That concludes general questions. We will now move on to the next item of business, which is First Minister's Questions. At question number 1, I call Douglas Ross. Thank you very much, Presiding Officer. An email revealed yesterday at the UK Covid Inquiry included... Really, SNP members are groaning because we're asking about the Covid Inquiry. So let me start again. Thank you, Presiding Officer. An email revealed yesterday by the UK Covid Inquiry. third party, y gwmddiad yw'r FFWF aethwr i'rói ffordd aethwr diwrnodol iddyn nhw'n rôl, ond pan oedd yn ymddangos i Siw Llywodraeth, dan y ffordd i'r FFWF. Mae'r e-mail yma wrthens, rwy'n bryd yn oed yn fynd i chi'n gweithio ymdarnol. Fel fau'r gwirionedd maen nhw'n gwaith ymddangos maen nhw oheithio maen nhw ymddangos, mae'r gwrthion gyngor yn cymaint i'n cael eu fod yn mynd i'r ffordd i'r lleol. diogelio. Felly mae'n llywodraeth, ac mae hynny'n gwneud eu mewn ystodau ar gyfer unrhyw o unrhyw Scotland yw y rheswm. Rwy'n mwy fydd yw'r cyfrifio o'r gwneud yw'r cyfrifio. Mae'r nid yw'r pethau yn y gallu'r ffrifio yn ni'n nrhyw. John Swinney yn ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n ni'n yw yw yw yw unig o'r byw sydd yn ddigidio ar gyfer y cyfnodol? Mae'n ddigidio, wrth gwrs, yw yw yw yw yw yw yw yw yw yw, ac Douglas Ross, yw'r e-mail yw'r SNP yw eisiau, yw yw yw yw yw yw yw yw'r Gwfffinol cyfnodol, yw yw John Swinney, yw Nicola Sturgeon, yw yw yw yw yw yw yw yw yw yw yw Yw Jeane Freeman, I can suggest that the decision around Spain was made for any other reason than epidemiology. I'm afraid it is an absolute fantasy. Even if we accepted Douglas Ross's example, or Douglas Ross's framing, that we were looking at this through a constitutional lens and attempting to curry favour with Spain, surely then we would have put them on the exempt list. We didn't put them on the exempt list—the exact point— Why did we not do that? Because let's look at the epidemiology at that point, that Scotland did not include Spain on the exemplars, like England and Wales did. Why? Because their point of prevalence at that time was 0.33. That was four times higher than the point of prevalence in Scotland. In fact, Spain was the only country at that point proposed for the exemplar list that had significantly higher prevalence than Scotland did at the time. When I look at the evidence and the advice from the chief medical officer at the time, he expressed concern about the importation risks. Ministers concluded that they should not add Spain to the list of exempted countries due to our lower prevalence and the fact that Spain had four times higher prevalence. Douglas Ross can do his best to spin. He can do his best to throw insults. He can do his best to try to malign and misrepresent facts and malign not just ministers but civil servants. I believe that the people of Scotland know, for all of the challenges that we had during the pandemic, that the Scottish Government always prioritised protecting the public from the harms of Covid. I don't think that Douglas Ross has to say the same of his party in the UK Government. Amid pretty stiff competition, that might be the most bizarre answer I've ever heard from Humza Yousif. He's saying it's fact, so here is a fact. The day after, Humza Yousif received that email speaking about political concerns that there might be with the Spanish Government allowing an independent Scotland into the EU, he stood up and announced that they were introducing a corridor, travel corridor, with Spain. The very next day they opened up travel to Spain and five days later they had to close it down again because Covid cases were rocketing. That's the fact and we know it because Humza Yousif told us and it's black and white in evidence to the inquiry that they were thinking about independence instead of focusing purely on public health. Now what we've not seen is any evidence of Humza Yousif's response to that email and Nicola Sturgeon's messages have all gone from that time because she deleted them. The former SNP leader destroyed all of her WhatsApp messages despite knowing that he do not destroy order was in place. Despite promising grieving families, she would be transparent. Despite assuring journalists that all her messages would be handed to the inquiry, she told the press unequivocally yes, her messages would be provided. So why did Nicola Sturgeon say yes when she actually meant no? First of all, once again, effective from 10 July 2020, Spain was not included on the first exempt countries list due to the higher prevalence. It had four times higher than it had in relation to Scotland. Let me just say in relation to WhatsApp messages. Douglas Ross has thrown all sorts of incendatory accusations the way particularly of Nicola Sturgeon for not retaining WhatsApp messages. He's demanded investigations and reviews. Not only did his boss, the Prime Minister, not retain his messages, he actually took the inquiry to court and lost. Just over the last hour, we've heard from Alistair Jack, again, Douglas Ross's boss when he was in the Scotland office. What did Alistair Jack say about his WhatsApp messages? He was asked, did he delete his WhatsApp messages? Here's what Alistair Jack said. He said, I did delete them because he wanted to free up storage capacity on his phone. When he was asked if there was any government business on these WhatsApps, he said and I will quote him directly, I didn't think anything of it. When he was asked if he considered the needs of the public inquiry, here's what he said and I will quote directly. No, I didn't. I was quite keen for my phone to start working again, is what he said. Is astonishing that Douglas Ross demands investigations and reviews in relation to Nicola Sturgeon for not retaining her WhatsApps. Not his boss, his colleague, who deletes his WhatsApps, didn't even think about the inquiry, well that's perfectly fine. Well there's one word for that, Presiding Officer, and his hypocrisy and the people of Scotland can see right through Douglas Ross. It is not perfectly fine. Alistair Jack was wrong to delete his WhatsApp messages. He has apologised and he regrets it. Hamza Yousif can't step out the shadow of his disgraced predecessor and say the same. Of course, Nicola Sturgeon has not apologised. She has not apologised for doing it. She has said she was right because she was following government policy. That's a massive difference, First Minister. I can't let the First Minister's confusion over this travel ban with Spain pass. He's just saying that they kept in place the restrictions with Spain. On 20 July, the day after that email was sent, Hamza Yousif said and I quote, we are able to lift the requirement for those travelling from Spain. Five days later, he says, the decision to exempt Spain earlier this week was taken when the data showed there was an improvement. The latest data has given us cause for concern to overturn that decision. So he definitely made a decision on the back of that email. Mr Ross, Mr Ross, can I just ask the front bench to please resist any temptation to contribute, Mr Ross? Well, I think they're trying to come up with a story here because what the First Minister has said so far does not match what he did in practice in 2020. But we know that the deleted WhatsApp messages were covering up major decisions from this SNP government. We know that because of the messages that we have been able to see. Hamza Yousif, when he was then health secretary in charge of the NHS, joked with the national clinical director, Jason Leitch. He laughed about false claims that children were hospitalised because of Covid. In one revealing exchange, Hamza Yousif said this, I'm winging it and we'll get found out sooner or later. First Minister, at what point do you think you were finally found out? First Minister, let's look at the facts. Where Douglas Ross is right, of course, there was Spain initially exempt, not exempt from a travel corridor and then put on a travel corridor. Why? Were they? Because we have the data that the UK Government presented by the London School of Hygiene. First Minister, we have so many members who want to put questions to the First Minister. That would be more likely if we could get on with our session and if I don't have to keep asking front benches to resist the temptation to contribute when they shouldn't be. They don't want to listen to the facts and the facts are this. Douglas Ross said in his own response that the situation improved in Spain and that is correct. The London School of Hygiene and Tropical Medicine showed a marked improvement in the position in Spain with point prevalence going down to 0.015 per cent. That is the reason why they were put on the exempt list. When the situation worsened, just a matter of days later, worse than considerably, all the UK nations decided to take them off that exempt list. Again, we made the decisions for purely epidemiological reasons. When it comes to the UK Government and the messages that we have seen, I remind Douglas Ross of what we have seen from the UK Government and the messages that have been revealed. He had a Prime Minister, Boris Johnson, that Douglas Ross not only backed to the very end but invited to his party conference. Boris Johnson, who allegedly, according to the evidence that we have heard, said, let the bodies pile up high. When discussing long Covid, he called it, and forgive me for the language, bollocks. We had a Prime Minister, Boris Johnson, who partied in number 10 while loved ones missed the funerals of their relatives. So, yes, we could have done better when it came to the retention of informal messages, but when it comes to steering this country through some of its darkest days, I am very pleased that we had Nicola Sturgeon in charge here in the Scottish Government as opposed to Boris Johnson. I would remind all members of the need for courtesy. Members, I would be grateful if you could desist for a moment. Just let's remind one another of the need for courtesy and respect in this chamber, and that applies to using quotations to use words that might otherwise be regarded as unparlumentary. I'm also very conscious, as I've said, of the numbers who wish to put questions today, and I would be grateful for more concise questions and responses. I call Douglas Ross. Even after yesterday's evidence from the former First Minister, the words we've heard from the Covid-19 bereaved, Humza Yousaf, still backs her to the hill, and that tells you everything you need to know about this First Minister, who is simply the continuity candidate for Team Sturgeon. As health secretary during the pandemic, he joked about not knowing what he was doing. When he sent that message by that stage, 10,000 people in Scotland had already lost their lives from Covid. But he wasn't the only one that's been found out. Nicola Sturgeon destroyed evidence on an industrial scale. The SNP Government considered independence for key decisions. They did things for purely political reasons. They broke promises to grieving families and the public who sacrificed so much. Humza Yousaf was winging it but hasn't the whole SNP Government being found out. First Minister, I go back to the point that I've made several times in these exchanges over the weeks that I absolutely accept, wholeheartedly, that retention policy and informal communications clearly could have and should have been better. That's why, of course, I've commissioned that externally led review. On the big calls, many of the decisions that we made helped to save lives. If we look at some of the evidence that has been presented to the Covid inquiry, if we look at the evidence from Professor Sir Ian Diamond and Jackie Baillie shouting, she may want to listen to the evidence by Professor Sir Ian Diamond. He's a chief executive of the UK Stats Authority and UK national statistician. He gave details of age standardised mortality rates per 100,000 right across the four nations. This is his data, not my data. That analysis shows that in Scotland, of course, we had the lowest level of deaths per 100,000 according to the ASMR data. Every single one of those lives lost is undoubtedly a tragedy. In fact, many of my colleagues on these benches lost a loved one to Covid. On those calls, the decisions that we made have helped to save lives. Let's look at what the World Health Organization said—again, not my data, but the World Health Organization's data—that it estimated that 22,138,000 lives in Scotland were saved as a direct result of the Covid-19 vaccination programme. I accept fully that, when it comes to informal communications, we could have and should have done better. There are also other decisions that, of course, we look at and we think that we could have perhaps moved quicker or moved earlier or done things differently. While political opponents may well try to rewrite history and engage in, frankly, smears insults towards Government ministers and civil servants, I can stand up here and say that I know that every single day of that pandemic, Nicholas Sturgeon, the rest of us in the Scottish Government, civil servants included, worked for one reason and one reason only to protect the people of Scotland from the harms of Covid. 2. Anna Sarwar That is what we have learned after three weeks of the Covid inquiry in Scotland. The most senior ministers and officials knowingly deleted evidence to how they operated during the pandemic. They subverted the Covid inquiry and broke freedom of information laws. They plotted how to maximise their own political advantage while thousands of Scots fought for their lives. It is a betrayal of the trust that the people of Scotland put into this SNP Government. Nicholas Sturgeon did not tell the truth to the public and Humza Yousaf seems to have misled this Parliament in an attempt to defend her. Now the SNP deputy leader is supporting attacks on the inquiry itself. Why is protecting the SNP more important to Humza Yousaf than getting to the truth? 1. Anna Sarwar I go back to the point that I just made to Douglas Ross. I repeat it again to Anna Sarwar. Yes, we should have done better on retention policy of informal communications. On the course of the pandemic, when it came to the important decisions that helped to save lives, I believe that we took first of all the decisions for the right reason. We can evidence that very clearly. Protecting people from harm and the people of Scotland from harm was the number 1 overriding priority. Through the actions that we took. When it came to one measure, the age standardised mortality rates per 100,000 across the four UK nations, Scotland had 124.9 per 100,000. That was different to England—145 per 100,000 and Wales—144 per 100,000. 144 per 100,000, the UK average 143 per 100,000. That is not to diminish the number of lives that continue to be lost to Covid to this very day. The decisions that we took also ensured that when it came to the booster vaccination, it was one of the fastest booster vaccination programmes in the world at one point, certainly the fastest in the UK by quite some distance too. Yes, we could have and should have done better, except fully on message retention. I, of course, handed over the messages that I had in question about them for almost three hours, but on the big calls that helped to save lives, I believe that we can evidence and we've seen the evidence, and not only did we do it for the right reason, but our interventions helped to save lives here in Scotland. Annas Sarwar. Minister and officials knowingly deleted evidence for the Covid inquiry, and the answer to this betrayal of the Scottish people are review into how the Scottish Government records information. In 2020, when we had the salmon inquiry and there were accusations of a cover-up, what did they do? Promise a review. In 2022, when we had investigations into the ferry scandal and there were accusations of a cover-up, what did they do? Promise a review. Now we have the industrial-scale deletion of evidence for the Covid inquiry, and what's this First Minister's answer? A review. They simply don't get it. Pamela Thomas, who lost her brother during the pandemic, said this yesterday. I don't think they're capable of actually telling the truth or being transparent. Pamela is right, isn't she? First Minister. I want to, of course, express my condolence to every single member of the country who lost a loved one through Covid. Pamela, of course, included. I make this point again to all of us, including members of this Government, who lost loved ones through Covid. Ministerial colleagues who have relatives who continue to suffer the long-term effects of Covid. I have colleagues who had to restrict the numbers, who could attend the funeral of a loved one. Many of us included children who were impacted because of the closure of schools because of Covid. I say that not because I'm trying to counter any sympathy from Anasawa or anybody else. I say that because we were all in this together. We were not detached somehow from the impacts or the effects of the pandemic. That's why every decision that we made was made with one overarching priority in mind—how to protect as many people as we could from the harm of Covid. Do I think that we've got every decision right? No, I don't. I don't think that any Government in the world—any Government leader in the world—could put their hand in their heart and say that they've got every single decision right. What I can say is that we did it for the right reasons. On the big decisions that were crucial to saving lives, I believe on many of them. We've got them right. Some, of course, will not have got right. I promise those who have been bereaved by Covid and the families of those who have been bereaved by Covid that not only will we continue to co-operate with both inquiries, but we promise to learn the lessons of those inquiries, too. Anasawa. The Covid-19 believes that families don't believe the First Minister when he gives those reassurances. The Covid inquiry is about learning the lessons so that this can never happen again, but they have been obstructed by this Government with evidence supplied late or not at all. The decisions that the inquiry is investigating still weigh on the people across this country. Why were Covid-positive patients sent into care homes? Why was inadequate PPE being supplied to care workers and leaving people exposed? What impact did lockdowns have on our young people who missed out on years of education? Three years ago, in an election during the pandemic, many people in Scotland voted for his party because they thought that Nicola Sturgeon did the best that she could. They trusted her when she said that this Parliament would be about Covid recovery. Now those same people have had their trust broken by this Government and they are appalled at the cover-up. First Minister, is it not true that it is not just the messages that have disappeared? So has the trust in this SNP Government. I intend to leave the verdict of trust to the people of Scotland. Anasawa is right. One of the major factors of why the SNP is back into power is because of her handling over the course of the pandemic. That was not judged. I am saying to Anasawa that he is absolutely correct and one of the reasons why we are standing here. What I do not think was an issue during the 2021 election was our retention policy, our record management policy. It was about whether or not we got the calls right in relation to the vaccination programme and whether we did the right thing in introducing non-pharmaceutical interventions. Anasawa talks about, in his words, an industrial scale deletion. We handed over 28,000 WhatsApp messages and 19,000 documents. Anasawa is right to ask questions about care homes, about PPE, about lockdown and its impacts. Those are exactly the questions that the inquiry is examining. The suggestion from Anasawa that somehow we are not being transparent. Can I remind Anasawa that not only are we cooperating with a UK inquiry, we are the only nation in the UK to specifically establish an inquiry in our country. We will also be cooperating with that Scottish inquiry too. Nicola Sturgeon, more than 250 media briefings ministers in this Government, attended this Parliament not on dozens of occasions but hundreds of occasions explaining the reason why we took decisions. I go back to the very central point here. We did not get everything right and certainly not in relation to retention of messages. What we did get right and what we did do is the intention behind our decisions was to protect people from harm. According to the world health organisations, through the interventions that we took, we helped to save over 23,000 people's lives. Those are 23,000 people who would not be here if it was not for vaccinations, if it was not for the non-pharmaceutical interventions and the decisions that this Government took. I make no apologies for that. Question 3, Alex Cole-Hamilton. Thank you, Presiding Officer. Do you ask the First Minister when the Cabinet will next meet? First Minister? Tuesday. Alex Cole-Hamilton. Presiding Officer, we did hear the striking testimony from the former First Minister at the inquiry yesterday about her personal phone on which she retained what that message is for the salmon inquiry but deleted them for every aspect of the pandemic. Forever denying the bereaved families an insight into the mind of the person who held all of the power, about hospitality rules seemingly made up at random, sending some businesses to the wall, unanswered questions about care homes, about school closures and a secret central committee in charge, it seems, of everything about which the finance secretary knew nothing and of which there are no minutes, a Government within a Government. Humzaeus have sought all of this and yet did nothing. So why is he now standing in the way of a ministerial code investigation into gold command record keeping, something only he can instruct, and does he agree that Nicola Sturgeon now has a duty to come back to this chamber? This chamber, he says, she addressed hundreds of times and wants more. Finally, explain herself. First Minister. Can I say, of course, that Nicola Sturgeon gave hours of testimony and evidence and under oath, of course, and was questioned extensively. It will be for now the inquiry to make its judgment and we respect the inquiry and, of course, hope that others will respect the inquiry and give it the time and space that it needs to make its judgment. I'm not sure what Anasau and others are shouting at, I'm simply saying that the inquiry should be respected. Can I say that Nicola Sturgeon or this Government got every decision right? First Minister, sorry, I'm actually being distracted by a conversation that is going across the aisles. Can I ask members to refrain from such contributions while we're trying to hear the First Minister? I think that the opposition should try to respect the inquiry and that is the point that I am making. I can say without a shadow of a doubt, as I've already said before, that overarching, overriding priority was always to protect the people of Scotland from Covid harm. Nicola Sturgeon's leadership was, in stark contrast, the leadership that we saw in other parts of the United Kingdom. She may not have got every decision right, but this Government may not have got every decision right. I accept that fully, but it's for the inquiry to examine and to explore that issue. On gold command meeting minutes that Alex Cole-Hamilton has asked me about, yes, the Government is urgently examining, exploring and will hand over to the inquiry any notes that we have on gold command minutes and meetings. To ask the First Minister what steps the Scottish Government is taking to prevent a resurgence of measles in Scotland. Cases of measles in Europe and England continue to rise due to under vaccination, while we have only seen two laboratory-confirmed cases of measles to date in Scotland since October. However, we are acting now to prevent the spread and to protect people. Public Health Scotland has alerted NHS Scotland, which has also met local health protection teams and immunisation co-ordinators to set out measures that need to be taken. Those include early detection and notification, infection control, contact tracing, post-exposure profile access for vulnerable contacts, to try to ensure that cases are contained and don't spread any further. Immunisation, of course, remains the most effective way of preventing illness from infectious disease, and the MMR vaccine is extremely effective at preventing measles. Anyone who hasn't had both doses of the free MMR vaccine should visit the NHS informed website and find a how-to-arranging appointment. I thank the First Minister for that answer. While Scotland's uptake of childhood immunisations has continued to perform really well across the four UK nations, there is recent data from Public Health Scotland that highlights the gradual decline. However, overall uptake of both doses has fallen below the World Health Organization's target of 90 per cent, a critical level that protects against the return of larger outbreaks. What steps the Scottish Government has taken to highlight the importance of receiving both doses of MMR vaccine and can outline what strategies are in place to ensure easy access to follow-up appointments for children and cases for vaccinations when both doses have been missed? Given the very serious nature of measles and the current risk of importation and onward transmission, we are working with Public Health Scotland and NHS boards on a whole range of measures promoting vaccination uptake. NHS informed has been updated on ensuring that information is available for the public on how they can receive the measles vaccination. Letters were issued to parents of pupils for nursery schools, P1 primary schools and S1 secondary schools to highlight the importance of ensuring that young people are up-to-date with their vaccinations. Boards have also been requested to undertake an MMR status check of all pupils. In S1, that check was previously performed in S3, but bringing forward those checks to S1 provides more opportunities for those unvaccinated or indeed under-vaccinated to obtain the vaccination that they require. I am very grateful for the previous answer from the First Minister, because work has undergone in our universities to make sure that the measles vaccinations have been up-to-date. He has talked about the work at S1. Can he give any specific initiatives that aimed at increasing the awareness specifically to parents, guardians and teachers about the importance of maintaining the up-to-date measles vaccination by having the two doses? I thank Martin Mittfield for a very important question indeed. He is right to reference higher education as well. I will ask the Cabinet Secretary for Health to write to Martin Mittfield with full detail of what we have done, including that we have issued letters to parents, for example, in the 23-24 intake of pupils for nursery schools, as well as other pupils. We have also sent a variety of letters from the CMO, from the chief medical officer, to health professionals to make sure that their interactions, often in primary care, with parents and families around the importance of the vaccination. I will ensure that the Cabinet Secretary for Health writes to Martin Mittfield with more details about the actions that we have taken in that regard. The worryingly low uptake of both the MMR and the flu vaccine in the Highlands increases the risk of public health and an outbreak of measles. Therefore, will the First Minister and his Cabinet Secretary for Health ask the NHS Highland to work with GP practices such as that in Nairn, who are very keen to resume local provision from GP practices of this service in order to bring up the vaccination levels to safe amounts? And, First Minister, an approach that I believe is favoured by the British Medical Association? The First Minister is right to raise this issue around the particularly lower levels of vaccination in Highlands that are concerning. I want to give him some reassurance that that engagement with the health board is already happening. I know that the First Minister has raised this issue before he has raised it with me in relation to Covid vaccinations as well, but I am worried about the levels of vaccination in Highlands. We are taking up that engagement with the NHS board and we will ask the direct question for those GP practices that do want to resume what the barrier is. We will examine whether or not the lower uptake and vaccination in Highlands is a result of the model. That is in place. I will ensure that the Fergus Ewing is kept up-to-date in relation to those discussions. To ask the First Minister what the Scottish Government's response is to reports that Scottish Water plans to increase charges by 29 per cent over three years. Let me start by clarifying the arrangements for setting water charges. They are set out in the Water Industry Scotland Act 2022. Decisions on charges are rightly a matter for the board of Scottish Water. They will announce their charges for 24.25 shortly. Charges for future years have not yet been agreed. They will be set annually by Scottish Water's board with approval from the independent economic regulator in line with the price cap across the 21 to 27 period. In 23.24, the average charge in England and Wales is 10 per cent higher than in Scotland, at £448, compared to a charge in Scotland of £408. I am not interested in what is going on in England and Wales. Let's hear Mr Simpson. Scottish Water is reported to want to increase bills by 8.8 per cent in 24.25 and then do the same every year until 26.27. That might be all right for the new chief exec, Alex Plant, who can well afford it on his £295,000 a year salary, but that's not okay for normal people struggling to pay their bills. Water bills are paid through our council tax. Given that the First Minister is committed to freeze council tax, is he not prepared to do the same with water? The brass neck of a Conservative talking about the impact on people's household bills is quite something to witness. Let me talk about Scotland and Scottish Water. I have already said that the charges haven't been announced, will be announced shortly, and they will be reviewed and announced annually. However, with Scottish Water, what we end up getting in comparison to England and Wales is better levels of service. We get lower water charges here in Scotland in comparison to England. We get a publicly-owned water company with every single penny of profit reinvested back into the public service. Unlike in England, where his party is in charge, where shareholders get millions in dividends, we get water quality as 87 per cent good or at a high level, as assessed by SIPA. As in so many issues, the Conservative UK Government is far better at looking at how we run Scottish Water and their public services for the good of the people of Scotland. It seems that, while the UK Government runs its services into the ground, it does so for the profit of shareholders, unlike Scottish Water, which is publicly owned. To ask the First Minister when the Scottish Government expects the remainder of the national treatment centres to be opened in light of reports that NHS capital infrastructure projects have been paused. The next two national treatment centres, NTC, Fauth Valley and also Phase 2 of the Golden Jubilee, are due to open in the coming months, providing additional orthopedic endoscopy and general surgery capacity. Our ability to fund capital projects has, of course, been detrimentally impacted and affected. By twin challenges of unprecedented levels of inflation, in some part caused by Brexit and disastrous UK Government decisions, but also one of those disastrous UK Government decisions being the cut in our capital budget. Our infrastructure investment plan identifies priority health capital projects, including national treatment centres for funding in that period. As a result of the almost 10 per cent cut in our capital budget from the UK Government, a revised pipeline of infrastructure investment will be published in the spring of this year. All due consideration will be given to what projects can be included and on what timescales. Of course, that would include national treatment centres, too. Jackie Baillie I thank the First Minister for his response, but he knows that national treatment centres are key to the SNP's NHS recovery plan. We now learn that those promises to patients and staff are in tatters, treatment centres in Esher and Arran, Lanarkshire, Lothian, Grampian and Tayside are all delayed and at risk of cancellation, but those treatment centres are not the only NHS capital infrastructure projects put at risk. Aberdeen Baird family, hospital and anchor centre, delayed. Institute of Neurosciences in Glasgow, delayed. Monkland's replacement project in Lanarkshire, delayed. Edinburgh Cancer Centre, the Hypervillian, delayed. Caithness, Rhaigmoor, The Belford, delayed. Health centres in Cincardin, Loggelly and East Calder, cancelled. Barra community campus, cancelled. Presiding Officer, I could go on, but can I ask the First Minister, with almost one in six Scots on waiting lists, how is he going to end their suffering when these developments were so central to his plan? First Minister, as always, Jackie Baillie will come to this chamber ignoring the fiscal reality and effectively act as a human shield for the Conservatives who are cutting our capital budget by 10 per cent. The fact that Jackie Baillie thinks that a 10 per cent cut can be imposed upon us with no consequences shatters any credibility that she has on this issue, Presiding Officer. We have, of course, made a dent into waiting times in terms of improvements that we are looking to make. When it comes to activity in the NHS, new out-pace activity was up on the last quarter and up 2.3 per cent on Q3 last year. Over the last 12 months to September 23, activity was up almost £1.24 million. That is 2.5 per cent more than the previous 12 months. I mean, I look at inpatient day case activity for Q3. That was at its highest since the start of the pandemic, so we are doing what we can, notwithstanding the financial constraints and the cuts that we are receiving from the UK Government. We will continue to invest in that capacity. I should say to Jackie Baillie that it would be very helpful if Jackie Baillie could use any influence that she has with her UK Labour colleagues who have this far refused to confirm that they will reverse that capital cut. Miles Briggs. Last year, 59,240 patients attended the Princess Alexander Eye Pavilion. For a patient in Edinburgh or the borders with a detached retina, the need for urgent emergency surgery is critical. The health secretary has suggested that if the Edinburgh Eye Pavilion is not replaced, then more surgery will be centralised to the Golden Jubilee national hospital in Glasgow. Can I ask the First Minister if he thinks that it would be acceptable for eye surgery to be centralised to Glasgow? Will he agree to meet with Lothian MSPs urgently to discuss those concerns and look towards where ministers can change their mind and commit to a new replacement eye hospital? First Minister, to Miles Briggs, the clue is in the name. There are national treatment centres that we are building, so where they can offer assistance right across the country, they should be utilised in that way. We know that patients are, if necessary, willing to travel, but our commitment to the Eye Pavilion remains. That is why we will bring forward detail on what we can take forward in regard to our investment plans. I am more than happy to assure that the Cabinet Secretary for Health and Sport meets Miles Briggs. What will be more helpful for Miles Briggs to do is demand that his UK Government Conservative colleagues reverse their 10 per cent cut to our capital budget. They could do that in the spring budget next month. Let's see if Miles Briggs and the Scottish Conservatives who come to this chamber demanding money that will be spent in capital projects have any influence, somehow, Presiding Officer? I think not. Thank you, Presiding Officer. Plans for a new Belford hospital have made great progress in recent years with Scottish Government support, and it is deeply unfortunate that the 10 per cent UK Government cut to capital has postponed the actual build. Can the First Minister commit to enabling the design process to progress so that it is shovel ready when capital does become available to allow the start of the actual build? We are absolutely engaged on that very issue at the moment. I think that the suggestion from Kate Forbes is a sensible approach forward and will certainly seek to do that. I think that it is essential that NHS boards continue to plan on how they will improve and reform services, and we remain committed to absolutely supporting boards in that process. That, of course, goes back to the point that there are many capital projects right across the country that are under threat not because of anything that this Government has done, but because of the disastrous mismanagement of the economy from the UK Government and a 10 per cent capital cut, which is not just going to impact on health projects but on capital projects right across the country. We appeal once again to the UK Government to use the spring budget next month to reverse that devastating cut to allow these important health capital projects to go ahead, Presiding Officer. Move to constituency general supplementaries, and I call Finlay Carson. To ask the First Minister if he will join with me in welcoming the very positive progress that has been made in negotiations which are likely to see the restoration of the Northern Ireland assembly at Stormont, and also welcome the huge job and investment boost which could be delivered as part of the proposed investment zone extending to Starrar and Cairnryne in my constituency, which is the main point of entry for Northern Ireland goods going to Great Britain along the A75 and the A77. I absolutely welcome the restoration, I hope the restoration of power sharing in Northern Ireland. The people of Northern Ireland have had for too long to have to put up without an elected Government in place, so this is good news for the people of Northern Ireland, and we welcome it absolutely wholeheartedly. I've been to a number of British Irish councils over the years in my time as First Minister, and in the last couple that I've been as First Minister, the absence of any elected members from Northern Ireland has been noted and their presence has been missed, so I think that it's incredibly important as part of the Good Friday agreement that we have power sharing restored. It would be fair to say that we weren't given any advanced sight of the command paper that was published by the UK Government yesterday. There was no meaningful engagement by the Westminster Government. The UK Government appears to unilaterally have decided that there will be no border control post at Cairnryan. It's not a decision that they have consulted us on. I also note that there was a £3.3 billion package offered by the Secretary of State to address public spending and for pay pressures in Northern Ireland, which I have to say again is welcome. Those pressures do exist in Scotland and I suspect that they exist in Wales too, so I know that the Deputy First Minister has raised with the chief secretary to the Treasury, as did her Welsh counterpart, that the devolved Government should be treated fairly in line with the Barnett formula. Mark Scott was murdered in 1995 as he walked through Brigton on his way back from a Celtic game. The murder was a brutal, unprovoked, sectarian attack, but from this tragic murder came hope in the form of the Mark Scott leadership for life award, which is now delivered by the outward bound trust and brings young people together to share experiences and reduce racism, sectarianism and intolerance. The Scottish Government has provided core funding since 2012, which has allowed the awards to leverage other funding in from alternative sources. That amount stands at £75,000, and the trust has been told that it will be removed from next year. Surely the First Minister agrees with me that this life changing award for young people that tackles sectarianism in the best way that I can think of cannot be allowed to fail due to Government cuts? Given that I am meeting with the trust today, will he engage with me to find a solution to reinstate the funding? I say to Paul Cain that he raises an important point. Indeed, I know that the work that Mark Scott Foundation has done over the years alongside the outward bound trust. I have met some of those who have taken part in the project. They have done incredibly well as an organisation. I think that they have had a really positive impact on young people as well. It is an organisation that I have engaged with over many, many years indeed, and I can confirm to Paul Cain to this chamber that the Mark Scott Foundation will receive £75,000. We will ensure that they are funded fully in order to carry on the excellent work that the leadership award has done over many, many years. That work, of course, is a lasting legacy and a testimony to Mark Scott and his family, too. This week, Liz Smith endorsed the reintroduction of backdoor tuition fees, which would deny disadvantage students from going to university. It follows Labour leader Keir Starmer ruling out free tuition fees under a UK Labour Government. Can the First Minister outline what progress the Scottish Government has made in widening access, and will he reaffirm his commitment to keeping tuition fees free? Hardly I am surprised to hear the Conservatives heckling when we mention free education. I have to say, Presiding Officer, I was absolutely delighted to see the progress that we have made in this regard. Highlighted by the commissioner of fair access this week, a 45 per cent increase in students from our most deprived communities entering university since 2013-14. No wonder that the Conservatives were groaning. They do not like it, Presiding Officer, one single bit. The commissioner also points out that that increase has not been at the expense of other cohorts of Scottish students with increases in home students right across the board. Unlike Labour and the Conservatives, we are absolutely committed to the principle that access to education should be based on the ability to learn, never on the ability to pay. Mums and babies across Scotland are missing out on vital health visitor appointments. I know that because it happened to me as my daughter was not seen for over 10 months. Parents in Angus have been told that their babies could be without a visit for up to a year. Health visitors are important because they check on a child's wellbeing but can also identify if mums are experiencing post-natal depression. The First Minister and the Health Secretary cannot bury their heads in the sand over this issue. Will the First Minister intervene urgently to ensure that mums and babies are not denied these crucial visits because of staff shortages? The First Minister is absolutely right about the importance of health visitors for a range of reasons. I think that she has articulated very well. Indeed, health visiting remains a universal service. Teams across Scotland work hard to deliver that entitlement, and the latest published data that we have shows that the overwhelming vast majority of eligible children are receiving their key health visitor contacts between 10 days and five years of age. That is not to say that there are not challenges. I am more than happy for the health secretary to write to Meghan Gallacher to give her the details of what we are doing to invest in the service, but also what we are doing, particularly in those areas where we are seeing disparities at what we are doing to further support health visiting services. I want to put on record my thanks to every single health visitor for the incredible work that they do. That concludes the First Minister's questions. The next item of business is a member's business debate in the name of Kenneth Gibson, and there will now be a short suspension to allow those leaving the chamber and public gallery to do so.


Hey, everybody, and welcome to the Addiction Counselor Exam Review. Today, we're going to be talking about intake and orientation. Now, this doesn't sound like a lot of fun, but this is where you really start beginning to develop rapport and engagement with your clients. So this is one of the most important parts of treatment. And in order to do it well, there are some things you got to remember. So the first part is screening and assessment. In order to get somebody into your facility, they need to first generally be screened. And if a screening determines that there's potentially a problem, then they go for a more in-depth assessment. So during the screening and assessment process, you want to demonstrate verbal and nonverbal skills to establish rapport and promote engagement. So what does that mean? That means don't be looking at your notebook all the time. Look up. Treat the person like a person. Establish rapport. Let them know that you actually care about them and their welfare and you want to do what's in their best interest. They're not just your four o'clock. Discuss with the clients the rationale, purpose, and procedures associated with screening and assessment. Before you start asking questions, you're asking them to be vulnerable. Before you start asking questions, let them know why you're asking, how this information is going to be used, and what this process is going to be like if you're going to be asking really sensitive questions or if you're just going to be asking a few general questions and you'll be done in five minutes. Assess the client's immediate needs, including detoxification. You can get a pretty good idea from just looking at the client's nonverbals, whether they need detox, but you want to assess their immediate needs. This can include housing. This can include food. This can include medical care. You know, I've had clients come in with a variety of different needs, and it's important that we identify those when we're doing the screening. So we can make appropriate referrals. Administer evidence-based screening and assessment instruments to determine the client's strengths and needs. You want to use something that's pretty standardized. Now, a lot of your assessment instruments are semi-structured interviews, so they give you questions, but you have room to expand.  You don't want to explore too much in the assessment because you may retraumatize the client, but you want to use tools that are, like I said, standardized, so you're using the same thing with each client, and they produce effective information. You don't want to just walk in with a notebook and go, all right, let's chat for a while. Obtain relevant history to establish eligibility and appropriateness of services. So you need to know things. Where I came from in Florida, if somebody was pregnant, if they had small children at home, if they were a needle user, if they were HIV positive, they got priority for admission based on state guidelines for state funding. So those were things that were important to gather when trying to identify appropriateness of services. If I'm talking to the person and establishing a history and I learned that they've got three small children at home and no family to rely on to speak of, you know, residential may not be the most appropriate recommendation for them. So it's important to understand the person and to individualize their treatment recommendations. Screen for physical needs, medical conditions, and co-occurring mental health issues. If you're in a substance abuse facility, I will tell you, the chances are really daggom good that the person is also going to have some co-occurring depression or anxiety. If they have started to get sober, if they realize that they need to make a change, they're in a period of mini-crisis right now, which brings with it some depression and anxiety. Does it mean they've got recurrent major depressive disorder? Not necessarily, but if they are experiencing depressive symptoms right now, we need to help them address those things because they ain't going to stay clean and sober very long if they are hurting that much. We need to help them make sure they can address all of their presenting issues. Interpret results of screening and assessment and integrate the information to formulate a diagnostic impression and determine the appropriate course of action. So when you get to that last page of the intake that is your diagnostic impression or whatever it's called, your cumulative assessment, it's called different things in different places, don't just spit out the same stuff that's already in the file. This is the time when you weave it all together and you say, you know, this is the patient. These are the strengths she has. These are the issues that she's got presenting. These are her diagnoses as evidenced by and this is the recommended course of action because, you know, we want to have all that in there. That's a summary of everything that you've learned and why you're making the recommendations you're making. During the intake, the intake is just the process of enrolling a client in a specific course of treatment. A series of activities is completed that's designed to organize information about the client and their significant others. Most insurance companies require the involvement of family, however the patient defines family. And in reality, recovery is going to be much more successful if the person has significant others involved that can help them in the process. Intake also ensures eligibility for services, completes basic data collection, identifies barriers and assets. So what might be some barriers? If you're talking about any form of outpatient or intensive outpatient treatment, transportation can be a barrier. Their job can be a barrier. If you're working with somebody who has shifts that change on a week-to-week basis, that can be a barrier to getting to treatment. Or if you have someone who works day shift Monday through Friday and your program is 9 a.m. to noon Monday through Friday, that's a barrier to treatment. So we want to identify those barriers and figure out workarounds. Another big barrier is often children. If the person is responsible for children in the home, then they may need childcare or they may not be able to get there because they can't afford childcare. We need to look at all these things. We also want to look at their assets, though. What do they have going for them? Who do they have that's supportive? Do they have transportation? Do they have a job? Do they have the desire to get better? Do they have some knowledge about what's going on? What are these assets they have that we can build on to help them towards their recovery journey? Then the final part of the intake is establishing a treatment approach. You don't do this on your own. You do this with the client. You say, okay, we've gone through this and we've done this scoring sheet called the ASAM. This is what my recommendations are and this is why. What do you think? This is where we get an idea about where the client is in terms of readiness for change and hopefully you've been listening through the intake to identify if they're in pre-contemplation, preparation, et cetera. This final step is what seals the deal when you make your recommendations and the person either says, yes, I'm on board or nah, not yet. I don't have a problem. I don't know why you're making those recommendations. Those are some different reactions you can get. This is when we're figuring out what the recommended course of treatment is. Intake is primarily administrative in nature. You're not going to do counseling during this. You may have a few moments where you have to pause and do a little bit of counseling, but this is not a counseling session. I tell clients that from the very beginning. We've got to get some paperwork out of the way and I really hate feeling like I'm interrogating you, but in order to get you enrolled in the program, we need to do that. Intake is not the time when you want to go into depth, into traumas, or in depth into anything else that's going on. The only real exception to this is if you learn they have suicidal ideation, homicidal ideation, or they are in danger in a domestically violent relationship, then you will probably need to put that other stuff aside and focus on the safety and well-being of your client. Intakes do need to be standardized. That way, there's no accusation that one person got admitted over another person because of biases. If everybody's asked the same questions and you use the ASAM on everybody and yada yada, then you can present the data and say, these are the objective reasons why this person was admitted and this person got put on a waiting list. Intake is an extension of the screening and assessment process and can be used to engage the client in treatment and enhance motivation for change. This is when we start talking and presenting our assessment of what's going on, what we see happening with the client and getting the client to clarify for us. We start putting the ball in their court going, you know, I'm not going to force you to do anything. I tell my clients that from the very beginning when they come in, this is an intake. I'm going to make recommendations, but we're going to decide together what the best course of action is for you. So I'm not going to force you to do anything, you know, assuming that I can say that. Orientation is the next step and it can be conducted in individual family or group settings and it's completed after the intake. Once you've decided this person is coming to the program, then we need to orient them to it. It describes the schedule, the goals and the rules and responsibilities for treatment, the hours of service, what to do about medication, what the policies are with drug testing, treatment costs and client rights. So these are all things that need to be covered and it's recommended strongly that this be all these things be part of a written informed consent that is gone over with the client, not all clients read very well, and is initialed and signed by the client. Now in Florida, and I use Florida statutes because that's where I came from. You want to look in your state of origin to find out information about client rights. But in Florida, the client rights statute is 381.026. And it says that clients have the right to individual dignity, confidentiality, non-discriminatory services. And that means that we cannot discriminate against them based on age, race, gender, sexual orientation or disability. We can't discriminate against them based on prior service departures. So if they've left AMA before, we can't hold that against them. We can't hold it against them if they've had multiple relapses or no relapses. We can't hold it against them if they're on certain psychotropics that are prescribed by a physician. And we can't hold it against them if they don't have the ability to pay. Now that's for public agencies that are receiving state funding. But all of these have to be taken into consideration. And Florida thinks it's so important that they've made it part of the law. Clients have a right to quality services. So we're not just going to stick them in a room and say, good luck. We're going to provide high quality services. They have the right to communication. Now in the beginning, with informed consent, informed consent is so important, communication can be limited. Sometimes people need a week or so break from the people in the outside world, especially in residential. So their mail and their phone calls may be limited for a period of time. But that has to be part of the orientation and the informed consent. You can't just get somebody in there and go, oh, by the way, you don't get to communicate with the outside world for the next month. That doesn't work. They have the right to personal effects unless those personal effects would infringe upon the right of another patient or is medically or programmatically contraindicated for documented medical safety or programmatic reasons. So personal effects that might fall into this may include certain perfumes. There are a lot of people who are sensitive to perfumes now. So there are a lot of treatment programs that have said you can't have perfume. A picture of your kid is not going to infringe upon the right of anyone else. Guitars, musical instruments, you know, those are generally allowed because they're generally not going to infringe upon the right of any other patients. And it can make your patient feel more secure. Personal effects may be temporarily held by the agency, but must be returned at the end of treatment. So sometimes when people check in, we collect their cell phones and some of their higher ticket items like musical instruments, and we keep them safe. And if the client wants to access them, they have to check them out. Miners have the right to be educated. Actually, they have to be educated. So schooling needs to be provided during a certain number of hours of the day. Clients do have the right to counsel, especially if they're involuntary proceedings, if they're being committed against their will, they have a right to counsel. And they have a right to what's called habeas corpus. That means they have a right to see the entire intake and all of the evidence of what is being alleged so they can defend themselves and they can say, you know what, no, I don't deserve to be here. I don't need to be here, specifically in Florida. Patients have the right to a prompt and reasonable response to a question or request. Now, this comes up a lot in treatment, not just residential, but in outpatient and IOP. So you want to make sure that if a client asks you a question, you get back with them in a prompt manner. You don't say, I'll get to it or I'll find out later and then not get back to them. Give them a date and time. I'll find out for you by tomorrow when you come into treatment or I'll find out for you this week and I'll give you a call on Monday. Let them know when you're going to call them back. A patient receiving care in a health care facility or in a provider's office has the right to bring any person of his or her choosing to the patient accessible areas of the health care facility or provider's office to accompany the patient while the patient is receiving inpatient or outpatient treatment or is consulting with his or her health care provider unless doing so would risk the safety or health of the patient, other patients or staff of the facility. So that's a little bit wonky, especially in residential because you can't decide that, oh, I want to have my significant other with me throughout treatment. But what it's saying is when you're having your individual sessions, for example, if you want your significant other to come, then the client has the right to have their significant other there. If they want to have their pastor come and be part of their treatment, then they have the right to have their pastor come. Unless doing so would risk the safety or health of the patient. Now you have to remember, especially in substance abuse facilities, you also have the standard of CFR 42. So we need to make sure we're protecting confidentiality. So a lot of times the nonpatients are not allowed back into the patient wing. They have to stay in the area of the therapeutic offices, the lobby, that sort of thing. A patient has the right to refuse treatment and the right to express grievances to a health care provider, a health care facility, or the appropriate state licensing agency regarding alleged violations of patients' rights. And I will tell you, it will happen. If something happens and patients get angry, they will file grievances and they may even call their ombudsman or even call the State Department of Children and Families. It happens. It doesn't necessarily mean you did anything wrong overtly. You know, probably there was a better way to handle the situation, but it doesn't necessarily mean you did anything wrong.  I need you to do this because or we're going to make this happen because.  You want clients to feel like they're empowered in their own treatment. If you do that, 80% of the time you will head off grievances. They may not be happy with you, but they're probably not going to call Department of Children and Families. The other 20% of the time it may be unavoidable because that client may have some enough other stuff going on with them that they feel a need to try to assert control and control their own treatment, even if it's not in the best interest of their treatment program. A patient has the right to know the name, function and qualifications of each healthcare provider who's providing medical services to the patient. The patient may request such information from his or her responsible provider or the healthcare facility in which he or she is receiving medical services. So patients have the right to know the name of everybody who's seeing their information and working with them. Everybody from the techs, all the way up to the CEO of the agency if they want to know who those people are. That's their right. They have the right to know what patient support services are available in the facility. Do you have HIV counseling available? Do you have nursing staff available? Do you have a recreational therapist available? Do you have childcare available? What types of services are available that they can take advantage of? They have the right to be given information concerning their diagnosis, planned course of treatment, alternatives, risks and prognosis, unless medically inadvisable or impossible to give this information to the patient. It's rare that it's inadvisable or impossible to give this information to the patient. So what we want to make sure is that we're telling the client what's going to happen. If you're enrolling them in a methadone program, what does that look like? What are their responsibilities going to be? What types of treatment will they be exposed to? So they can make an informed choice about yes, that's okay or no. Some clients are not okay with hypnosis, for example. So if your program does that, they may go, yeah, not. We had a program at the residential facility that I worked at where we had acupuncturists come in that would work with the clients. And acupuncture is a evidence-based practice for addiction. And not all clients were okay with acupuncture. And that was okay. They had the right to refuse that type of treatment. But we needed to let them know. This is why we're bringing these people in. This is why we think it's a good activity for you. These are the risks. This is what we think you'll get out of it and let them make the choice. Healthcare providers shall respect patients' legal right to own or possess a firearm and should refrain from unnecessarily harassing a patient about firearm ownership during an examination. Okay. So this usually comes up if the patient is expressing any sort of suicidal or homicidal ideation. But if you're talking to a patient and they say that they're an avid hunter, that doesn't mean they're a danger to themselves. So it's important to respect their legal right to own a gun. And then, you know, you need to consider if they're suicidal or homicidal what steps need to be taken in order to make sure that they're safe. But remember, you know, just because somebody has a gun in the house doesn't mean they'll use it. And just because somebody doesn't have a gun in the house doesn't mean they're safe. They have butcher knives in the house. They have rope and belts in the house. There are ways they can kill themselves. So it's more important to focus on their state of mind and their personal safety than on specifically what implements are there. Recovery management focus. Collaboration between traditional and non-traditional service providers and clients with the goal of stabilizing and actively managing the ebb and flow of symptoms is sort of the recovery management mantra. That means we're going to have clients come in and it's going to be episodic. You know, they'll come in maybe for residential and then they'll step down to IOP and then they'll step down to outpatient and then maybe something happens and they need to come back to outpatient and then they'll discharge to their physician for a while who manages their medications. And then maybe they need to come back into outpatient for a little while. So there's going to be an ebb and flow of symptoms as life happens. But recovery management means we all talk together and figure out what's going on with the client and we maintain continuity of care so the person can get back into the system easily and can manage their recovery. So they're not, you know, once they're discharged, you don't want them to have to wait eight weeks on a waiting list before they can get back in. Recovery goals are more than treatment goals. Recovery goals seek to reduce and eliminate symptoms instead of just stabilize the person. So stabilization is the old way. The new way is to reduce and eliminate symptoms and help clients learn how to manage them. The old way was to meet established outcomes. The new way with the recovery management focus is to improve wellness and health. We want to really help this person thrive and grow. And the recovery management focus helps the client rejoin and rebuild life in the community instead of just reducing vulnerabilities and increasing resilience. We want them to get out there and get involved and be productive and as productive as they want to be and integrated as they want to be into that community. So recovery management has multiple components of recovery. Number one is abstinence and symptom reduction. Number two is improved psychological and physical health. And number three is improved relationships. We want to help them develop that support system so they feel like they're loved and they're cared for and they've got somebody to lean on when life hands them lemons. Recovery is a process of change through which an individual achieves abstinence as well as improved health, wellness, and quality of life. It's long-term and wellness-centered, not disease-centered, wellness-centered. We're not going to focus on stopping alcohol. We're going to focus on becoming the person you want to be, which probably means stopping alcohol. But it's a positive thing we're looking at. It involves ongoing growth and self-discovery and creation of a new identity. Who am I? What do I want to be? Where do I want to be six months from now? In order to help people do this, we have to provide them relapse prevention education so they don't end up back here as quickly. They may end up back. They may have a relapse. Their symptoms may resurge at some point, and that's okay. We can get them back into the system. But we want to help them prevent as many relapses as possible. We want to make sure they have access to medications and other treatments necessary to maintain their wellness and continue their growth process. We want to make sure they can connect with mutual self-help so they've got a foundation from which they can grow. Encourage exercise and nutrition and proper activities of daily living to prevent vulnerabilities, to help them be as healthy and happy as they possibly can be. Encourage spiritual practices and affiliations in clients that are embracing of that in order to help them develop a sense of authenticity with themselves and connection with other people. Help them find supported community activities that they can engage in so they feel a connection. When people feel like they're isolated, when somebody cares like nobody would notice if they dropped off the face of the earth, then they're more likely to have a resurgence of symptoms. When they feel connected to the community, when they feel like they've got a purpose, then they are more likely to stay on that wellness and growth path. Help them access homeopathic and naturopathic remedies if that's what they choose. So know where your resources are for aromatherapy for acupuncture, for naturopaths in your community. And consider helping them connect with cultural healers if they believe that would help them in their recovery process. As counselors, we help clients formulate recovery goals. And a lot of times, clients are coming from that old way of thinking where they're trying to get rid of something. They're trying to stop being an alcoholic. They're trying to get rid of their depression. So we're going to help them formulate their recovery goals in terms of what do you want? Where are we going? What's our destination? Let's not worry about where we've been. Let's look at what is our destination. We'll help them identify objectives to meet those goals, facilitate linkages to support services to help them achieve their goals. We'll help them establish measures to mark progress. Those are those little goals, those little achievements that they'll do so they can see that, yeah, I'm moving along. We will monitor their progress in order to make sure they're continuing to move forward and we want to monitor their motivation to make sure that they're not waning in their motivation. Pull out some motivational enhancement exercises if clients start kind of faltering a little bit. We provide support and encouragement because not every day is going to be a good day. And we want to help them embrace that and see their strength and their ability to get through the rough times as well as to revel in the good times and help them create emergency relapse prevention plans. So when they are triggered for some reason, they have something written down and handy that they can access to prevent them from making an impulsive decision. Peer recovery support links professional treatment with natural support networks in a structured way to maximize the likelihood of long-term success. Peer-based recovery support provides non-professional and non-clinical assistance by people who are experientially credentialed. Now, a lot of states, state of Florida included, actually has a certification process for peer support people. So it is more of a professional position than it used to be. So peer recovery in Florida, you can get certified as a peer recovery specialist that can give you a little bit of knowledge to help take your personal knowledge and help others with it. Peer recovery services may be offered while a patient awaits entry into treatment, during treatment to provide a connection to the community, and after treatment to assist the person in managing recovery. So this can be a great step-down person. It's a step-down from the clinician to the peer recovery support person. So common pathways to recovery. If the person is in the community using, then they may end up in the recovery process. If they're in the community and not using, but they're having trouble staying clean and sober, they may come into treatment. If they're incarcerated, they may seek out treatment. And if they're in treatment, obviously there's a part of them that may want to recover. So we need to meet each client where they are and address the needs that they have at that particular point in time. Now people can seek recovery from any of these different stages via self-help, peer support, or formal treatment. And ideally when we get them into a recovery-oriented system of care, they're going to have access to all of this. Self-help, peer support, and formal treatment. So 12 principles of recovery that you need to remember. There are many pathways to recovery. Not everybody's going to do it the same way. Some people will go to a methadone clinic. Some people will start out with mental health treatment. Some people will embrace the 12 steps. Some people won't. It doesn't mean that they're not going to recover. Everybody has a different path that they're going to take. Recovery is self-directed and empowering. We want people to help, we want to help people feel like they're growing and they're moving and they're doing positive things for themselves. We don't want them to feel like we're doing it to them. We want them to feel agency and ownership in what happens. Recovery involves personal recognition of the need for change. We cannot force anyone to change. So they have to recognize the need for change. Recovery is holistic. Yes, we can help them stop using and get the alcohol out or whatever. But recovery involves helping them feel better emotionally.  Recovery is physical. It helps their brain rebalance the neurotransmitter so they can feel happy again and they can see colors and feel excitement. It helps their body get healthy again.  Recovery is social because it helps them develop healthy support systems. Recovery is environmental because it helps them arrange their environment to be self-promoting and self-growing instead of self-defeating. So we want to get out the stuff in the environment that could be potentially toxic or harmful. Recovery has cultural dimensions, so we need to be sensitive to that. Recovery exists on a continuum of improved health and wellness. So when people first come into treatment, they come into detox for example, when they move over to the treatment wing, they are detoxed. That is part of the continuum. After 30 days, their brain, the fog is starting to lift. They're moving along the continuum. After 90 days, they're starting to get their energy back and their mood is starting to stabilize a little bit and they're maybe having more energy to, maybe not exercise yet, but to do some activities. So they're moving further along the continuum. But each step along the way is a step toward improved health and wellness. Recovery emerges from hope and gratitude. If people don't have hope, they're not going to recover. They need to see that there is a light at the end of the tunnel. Recovery involves a process of healing and redefinition. The person has to forgive themselves for things they've done. They have to grieve the losses they've experienced. They have to address any depression or anger they have. They have to heal their body while they heal their mind. And they have to redefine themselves. Because a lot of times when people come into treatment, they feel really bad about themselves. And they have very not nice adjectives to use to describe themselves. We want to change that description in their recovery. Recovery involves addressing discrimination and transcending shame and stigma to help them feel empowered to make changes in their life. Recovery is supported by peers and allies and involves rejoining and rebuilding a life in the community. So we need to make sure that our community is welcoming to people and supportive of people in recovery. And finally, recovery is a reality. It's not a myth that exists. People can find recovery.  So formal treatment begins with the development of an individualized treatment plan with the client. Treatment plans are continually updated and reassessed to address developing treatment needs and match them with community resources. That's that whole recovery approach that we were talking about. Counselors communicate client needs to referral sources to ensure a smooth transition and engage in follow-up and advocacy. So we want to kind of be there behind the scenes, powering clients to go connect with these referral sources, do what needs to be done, but we want to make sure that we're following up and ensuring that the connection happened and it went okay. And if not, then we can try to facilitate improving that connection. The counselor must document treatment progress, outcomes, continuing care plans, and use multiple pathways of recovery. So it's not just one way. We need to be open to the fact that people recover in different ways. So if they want to use a cultural healer, if they want to use naturopathic approaches, if they want to use medication-assisted therapy, that that's okay. We need to be open to each person's individuality. So that was your sort of brief review on the intake and orientation process. A lot of that stuff is sort of mundane, but it's really important for you to remember for your addiction counselor exam. So please feel free to review it. If you're listening to this as a podcast, the video is on our YouTube channel at youtube.com slash all CEUs education. That's A-L-L-C-E-U-S education. All of us at All CEUs wish you great success on your exam. Once you're certified or licensed, please remember to visit All CEUs for all of your continuing education needs. We offer unlimited CEUs for $59 for addiction and mental health counselors, social workers, and marriage and family therapists. If you're still thinking about becoming an addiction counselor, All CEUs offers the training you need in three different formats. You can choose online multimedia self-study, self-study plus live webinars, or even face-to-face weekend intensives, which meet one weekend per month for 12 months. We can even present a training series at your facility. Just email support at AllCEUs.com to schedule it. To learn more, you can also visit AllCEUs.com slash Acer. That's AllCEUs.com slash A-C-E-R. Thank you.


What's the word y'all welcome back to Kenny for real. We are finally doing this Philadelphia 76er video A lot of Philly fans been mad at me because I've been teasing it at the end of every video for about a week And they like Kenny we need you to talk about Philly and I will Philly every single season I feel like I make the same video where we try to figure out if they are contenders or pretenders before the season start And I'll be the first to admit it. I bit last year. I had them winning the Easter conference I had them going to the championship I don't remember if I had them winning at all But I had them on that upper echelon of NBA teams and of course it did not go that way First round exit and we'll talk about all of that and I think now I am way more wise than I was back then Be sure to leave a like on the video subscribe if you're new at four o'clock eastern time My merch is going on sale our called game merch It's relevant to this channel because we'll probably reband this channel to called game So if that sounds something like something you're interested in it's going on pre-order starting at four And it'll be live for a couple weeks. So if you're interested link is in the description I'm like I was saying I'm way more wise now than I was last year I think last year I kind of had this idea and I think a lot of people did when we picked Philly It's like sure Tobias Harris contract looks disgusting I'm sure you had to get rid of Jimmy Butler, but you got back Josh Richardson And sure Al Horfrey will probably look weird alongside Joel and B But in our mind, we're like they'll figure it out talent is talent And at the end of the day that is the only thing you really need to win basketball games, right? I'm way more wise now. I think that the overall team construction is way more important Than just getting talent think about the team that won a championship this year the Lakers Sure, they have two of the top five top six players in the NBA, but after that we always question Who's that third player? Who is there? Who was their third best player last season? You can make the the case that it was rondo on the playoffs But throughout the course of the season there was never really a third best player for their team But the end of the day they put together a roster that fit well together and played well together We saw with the with the Clippers last season We thought that just because they brought in these two superstar level players They already had a team that was pretty good that they'd be able to come out and win a championship It just doesn't really work like that. There's chemistry things There's ego things and they need to have solidified roles and they didn't really have that with the LA Clippers And that's something we also found out the 76ers that you can't just put talent on the floor and think it's all gonna mesh Especially when you have such a unique talent at your point guard And that has been Simmons where he is so much different than the average point guard that you need to really orchestrate a team around him that fits his strengths and and caps his weaknesses So they made some moves this offseason started with firing Brett Brown And I recognize that Brett Brown was super important to Philly Being there for the process And I'm happy that they gave him a few years after the process to try to make his case to stay the coach And at the end of the day they may have Ran out of rope when it came to to Brett Brown and they brought in dock rivers I don't know how much of a better coach dock rivers is in 2020 compared to what Brett Brown was But we'll figure it out. Um, just having a new coach in there will matter And then the biggest surprise is that after Daryl Morey stepped down from the Houston Rockets about a week later He signed to be the top guy in Philly and we're like, yo Daryl Morey is a dude that averages I think the number was averages eight trades a season and the 14 years He was with the or the Rockets or however many years eight eight Which means that he was about to come in and he's about to boom break it down because at the end of the day This team had bad contracts It had just players that didn't fit together and the the future was kind of grim People had always brought in do they want to trade joe well? Do they want to trade ben Simmons and Daryl Morey was like not at least not yet We're gonna try to put together a team that every NBA fan knows that this team should look like Going into like we know that would a guy like ben Simmons if he doesn't have shooters around him He's gonna be less effective How the heck that I expect that team to win games when they didn't have much shooting around him Josh we're just saying good good shooter a Tobias here is good good shooter, but like nothing great And they made those changes the first thing that Daryl Morey did was an absolute Amazing deal to get rid of Al Horford I do believe that Al Horford still has a lot left in the tank again The Philly mess just wasn't really there and I think that he can contribute and Sam Price He may turn around and turn Al Horford to another first round pick because he's gonna do the old cp3 thing Go out next season be silent and some team is gonna want him But then again, he has such a big contract And and looked so bad last season It felt like Daryl Morey would have to throw in two To two first round picks at the least and maybe a young asset to get rid of Al Horford And at the end of the day, he got it done for one pick And not only that he got back a quality NBA player in Danny Green that fits what Philly should be wanting to do Danny Green again the butt of a lot of jokes, but he does shoot the three ball well Most of the time and he does play defense He's may not be as quick as he was back when he was in san Antonio But he's still a plus defender and he's still a plus floor spacer for your team exactly what ben sem is needed So you are you trade that and that's just a beautiful thing You able to slide to buy his hairs back to the four because the four has been where Tobias Harris has had the most success They brought in doc rivers to coach that coached Tobias Harris went to buy his Harris was at his best It's it looking it's looking solid, but not only that he made a couple more moves He traded Josh Richardson and Josh Richardson is a good NBA player This is going to be one of those trades where I feel like both teams ended up with with what they wanted, right? Josh Richardson goes to Dallas and now Dallas has a more defensive oriented backcourt may for luka donchets who can still score the ball a little bit And the 76ers get shooting like literally one of the most lethal shooters in NBA history as far as percentage goes um And now they have a lineup Is what i'm guessing the lineup's gonna look like ben Simmons Seth curry dany green to bias and joelambie and the reason i am laughing Because I had saw a screenshot on twitter of people on the jump or first take i get them all mixed up Where they were projecting to start a lineup for the 76ers They had the white howard starting at the four and it just makes me laugh They're like i don't know how you would go on national tv and talk about philadelphia starting the white howard at the four how anyway That team has way more space than that they ever had before And when you look at the stats for philly last season, they were a good 3.1 percentage team But the volume of which they they shot three pointers was not up to par with the current mba The ormory is a great guy by this analytics. He's gonna want layups He's going to want three point shots and set set curry and dany green helped that a lot And now to bias harris has a lot a lot more room to to work um You're going to see at least I hope you're going to see a lot of dh shows with set curry And joel and bead it won't be on the level of jj reddick jj reddick is such a good dho player And I don't think set curry has that same play making a ball handling ability But they should definitely definitely think about that because the most lethal thing philly did during that run With they had the du du du du du from kawai liner is when they had that dribble handoff between jj reddick and joel and bead and when i listen when you listen to them talk to each other On jj reddick's podcast JJ was like I'll I'll never play with a center as good as you are on those dribble handoffs And then joel and bead was like and I'll never play with a guard That's as good as that like they had that type of connection And philly fans should be hoping that set curry can do the similar things to what jj reddick did on that front So dear mori comes in he makes these two significant trades When now the top end of your team looks different than what it did last year and then they they actually Draft really well too. Um, there are some concerns when I have a philly like Other than to bias harris, they don't really have a shot creator anymore Um, and I'm guessing they're gonna rely on ben Simmons being that but obviously ben Simmons is limited to the Seven feet from the rim. Um, at least at this point in his career But that that will be like my main concern and they don't have that off the bench either I would love for them to end up with a player that can shot create off the bench You know, I'm not saying Lou will like but like a guy where you like, okay We could give him the ball and he can get us a bucket off the bench because they don't really have that at the moment I like for a concord masby is similar in a similar mode of like the stef curry's and the and the danny greens Where he's mostly going to be a catch a shoe guy They don't have the guys to create for them on their selves and that's a little bit um concerning I do believe this could be a season where jewel and bee bounce back heavily The last time I saw a jola beat in the bubble and in the playoffs. It just it just wasn't great. Um, you wanted to see him dominate You know, boston because they didn't really have that back end defense that you would think would be successful It gets drill and be but shout out to brad steven daniel tyson all those guys They played it very well You want to see him dominate again and going into last season He has said is his real goals was to win defensive player of the year or win the mvp and obviously he didn't live up to any of those I don't even think he was an all NBA player at the end of the day So this is a resurgence season for him and honestly, this might be This might be the last year that we see the jewel and be been sent his experiment Because we know that daryl morey is not afraid to pull the trigger on the trade He's not crazy enough to come in and make that big time trade a month after getting the job He don't want to do that But if we get a year into it and philly doesn't perform to the to the way we want them to to perform I wouldn't be surprised if daryl morey was shopping those two guys one of them two guys And they try to pick who to build around me and my guys have this conversation or podcast a lot When we talk about philly like if you were the general manager of these 76ers, who would you rather build around? Jorlin bead is a amazing talent Offensively and defensively But we know he has his questions with his motor and we know he has his questions with his injury And then ben sements is such a natural talent of the game of basketball But you know, he has that big limitation of not being able to hit a jump shot Both of them have pros and cons to it And I know some people that would pick ben sements and be like hey get ben a bunch of shooters And I know people that pick jorlin b because he is that nice and at the end of the day I don't know. I do not envy daryl more because he might have to make the decisions soon He just might I don't know if he has done this off season Um, it was some rumors that some players could be on the move and they might be willing to look at But I don't want to just make videos talking about potential rumors, you know Um Philly is an interesting team. Are the philadelphia 76ers contenders Are the philadelphia 76ers contenders? Yeah Yeah, I would say yes Some of the teams they will battle with in the eastern conference. They get worse It may be not that much worse, but you can't tell me toronto losing their two big man rotation That was was very very great for them in the last couple seasons Though they did replace it with the goat erin veins. It's just like losing those two players does hurt Um, boston lost gordon. Hey refer nothing Some of the top end teams got worse And I would argue that philly got better so I would say they are contenders More than If they didn't make those changes going to the off season, they would not be contenders in my book But I would say they are now Let me know what you think. Do you see philadelphia 76ers as contenders or pretenders? All of this could change once I see that first night of mba season to see how they're working with things I may switch I'd be like, boy, these dudes are pretenders Um, but again another season where they are one of the most interesting teams in the league Gotta love philly, right? Be sure to leave a like subscribe if you new link in the description to the to the merch And uh, I'll see y'all tomorrow. Peace