Mindful Continuing Education

Introduction to Behavioral Health Care for the Homeless

Introduction

1. People with substance use or mental disorders who are homeless are more likely to have immediate life-threatening health conditions, to live in life-threatening situations, and to experience current or past trauma.

A. True B. False

Preventive Services for People Who Are Homeless

2. Substance abuse and mental health services include selective prevention services, which are delivered to individuals and target people who are exhibiting early signs of problem behaviors.

A. True B. False

Homelessness in America

3. According to the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009, a person or family who is homeless includes anyone who has any of the following characteristics EXCEPT:

A. Resided in a shelter or place not intended as a home and is now leaving an institution where he or she temporarily resided B. Is losing his or her housing in 30 days or fewer and cannot obtain housing through his or her support networks or other resources C. Has, at some point, lacked independent permanent housing for a long period of time, has moved frequently, and is likely to continue doing so as a result of physical disability, mental disorder, addiction, or other barrier D. Has experienced domestic violence, sexual assault, and/or other dangerous or life-threatening conditions in a housing situation that he or she is leaving or is an unaccompanied youth who is homeless

Individual Factors

4. Lack of familial support increases the risk of episodic and chronic homelessness and manifests as disconnection from family, childhood placement in foster care or other institutions, and childhood physical and/or sexual abuse by family members.

A. True B. False

Are There Different Types of Homelessness?

5. Which of the following accurately describes the various types of homelessness?

A. Episodic homelessness means entering and leaving homelessness repeatedly, and between episodes of homelessness, a person might be tenuously housed and at high risk for becoming homeless again B. Transitional homelessness generally consists of frequent episodes of homelessness, ranging from a few days to a few months C. Chronic homelessness encompasses those who have been continuously so for at least 2 years, without periods of episodic or transitional homelessness D. The greatest majority of those who are homeless experience episodic homelessness, followed closely by transitional homelessness

How Do Communities Respond to Homelessness?

6. Transitional supportive housing provides stable housing along with social and health services, and an individual leaving addiction treatment who has no place to live, needs a sober environment to support recovery, and can be expected to regain employment in the near future would be an appropriate candidate for such housing.

A. True B. False

The Special Rewards of Working With People Who Are Homeless

7. Helping homeless clients obtain even temporary housing will substantially reduce their vulnerability to harm by decreasing risk of victimization, morbidity or mortality from exposure, and:

A. Escalation of substance abuse B. Harm faced by their children C. Risk of injuries such as contusions, lacerations, bruises and burns D. Exacerbation of mental illness

Counselor Competencies for Working With People Who Are Homeless

8. Those who provide behavioral health services to homeless individuals need at least a basic level of competence in various skills, levels of knowledge, and attitudes to ensure that they deliver specific, selective, and specialized care and services for the homeless person.

A. True B. False

Attitides

9. When working with the homeless, professionals should strive to bring clients to where they should be rather than settling for meeting them where they are, and help them make large changes that will impact their lives in the long run.

A. True B. False

Skills

10. Effective behavioral health professionals recognize that psychological trauma impacts a variety of personal and interpersonal dynamics that are important in treatment and recovery, including trust and:

A. A constant fear of losing control B. The feeling that they don’t deserve help C. Willingness to persevere and accept help from others D. The way they view the world

Common Responses to Working with People Who are Homeless

11. One issue that behavioral health professionals may face is the temptation to violate ethical boundaries or agency policies to meet the immediate needs of a person who is homeless, such as by giving them personal funds.

A. True B. False

Stages of Change, Recovery, and Rehabilitation

12. Although the stages of change are often applied to prevention or treatment interventions, they are clearly more beneficial in the treatment stage where problem behavior change is the focus.

A. True B. False

Critical Stages of Recovery

13. In contrast to the stages of change model which addresses psychological readiness for behavioral change, the stages of recovery model addresses each of the following EXCEPT:

A. Developmental goals that are more closely related to mental health recovery B. The degree and nature of social connectedness C. The relationship between an individual and the service delivery system D. The role of risk and protective factors in seeking and maintaining a healthy lifestyle

Exhibit 1-4: Behavioral Health Service Provider Roles and Best Practices According to Stage of Recovery

14. During the dependent/unaware stage of recovery, the role of the service provider is to demonstrate hope, encourage self-acceptance, educate about behavioral health problems and the benefit of a recovery plan, and:

A. Engage family and other social support B. Promote individual coping strategies C. Help with choosing initial goals D. Work with clients on coping and problem-solving skills

Stages of Homelessness Rehabilitation

15. During homelessness rehabilitation, clients move through stages from outreach and engagement to ongoing rehabilitation, and the amount of time a person spends in any of the stages of depends on barriers to providing and accepting service, such as availability of appropriate housing options, severity and chronicity of substance use and mental illness, and availability and acceptability of social supports.

A. True B. False

Intensive Care

16. During the intensive care phase of homelessness rehabilitation, younger people who are homeless, including young adults, should be given the opportunity to participate in mental health promotion activities that help create a sense of:

A. Independence and strength B. Community and empowerment C. Acceptance and confidence D. Self-reliance and motivation

Clinical Interventions and Strategies for Serving People Who Are Homeless

17. Which of the following are generally not included in the menu of behavioral health services for homeless populations?

A. Outreach and initial screening/evaluation B. Early interventions/stabilization and treatment/prevention planning C. Case management and relapse prevention/recovery D. Providing client-driven services, advocacy, and education

Early Interventions

18. Sustainability is a term used by behavioral health professionals to describe the process of beginning to restore physical health and feelings of safety, to relieve emotional turmoil, and to get a sense of future goals and needs.

A. True B. False

Retaining Clients in Treatment and Maintaining Continuity of Care

19. For clients who have been living with chronic crises in the areas of housing, health care, drug use, criminal justice constraints, financial needs, and perhaps other issues, it becomes important to keep treatment and prevention goals realistic and achievable, relatively short term, and:

A. Positive B. Specific C. Measurable D. Flexible

Evidence-Based Practices in Homelessness Rehabilitation

20. Assertive community treatment (ACT) is a time-limited adaptation of intensive case management to bring problem-solving resources, community advocacy, and motivational enhancement to clients who are homeless, and it is particularly useful during the transition and ongoing rehabilitation phases.

A. True B. False

21. Supportive employment assists clients in accessing, obtaining, and maintaining employment as a primary method to prevent or end homelessness, as well as helping to achieve continued employment by teaching skills such as problem-solving, managing interpersonal conflicts, developing appropriate work-related behaviors, and managing money wisely.

A. True B. False

Special Issues in Service Delivery

22. People with substance use and/or mental disorders who are homeless have a variety of specific needs and considerations in treatment and prevention, which tend to fall into three major categories of specific client needs, family services to reduce the risk of intergenerational problems, and:

A. Cultural competence B. Community connections C. Case management concerns D. Daily living functions

Community Housing Services for People who are Homeless

23. Permanent supportive housing has been shown to be economically viable by creating safe stable environments in which individuals and families can regain employment, reduce social service and healthcare costs, and reduce costs related to dependence on more expensive housing options.

A. True B. False

Housing Services for Individuals With Substance Use and/or Mental Disorders

24. Many housing programs for the homeless offer behavioral health treatment and prevention services primarily directed toward the preparation and action phases of treatment.

A. True B. False

Housing Services for Individuals With Substance Use and/or Mental Disorders-Exhibit 1.7

25. Which of the following is NOT one of the characteristics of damp housing accommodations for individuals with substance abuse disorders?

A. Abstinence is recommended but not required and intervention occurs if safety becomes an issue B. Residents pay rent, utilities, and other household expenses and are generally in the action stage of change C. They meet basic needs for safe shelter and increases clients' readiness to accept other services D. Staff creates consistent, empathic relationships with clients and addresses behaviors related to substance use


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