get into detox and in order to get into detox they had to be under the influence and they accidentally used too much. So we want to look for substance toxicity, withdrawal, aggression or danger to others, potential for self-harm or suicide and any coexisting mental health issues, especially when we're talking about risk, being aware of any psychotic features, hallucinations, delusions, lack of ability to cognitively put things together like you would expect. Signs of drug toxicity or intoxication, we've gone over that in other reviews, especially in the diagnosis review, we're going to hit it a little bit right here, nausea, vomiting, diarrhea, agitation, lethargy or stupor, increased or decreased heart rate, lack of coordination and slurring words. Now remember, some of these can also be signs of life-threatening conditions. So you want to be aware and get medical input if people are slurring their words or have lack of coordination especially. Signs of violence, if they have a history of previous violence and mental illness is not a good predictor of violent behavior. So don't just think that because they have a mental illness they're going to be, no. What we want to look at is previous violent behavior. If they've done it before, they're more likely to do it again. How old they were at the first incident of violence. If they started being violent when they were eight and they've been having problems ever since then, more likely that they're going to have another episode now than if their first violent episode was when they were 27 and they're 30 now. Stability, employment problems, substance use problems, a lot of substances are disinhibitors so it takes off that filter that says this is a bad idea or their stimulants which just get the person revved up and angry or anxious and kind of ready to go get them. A major mental illness can be a sign of violence. Now a lot of times the violence that someone with mental illness does commit is towards themselves. Suicide, self-injury.  So we want to remember that. Many traits that deviate from social norms, if they tend to exploit people or manipulate them, we're going to be looking for your antisocial personality disorder traits here. Early maladjustment or trauma, paranoia and failure to respond to treatment in the past can all be indicators that there's a potential for this client to be violent.  So again, a lot of the violence in people with mental health issues is self-directed. They're trying, they're making the pain stop. They don't feel like they can do it anymore. They feel hopeless and helpless that life is going to get any better. Three domains for assessment for suicidality. Current presentation of suicidality, their history and risk management. So current presentation, are they tying up loose ends? Are they willing to talk about and make future plans? If they are, that's a good sign. It doesn't mean you're in the clear, but it's a good sign. Do they have access? Do they have a plan? Do they have access to the means? What might trigger them to actually commit suicide? You know, what things might happen? These are all questions that you want to ask. And there are, it's important that you take a couple of really good classes on suicide assessment because it is art, not a science. If they have a history of suicide attempts or self-injurious behavior or a family history of suicide, they're at higher risk. And then as far as risk management, you know, somebody who lives alone and is clinically depressed and having suicidal thoughts is at much greater risk than someone who lives with their spouse and three kids and also has suicidal ideation. Now that doesn't, again, doesn't mean you're in the clear. I know of situations where a parent has gone upstairs and committed suicide with their spouse and the children in the house. So you can't assume that just because any one or three or five conditions are present, that the person is out of the woods. You know, you want to use due diligence. Signs of suicidality include suicidal or self-harming thoughts, plans, behaviors or intent, a specific method identified, evidence of hopelessness, impulsiveness, panic attacks or anxiety, a lack of and or unwillingness to make future plans, signs of tying up loose ends, alcohol or other substance use, especially your depressants like opiates and benzos, but any substance, thoughts, plans or intentions of violence towards others and any current psychiatric illnesses, which again may make them at higher risk for suicide. Previous attempts or aborted attempts at suicide or self-harm is also another risk factor, as is a family history of suicide attempts, suicide, mental illness and addiction. If there's a family history of mental illness and addiction, it indicates that the family unit may not have the skills and tools to cope. So, you know, if the parents couldn't teach it to the children, then the children, because they didn't have it, then the children may not have skills and tools to cope. So they may be at higher risk. Acute psychosocial crises including financial changes or changes in status. So if somebody gets fired, demoted, passed over for a promotion or, you know, something happens and they have to declare bankruptcy or whatever, this could be a risk. Chronic psychosocial stressors including actual or perceived interpersonal losses, so fears of abandonment, for example. Family discord, domestic violence, current or past sexual or physical abuse and the absence of external supports. So these are all things we're going to look for in a suicide assessment. And as we're going through each of these things, you know, when I identify, if they have a specific method identified and they have the means available, you know, I'm going to talk about what can you do with those means to make yourself safer. We're going to make a plan. We're going to make future plans for when they're going to call me, when they're going to contact me. We're going to talk about how they can avoid using substances. We're going to talk about what external supports they may be able to rely on in order to help get them through each hour. And we're going to talk about, you know, if they're having financial, a financial crisis, we're going to talk about that a little bit and identify steps that they can take to start resolving this crisis. So they have some hope, they have some tools, and they have some actions that they may be able to engage in, which are going to obviously happen in the future, which may get them a little bit past this crisis point. Borderline personality disorder is something that is common in co-occurring disorders. A lot of times when I'm working with clients with addictions, I refer to borderline personality characteristics because once they get clean and sober, a lot of times those characteristics kind of go away. Not always, but do be aware of a pervasive pattern of instability in personal relationships, self-image, and mood in addition to impulsivity.  So you're constantly walking on eggshells to keep from setting them off and to stay on their good side because there's no gray area. There's no, it really hurt my feelings that you did XYZ.  And it's exhausting for both the person with BPD characteristics as well as their significant others. Another common issue is antisocial personality disorder. And again, the characteristics of APD are often present in people in active addiction, but they dissipate or completely disappear once the person is in recovery. So I want to see some recovery time. I personally want to see some recovery time before I assign a personality disorder diagnosis. But what you're looking for with antisocial is a pervasive disregard for and violation of the rights of others, inability to form meaningful relationships, and lack of empathy. So think about somebody who's addicted. You know, whatever's gone on, they're at the point where they're at bottom. Well, you know, they've probably been doing whatever they needed to do to get their drug in order to survive. So they've been disregarding the rights of others. They've not wanted to form meaningful relationships because they hate themselves. They feel bad about what's going on with them. And they don't trust other people because they feel like they've been let down and abandoned. And they may not have empathy because they don't have any energy left to be empathetic with other people. It's just they've tried to be empathetic and they've been burned too many times and they're sort of cynical at this point. So if you look at it in terms of what is causing these particular characteristics and how did this person come to feel or act this way? A lot of times you can see where the situation is their life over the past five or 10 or 20 years. It really makes sense that they're acting or behaving or thinking or feeling this way. It doesn't necessarily mean that it's a personality disorder that's going to stay. Major depressive disorder is very common. When people use they have rushes of dopamine and to avoid getting into pharmacology, we're just going to stop short and say when the neurotransmitters are out of whack because that dopamine system has been an overdrive, then when they don't have something causing that dopamine to be dumped, people may feel clinically depressed and it can last for quite a while.  Also when people start to sober up, they may look back over, you know, the chaos that their life has become and get clinically depressed. So do assess for clinical depression. You'll see changes in sleep, appetite, energy, concentration, excessive feelings of worthlessness and guilt, a sense of apathy. You know, just nothing does it for them. They don't really care. And there may be suicidal ideation. Also look for bipolar disorder. Not uncommon with people with bipolar disorder not wanting to take the bipolar meds because it flattens the highs. It brings up the lows, so they're not having that major depression anymore, but they're not getting the highs from the mania. So a lot of times they may be non-compliant with prescribed meds and then they self-medicate with illicit drugs. So as they sober up, start paying attention and looking to see if there are signs of bipolar one or two. Anxiety disorders are very common. Remember the Teter-Totter philosophy with detox. Whatever drug the person was using and the effects it had, when they detox, likely symptoms are going to be the exact opposite. So if they were using anti-anxiety meds, if they were abusing benzodiazepines, when they start to sober up, they may have a lot of panic. Same thing with alcohol. Alcohol does have some depressant effects, but when people start to sober up, they often have a lot of anxiety that goes with it. So assess for panic attacks, panic disorders, and obsessive-compulsive disorder. Other things to look for. A lot of people, more than 50% of the United States population has been exposed to trauma. Now, just because you're exposed to trauma doesn't mean you develop PTSD. But it is important to assess for it because the symptoms of PTSD overlap with depression and anxiety quite a bit. So we want to make sure that we don't misdiagnose something and fail to treat PTSD when it really is there. Also assess for eating disorders. There's a strong correlation between alcoholism and bulimia. But we want to look for anorexia, bulimia, and binge eating disorder in clients. And schizophrenia and psychotic disorders.  Characterized mainly by your hallucinations, you think you see, hear, smell, taste things that aren't there, or delusions, false beliefs, and a deterioration in thinking, judgment, and self-control. Some people have delusions of grandeur where they think they are head of the CIA or they think they are God. Other people will have paranoid delusions that the squirrels are after them and trying to read their minds. So if you hear things that don't seem to make sense in your reality, start probing for psychotic features. Now, not everybody who has psychotic features is schizophrenic. You can have psychotic features with postpartum depression, with depression. But it's important to recognize if you see psychotic features and probe to figure out exactly what's going on. Schizophrenia is the most common psychotic disorder, not multiple personalities. Schizophrenia is a detachment from reality. People who are schizophrenic will talk about the people on the news media talking directly to them. They will say things that don't seem to make sense in your world. Multiple personality is completely different. That's when somebody has two different or multiple different personalities in their head. They are still in touch with reality, as we understand it, but you are sort of meeting different people depending on the situation. So don't confuse the two. People do, and that's one of my pet peeves. Symptoms of schizophrenia often begin to develop before this first psychotic episode. The persons will start having hallucinations or delusions. Also Parkinson's disease, people sometimes have hallucinations and delusions. So rule out some of the physiological causes too. They may have disorganized speech where their speech doesn't make any sense at all. Disorganized or catatonic behavior and deficits in functioning, such as getting up in the morning and getting themselves ready and typical activities of daily living. So assessment is an in-depth process that involves information from the client and collateral sources to determine the nature, course, and severity of all the issues, the mental health issues, the physical issues, and the substance abuse issues. Assessment is a bio-psychosocial in nature. So we wanna look at what are all the possible causes or contributing factors to this issue that we may need to address in treatment. Housing, people need safe housing, they need access to medical care, they need to be able to afford their medications, they need good nutrition, they need financial independence of some sort so they know where their next meal is coming from. They need a decent self-esteem, they need social support, people, other people that provide them love and comfort and attachment in the safety net. They may need childcare, legal help, there's a whole bunch of stuff that people may need and all of those things or lack of all of those things can increase stress and precipitate or relapse or perpetuate the problem. Assessment must take into consideration cultural factors regarding having multiple illness, the participants in the treatment process and who the decision makers are for the client. So some cultures will want to have the family unit in the assessment and obviously if that's okay with the client, then that needs to be okay with us. Some cultures are not that way. Some cultures have a specific decision maker for care for anybody in the family. Usually it's the father. Other cultures, people decide their own treatment course. It's important to evaluate for multiple co-occurring disorders which may have overlapping symptoms such as PTSD and anxiety or substance abuse and or substance use disorder and borderline personality disorder. The assessment will guide placement and the development of the treatment plan.


mangroves and salt marshes are biogeochemical hotspots that store carbon in sediments and the ocean through lateral carbon export outwelling. Coastal seawater pH is modified by both natural biogeochemical processes and anthropogenic carbon dioxide uptake. Observations from 45 mangroves and 16 salt marshes worldwide revealed that more than 70% of intertidal wetlands export dissolved in organic carbon, DIC, than alkalinity, potentially decreasing the pH of coastal waters. Poor water derived DIC outwelling was the major term in blue carbon budgets, but substantial amounts of fixed carbon remain unaccounted for. Alkalinity outwelling is a significant but often overlooked carbon sequestration mechanism that is similar or higher than sediment carbon burial. This article was authored by Gloria M. S. Reithmeier, Alex Cabral, Ani Bunacand, and others.


Moving to Class A, Brouwerville, Eagle Valley squaring off with Manoman. The Tigers jumped out to an early 16-0 lead as Bryce Ersefeld hits Dalton Butler out of the backfield. He scampers 66 yards for the touchdown, but Brouwerville would trail by two at the half. However, the Tigers would roar back in the second half. Ersefeld hits Griffin Webster from 24 yards out. And then Brendan Emory, the backup, puts the exclamation point on the game. He hits Ryan Warwick for the 48 yard strike to give the Tigers a 12-point lead. And they move on with a 40-28 win over Manoman.


What's up everybody, Jason here for jasperyskatesrace.com. We just sold out 20, 21, Mosaic, Choice, Basketball, 4 box break, PYT number 5 guys. And again guys, we are giving away 5 interleaves and break credit if you buy a team. Now, as an added bonus, if you buy either the Hornets, Tewels, Kings, Warriors, Lakers, 76ers, you get 5 times the entries. And we were down to I think about 2 or 3 teams left today, so we did 30% off the remaining team so that we can get this knocked out. And this will be the last break here. So here we go guys. We'll do that randomizer for the giveaway after this. But here's everybody else in it. Freda got Laughbomb, Mulder, Charlotte Hornets, and here's everybody else of course. Let's go guys. We got Jay Chantay, a nice Tyrese Maxi for the 76ers. I go Tristan with that one. Fornia, Josh Green, and Desmond Bain. Nice rookie autograph there for Memphis. What a Michael. That's a sweet here right there. Jordan Clarkson, number 88, Paul Pierce, number 88, and Trey Burke, number 88. All right, next one. Mingo Manion. Nice Lamello ball. Last ball, Mulder. They're going to Fred. A little green red. And Guasman Bojan. And Brent Berry for the Spurs. Spurs going to Oliver. We got Robin Lopez to 88, Killian Hayes to 88, and a O.J. on the road to 88. Then we got a black gold. All right, nice Devon Bain rookie there, and then Aaron Nesmith. There's Cedric McCollum, Cedric Washington, Jr., and a James Weisman. So many panels so much for the Warriors, but Jeremy Porter, there you go. Good class though for that one in this one. Evan Fornie, Keras Levert, I mean then we got a Bojan Bogdanovich for the Utah Jazz. Alan Murdoch there with the three out of eight gold, black gold. All right, let's get an Ant-Man right here. All right, let's see if we got another black gold. Mason Jones, a little Killian Hayes. Will be topping. And a Gordon Hayward to eight. Black gold. That's actually pretty nice. Last bomb mojo, Charlotte Hornets going to Fred. Got a Lamello green-red, and then you got a Gordon Hayward to eight. Now we have a black gold coming up, and it's Mo Bomba. One out of eight for the Orlando Magic going to Aaron. Alrighty guys, so there you go. That was the break. No Ant-Man unfortunately, but we did get some nice color rookies. Got a couple black golds. Mo Bombo, Gordon Hayward, Bojan Bogdanovich. James Wiveson of course was a great hit back in 20-21. That Bane, Lamello, Tyrus Maxi, and then Bane Rookie autograph. Actually it was a pretty decent four boxes. All right guys, now let's give away some money. Good luck. So again, obviously like I said, I'm going to get this list here. Just got a second one here. Just made it a little easier. It's basically Fred. All right, sweet. So there you go guys. So that's the way it pans out there. Fred got five. Jeremy Pore got five. Jeremy Pore another five. Nicholas got five. Tristan got five. And then Nicholas got five. Just for grabbing those teams of course. That gave you five times the entries. So there we go. Boom. That's all of them there. All right, here we go. Roll it. Six and a one, seven times. One, two, three, four, five, six, and seventh and final time, six and a one. Seven. Just missing out, Nicholas. Kev first, now Oliver. Getting $500 in break credit. Wow. There you go, buddy. Seven times. So I have to tell you right now, using it on whatever you'd like. And like I said, this will be the last one for the little bit, just because I know we've done a lot of these already. So I'm going to send it to your three at Gmail. Using whatever you like, buddy. Appreciate you guys. Thank you.


Now, when you teach an activity to your class, make sure that all of your students can understand. It can be very confusing if someone doesn't understand. We've all been there before. Yes. Okay, Katie, drop the oars in the water. Oh no, wait, first lock the oars in place and then drop them in the water. When giving instruction, make sure you plan what you're going to say and write it on a piece of paper. Right, and before class, practice either alone or with someone else. This will increase your confidence. Before you start, make sure all your students are listening. That is a good tip. Yeah, I thought you'd like that one. Oh, I thought of another good tip. Use simple language. Today, class, we will sing Ring Around the Rosie. Everybody stand up and form a circle. Great. You can also say find your partner or pair up. Or you might want to put students in pairs on your own. That will save a lot of time. Good idea. Okay class, now I will put you into pairs. You two are partners. You two are partners. And you two are partners. Great, let's play our game. Tell your students this activity will take 15 minutes or this is going to take 20 minutes. Time limits are so important. Students need to know how long they have to do the activity. It's really helpful. It's a good thing. Okay class, time is up. Class, today we will draw blackbirds. This activity will take 10 minutes. Then you will use your blackbirds to sing the song to little blackbirds. And use body language when you give instructions. So open the book. Speak loudly. Listen please. Cut paper.  And if the activity is very long, if it has a lot of instructions, don't give them all at once. Break them up into parts. Students might forget instructions you gave them earlier. Right. That can be confusing. I can't wait to get started. Let's wait until we read the instructions. Okay. I'll read the instructions. We can do the experiment now. Let's do it. Oh wait, I forget. What came first?


On the Sunday following his inauguration the very next day the president took his problem to the Great Councilor. He went to church and bowed his head in prayer as he'd done on the morning of March 4th before proceeding to the Capitol to take the oath. While we cannot know what Franklin D. Roosevelt confided to his God or asked to be God, we do know that the people felt an even greater reassurance in this simple act of devotion on the part of the man who had so thrilled and uplifted him. And then without the loss of an hour he called in his Secretary of the Treasury, William H. Wooden, and planned and executed those brilliant and decisive strokes by which the country's financial structure was preserved. By declaring a bank holiday he halted the growing penny and provided a breathing spell in which to read just credit and provide more currency. March the 9th was a notable day in our history with Congress eagerly accepting the president's recommendation. By a vote of 73 to 7 the United States Senate hastened to pass the president's banking major. It was the most emphatic vote of confidence which that party had given to the head of the nation in many a long year. In the house, the new speaker, white-haired Henry W. Rainey of Illinois was at the throttle running the legislative locomotive in the direction of his party leader, the president, was demanding it should grow. Rainey knew it was no time for quibbling. Straight through, he drove the Roosevelt measures. Intense interest was shown in the house as the clerk read the president's great economy bill, which planned the saving of 500 million. And with the banking situations moving out, the president went on the air on the night of Sunday, March the 12th, and talked to the people in simple, friendly terms. While resulting in many cases, in great inconvenience, is affording us the opportunity to supply the currency necessary to meet the situation. No sound bank is a dollar worse off than it was when it closed its doors. It is possible, of course, in a very few places that when the banks resume, a very few people who have not recovered from their fear may again begin withdrawals. Let me make it clear that the banks will take care of all needs. And it is my belief that hoarding during the past week has become an exceedingly unfashionable pastime. After all, there is an element in the readjustment of our financial system that is more important than currency, more important than gold, and that is the confidence of the people themselves. Confidence and courage are the essentials of success in carrying out our plan. You people must have faith. You must not be stampeded by rumors or guesses. Let us unite in vanishing fear. We have provided the machinery to restore our financial system, and it is up to you to support and make it work. It is your problem, my friends, no less than it is mine. Together, we cannot fail. The entirely new spirit came over the face of the government under the President's guidance. For the first time in history, the Treasury Department, under orders from Secretary Woodin, permitted pictures to be made of the processes of printing and graving United States currency in the view of engraving and printing in Washington. I have made the old timers gas they were so starting. Confident in their President, in his policies, people all over the country rushed back to replace the deposits as the closed banks reopened their doors. Since trading felt the impetus of this new confidence and courage, the wheels began to turn again. There was a rush of trading in the Great Chicago Weekend. In the New York stock market, prices rose sharply. People began to buy it, and encouraging reports were heard on all sides about the upturn in business that had come at last. A memorable day when at the President's behest, the Senate in record time voted for beer, and the end of the long drought was in sight. He later but resolute the President sat at his desk, facing one new problem after another. With the financial structure of the country strengthened and revitalized, with new impetus given to commerce and industry, his mind now turned to farmers in their place, to the crop farmers who raise our vegetables, to the big grain farmers who provide our breads, and his thoughts took in also the distressing situation of the sheep raisers of the West. And as what could be done soundly and practically for those men whose flocks cover a thousand hills, a wealth of wool and a mutton, and no market worth the trouble of shipping. As our President sat and thought at his desk, he visioned the troubles of the Western cattlemen, sons and descendants of the bold spirits who carved out the famous cattle trails of the Old West. And in his mind's eye, no doubt, he could see the great and useless herds of fine beef, for which also there was no price to bring joy to the heart of the cowmen. The days passed swiftly in that historic month of March 1933, when so much was done, so much was planned. And this man of many burdens gave his whole mind and soul to pondering the swift and practical things. And to him came the great vision of relieving unemployment by a great reforestation project, embracing 10 states to provide work for 250,000 men and to create new farms, new towns, new wealth for the people as a whole, clearing and reinvigorating the forests of the land, providing the building material which industry needed, visioning the progress of timber from the new forests that are to arise to the mills of industry that will await them in the future. First it will not be robbed by haste and by greed. His rapid mind moved on to the 22nd of that historic march to another decisive stroke. At his desk in the White House, he signed the bill which kept one of the most important pledges of the Democratic platform, a pledge to give beer back to the people, if the democracy came in the power. There it was, the document which reversed the iron-clad restrictions of 13 years. And immediately all over the country, the work of preparing to brew good beer was begun. The cobwebs of years of neglect were swept from vats. Armies of men were called to polish the brewing machinery, to put the long neglected plants in perfect order for the Russian business that was certain to come. Another impetus was given to business when the President put his name for the beer bill and made it fall. And they brushed up the brewery horses.  And Broadway got lit up to celebrate. It had anything to do with it. Something fine has occurred in this country. We see people growing to work. Factories which have been closed for months, for years in some cases, have called for men, have started the wheels to turning, and are resuming the long interrupted routine of production. America is catching its full stride. There is a new feeling of hope, of determination in the air. It is a new march of prosperity behind the country's militant leaders, the fighting President.


What should we answer go answer? All right, let's see what's up bro this real Bro, we've seen this I'm gonna get my number bro. You've been putting your number in the dark web Maybe Just hang up, bro. It's gonna say what if it was like a prank or something.  You're messing with me bro, not me bro. I swear.  But scrap yard, what does that mean? Oh, dude, do we mean the train tracks maybe in the back? I think so, but let's I don't know man Let's just check it out. Let's get it over with let's go to the scrap yard and see if there's anyone just pranking us All right, let's go back come on. Oh man, wait. All right man, let's see what's up with this We're going to the scrap yard. It better just be someone pranking us because this is not even funny more It's getting out of control bro. Um, I'm actually kind of nervous bro.   Oh, come on, bro. I told you not Getting a wipe. All right, man. I think we're at the scrap yard, bro But where is it We're feeling about this bro like what should we do man like