This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to Improving Cultural Competence based on SAMHSA tip 59, and this is part two of three. There is a lot of stuff in that tip, and tip stands for treatment improvement protocol. It's put out by the Substance Abuse and Mental Health Services Administration. You can order the hard copy for free, you can read it online. If you're interested in getting more information than what we have in the three hours of presentation that comprise the three parts of this series. In this presentation, we're going to define clinical worldview, and it's something that I found relatively interesting. We'll discuss how our clinical worldview impacts treatment, case formulation, and report development. Explore questions to consider when developing the case formulation and treatment plan, and finish by learning how mapping the client's cultural views and influences can help us as well as clients develop insights into current struggles and clarify culturally relevant goals. And I'll start by saying this is a conversation that comes up a lot when I've been talking to different professionals. What do you call the people whom you work with? Clients, patients, consumers. I tend to like the word client because lawyers have clients. And a lot of different professions have clients. And a client, in my view, is someone who has the ability to choose which service provider to use. So it kind of puts them at a position of power in choosing whether or not to use my service or the service of the clinician down the road. Some places, especially your accreditation agencies, may prefer that you use the term consumer. And that's cool, too. And some people with whom you work may have a different term that they prefer being used as referred to. So it's important to ask, or at least if you're referring to somebody as clients, helping them understand that that's not a term that's intended to be pejorative. And if they feel that way, what would they prefer to be referred to as? Anyway, the term world view refers to a set of assumptions that guides how we see, think about, experience, and interpret the world. So we talked about that last time to a great extent. And each of us has our own world view based on the different cultural groups to which we belong, our geographic location, our family history, all kinds of things have shaped how we perceive the world and approach the world and what's important. Our world view is shaped by significant relationships, our environment, and our life experiences. So even if you have a similar background to somebody else, you may have a very different world view if you have different life experiences. Bearing that in mind, not assuming that everybody who came from your same hometown or whatever are going to have the same approach to life and things. Influences on your world view, your values, attitudes, beliefs, and behaviors, obviously. The concept of time, your world view really influences what you consider punctuality. My stepfather was my first stepfather, was first generation Italian. And whether this is a cultural thing or it was just a hymn thing, he was much more lackadaisical about time. If he said he was going to be there at 7.30, that could mean 7.30, 8.30, 9 o'clock. Usually it was within an hour and a half, but it wasn't 7.30 to 7.35. And we just got used to that, so we could kind of prepare ahead of time. The definition of family is important to understand how does your world view help you define what family means. Family to me may mean something different than family to an adolescent who's been living on the street for the past four or five years. They may consider a lot of non-blood relatives as their family and want to have nothing to do with their blood relatives who they don't consider even part of their family anymore. So we want to ask, who is your family? And if they don't know how to define that, that's something we can talk about in treatment. But when we look at level of care guidelines, it does talk about incorporating family in treatment whenever not clinically contraindicated. So again, we need to ask them what do they consider, who do they consider family? And how do they want family involved in their treatment process? Because that's going to be important. They may believe that family should be really involved. They may not want family involved at all. Your world view influences your organization of priorities and responsibilities. Are you more family and group oriented or are you from a more individualistic world view?  We wanna look at that because that's going to guide what our treatment goals really are. Their religious and spiritual beliefs are influenced by world view and influence our world view. It's important that we ask people about that but not make them feel necessarily like there's something wrong with them if they say, I'm not spiritual and I'm not religious. I'm a nun, which is a new term and we won't go there. I've got bunches of other classes coming up on cultural approaches to working with people from different spiritual backgrounds, but an idea is about success. What one person defines as success may be very different. My best friend and I define success very differently. His definition about success is very much centered around how much money he makes, how big his house is and what kind of car he drives. That's not so much how I define success. Not that his is wrong, but when we're talking about making decisions on a day-to-day basis about what's important and what makes us happy, we have different approaches and different things that are important to us. Our clinical world view, and this was a really interesting part of the chapter that I hadn't really thought about in this way. I mean, I thought about it but I hadn't really thought about it. Our clinical world view is influenced by education, clinical training and work experiences. So think about our counseling culture.  And I just picked three out of the air, psychoanalytic, humanistic or cognitive behavioral. Very different approaches. And depending on your client's world view, one may be much more appropriate than the other. Some people do not respond well to CBT and as we talked about last time, for example, military and law enforcement tend to respond much better to CBT than necessarily psychoanalytic, which is free association and all that Freudian stuff. But there are a lot of people who respond really well to humanistic. The thought that if they are able to talk and receive unconditional positive regard, they can clear their own blockages. Some people think that that's too slow and really want something that's more active and directive. So we wanna pay attention to how our theories and our approach to counseling impacts and works with people. I got my master's degree in vocational rehabilitation. So there's a lot of emphasis in vocational rehab and rehab counseling in general, in terms of looking at the whole person, looking at what they need in terms of transportation, in terms of making sure that they can get to work, in terms of reasonable accommodations, which we don't talk about, well, at least in the program that I went to for counseling, from a doctoral program when I was working on my LMHC courses, we didn't look at that at all. We looked at counseling, mental health, thought processes. So we wanna look at the differences in our approaches. One's a more holistic approach, one's a more cognitive approach, not necessarily better or worse, but understanding how our own training impacts how we conceptualize people's problems. I tend to, when I look at, to encase conceptualization, I tend to look at the whole person and I tend to look at the stressors and any physiological factors that may be going on like chronic pain that's contributing to it. Whereas somebody who came from a different training program may not have even been educated about how those things could impact. Thinking about that, our techniques and our modalities. Some of us are very comfortable with individual group and technology assisted care. Other people may not be making sure that the techniques and modalities that we use that we think are effective in a counseling practice in a counseling situation fit and work for our clients. Not everybody is gonna be comfortable with technology assisted care. Some people will prefer that over individual or group. We talked about that in the first session. And our general office practices such as privacy, punctuality and assessment and intake, we really wanna look at from the minute that client contacts our agency on the phone or walks in our door, what message are they getting about how much we respect them, how open we are to different points of view, how, what the power differential is. One of the things that always frustrated me and my staff got tired of hearing about it. So new staff would have to be acculturated to working in our facility. But when a clinician would call a client back, number one, call them by their first name, which is not necessarily culturally appropriate. And then walk in front of them, leading them down to the clients, wherever their office is. Indicated a distinct power differential. Now that may not be bothersome in some cultures. However, I felt it was important to at least have the clinician and the client walk side by side down to the counseling office. So they didn't feel like they were being led into the principal's office or something where there was going to be a significant power dynamic and they had less control. I want them to feel welcomed and I want them to feel empowered. Punctuality is another thing. When people come into our offices, if they're from a culture that is a little bit more free flowing with time management, how do we respond to that? If they're 10 minutes late, do you reschedule their appointment? What happens there? Likewise, if we run over and we run 10 minutes late, what does that communicate to the client about their stance in our mind and about their power in the relationship? So thinking about things as simple as, like I said, how you walk a client down to your office, what you say to them, how you greet them, what kind of arrangement your chairs have, whether the client will feel comfortable or not. Those are all important things to kind of look at and consider based on your population. Now, everybody's wherever you work, your offices are going to be different. You're gonna be dealing with different populations than necessarily I deal with. So I look at it in terms of the people that I serve. The worldview of the client and the worldview of the counselor need to work together. A client's worldview shapes their beliefs and ours too, our worldview shapes our belief regarding the nature of wellness, illness, and healing. Like I said before, you could come from a training program that taught you that if you implement unconditional positive regard and you provide CBT skills and yada, yada, yada, the client will improve. You may have gone to another program that said, well, yeah, we need to provide that, but we also need to consider the Maslow's pyramid and make sure they're getting their basic needs met. They're getting enough nutrition. They've had a physical to rule out any physiological causes of their depression or anxiety, such as thyroid issues or something else. So the nature of illness, what causes depression varies greatly, probably even among the 10 people that are in this class right now. So it's important to think about where do you think depression comes from? What do you think causes anxiety? What do you think causes addiction? And I remember doing a paper on that my first semester in graduate school and I found it so helpful to be able to articulate where I thought that came from. And four years later, I looked back at it and I said, oh, I knew so little and I expanded upon it. But knowing where I think this stuff comes from, I'm able to tell a client, this is what I believe. Now tell me what you believe. A lot of times if you ask them, what do you think causes depression? They're gonna look at you like, well, I've had a lot of really bad stuff happen in my life. And that's true, but if you give them a model of the different, so they can see that where there might be different causes of depression or maybe you think there's only two or three, whatever it is, they will understand more the question about where wellness and illness and healing come from. Are they a group that believes that healing comes from a combination of physical and spiritual? That's important to know. Otherwise, you're thinking of a three-legged chair and if you're only reinforcing one of the legs, the chair's probably gonna fall eventually. So we wanna know what's important in the client's mind in terms of what's causing their current distress and what needs to be addressed to improve their current situation. Our interviewing skills and behavior is obviously gonna be shaped by our worldview and their response to us is going to be shaped by theirs. So generally, when somebody comes into a clinician's office, obviously there is a power dynamic. There's just no way to get around that.  The more aware we are of culture and the more culturally sensitive we can be, we're going probably to have better success at getting a good rhythm going, if you will, at establishing rapport. And diagnostic impressions and prognosis are also going to be greatly shaped by not only our worldview, because what we think in our culture, whether it's a clinical culture, we look at the DSM-4, we say this is, if they meet these criteria, then they've got XYZ diagnosis. Well, they could or they could have ABC diagnosis over here because there sometimes is some overlap. Depending on your point of view, whether you look at health causes, whether you look at spiritual causes, whether you look at just DSM causes, it's going to shape whether you think somebody meets diagnostic criteria. And culturally, things that we may perceive as diagnosable, if you will, or symptomatic in one culture may be very culturally appropriate in the person's culture of origin to which they ascribe. We want to talk to them about what they see as problematic. They may say I was referred here because of this, that and the other. Okay, so your boss told you you had to come because you were being loud and aggressive and something else, I don't know. So then I want to know what is your perception of that problem? That's always my second question. What brings you here? What's your perception of the problem? What do you think causes it? And what do you think needs to happen in order for it to improve? And they don't always know those answers, but I want to have an idea of where they're coming from because it doesn't do much good if I just start telling them a lot of stuff. If I don't know enough about them, I need to get more information. And they've lived in their skin for a lot longer than I've known them. So they're the experts on themselves. The worldview that we have and the worldview the client has influences the definition of normal versus abnormal behavior. So what one client may consider normal and we may consider abnormal or vice versa is important to talk about. The determination of treatment priorities may be different between two clinicians, let alone between clinician and client. So it's important for the client to be able to, if they feel comfortable, articulate what their treatment priorities are. Now some cultures defer to the expertise of the clinician or the physician. They put us in a power role. And so you've got to figure out a way to work with those clients in a way that's meaningful to you where you don't feel like you're just telling them what to do. But it's respectful of the fact that culturally they are deferring to you and going, you're the expert, help me figure out how to get better. The means of intervention is also going to be important. We don't know them from Adam's house cat probably when we're doing the initial intervention. And you can glean and make some assumptions broad gross assumptions based on where you live, generally the community around you, based on race, ethnicity and other things, but you may or may not be right. So we have those schema and then we've got to decide if those are right when we're looking at interventions, which most of the time when I'm working with clients I will talk about what I think needs to happen. And then I ask them what their perception of that is. And if they think something different needs to happen, what they're comfortable with. And if they're not comfortable with something that I've recommended, then we might talk about why they're uncomfortable with it and then consider what to do from there. For example, if I refer somebody to residential treatment whether it's for mental health or substance abuse, if they're not comfortable with that I wanna understand why. Is it because they've got two children at home and they're a single parent and they don't know where their kids would stay? That's different than believing that residential is not an appropriate fit for them because they will not feel comfortable in group. So we wanna look at the means of interventions that we suggest that we're comfortable with. Make sure the clients are comfortable with them, willing to at least try them if we go down that road. And what do they define as a successful outcome? And this is interesting because when I work with clinicians, especially new clinicians who haven't written treatment plans before, and obviously on a treatment plan you have a goal statement. Well, the goal is remission, for example, remission of depression as evidenced by or elimination of depression or improvement in mood as evidenced by. So as evidenced by what? If your client is happy, what does happy look like to them? What does less anxious look like to them? How will we know? So we wanna be able to work with the client to define what they are hoping for in their quality of life and not just put on them the antithesis of the DSM-5 diagnosis. So cultural awareness and non-malphesance. Counselors must engage in self exploration, critical thinking and clinical supervision to understand their clinical abilities and limitations regarding the services that they're able to provide, the populations they can serve, and the treatment issues that they have sufficient training to address. So a couple of them that come up frequently.  Can you treat them? Well, unless you've had training in that area, you likely don't have enough education to be able to ethically serve them without, and here's the caveat, without supervision while you're doing it. So sometimes, especially if you work in community mental health or if you're working in a detox unit and you're trying to help the client out, you may not be able to pick and choose the clients you treat and say, well, I don't have the training to address that. So you may have to get supervision from somebody who does have that training. Go through the treatment plan, talk about each session, back to before you were licensed type of supervision. Other things that may come up if you're dealing with something like LGBTQ issues, you may have a general understanding and you can work with that person on certain issues, but there may be certain issues such as coming out or dealing with racial prejudice that you don't feel you have enough training or knowledge to be able to be effective and supportive. So you may need assistance from either a supervisor or another counselor that can provide guidance on those issues. Cultural competence requires an ability to assess accurately one's clinical and cultural limitation skills and expertise. Counselors risk providing services beyond their expertise, which is an ethical issue, if they lack awareness and knowledge of the influence of cultural groups on client-counselor relationships, clinical presentation and the treatment or process or if they minimize ignore or avoid viewing treatment in a cultural context. So basically that's a big long spiel there are a lot of situations when I lived in Alachua, which is just outside of Gainesville, the Hare Krishnas had their national headquarters there and there was a significant population of Hare Krishnas. I had a couple of Hare Krishnas come to me for treatment. I was working in private practice at that point and the issues they were dealing with were significantly integrated with their culture. So it was important for me to get supervision because I knew that just spouting off random stuff that I learned in counseling wasn't necessarily culturally sensitive or appropriate. So we would talk and if something would come up in session that I didn't know how their culture perceived something, obviously I would ask them there and you can work with that. But at the outset, I let them know that I don't have a lot of education on the Hare Krishna culture. So if you wanna see me, we can work together and I will get supervision to try to help you the best I can but I wanna make sure that that's out there at the beginning. Sometimes you're gonna be working in a position where you would be asked to be working with someone for whom you don't have the training or expertise and you don't wanna abandon the client. You don't wanna say, well, I can't see you so good luck. We wanna be able to provide referrals but if you feel that it's so far afield and you won't be able to get supervision and you won't be able to provide ethical effective services, then it becomes an issue. Tennessee House Bill 1840 came up, I believe it was last year and it caused a big hubbub in the state of Tennessee because it said that, and I can't quote it exactly, that clinicians did not have to serve people if the clients view significantly conflicted with the deeply held beliefs of the clinician. And that could be taken way out of proportion. That was very broad language there. However, there is something important in there to point out the fact that if you are completely ignorant of somebody's culture, it may not be ethical to provide treatment to them unless it's just an absolute necessity to prevent abandonment, et cetera. So there's a guideline there that we need to use our best judgment. We got into this field to help people, not hurt them, and we need to know when we are effective. You wouldn't find a physician who was an orthopedic surgeon trying to do brain surgery.  So it's important to understand our own professional limitations based on our knowledge. So learn at intake. Somsa likes acronyms as much as I do, I think. Elle stands for listen to each client from his or her cultural perspective, including their perception of the problem and treatment preferences. Explain, preferably before listening to the client, the overall purpose of the interview and the intake process. I tell them what we're gonna do from the beginning. I personally, and this may not work in your organization or you may not agree with it ethically, I tell clients anything I write down, they can read, you know. When we're going through the intake, one of the most nerving things for me is when I'm talking to a physician and they're just sitting down there scribbling madly. I'm like, oh Lord, what are they writing down? I don't want clients to feel that way. So I want them to know, at least in my office, they can read whatever I'm putting down in the intake and if they disagree with it, we can talk about it. And I also explained to them at the beginning that at a certain point, I'm going to have to switch over to filling out these forms and I'm not trying to be disrespectful. I want to know about them, which is why I spend the initial part, five minutes or so getting to know them, but we have to keep on a time schedule, for the organization. And I really want to make sure that they get the best services possible. So listen, explain. Acknowledge client concerns and discuss the probable differences between you and your clients. With one of the people that I worked with in Alachua, who was a Hare Krishna, she came to me because she was having marital issues.  So I put that out there at the beginning about what I knew, what I would try to do. And whenever something would come up in counseling and with any client, I own my perceptions and I say, this is my perception of what causes depression or what may be causing your depression. Let's talk about what your perception is. And if we have differences, that's okay. But so we're all on the same page. We want to take time to understand each client's explanatory model of illness and health. So if they feel, for example, that this current problem they're experiencing is a punishment by God, okay. I'm not going to tell them, well, no, there's this other explanation for it. We're going to look at what they believe and how they believe it needs to be addressed. And that's just culturally appropriate. Recommend a course of action through collaboration with the client, including how much involvement he or she has in the planning process. Like I said, some cultures are not down with that whole mutual participation. They see you as the expert.  They want you to fix them. I tell my clients at the beginning, I can provide guidance, but I need some input from you on what's working in order to make this program work. So I try to maintain, if they want me to maintain that expert role, I can. Most of the time with the people I work with, they're happy to have a more collegial or interactive role. And negotiate a treatment plan that weaves the client's cultural norms and lifeways into the treatment goals, objectives, and steps. What do they want? What does recovery look like for them? I don't want to put them into a drop-down menu where everybody does this step or everybody does that step. What looks normal and happy for you? So listen, explain, acknowledge, recommend, and negotiate, and respect another acronym. Understand and reflect how respect is shown within a given cultural group through verbal and nonverbal communications. There are certain cultures where just depending on how your, if your toe is pointed at somebody or away from somebody, it's considered a sign of respect or disrespect. Understanding that within the cultural groups that you work is important. Understand how respect is shown to clients, whether direct eye contact all the time is appropriate. A lot of this you learned in basic multicultural when you were in grad school. Explanatory model, devote time to understanding how clients perceive their presenting issues. And I crossed out the word problems. SAMHSA uses the word problems. That's cool. If you're good with it, I personally like the word issues because it's only a problem if the client sees it as a problem and it could just be an issue. Problem seems pejorative and more diagnostic than I like. What do they see as the origin and impact of their issues and how do they think it's best to address them? What's the best course of treatment? They've probably done some research even if they've been asking their friend or their auntie or somebody, what did you do? Understand the sociocultural context, how class, race, ethnicity, gender, education, socioeconomic status, et cetera, affect care, affect how willing they are to go to receive services, how comfortable they feel in your office, what types of things they're gonna participate in, what the cultural thoughts are about illness and wellness, et cetera. Power, acknowledge the power differential between clients and counselors. Even if you try to make it as to minimize the power differential as much as possible, there's always going to be one. I mean, most of us have more education than our clients most of the time, which can be seen as a power differential. Even if you're working with somebody who has equal or higher education, they're telling you some of their deepest, darkest secrets. So they are empowering you in some ways, recognizing that no matter how you slice it, we do have power in the relationship and we wanna acknowledge that and try to be as respectful as possible. Empathy, express it verbally, non-verbally. So the client feels understood by you, whether it's not making direct eye contact, giving them their silences, whatever is appropriate for that client. Talk about their concerns and fears regarding help-seeking behavior and the initiation of treatment.  Congratulations on having the courage to come into treatment. I generally do that regardless. And then asking them if they have any concerns or fears about participating in the process. And develop a therapeutic alliance and trust. Commit to behaviors that enhance the therapeutic relationship, recognizing that trust is not inherent but must be earned. They're gonna come to us, some clients will see us as part of a larger oppressive system. Some clients will see us as people who are experts who are there to help them. Some people will see us as people that may or may not be able to help them out. We have to earn their trust. All of us probably have a different approach to establishing rapport, but you probably wouldn't walk into someone's office, whether it's a physician or a psychiatrist or a CPA and automatically just start putting all your private and important information out there without establishing some sort of trust to know that they're not going to harm you in some way. Considerations during assessment. The patterns of substance use and treatment seeking behaviors specific to people of diverse racial and cultural backgrounds. So we need to know how common is it for people in this general culture? Obviously it's a broad schema. We don't know if they're fitting into it, but in general in this culture, how likely are they to seek treatment? What types of treatment do they want? How can we be as socially and culturally responsive as possible? And the age of the people may also have a huge impact on what they see as appropriate treatment, what they see as whether treatment is appropriate at all and what they see as appropriate treatment goals. What are their beliefs about treatment including expectations and attitudes toward healthcare and counseling in general? Do they see it as something worthwhile? Do they think they would get more benefit from going to see their spiritual leader? We want to understand this. Some people are there because they're at their wit's end and they don't know where else to go. So let's understand what their concept of healing is and maybe we can help integrate some other people into the treatment team to make it more responsive to their cultural needs. Community perceptions of behavioral health treatment. If you're in a community, whether that be, maybe you're in a community that thinks that, if you're going for mental health treatment, I don't know. You may be in another community where mental health treatment is widely accepted, understanding what the community perceptions are because that's going to shape partly your office and whether you have people coming and going through the waiting room or there's a back door they can go out and a private entrance. One of the clinics that I worked at, we worked with some high profile individuals who were not willing and didn't feel comfortable coming through the front door and through the lobby where there might be other clients waiting. So we did have a VIP entrance for people who felt uncomfortable and they could leave by the same entrance. Obstacles encountered by specific populations that make it difficult to access treatment such as geographic distance from treatment services, transportation, childcare, timing. If you have banker's hours and you've got somebody who works banker's hours and especially if they're an hourly employee and if they take time off, they don't get paid, that's a huge problem. If they're a single parent, they may have issues with childcare. So we wanna ask them what obstacles, hurdles do you have getting here? One of the programs that I worked at was an evening intensive outpatient program and the buses stopped running at seven o'clock but our program ran till nine. So obviously we had to figure out if somebody was gonna come to that program and they didn't have their own transportation, how are they gonna get to and from treatment? We don't want treatment to add additional stress. We want to empower them to problem solve, of course but we do wanna be sensitive to the fact that some people, this was a substance abuse treatment program, some of these people had lost their license because of drunk driving and if they couldn't ride the bus they didn't really have many other options. Patterns of co-occurring disorders and conditions specific to people from a diverse racial and cultural backgrounds. Let's know what the patterns look like in the research. Is there a higher percentage of people from a particular culture with anxiety related symptoms? Is there, what are we looking at? Not that everybody's gonna fit into that which is I don't like to rely on research because that's so generalized but it gives us a place to start and then we can narrow it down and tailor it to meet the specific cultural and worldview needs of our clients. And awareness of common diagnostic biases and there are several in the tip that they talk about for cultural syndromes that would be considered quite appropriate in a given culture that would meet DSM diagnostic criteria potentially in other circumstances. So just be aware of what is normal, normative cultural behavior. During assessments, you also wanna consider individual family and group approaches specific to the racial and cultural backgrounds with diverse clients. Do they feel comfortable in a group setting? Maybe they feel fine in group psycho-ed but group therapy where you're doing trauma work or something, they're not down with that. That's cool, maybe they don't feel comfortable in support groups with other people but they feel comfortable in other situations. How do they feel about family therapy? Do they think the family should be involved or not? And culturally, maybe they feel the family should be involved but individually they're part of their issue comes with family right now so they're not ready to embrace that. We need to make that decision. Culturally appropriate peer support, mutual help and other support groups.  The well-briety movement for certain, come on over here, Native American groups. Now, there are hundreds of different Native American tribes and groups so I don't wanna say that this is gonna fit for everyone because it's not but there are people who would find this approach to recovery much more empowering and welcoming than a traditional 12-step approach. So you can go explore that on your own later. Traditional healing and complementary methods such as the use of spiritual leaders, herbs and rituals can be really important in the treatment process. If they believe, for example, that part of their problem is caused by a blockage in one of their chakras, then acupuncture, acupressure may be important. There could be a need for having a spiritual leader help them deal with some of their issues as well. So ask them what things they think might help and not confine them to Western medicine's approach to counseling. Continuing care and relapse prevention and accessibility of care within their communities. If you have somebody come to you for treatment, that's great. However, once they discharge from treatment or if they're only seeing you what to week, what resources are available in their community? If they're driving an hour to see you and then they go back to rural middle Tennessee, they may not have much in the way of support meetings or outreach or anything like that. So we wanna ask them what's available in your community and be creative in helping them try to get connected with resources as much as possible, including technology-assisted care. Sometimes it may not be their first choice. However, if they know it's there and they can reach out to it in a crisis, then that's helpful. And treatment engagement and retention patterns. We used to do this at the first clinic that I worked at looking at do we have certain groups of people that we historically discharge or terminate treatment prematurely? If so, why? In what way are we not meeting their needs and explore it from that point of view of improving retention and accessibility? Questions to consider for case conceptualization. Does the cultural group in question consider psychological, physical and spiritual health as separate or unified? I guess my nonverbals were backwards on that. It's important to understand because if they consider it unified, then you're probably going to wanna have physical and spiritual consults in terms of a multidisciplinary treatment. How are illnesses and healing practices defined and conceptualized? What are acceptable behaviors for managing stress? Some people would say, for example, meditation works. Other people are like, no, meditation doesn't work. You need to go on a run or in some cultures, they may say you need to have a drink. Not necessarily the healthiest culture, but understanding what things that they've been taught for dealing with stress. How do people in this culture typically express emotions and emotional distress? Are they emotive or are they relatively restricted? What behaviors and practices do members of this culture consider to be preventative? What words are used to describe a particular problem? There are a lot of concepts that exist that are not recognized in the DSM-5 that are culturally appropriate expressions of emotion that might be pathologized in typical Western approaches. How do members explain the origins or causes of a particular condition? Are there culturally specific conditions or concepts of distress? Are there specific physiological variations among this population? So do they respond differently to medications or substances, et cetera? What are the commonly misdiagnosed symptoms in this population? We don't wanna pathologize something that is culturally appropriate. And where do people from this cultural group typically seek help? Again, I'll state it for like the sixth time, we're dealing with large schemas, we're not dealing with necessarily as individual, but it gives us a starting point to understand how we can be more inclusive and receptive to people from populations within our community. We wanna know what traditional healing practices and treatments are endorsed by members of this group. Medication maybe, it may not be. Group may or may not be. Prayer may or may not be. Are there treatments that would typically be unacceptable? Don't wanna force something on them that they feel is unacceptable or shameful. Which counseling approaches are more congruent with the client's belief? What are some common health inequities for this population? Maybe they have a higher incidence of premature births. So we may wanna look at how that might be impacting the person if they were potentially preemie. What are acceptable caregiving practices? Do members of this group value caring for family members? If they do, then the family may be more involved than if it's a more individualistic society where family may or may not be there. Are individuals with specific conditions shunned? The black sheep of the family, if you will. What are family member roles in providing healthcare and decision making? In discussing consequences for behaviors or issues, is this acceptable? Do we wanna talk about what are the potential consequences or do we wanna stay kind of in the moment? And is it customary for family members to withhold prognosis from the client? So in cultural groups that value the family as much as the individual, it's often helpful to address the substance abuse in light of its consequences to the family or the community by asking something like, how are your family affected by your issues? How do your family and community members feel when they see you struggling this way? For clients who value independence over family, it can be more effective to point out how their current behaviors and issues undermine their ability to manage their own lives through questions like, how might your current thoughts and behaviors affect your ability to reach your goals? So there's a lot of you and you're in that statement. Just figuring out how to phrase it in a way that's meaningful to them. One of the first steps in acceptance and commitment therapy is to have clients identify their values and their goals. I do this as an activity usually in the second session by examining how clients define what and who is important to them, we can start to gain an understanding of their worldview and work from there. So it's kind of on paper in black and white. I'm a visual learner. So I have them right down over here. This is where we're going. This is what you hope for. Behaviors we want to avoid addressing clients informally until we grasp the client's cultural expectations and preferences, such as calling them back by their first name. Failing to monitor and adjust to the client's verbal pacing. If they talk slowly, if they like silences, we need to respect that. Obviously, I tend to talk a little faster. So I would need to slow down and ramp it at the client's pace. We don't want to use counseling jargon. We don't want to make statements based on stereotypes or other preconceived ideas generated from experiences with other clients from the same culture. Broad schema, but individual client. Using gestures without understanding their meaning and appropriate context within a given culture. Think about the skater culture. They have a lot of verbal or non-verbal gestures, but if you use it, you need to know what it means and what it communicates. And if it's even respectful for an outsider to use those kinds of gestures. Ignoring the relevance of cultural identity in the client-counselor relationship and neglecting the client's individual cultural background. What is shaped their personal worldview? We don't want to provide an explanation of current difficulties and how they can be resolved without including the client in the process to understand his or her explanations of the problems and how he or she thinks the problem should be addressed. Now this can be more detailed or less detailed depending on the client's preference for being involved in the treatment planning process. But we do want to get an idea. And we don't want to downplay the importance of traditional practices and fail to coordinate these services as needed. So if they believe in faith healers and they think this is important in their recovery process, we want to incorporate that. If they believe that they need to go to confession, then that's going to be something that we want to address in the process to help them feel like they are addressing the issue in a way that's meaningful to them. Feelings are expressed differently across and within cultural groups. So not everyone in a particular culture is emotive. Some maybe, but there may be some aspects or some sects of the culture that are not. So it's important to understand generally what happens and then kind of get an understanding of the client and the client's individual culture. Expression is influenced by the nature of a given event and the individuals involved in the situation. So what may seem comfortable and appropriate for them to do with their friends, they may not feel comfortable doing in a therapist's office. They may feel they've got to hold it together or vice versa. They may be more than comfortable crying and being emotive in your office. But when they're with their friends, they feel like they've got to have a stiff upper lip. A certain level of emotional expression can be socially appropriate within one culture, yet inappropriate in another. So can feelings be expressed directly? What feelings are appropriate? Sometimes anger's okay, but fear's not. Or vice versa. So understanding what the culture expects. Do they expect you to be dominant or are they accepting of less dominant behaviors? Some cultures may not perceive that emotional expression is a worthy course of treatment and healing at all. They may not want to deal with their feelings. They want to deal with the problems. And this can also be a temperament thing. People who tend to be more thinking oriented, if you go back to your Kiersey, are going to want to problem solve more and address the issue and spend less time talking about their feelings and more time talking about problem resolution. Counselors should not impose a prescribed approach that measures progress and equates healing with the ability to display emotions. Some people are not going to feel comfortable and it's not going to be culturally appropriate for them to be what we would consider emotive. That doesn't necessarily mean they haven't reached their recovery goals. We need to understand what their recovery goals look like for them. So this last thing is mapping the emotions. So this last thing is mapping the role of culture and it's again covered in the tip. But one thing you can do is to get a, put this up, I like projecting it, using an old fashioned projector, projecting it up onto a whiteboard. And we talk about things that may be influencing their current worldview, legal and socioeconomic status. If they are in the criminal justice system, they may perceive you as part of a more oppressive system, whatever their experiences have been. So socioeconomic status, how does that impact? How they perceive you? How they perceive counseling? How they perceive their problems? But we can start getting all these cultures, these various micro cultures, if you will, out there so we can understand how they might weave together to create this individual's worldview. Clinicians have to consider the impact of their clinical worldview as well as their personal worldview on treatment. The culturally aware counselor will reflect on the impact of everything from the decor in the lobby to clinic procedures and treatment selection have on the client and make every effort to respect and empower the client to achieve wellness as he or she defines it. It's important to consider the client's worldview when developing case formulation and mapping the client's cultural views and influences can help clinicians, us and the clients, develop insights into their current struggles and clarify culturally relevant goals. Do you have any questions? Do you have any comments? We covered a lot of stuff today. And one of the things, and I'm just gonna kind of keep talking in case you wanna type something, give you a little time to type. One of the things that I really appreciated, like I said at the beginning about this part of this chapter was the fact that they brought to our attention the impact that our clinical training and even the clinics that we were trained in, not just our academic training really shape how we perceive diagnosis, how we should, shapes how we perceive illness, recovery, health, yada yada and what it should look like. For example, in substance abuse recovery, some people see recovery as harm reduction and include medication-assisted therapies, methadone. Other people, other clinicians, other clients would not necessarily define that as recovery if the person is still using medication-assisted therapy. So that's a cultural worldview that we need to look at because I've had some clinicians working under me who were not willing to embrace methadone treatment even though we had a methadone clinic and we had clients coming over to our programs from the methadone clinic. So we needed to talk about the worldview and the impact of the client and how that interfaced with the clinician. There were a lot of meta concepts in this particular presentation, so I'm not just saying this to say it, I like talking to you guys about the stuff that we cover and about stuff that you would like us to cover in these webinars. So please feel free to shoot me an email if you think of anything, topics for discussion or you just wanna bounce something around. That's awesome. Thank you, Ms. Scott. Okay, so Dr. Snipes at allcews.com. If anything comes up, meta concepts, things you wish I would have covered, do have some stuff coming up in the third presentation. One of the interesting things, and if you need to go, please feel free, this is not a mandatory part of the presentation. In presentation three, we're gonna look at the difference between addiction and substance abuse cultures and mental distress cultures versus recovery cultures. Let's see, in terms of office decor, try for a blend or keep it plain. I think you can make an argument for both. And the tip didn't really address that. I would, my experience has been in the clinics that I've worked in that if it is too intense in one direction, then it can be off-putting, but either blend or plain can be acceptable. There are some people who are, if you use a blend, there are some people who may find that offensive. So plain may be the better choice, but that also depends on your worldview and who you are as a clinician, because you aren't just a robot in there, because that'll help them understand you a little bit more too. But if you're open to respecting different points of view and reflecting that, that can be true too. I was just talking to my husband today about sort of the fragmenting, if you will, of counselors. So we have LPCs, CRCs, LCSWs, and what each means, because most people don't understand the difference between a psychologist and an LPC and a clinical psychologist and a psychiatrist. Psychiatrist is easier, MD can prescribe, but in terms of what we can treat and the approach that we have and the clinical foundations and our philosophical approach to treatment and illness are very, very different. And there is some overlap among all of them, but there's also some very unique aspects of all the different fields. So I think it's helpful to have a multidisciplinary team available or at least somebody multidisciplinary team to consult in the event you need it. So a qualified mental health professional can be someone just taking a simple intake with no training, which you can see where that could become a problem because they may not have the background in cultural awareness. Gotcha, licensed mental health provider. And around here, for example, in Tennessee, they changed it and they gave people like five years to grandfather it in where LPCs can no longer diagnose or write treatment plans unless you have the MHSP designation in addition to your LPC. So you may have been diagnosing and writing treatment plans for 20 years, but you also had to once that new test came out, you had to take and pass that or you lost your privileges for diagnosis and treatment planning. So things do change, whether it's for the better or for the worse, you can argue, but there are so many permutations and things that I think it gets really confusing to clients, which is why I like to kind of go back to basics and put it in the client's court to figure out what they are looking for and what they think would help them. Alrighty everybody, well, I will see you on Thursday at 12 o'clock my time, whatever time zone you're in. Same time, same station. Email me if you have any other thoughts and it's been a great class. I enjoyed our post-class discussion. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com, providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists and nurses since 2006.


In Belgium, I'm really looking forward to this meeting that we're having in November. It will be the first time that we'll meet in an EOSC-related context. So the idea is that we'll meet with EOSC partners, but also with the government, so the regional government and the national government in Belgium. And it's really an opportunity for us to meet each other, to connect and to network, and to meet those other EOSC projects that are involved. And as open air, we really hope that our services and our expertise can provide some help. And we also really hope to connect with all the other projects. But not only that, we also hope to listen to the other projects and to the government to their concern and see how we can meet those concerns. So that's what I'm looking forward to.


Welcome to Tick Mill weekly market outlook for week commencing the 16th of March. The dollar index rallied strongly after a midweek reversal, largely on the back of deleveraging back into dollars triggered in part by a dislocation in the USD money markets. There are no real winners at this stage in terms of the COVID-19 pandemic, but many market watchers suspect that when the dust settles the dollar could end up lower. This assumes that the Fed responds to the dislocation with a 100 basis point rate cut on March 18th and restart some form of quantitative easing perhaps as much as $50 billion per month. This is an aggressive call but faced with zero lower bounds. There is no real point in the Fed hanging around. The week will start with a G7 video conference call on Monday. French President Emmanuel Macron seems to be showing some leadership here and will hope to coerce G7 partners into some sort of coordinated fiscal response. It's then clear where the US Congress is ready to play ball. However, President Trump wants a payroll tax freeze that could be worth up to $300 billion over a three month period. Perhaps one more targeted measures to support those most affected. Equity markets should stay pretty volatile through the week with the Dow currently expected to open down 900 points. However, we're likely to see a base built really in the equity markets until the COVID-19 cases starts plateau. This is earlier than expected to be around April time. So let's take a look at the Dow from a technical perspective. This big reversal that we saw from the target area that I highlighted in last week's review of this 94-50 area. We have since traded back through the yearly pivots at 97. We're now testing this resistance area at 98-50 to 99. If we don't see an early reversal in the markets here this week, I'm looking for the dollar index to actually challenge the current cycle high at 99.93. And ultimately the monthly descending trend line from the all-time highs here, which will bring us into around the 121.30 level. If we don't see a reaction here, then certainly I think the scope will move up to 101.50, 101.60, which is the 127.50 extension, and the yearly R2. So my key area is then watching, if we get an early reversal here, at the beginning of the week I'll look to re-engage the dollar on the short side. If we do trade higher, then my next area of interest is going to be this trend line. If we get a reversal from that area, certainly again I'd look to re-engage on the short side. If wherever we break out through this trend line then I want to play the momentum and trade this from the long side up to see a test of this 101.50 area. As we're talking about the dollar, let's check in with gold. Gold obviously, sorry, short reversal to the downside coinciding with the dollar reversal to the upside. We're now down testing projected, ascending trend line support at this 15-20 area. And this is going to be key now as we start the week. Our buyer is going to step in and defend this trend line. If they do, that would obviously coincide with the downside reversal in the dollar. Then we can be back up retesting highs and up towards potentially the ultimate upside target of this 17-40, 17-50 area. However, a failure to find support as Asia comes in, then I think we're down retesting the yearly pivot from above down towards this 14-50, 14-45 area. European Central Bank President Christine Lagarde's press conference did not help the euro. And these debt sustainability challenges are now very much in focus. However, market watches think it's with aggressive money printing from the Fed that can potentially support the euro nascent trend to the upside. As a new round in the global currency war starts to emerge. Beyond the G7 meetings, let's see what the euro group meeting of finance ministers also has to say on Monday. Italy has delivered the most fiscal stimulus so far, but Lagarde is going in European politicians into doing a lot more. And we have had rumblings out of Germany and France. So with the euro, similar scenario as with the dollar. If we can find some early support here at the beginning of the week, defend this one 10-50 area on a closing basis, then we could see the development of another leg higher to retest price cycle highs and ultimately see a move up to test this 15-50 area. If we don't find that support here, certainly if we trade sub 110, then I'm looking at an immediate retest of the lows down below 108. And if we don't catch a bid there in terms of a double bottom type pattern, and I think we can safely look down to potentially as low as 105-40, which again coincides with that dollar index breaking its trend line to the other side. Sterling's support stemming from the UK government budget announced was pretty short-lived last week, and Sterling has been one of the main losers in the G10 FX space. It looks as though the current account deficit is really starting to weigh on the currency. With the UK-EU scheduled trade talks for next week cancelled due to the coronavirus, the main driver for Sterling should be global sentiment. With the Fed likely to deliver a powerful 100 basis point cut as of next week's FO&C meeting, there's possibly a hint of quantitative easing. This could lead to a higher Sterling. However, should note that the move should be primarily driven by the possible US dollar weakness rather than Sterling's strength. Similar here with Sterling, if we can't catch a bid early in the week here, this 123 area, I'm looking for an immediate move to test bids below 122. A failure here opens the retest of $1,950, and then on, if we can't catch a bid at the $1,950 area, then I'm looking for a test of the post-Brexit loans. So really watching the action at the beginning of the week here, if we get some sort of sharp reversal or key reversal pattern early in the week, then I certainly would be interested in looking at some long positions in Sterling, but if that doesn't emerge, then I want to play the momentum and target a test of these $1,950 loans. One week, Dolly in volatility has traded up to 30%, perhaps higher than the great financial crisis. Monday's low of $1,050, triggered a lot of stops and came off to Japanese residents and bought about $40 billion worth of foreign bonds in the prior week. Here the suggestion is that semi-official institutions like the Government Pension Investment Fund or GPIF are aggressively buying foreign bond treasuries as a proxy for BOJ intervention. Mentioning the BOJ they meet on Thursday, it still has plenty of room to increase its JGB and ETF buying within its existing mandate, but may focus its attention on liquidity measures, as we'll hope that the government's $10 billion stimulus will buy some time. From a technical perspective, Dolly in saw that rapid reversal. We're now trading up to test the prior ascending trend line support as resistance, along with the monthly pivot $109 and just above there. Again, if we see some reversal patterns develop in this area, then I would look to re-engage Dolly in on the short side, looking on to me for a retest of these $101 lows. However, if we get some closes above $109.51, $110, then all bets are off really at that stage of the downside. And I'd be looking for a retest of $1,250, these prior cycle highs, and potentially trading much higher in the coming weeks. But first public call is going to be this $109, $109.50, and we'll see how the market responds there. We'll get some key reversal patterns and I'll look to do something on the short side. But again, sustained close through here, no reversal pattern, and I will try and play the momentum and target a retest of these prior highs. Disasterous week really for the Australian dollar down about just over 5%. It really wasn't only just a function of extra bearish risk sentiment, but also related to mounting speculation about quantum veezing from the Reserve Bank of Australia. Deputy Governor DeBell outlined the possible shape of what now appears in a never-to-move into an orthodox monetary policy, a BOJ-style bond-yielding target aiming to control the three-to-five-year segment of the curve. Such a prospect may indicate that the Australian dollar is bound to explore the 2008 lows at the $0.60 level in the coming weeks and months. This fiscal stimulus package deployed by the Australian governments if around 1% of GDP may not be enough to upset the significant downside risks to the economy, which should keep rate expectations depressed at least through the second quarter. In terms of data next week, we have employment data, which will be the key focus, but we will likely have limited effect compared to the impact of more equity volatility. If anything, another rise in employment may well endorse market expectations about QE package. Aggressive easing from the Fed may mitigate some of the downtrend in the Australian dollar. From a technical perspective, I'm looking for this test at the $0.60 level. We've got the yearly S3, monthly S3 coming in just above there. If we can catch a bid here at this level, then from a speculative perspective, I think longs in the Australian dollar to play for a correction could be attractive, but if we can't find a bid at this $0.60 level, the next stop from a technical perspective really would see us down in the mid-50s. So again, a couple of closes below the $0.60 level, play the momentum and target a move down to the mid-50s. But if we can find support here, get some decent bullish reversal patterns, then I'd look to put some speculative longs into the market. Slump in oil prices will likely have a pretty negative effect on the Canadian economy, which will already have to deal with the headwinds of the coronavirus. The self-calling Cority Prime Minister Justin Trudeau will unveil a fiscal response package soon, despite the parliament now being shut due to the virus. The BOC on Friday, late Friday, cuts another 50 basis points into meeting, looking to provide additional easing as one of the few central banks with the room to do so. From a technical perspective, any pullbacks really towards this $1.36 area should provide a buying opportunity to ultimately retest the $140 area en route potentially to the yearly R3 at $141.50. Any failure below $136 could suggest a false upside break and we could trade back into the mid-range down into the low $130s. And that concludes the weekly market outlook for week commencing the 17th of March.


What's going on everyone Sam here with late in sports cards doing 10 box Tuesdays 10 box mosaic treasures football mixer number 140 Random team style. There's a look again at your random results As always you can find these on the website under the results tab as well as the link in chat Good luck here everybody. Let's do it. We're gonna start with elites We'll do our two contenders after get some of the base heavy stuff out of the way We'll finish her course with NT hobby 21 NT hobby Tire elam to 999 for the bills Our elite deck is Najee Harris Turn of the century Derek Stingley jr. Nice one there for the Texans 57 out of 99 grads H town We got Kenny Pickett It's gonna be 18 out of 92 for the Steelers cool one there Grats Pittsburgh Scary Terry fight Edward Tulare to 49 for the Chiefs Jameson Williams rookie elitist of the Lions DJ Moore Teal to 25 one of 25 for the Panthers Harrison Smith Harry the hitman elite coverage going to the Vikings Nice one there. Love Harrison Smith, man such a beast Traylon Burks can makers Matt Judon Is Aaron Rogers to 399 for the Packers What what do you guys think about Aaron Rogers saying he's gonna keep his jersey? What do you guys think that was all about? Did you hear about that? Yeah, right? Yeah, what's it won't come when Jameson Williams wanted his jersey is not man thing. I'm gonna keep this one because that's the last time He's gonna put on a Packers uniform That's Stafford last game at Lambo He was like he's here his press conference. He's like, yeah, you know, it's week 18 at Lambo like You know, I just want to keep that jersey I don't know. I just want to keep it. I'm like, what? It's a boy a mafia To 340 not Retiring our last game as a packer You think he's retiring uh, bgs I Think that's I think that's possible. Yeah That isn't pricing to 349 Justin Herbert Now it would be it'd be scary. That'd be a scary offense. I they don't have the money for it though You're gonna have to get rid of everybody, you know That press got because what's his face? Um This hill is expensive Armstead's expensive. Jones is expensive. Xavier Howard. It's expensive John Dotson to 999. That's just that it's a lot of money on the on the dolphins books But you can make it work. I mean if you get you got to go for it Elitis to March ace Also, true. It is a lot of money to turn away if he does retire It's a very good point as well. He just there's the bunch of smith to 94 Eagles He's getting up there now. I mean we're going on almost 20 seasons Still all it's still sling it. Yeah, dude All right, you could recap the jerseys do that My god, because there's gonna be like NT stuff Nicoby Dean to 999. Yeah, you're good. No, you're good Should have our pen pal in here. Hopefully Oh, yeah We've got James cook for the bills Nice one there. Aaron rogers. The legacy is in jeopardy Okay, Vontimido, Aaron Jones. I see what you did there bebo. I see it I like it Got uh to do 21 contenders hobby. I'm thinking there's a call a big card in 19 this time So all cards do ship on this Should go to the raiders. It's not a bad idea wants to link up with the vante again Greg Newsom for the Browns Base rookie ticket auto rookie here contenders a large more gladiators Tony Gonzalez. I'm Tony Gonzalez University of California Jonathan Cooper Base rookie ticket auto for the Broncos San Darnold MVP contenders That's a negative. That's a new that's a big old goose egg On that one Gladius Joe Thomas That's a garbage team. That is a garbage team Winning ticket Alvin Kamara Cameron McGrown for the Patriots base rookie ticket auto It's your own bet. Hi, Simone Ross St. Brown on the base Rookie ticket on card auto congrats lions nice one there Yeah, add him to the the quarterback carousel the last five years The post Andrew Luck panic at QV Screech rookie in the air contender. Yeah, there we go. That's what I like to see Screech, baby Jay Jettis the duals. Yeah, I'm surprised Earl Campbell He is kind of a weird guy. I got points random to all at the end 400 Yeah Justin Fields supernatural Andrew Luck just retired when I was at a concert Bob greasy Cannot process it the Wiggles. Oh, yeah, probably the Wiggles. Yeah Of course third to last pack we got a dual All right, gotta do a dice roll one two three top four five six bottom. Just make sure you specify 21 in 19 because I'll do two separate for them. So this is 21 right here It's gonna be a four. We're gonna go to the bottom with Ramon Dre Bottom for 21 contenders There's kella that's going to the bottom with kellen mond davis mills That is erin rogers chain movers All right on to 2019 contenders hobby now That was a real that was so shocking dude when he retired Cocoa melon concert. Thank you very much.  Oh, yeah, you would know Well, that's both on the Patriots Yeah, exactly for us. That's a that's a tough question here contenders collar off question If you don't make so much money on the side over there Oh, yeah I thought he needs it though. I know Oh Yeah All right one two three top four five six bottom. This will be for 2019 It's gonna be a six going to the bottom That'll be with no offense God MVP contenders baker mayfield to 49 Very true What a great moment they caught on camera of him saying that he's going to keep the jersey Yeah, scottie miller nice one there going to the buccaneers Grats on that on the rookie autumn Seriously He reunites the bike mccarthy Oh, no, god, no Rodney anderson rookie autumn so they banged his steam He would be so he would retire immediately if he got traded to ballast to that He would not show up. Yeah Gardner mint you Yeah, do you imagine uh daren hall rookie ticket auto for the packers I need somebody What about matt ryan? Ray lewis winning ticket should have two autos in this next two packs Just want him out of there. I feel that Devlin Hodges duck Hodges. What a name man going to the stealers duck Hodges Wow What a blast from the past that is right there Justice hill rookie the air contenders. Yeah, uh, no Think dan quinn gets another shot at the cowboy's job Yeah, vaughn's pumped about that one We got gary jennings junior on card rookie auto for the seahawks and base All right, let's do uh, let's do 22 mosaic hobby To the hit of the night is duck Hodges Yeah, gary jennings. Yeah, I know right good lord, man What a couple of names right there Really pulled those two autos back-to-back gary jennings and duck Hodges That's david and jokie haunter henry purple to 49 for the pats Jerry rice straight fire tom brady What Yeah, right. I know I just want to rock and roll all night and purdy every day Blue Erica's conma G9 Silver logan hall At least you know after you break utopola for me or he's gonna sleep well at night. Oh, I do. I do like a rock. Oh my god.  That is an annoying one Fred Warner Red alec pierce rookie and rod smith Yeah, I think they did jay. I'm pretty sure they did. Yeah, what was that in reference to florist that you got to stop the brock and roll It's jail and waddle. It was a reference probably to everything. Probably. Yeah, Tony Gonzalez overdrive That one I can't take credit for that one because that was a barstool shirt That I just saw like when I was scrolling instagram the brock and roll But that's a hole. Yeah Red It really is man, just getting your face pounded for 12 wrongs getting your face pounded for uh 12 hours 12 rounds javis and williams silver pierce strong The suffering stop the suffering I'm not gonna do the brock and roll because it's it's too awkward off the tongue. It's too much There's jesson fields Justin or uh jesson fields again on the red. You got a gold on the back here of macarral blue chips That is nine of ten jersey number going to the panthers. Nice one there Stop it stop it get some help Classic I know I know that Please I'm so far gone from that Sean Yeah There's cave on tibit oh on the red auto going to the giants. Nice one there pureness Wanda Robinson jubilee silver Bass and bass. All right, let's do 22 mosaic choice as well Silver chase claypool Jalen nailer Sean slowly give in to the grass There's auto chrysalovay nice one there for the saints Not numbered congrats on that new orleans the choice exclusive auto Got bow melton to 80 Followed by ron dale more to 80. We've got come on michael thomas the 80 as well Now choice exclusive rookies debon loyde for the jags and kyle hamilton for the ravens 21 mosaic hobby kind of gain well rookie auto not numbered for the eagles Nice one there philly at oliver beyond jones red michael thomas erin donnell andre hopkins jalen waddle rookie mcboulton silver scringe there we go Oh, baby. Jamar chase debut rookie. Kyle pits rookie. Oh boy. Here comes the bond to be fair You're in trouble Caleb farley. Oh, that's true To 49 on the pink rookie being a patriots fans feel like the slow descent of madness silver quity pay That's true Rashad bateman shy smith watching a greg roman let off and starts to put you into Into in san v as well. Joe try and show you inka for the bucks red march ace rookie Our second auto kevin byard on the auto going to the titans cool one there Such a start at safety. First it was potatoes ash potatoes with his hands and it was cardboard Najee Harris debut rookie strong gravy. Yep strong the gravy ivy in the gravy Who's on the trash list? Lashmore silver blue chips jets jalen waddle debut there's tony keenon alan Stair masters nick chubb not numbered there's tony trace sermon and jake bunk Tootie go these knuckleheads like us Got a blue diami brown to 99 for the commanders rookie silver day marina There's joe montana in it to win it Zach wilson debut still in the top load that Travis kelsie Demetric felton that's very true of on jamar chase blue chips What's up cute trail ants debut rookie dj cute At that point things are back hoping for a bill o brian 21 mosaic choice Yeah, that was still kind of wild that he sat Malcolm Butler for that. That's kind of insane, dude Uh peacock coming up like thomas nasty nico collins Uh, i'm on green That's cool Going to the packers not numbered autographs There's thomas davis to 80 man of the year for the panthers Deon jones the 80 as well. We got a peacock coming up of jarvis landry going to browns nice one there Got trail ants exclusive choice for the niners and zack wilson Uh 19 of 80 for the jets All right, let's do 22 mt collegiate toby And any card that's multiple teams will be random to those teams represented at the end If it's a guy still in college, then it will be random to everybody at the end disgusting nasty cards, right patrick Jalen waddle 12 of 99 First time you're gonna get this one all night We've got 65 of 75 bailey zappy Make sure to recappy the zappy Going to the patriots Hey him and i hate him We got a uh isiah spiller 23 out of 49 two colored rpi for the chargers So let's Nice one here is going to be going to the bill's 18 of 49 james cook the cookbook Congrats on that there Yes, i am patrick But you're not a rapper Got a two attack of my loa 7 of 10 for the dolphins. Nice one there on the sentry materials Here donnie So nasty 8 of 10 justin herbert for the chargers dude. This is the coolest card of this guy i've ever seen This is insane That's actually insane That's a combo spot two going to null and w we got for the panthers How about a matt corral team slogans inscribed hotty totty? Oh, that's cool dude. That's all that's so nasty old miss old missus slogan Hotty totty, baby 22 out of 25 matt corral That's since that's insane. That's such a cool card I love that man. That's so freaking cool, dude And we've got jameson williams 45 out of 99 true rookie jersey auto going to the lions Congrats leonice That's so freaking cool, dude Like if i saw that at a show i would buy it. That's one of those things just stuff like that I just love dude. All right, we've got 21 select first off the line There's your photo sticker right there It's one of those. That's just really freaking cool mac jones rookie grab ctn nico collins blue checker to 149 Dazz new some silver and jamar jefferson yami brown Jay jettus silver ed reed premier level ronda elmore premier level rookie james we got our first off the line exclusive of Cooper cup very nice on the field level numbered five of seven congrats rams Nolan w again on the combo spot. There you go, buddy Nice one there nice cup silver kellen mond quit melson right baker mayfield to 40 35 even better for the browns silver kellen mond field level. Kyle hits rookie. We have a green Is that a green now that's You know jones wow it is a green three of five matt ryan going to the falcons nice one there at lanta The green patch one off jersey number scott f congrats scott Elijah more silver rookie matt ryan This christian mccaffery field level Tri-collar to 75 for the panthers silver semi fahoko jonathan dale So weird saying it's going to be weird saying mccaffery to the niners next year More dune breaks mac jones sensations silver ian book ronda elmore It's not going to be used to that at all sensations a j brown silver josh allen russell wilson ronda elmore silver rookie selections to a silver erin donnell the agent peterson lute checker to 199 silver demetric felton terris marshal jr There's justin simmonds 52 out of 75 for the broncos nice one there i'm down i'm down forced You want to go to the show on saturday? Yeah, i'm down. Is that the uh a popko one or is that the one we're setting up at? Like the new one There's javante williams one out of 25 first off the line exclusive Two-color rpa congrats broncos So in there denver. Yeah, i'm down Yeah, i'm down. I'm in And monrasey brown One box of nt hobby 21. Good luck everybody Pardon me a minute, dude. I'm down so down start listening stuff on you I've been selling a ton too just my stuff. That's up dude. I haven't been putting anything new up yet Same Sin victor will be there Sin is in let the fun begin That's good Usually I don't like to give you credit, but that was good. Yeah All right, we've got erin donald the 49 matt ryan to 99 Got cam newton 30 out of 49. That's going to the panthers two-color patch panthers spotted very well Next up we've got century materials. That's seven out of 99 josh jacob's for the raiders 16 out of 99 Dan the man dan marina treasures of the hall player warn for the dolphins Stuff we've got pat fryerviews big moose 14 out of 99 for the stealers I think i'm gonna be daytime forest nighttime be jets Leave that's what it's gonna be. Uh, who's breaking? It's not sure they have on friday 29 out of 49 Is chas syrup to this unreal this spot, dude Going to nolyn w how about one of one printing play rpa chuba hubbard Nice one there one of one That's insane. Do you can bag this one? And you can bag the one after this next one too Congrats on that again. Nolan. There you go, buddy. Wow Jalen Phillips in javon holland 21 out of 25 going to the dolphins.  What a hit We've got number five of five going to jeff riem and the jaguars. How about a trevor lorenz? Wondry tag horizontal Let's go. That's so nasty. That's a big boy card Wow, what a last card of the night for group breaks, man. What a way to end group breaks. That's a big boy. That is fantastic Big time. Congrats. Jeffrey.  What a time to have this one. You have to make that. I bet the one after this by bad Let's go. Congrats. Jeffrey. There you go, buddy. Let's get that mag right away And let's do the random. Wow. That's awesome, dude All right, gonna do a random for uh 400 punini points We'll do a quick recap as well All right, guys, again, gonna do the random for 400 points gonna roll the dice whatever team is on top after 11 rolls of the die We'll get the points one Two three four five six seven eight nine 10 11 go to the cowboys cowboys getting the points Do a quick recap here, yo Man, what a break to end it, man.   I forgot to put it on the main cam. Let's do that again. My bad everybody. My bad. I'm a fool Matt Ryan the Falcons Cam Newton for the Panthers Dan Marino Dolphins Pat Fryer me with Steelers Josh Jacobs Raiders to a tag of Iloa Dolphins Justin Herbert Chargers Uh Harrison Smith for the Vikings Autos For yeah, my first day out here, man. Tell me some slack That's when I third out here third day out here. I don't know Uh James Cook for the Bills Bailey Zappie for the Patriots I didn't even bring that up, man. Dolphins dual uh Chaserot Vikings That Javante Williams Broncos Justin Simmons Broncos Matt Corral for the Panthers inscribed Hotty Toddy So cool, dude Jameson Williams Lions Isaiah Spillard Chargers. What are you three? Got him! Amon Green Packers Kevin Byer Titans Kenneth Gainwell for the Eagles Chris Alave Saints Came on to the Giants James Cook Bills Stupid Gary Jennings Jr for the uh Seahawks Duck Hodges Steelers Daren Hall for the Packers Ron Anderson for the Bangles Scotty Miller Buccaneers Amon Ross St. Brown for the Lions Kenman McGraw and Patriots Jonathan Cooper Broncos Craig Newsome Browns James Cook for the Bills Derek Stingley Jr. Uh Texans We had one of one Shuba Hubbard Going to the Panthers on the printing plate auto and how about hit of the day Five of five Trevor Lawrence RPA with the laundry tag That's sick so nasty That'll do it for the break that what do you three is in one one two? Yeah, one of one. What are you three? Of course that's inscribed one of one. Let's go. Got him. That'll do it for the break guys Thanks again for the night Next up is


In today's Cobb highlight, we're talking about the 2015 and up WRX shift plate. Starting in 2015, Subaru switched over to a cable link shifter on the WRX as opposed to the direct linkage on the old five speeds. What that means is that if you want an aftermarket solution for a short sporty throw, you don't adjust the lever in the car, you actually adjust at the end of the cable where it attaches to a shift weight. The adjustable Cobb shift plate, or you could call it a shift weight if you wanted to because that's what the OEM would refer to it as, is made out of a zinc coated steel and we also give you a stainless steel pivot pin that goes into either one of the adjustment slots. And lastly, we include some Loctite to make sure everything stays in place. And of course, the most important benefit of the Cobb shift plate is reducing that shift throw for a sportier feel. If you put the pin in the furthest out option, it's a 15% reduction in throw. But if you move it in a little closer, it's actually a 35% reduction. So it's a pretty big difference and you can pick whichever one suits you the best. Another really important part of the design is the actual weight and shape of the plate itself. You can't just make it any size and shape that you want. The inertia as it moves has a big impact on how it feels when you're pulling out of one gear and trying to put it into the next. So we had to actually stick pretty close to the OEM design, but also try to improve it a little bit. If you have a manual transmission WX, the ability to change gears on your own is probably a big reason why. And just like you can install an access port to make more power or put coilovers on to lower the car, installing a shift plate is an affordable and easy way to make something that you already love even better.


The Saint Louisian Medical and Dental Association hosts an annual grand gala event to recognize outstanding professionals within the local medical fraternity. The awardees were distinguished by their outstanding work, determination and drive in the fields of medicine and dentistry. Awards for the evening included the most dedicated team member, which went to Dr. Samantha Mathre, outstanding intern, which went to Dr. Kyra Joseph, Dr. Alwyn Benjamin, walked away with the outstanding physician award. The award-winning district medical officer for 2023 was bestowed upon Dr. Delphine Venor. Outstanding junior physician was awarded to the very promising Dr. Christy Gerald, and this year's outstanding dentist award went to Dr. Randall Borai. The SLMDA also took the opportunity to pay homage to a long-standing physician through its Lifetime Achievement Award. This year's Lifetime Achievement Award went to Dr. Menso, who retired from the position of consultant at the St. Jude Hospital in May 2023. I'm very happy to be recognized and what I was done in St. Jude Hospital for the improvement of the NACCR system, at least in St. Jude Hospital and some ICU management protocol and then the recording system. The keynote speaker for this year's ceremony was chief medical officer Dr. Sharon Belma George, following her participation at a two-day Karakam conference focused on improving responses to crime across the region. Dr. Belma George presented on the topic, crime as a public health issue. So let us look at the intersection of crime with our health system. Physical injuries, we start with the most obvious, loss of limbs, disabilities, chronic health conditions, mental health, the disruption of social services, the high crime rates can disrupt the delivery of essential social services such as education, as we saw in some communities where schools had to be closed down. We had to close down health facilities in some areas at one point. The chief medical officer says tackling crime through public health is among the many strategies under consideration. Her presentation also included recommendations to mitigate crime using the public health approach. If we are to look at crime prevention strategies based on the public health approach and this would aim to reduce the occurrence of criminal activities and to enhance public safety and that's really where we should be going. Looking at community policing that is building positive relationships between law enforcement and the community to address crime collaboratively and this is really the most important aspect where we look at the preventative measures. Dr. Belma George stressed on the importance of data collection in the push back against crime across the region. The SLMDA award ceremony also marked the beginning of the annual conference themed updates and controversies in medicine and dentistry. For the communication unit of the Ministry of Health, Wellness and Early Affairs, I'm Sant Justin.


from because there is a community celebration evening happening this Friday and it is in Austin Law Alton Gorda Hork and it's the Clowny Lee Community Awards celebration and here to tell us more too from the committee Katrina Kelly and Helena McLean ladies thanks for coming in thank you thank you great to be here who wants who wants to start and tell us a little bit of the background I think I like Katrina okay well look at this was an idea that a few of us came up with maybe six months ago we wanted to celebrate congratulate and valorize the efforts of all our many community volunteers that make up the entire community of Clowny Lee which stretches from Tory Island to beyond Falkara okay I mean a great idea you know they're vital in any community so somebody right I suppose that you shine a light on them exactly and there are so many volunteers behind every one of these groups clubs societies and organizations some of them may be charitable organizations some are sporting some are directly involved in youth services and youth coaching others are cultural musical but the one thing they all have in common and we've collated all of the information from up to 55 groups John and the one thing we found in common all of them have a fundraising aspect to them as well as looking after their own populations and another thing about it is that we see how much of a network they are creating for members of the community in Clowny Lee. Alina I suppose it's only when you start to do something like this and put on an event like this that you realize just how many groups there are out there yeah we have to be surprised we were surprised we actually knew there was a lot of groups doing a lot of good work in the community but then but then when we started going down then we actually have up to maybe 55 community groups and that's in Clowny Lee area alone and will all 55 be represented on the night? There's going to be at least 53 so it's brilliant and it's great for the community to see what every other group is doing and we're all going to learn from the night we're all going to see what everybody or whatever other group is doing and I suppose as well as we're looking at maybe we'll be able to form a database so that when everybody else comes into the community this is exactly what's happening within their own community and these groups you can't happen to. So Katrina you've spread the network yet you haven't confided to one particular area because as you said there they're sporting groups and to charitable groups and really a complete across the board mixture. Exactly and it has been such an encouraging and enjoyable activity collating the work of all of those groups and I just got one email in this morning from a member of the Clowny Lee Anglers Association who were doing phenomenal work in protecting the vital ecosystems and habitats that are in the rivers and he said to me in the email it's good for a community to hold a mirror up to reflect all the good and many things that it can celebrate and take pride in and I suppose that reminds us of why we're doing this and again we want to stress this is a snapshot in time of it's like an audit of all that's happening in our community at the moment and we remember very very fondly at this time past members as well as present members of all of the groups and we invite them to to recognize within their own groups all of that their communities have done to bring them this far. I suppose when you're going down through the groups and you realize and you sort of dip in and do a bit of research that you realize that the work that they do behind the scenes and how much in a way we all take them for granted. Yeah and I think this is where I suppose I'm going to give credit to Katrina actually that came up with this idea first they think about doing this here and it was coming from that angle that there are so many groups out there they're doing this work voluntary they don't look for any attention they don't look for credit they just go on and they do it from day to day you know you're talking to St. Vincent Paul you're talking about all these groups that are out there they do to give up the time you know and behind every community group there's a voluntary board you know they come out in the evenings seven o'clock in the evenings they're heading into meetings to make sure that this work is done you know and they're working behind the scene and they're doing it on a voluntary basis. And then trying to gather money as well to raise money to you know pay the expenses and to keep it going. It is and it's expensive and funding is not easy to get we're all depending on to the same pond you know I suppose again we have to thank our own funders that actually helped us to get this event up and running because without without the funding we wouldn't have been able to manage or to be you know to celebrate. And you managed to secure a lead sponsor. We did thank you. I suppose when we began this journey I was at a meeting at which happened to be councillors John Hamish O'Farray and councillor Michael McLeafarty and they straight away offered their support for this event and it was thanks to them that we got the courage to run with it and apply to Donnie Gull County Council members fund and they were forthcoming with a very very nice basis for which to give us great foundation. Udhris Nagyelthukta came along, Donnie Gull Volunteer Centre and finally just today now we have Energia Sharkt in the Gaelike and they were they're happy to be associated with with this event because it is happening in our Gaelthukta area and we're so proud of our Irish language and we recognise all of the work that has been done in our area through many of these groups efforts to to foster and develop the Irish language. And relatively speaking it's a small area and yet there's 55 groups now a lot of them have a bigger imprint around the the wider north-west region maybe elsewhere in the country but nonetheless 55 groups active in that one area. And we made sure we kept it within Clohon Ely because it wouldn't be fair to go outside that border you know and we kept it within that there you know so and it's going to be a bilingual event as well because we are in the heart of the Gaelite. Is it going to be an annual event? Well as I said recently there's a great there are possibilities there for more ideas going forward maybe the business community would like to replicate this event. I suppose we're learning as we go along out of this other other ideas will be inspired and other events will take place because people will be networking no doubt exactly it's an opportunity there for all of those groups to drum up new members and to let others know what they're about. I was just going to say like I'm I working in Lowe myself and I was talking to them and they were like oh this is something we might copy next year within the Rosses area you know so there is others looking on there will be others looking on and that will you know they would see how this event went and they could see how things go from there because I know there's celebration a county-wide celebration but no harm in bringing it down further and you know and bringing it down to a locality in this case Cloughaneely. So anyhow it is Friday night it's an Austin Law Alton and the Cloughaneely Community Awards celebration and entry tickets availability? Well we've had all of our all of our people our nominees from all of the groups have all responded we have a packed house now at the stage okay and we thank all of the members of all of the committees who got back to us with their numbers and looking forward. Yeah well it's up to be a great night and who knows what you know where the future lies maybe maybe it will become manual or if you know who knows what might come off it. Thank you both very much. Thank you very much thank you.