Executive Solution Overview
**files (2)** – ## NUR650Diss1-7.pdf – ## NUR650Wk4response.pdf **## NUR650Diss1-7.pdf** NUR650 Discussions Submission Instructions: Your initial post should be at least 500 words, formatted and cited in the current APA style Provide support for your work from at least 2 academic sources less than 5…
Instant Solution Download
$6.99Immediate access to the full model answer, formatted citations, and rubric breakdown.
Need a Fresh Custom Paper?
Have this question answered from scratch according to your specific instructions and deadline.
Order on TutorsGallery →Assignment Prompt & Instructions
**files (2)**
– ## NUR650Diss1-7.pdf
– ## NUR650Wk4response.pdf
**## NUR650Diss1-7.pdf**
NUR650 Discussions
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in the current APA style
Provide support for your work from at least 2 academic sources less than 5 years old.
Wk1 Tom’s Parents are Fighting
After studying Module 1: Lecture Materials & Resources, discuss the following:
Tom is a 16-year-old who comes to you to evaluate his lack of attention because his grades are
progressively getting worse. When you ask about stress in his life, he notes that his parents are
always fighting, and this upsets him. He believes that they fight more when they have been
drinking, and he believes that his father is the heavier drinker of the two, but he cannot quantify
either parent's use.
• What information would be most critical for the group leader to collect in the first visit?
• What is the primary goal for group treatment of this patient’s family problem based on
US group therapy best practices?
• Which harm reduction strategies would you recommend?
• Identify your city. Then refer this patient to three support groups near you that promote
positive health outcomes for this patient. What was your rationale for choosing these
three agencies?
W2 Harriet Needs Surgery
After studying Module 2: Lecture Materials & Resources, discuss the following:
Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has
been attending AA and NA meetings regularly and does not report urges to drink or use drugs
during the 4 years you have been her psychiatric mental health nurse practitioner. She needs
carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.
• What information would be most critical for the group leader to collect in the first visit?
• What is the primary goal for the treatment of this patient’s family problem, based on the
US clinical guidelines?
[https://stu.instructure.com/courses/50346/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-1-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-2-lecture-materials-and-resources)
• Discuss one curative factor the group would observe during the initial, middle and
termination phases in group therapy?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in past
discussion posts). What was your rationale for choosing these three agencies?
W3 Motivational Interview with Mary
After studying Module 3: Lecture Materials & Resources, discuss the following:
Mary is 27 years old and has had a history of alcohol dependence for several years. Mary has a
daughter Kylie, aged 3 years, who displays signs of fetal alcohol syndrome. Social work services
have been involved with Mary and Kylie since her birth, culminating in Kylie being looked after
by the local authority as a result of Mary arriving to collect Kylie from the local nursery while
significantly under the influence of alcohol. Mary has demonstrated ambivalence regarding her
ability to control her alcohol use. Mary has referred herself to a local counseling agency as
suggested by the social worker and her PCP.
• Discuss how you might use the principles of motivational interviewing with Mary.
• Provide a detailed overview of how the interview may progress. Include each step of
motivational interviewing in your discussion.
• Describe how a provider would recognize this patient is ready to change. Use principles
of motivational interviewing to support your answer.
W4 Richard is Motivated
After studying Module 4: Lecture Materials & Resources, discuss the following:
Richard is a 62-year-old single man who says that his substance dependence and his bipolar
disorder both emerged in his late teens. He says that he started to drink to “feel better” when his
episodes of depression made it hard for him to interact with his peers. He also states that alcohol
and cocaine are a natural part of his manic episodes. He also notes that coming off the cocaine
and binge drinking contribute to low mood, but he has not responded well to referrals to AA and
past inpatient stays have led to only temporary abstinence. Yet, Richard is now trying to forge a
closer relationship with his adult children, and he says he is especially motivated to get a better
handle on both his bipolar disorder and his substance use. He has been more compliant with his
mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual
diagnoses addressed with psychotherapy.
• What diagnostic information would be most critical to collect in the first visit?
[https://stu.instructure.com/courses/50346/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-3-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-4-lecture-materials-and-resources)
• Which diagnostic measures are recommended by the US clinical guidelines for the
treatment of this patient’s family problem?
• Which evidence based harm reduction strategies would you recommend to treat this
patient?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W5 Pretty Serious Partying
After studying Module 5: Lecture Materials & Resources, discuss the following:
Jackie is a 31-year-old pregnant patient (2nd child, two different fathers) single mother of a 6-
year-old who is coming for prenatal care since she suspects she is pregnant. She is no longer with
the father of Robby, her firstborn. She indicates "pretty serious partying" with the likely father of
the baby. By pretty serious partying she means 10-12 drinks per occasion, one to two times per
week, plus intermittent methamphetamine use.
• Which clinical information would be most critical for you to collect in the first visit?
• What are the greatest risk factors for substance use disorder for this patient?
• Which harm reduction strategies would you recommend?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W6 Toneika
After studying Module 6: Lecture Materials & Resources, discuss the following:
Tomeika is a three-year-old girl. She was recently diagnosed with autism spectrum disorder
(ASD).
Tomeika is able to make many vocalizations and is able to say one recognizable word. Tomeika
will say “juice”, which she pronounces as “oos.” Throughout the day, Tomeika cries and falls to
the floor to gain access to food, obtain a favorite toy, or when she wants to be picked up. Her
parents, Mr. and Mrs. Williams, would like for Tomeika to communicate her desires with words,
but do not know how to help her. Tomeika recently began attending an early childhood special
education classroom for learners with ASD in the County Public School System for six hours a
day, four days a week. On Wednesdays, Tomeika and her peers do not go to school. Instead, on
this day, Tomeika’s interventionist, Mrs. Dell, has parent conferences in her students’ homes.
[https://stu.instructure.com/courses/50346/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-5-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-6-lecture-materials-and-resources)
During the conferences, Mrs. Dell discusses educational programming, learner progress, areas of
concern, and also provides training to parents.
• Which diagnostic information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient’s family problem based on
current US clinical practice guidelines?
• Which complementary and alternative medication treatments would you recommend?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W7 Hip Fracture
After studying Module 7: Lecture Materials & Resources, discuss the following:
The patient is a 71-year-old widowed man who is seen regularly in the clinic for health
maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for
triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been
reporting frequent episodes of losing his balance and falling, and eight weeks ago was
hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this
visit, he also complains of becoming increasingly confused.
• What information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient?
• Identify potential obstacles for change. Which educational approach would the PMHNP
provide to overcome these obstacles?
• How would you teach the patient about the Beers list and Halcion?
• Discuss a medication in detail that could be safely substituted to treat insomnia in
geriatric patients.
[https://stu.instructure.com/courses/50346/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-7-lecture-materials-and-resources)
**## NUR650Wk4response.pdf**
Reply Charlotte Torp
Richard is Motivated
Diagnostic Information
The first diagnostic information to collect from Richard during the first visit should start
with his psychiatric history. Richard mentions that he has a history with bipolar disorder. More
information should be collected on the type of bipolar disorder and the severity of his depressive
and manic episodes, as well as the frequency at which he has been getting symptoms. Richard
should also be asked more information relating to his depressive episodes, including any suicidal
ideations he gets, previous attempts at suicide, and any self-harm behavior he has engaged in.
Information about the potential triggers to manic or depressive episodes as well as sleep
problems, psychosis, delusions, and hallucinations that he has ever experienced should also be
gathered.
The provider should also ask Richard to provide information about any mood stabilizers
and antidepressants that he has been prescribed for his bipolar disorder diagnosis. If he has had
poor adherence, information about the different causes of nonadherence should also be noted.
This will help to identify if he stopped taking his medication because of side effects or because
of other factors. Information about his substance use history must also be collected during the
first visit. Richard mentioned using alcohol and cocaine as part of his manic episodes. He should
also be asked about any other substance that he has used before, including the amount, duration,
and frequency of use. Richard should also ask about any symptoms he gets when he is not
consuming alcohol or cocaine and if the use of substances affects his mood in any way.
Diagnostic Measures
The recommended diagnostic measures for the case of Richard should start with a
structured diagnostic interview. This involves collecting proper information that will help
identify an accurate diagnosis for Richard. The diagnostic interview will help identify a formal
DSM-5 diagnosis and reveal the additional testing that Richard will need because of his current
severity (Schneider et al., 2022). Another diagnostic measure should be the Young Mania
Severity Scale, which would help to measure the severity of the manic symptoms that Richard is
experiencing (Rabinowitz et al., 2024). The mood disorder questionnaire can also be used to
confirm his bipolar disorder diagnosis (Chang et al., 2025). Richard should also be screened
using a substance use tool. The recommended substance abuse screening tools for Richard’s case
would include the alcohol use disorder identification test and the drug abuse screening test.
These will help identify the use, severity, and potential risks from the use of substances. If
Richard admits to also experiencing ideation for suicide, the Columbia Suicide Severity Rating
Scale should be used to assess any risky behaviors, intentions, and plans that he has (Nam et al.,
2024). This will ensure an accurate diagnosis that will also affect the treatment plan that will be
selected.
Harm Reduction Strategies
The first harm reduction strategy that should be used in Richard’s case should be
psychoeducation on the relationship between substance use and bipolar disorder. He needs to
know about how substances affect his mood and how they can even trigger manic and depressive
episodes in the context of bipolar disorder (Anona et al., 2023). Education should also involve
the risks that come from using multiple types of substances like alcohol and cocaine at the same
time (Anona et al., 2023). Since he shows great interest in getting proper control of his bipolar
disorder and substance use, inpatient management can also be another harm reduction strategy.
This will ensure that he does not have to undergo risky withdrawal side effects from his alcohol
and cocaine use. Through inpatient management, Richard can also be enrolled in a gradual
reduction plan that is consistent and will help him gain sobriety more effectively. This can even
involve medication-assisted treatment for his alcohol and cocaine usage.
Patient Referrals
The agencies in Miami, Florida, which would best suit Richard, include South Miami
Recovery Outpatient Treatment Center, Summer House Detox Center, and Agape Behavioral
Healthcare. I would refer Richard to South Miami Recovery Outpatient Treatment Center
because it focuses on providing substance use care in an outpatient setting. This is suitable in the
case Richard is not ready to be admitted for inpatient services. It can also be a suitable means for
him to start with before transitioning to inpatient management. Agape Behavioral Healthcare is a
suitable referral because it not only focuses on substance abuse but also focuses on mental
health. This means that Richard will get assistance for his substance abuse and bipolar disorder at
the same time in a holistic manner. Summer House Detox Center also provides mental health and
addiction treatment in an inpatient and outpatient manner. This gives Richard another alternative
for treatment in the event he does not prefer to go with the first option.
Reply from Sergio Pereira
Richard is Motivated
Richard presents a dual diagnosis of bipolar disorder and substance use disorder, which
provides a complex clinical challenge to the healthcare team. The connection between mood
disturbance and increased use of alcohol or drugs, or the worsening of mood disturbance with
substance use, creates a cycle of dysfunction. In Richard's case, the depressive and manic
episodes that he experiences appear to be tied to the use of alcohol and cocaine. Richard's desire
to reconnect with his adult children is a positive motivator for his recovery from both disorders.
A comprehensive evaluation of both co-occurring disorders, implementation of harm-reduction
methodology, and connection to community-based resources will be necessary to help Richard
address both disorders effectively. Structured clinical interventions will provide clinicians with
valuable insights into Richard's needs, enabling them to establish a treatment strategy that will
target both of his conditions.
Data Needed at the First Visit
At the first visit, data will be collected to provide a comprehensive first assessment of how
co-occurring bipolar disorder & substance abuse interact. Clinicians need to document the timing
and frequency (how often) of mood episodes or substance use; the severity (how intense) of both
mood episodes and substance use; and the duration (how long) of all mood episodes and
substance use. Research shows that co-occurring disorders lead to more functional impairment
and complicate treatment. Evaluation of assessments must include the patient's psychiatric
history, substance use history, family history, and present life stressors, as these are used to
predict prognosis and plan for treatment (Sperry & Lippard, 2025). Medication adherence,
medical health status & the patient's risk of suicide also need to be evaluated, as those
experiencing unstable mood states may have increased risk of self-harm as a result of withdrawal
from substances. Understanding the patient’s reasons for seeking treatment and their past
experiences with treatment can help the clinician to support the patient in remaining engaged
with their healthcare provider.
Clinical Guidelines and Diagnostic Tools
Clinical guidelines recommend that clinicians utilize validated assessment tools for
patients with co-occurring bipolar substance use disorders, such as the CANMAT and the ISBD
guidelines, to assist in the comprehensive screening of a patient’s mood symptoms, substance use
patterns, and activities of daily living. Use of standardized scales that assess depression and
mania allows the clinician to assess the severity of a patient’s mood symptoms and track the
patient’s progress (Keramatian et al., 2023). Clinical guidelines emphasize that attention to the
co-occurrence of psychiatric or medical conditions is critical to understanding a patient’s
treatment outcome. Furthermore, the use of combined methods to assess the symptoms of either
bipolar or substance use disorders helps treat a patient’s other condition by correctly identifying
the patient’s bipolar symptoms from his or her substance-related symptoms.
Evidence-Based Harm Reduction Interventions
Harm reduction strategies aim to help reduce the negative impact of substance use on a
patient by encouraging gradual changes in behavioral patterns. Patients receiving integrated care
will benefit most from addressing both their mental illness and their addiction (Minkoff &
Covell, 2022). Coordinated care models have been documented as effective due to the
collaboration and continuity of mental health and addiction services to improve clinical
outcomes.
The second strategy that has proven to be effective among individuals who are ambivalent
to change behavior is motivational interviewing in combination with cognitive behavioral
therapy. Ghaderi et al. (2022) disclose that motivational interviewing coupled with cognitive
behavioral therapy can potentially raise the rate of treatment compliance and reduce adverse
lifestyle practices that cause mental illnesses. Such plans, in the case of Richard, may include
determining the triggers behind mood changes, strengthening the coping process, and reducing
the consumption of substances over time without aggravating the psychiatric status.
Community Resources
Ellie Mental Health is a mental health facility in Pembroke Pines and is situated at 9050
Pines Boulevard, Suite 305, Pembroke Pines, Florida 33024, and may be contacted at 754 400
4805. This clinic offers personal therapy, family therapy, couples therapy, and medication
management to people with mental health issues. The clinic is appropriate for Richard, as it can
provide integrated psychotherapy services; the services cover mood disorders and substance-
related behaviors in an outpatient environment. Counseling and medication management would
facilitate continued monitoring of the bipolar symptoms, as Richard can cultivate coping
mechanisms that will enable him not to rely heavily on alcohol or cocaine.
Serenity Community Mental Health Center is located at 12542 Pines Boulevard, Pembroke
Pines, Florida 33027, and can be contacted at 954-391-9478. It is an outpatient mental health
clinic that offers full behavioral health care, such as psychiatric assessment, treatment planning,
and treatment of mood disorders and other mental illnesses. The facility is interested in the
emotional state and improvement of family functioning through the utilization of supportive and
structured care. The facility manages various psychiatric disorders such as bipolar disorder and
depressive disorders and is therefore suitable for people with complicated mental health issues.
This center is the right option for Richard because it offers professional care in the aspect of
mental health treatment within a supportive outpatient facility where he will be assisted in the
management of the bipolar symptoms, as the clinicians will be in a position to monitor the
impact of the use of substances on his mental health.
The Center of Psychological Counseling Services is situated at 5124 Hollywood Blvd,
Hollywood, Florida 33021, and can be reached at 954-894-1174. It is an organization offering
scheduled outpatient therapy to the residents of the entire Broward County, such as Pembroke
Pines and Miramar. The center has psychotherapy programs that will help resolve mood
disorders and behavioral health issues in a friendly clinical setting. This facility will be suitable
in the case of Richard since the structured outpatient treatment can involve regular therapeutic
support and allow support from family and social networks.
**## NUR650Wk4response.pdf**
Reply Charlotte Torp
Richard is Motivated
Diagnostic Information
The first diagnostic information to collect from Richard during the first visit should start
with his psychiatric history. Richard mentions that he has a history with bipolar disorder. More
information should be collected on the type of bipolar disorder and the severity of his depressive
and manic episodes, as well as the frequency at which he has been getting symptoms. Richard
should also be asked more information relating to his depressive episodes, including any suicidal
ideations he gets, previous attempts at suicide, and any self-harm behavior he has engaged in.
Information about the potential triggers to manic or depressive episodes as well as sleep
problems, psychosis, delusions, and hallucinations that he has ever experienced should also be
gathered.
The provider should also ask Richard to provide information about any mood stabilizers
and antidepressants that he has been prescribed for his bipolar disorder diagnosis. If he has had
poor adherence, information about the different causes of nonadherence should also be noted.
This will help to identify if he stopped taking his medication because of side effects or because
of other factors. Information about his substance use history must also be collected during the
first visit. Richard mentioned using alcohol and cocaine as part of his manic episodes. He should
also be asked about any other substance that he has used before, including the amount, duration,
and frequency of use. Richard should also ask about any symptoms he gets when he is not
consuming alcohol or cocaine and if the use of substances affects his mood in any way.
Diagnostic Measures
The recommended diagnostic measures for the case of Richard should start with a
structured diagnostic interview. This involves collecting proper information that will help
identify an accurate diagnosis for Richard. The diagnostic interview will help identify a formal
DSM-5 diagnosis and reveal the additional testing that Richard will need because of his current
severity (Schneider et al., 2022). Another diagnostic measure should be the Young Mania
Severity Scale, which would help to measure the severity of the manic symptoms that Richard is
experiencing (Rabinowitz et al., 2024). The mood disorder questionnaire can also be used to
confirm his bipolar disorder diagnosis (Chang et al., 2025). Richard should also be screened
using a substance use tool. The recommended substance abuse screening tools for Richard’s case
would include the alcohol use disorder identification test and the drug abuse screening test.
These will help identify the use, severity, and potential risks from the use of substances. If
Richard admits to also experiencing ideation for suicide, the Columbia Suicide Severity Rating
Scale should be used to assess any risky behaviors, intentions, and plans that he has (Nam et al.,
2024). This will ensure an accurate diagnosis that will also affect the treatment plan that will be
selected.
Harm Reduction Strategies
The first harm reduction strategy that should be used in Richard’s case should be
psychoeducation on the relationship between substance use and bipolar disorder. He needs to
know about how substances affect his mood and how they can even trigger manic and depressive
episodes in the context of bipolar disorder (Anona et al., 2023). Education should also involve
the risks that come from using multiple types of substances like alcohol and cocaine at the same
time (Anona et al., 2023). Since he shows great interest in getting proper control of his bipolar
disorder and substance use, inpatient management can also be another harm reduction strategy.
This will ensure that he does not have to undergo risky withdrawal side effects from his alcohol
and cocaine use. Through inpatient management, Richard can also be enrolled in a gradual
reduction plan that is consistent and will help him gain sobriety more effectively. This can even
involve medication-assisted treatment for his alcohol and cocaine usage.
Patient Referrals
The agencies in Miami, Florida, which would best suit Richard, include South Miami
Recovery Outpatient Treatment Center, Summer House Detox Center, and Agape Behavioral
Healthcare. I would refer Richard to South Miami Recovery Outpatient Treatment Center
because it focuses on providing substance use care in an outpatient setting. This is suitable in the
case Richard is not ready to be admitted for inpatient services. It can also be a suitable means for
him to start with before transitioning to inpatient management. Agape Behavioral Healthcare is a
suitable referral because it not only focuses on substance abuse but also focuses on mental
health. This means that Richard will get assistance for his substance abuse and bipolar disorder at
the same time in a holistic manner. Summer House Detox Center also provides mental health and
addiction treatment in an inpatient and outpatient manner. This gives Richard another alternative
for treatment in the event he does not prefer to go with the first option.
Reply from Sergio Pereira
Richard is Motivated
Richard presents a dual diagnosis of bipolar disorder and substance use disorder, which
provides a complex clinical challenge to the healthcare team. The connection between mood
disturbance and increased use of alcohol or drugs, or the worsening of mood disturbance with
substance use, creates a cycle of dysfunction. In Richard's case, the depressive and manic
episodes that he experiences appear to be tied to the use of alcohol and cocaine. Richard's desire
to reconnect with his adult children is a positive motivator for his recovery from both disorders.
A comprehensive evaluation of both co-occurring disorders, implementation of harm-reduction
methodology, and connection to community-based resources will be necessary to help Richard
address both disorders effectively. Structured clinical interventions will provide clinicians with
valuable insights into Richard's needs, enabling them to establish a treatment strategy that will
target both of his conditions.
Data Needed at the First Visit
At the first visit, data will be collected to provide a comprehensive first assessment of how
co-occurring bipolar disorder & substance abuse interact. Clinicians need to document the timing
and frequency (how often) of mood episodes or substance use; the severity (how intense) of both
mood episodes and substance use; and the duration (how long) of all mood episodes and
substance use. Research shows that co-occurring disorders lead to more functional impairment
and complicate treatment. Evaluation of assessments must include the patient's psychiatric
history, substance use history, family history, and present life stressors, as these are used to
predict prognosis and plan for treatment (Sperry & Lippard, 2025). Medication adherence,
medical health status & the patient's risk of suicide also need to be evaluated, as those
experiencing unstable mood states may have increased risk of self-harm as a result of withdrawal
from substances. Understanding the patient’s reasons for seeking treatment and their past
experiences with treatment can help the clinician to support the patient in remaining engaged
with their healthcare provider.
Clinical Guidelines and Diagnostic Tools
Clinical guidelines recommend that clinicians utilize validated assessment tools for
patients with co-occurring bipolar substance use disorders, such as the CANMAT and the ISBD
guidelines, to assist in the comprehensive screening of a patient’s mood symptoms, substance use
patterns, and activities of daily living. Use of standardized scales that assess depression and
mania allows the clinician to assess the severity of a patient’s mood symptoms and track the
patient’s progress (Keramatian et al., 2023). Clinical guidelines emphasize that attention to the
co-occurrence of psychiatric or medical conditions is critical to understanding a patient’s
treatment outcome. Furthermore, the use of combined methods to assess the symptoms of either
bipolar or substance use disorders helps treat a patient’s other condition by correctly identifying
the patient’s bipolar symptoms from his or her substance-related symptoms.
Evidence-Based Harm Reduction Interventions
Harm reduction strategies aim to help reduce the negative impact of substance use on a
patient by encouraging gradual changes in behavioral patterns. Patients receiving integrated care
will benefit most from addressing both their mental illness and their addiction (Minkoff &
Covell, 2022). Coordinated care models have been documented as effective due to the
collaboration and continuity of mental health and addiction services to improve clinical
outcomes.
The second strategy that has proven to be effective among individuals who are ambivalent
to change behavior is motivational interviewing in combination with cognitive behavioral
therapy. Ghaderi et al. (2022) disclose that motivational interviewing coupled with cognitive
behavioral therapy can potentially raise the rate of treatment compliance and reduce adverse
lifestyle practices that cause mental illnesses. Such plans, in the case of Richard, may include
determining the triggers behind mood changes, strengthening the coping process, and reducing
the consumption of substances over time without aggravating the psychiatric status.
Community Resources
Ellie Mental Health is a mental health facility in Pembroke Pines and is situated at 9050
Pines Boulevard, Suite 305, Pembroke Pines, Florida 33024, and may be contacted at 754 400
4805. This clinic offers personal therapy, family therapy, couples therapy, and medication
management to people with mental health issues. The clinic is appropriate for Richard, as it can
provide integrated psychotherapy services; the services cover mood disorders and substance-
related behaviors in an outpatient environment. Counseling and medication management would
facilitate continued monitoring of the bipolar symptoms, as Richard can cultivate coping
mechanisms that will enable him not to rely heavily on alcohol or cocaine.
Serenity Community Mental Health Center is located at 12542 Pines Boulevard, Pembroke
Pines, Florida 33027, and can be contacted at 954-391-9478. It is an outpatient mental health
clinic that offers full behavioral health care, such as psychiatric assessment, treatment planning,
and treatment of mood disorders and other mental illnesses. The facility is interested in the
emotional state and improvement of family functioning through the utilization of supportive and
structured care. The facility manages various psychiatric disorders such as bipolar disorder and
depressive disorders and is therefore suitable for people with complicated mental health issues.
This center is the right option for Richard because it offers professional care in the aspect of
mental health treatment within a supportive outpatient facility where he will be assisted in the
management of the bipolar symptoms, as the clinicians will be in a position to monitor the
impact of the use of substances on his mental health.
The Center of Psychological Counseling Services is situated at 5124 Hollywood Blvd,
Hollywood, Florida 33021, and can be reached at 954-894-1174. It is an organization offering
scheduled outpatient therapy to the residents of the entire Broward County, such as Pembroke
Pines and Miramar. The center has psychotherapy programs that will help resolve mood
disorders and behavioral health issues in a friendly clinical setting. This facility will be suitable
in the case of Richard since the structured outpatient treatment can involve regular therapeutic
support and allow support from family and social networks.
**## NUR650Diss1-7.pdf**
NUR650 Discussions
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in the current APA style
Provide support for your work from at least 2 academic sources less than 5 years old.
Wk1 Tom’s Parents are Fighting
After studying Module 1: Lecture Materials & Resources, discuss the following:
Tom is a 16-year-old who comes to you to evaluate his lack of attention because his grades are
progressively getting worse. When you ask about stress in his life, he notes that his parents are
always fighting, and this upsets him. He believes that they fight more when they have been
drinking, and he believes that his father is the heavier drinker of the two, but he cannot quantify
either parent's use.
• What information would be most critical for the group leader to collect in the first visit?
• What is the primary goal for group treatment of this patient’s family problem based on
US group therapy best practices?
• Which harm reduction strategies would you recommend?
• Identify your city. Then refer this patient to three support groups near you that promote
positive health outcomes for this patient. What was your rationale for choosing these
three agencies?
W2 Harriet Needs Surgery
After studying Module 2: Lecture Materials & Resources, discuss the following:
Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has
been attending AA and NA meetings regularly and does not report urges to drink or use drugs
during the 4 years you have been her psychiatric mental health nurse practitioner. She needs
carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.
• What information would be most critical for the group leader to collect in the first visit?
• What is the primary goal for the treatment of this patient’s family problem, based on the
US clinical guidelines?
[https://stu.instructure.com/courses/50346/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-1-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-2-lecture-materials-and-resources)
• Discuss one curative factor the group would observe during the initial, middle and
termination phases in group therapy?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in past
discussion posts). What was your rationale for choosing these three agencies?
W3 Motivational Interview with Mary
After studying Module 3: Lecture Materials & Resources, discuss the following:
Mary is 27 years old and has had a history of alcohol dependence for several years. Mary has a
daughter Kylie, aged 3 years, who displays signs of fetal alcohol syndrome. Social work services
have been involved with Mary and Kylie since her birth, culminating in Kylie being looked after
by the local authority as a result of Mary arriving to collect Kylie from the local nursery while
significantly under the influence of alcohol. Mary has demonstrated ambivalence regarding her
ability to control her alcohol use. Mary has referred herself to a local counseling agency as
suggested by the social worker and her PCP.
• Discuss how you might use the principles of motivational interviewing with Mary.
• Provide a detailed overview of how the interview may progress. Include each step of
motivational interviewing in your discussion.
• Describe how a provider would recognize this patient is ready to change. Use principles
of motivational interviewing to support your answer.
W4 Richard is Motivated
After studying Module 4: Lecture Materials & Resources, discuss the following:
Richard is a 62-year-old single man who says that his substance dependence and his bipolar
disorder both emerged in his late teens. He says that he started to drink to “feel better” when his
episodes of depression made it hard for him to interact with his peers. He also states that alcohol
and cocaine are a natural part of his manic episodes. He also notes that coming off the cocaine
and binge drinking contribute to low mood, but he has not responded well to referrals to AA and
past inpatient stays have led to only temporary abstinence. Yet, Richard is now trying to forge a
closer relationship with his adult children, and he says he is especially motivated to get a better
handle on both his bipolar disorder and his substance use. He has been more compliant with his
mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual
diagnoses addressed with psychotherapy.
• What diagnostic information would be most critical to collect in the first visit?
[https://stu.instructure.com/courses/50346/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-3-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-4-lecture-materials-and-resources)
• Which diagnostic measures are recommended by the US clinical guidelines for the
treatment of this patient’s family problem?
• Which evidence based harm reduction strategies would you recommend to treat this
patient?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W5 Pretty Serious Partying
After studying Module 5: Lecture Materials & Resources, discuss the following:
Jackie is a 31-year-old pregnant patient (2nd child, two different fathers) single mother of a 6-
year-old who is coming for prenatal care since she suspects she is pregnant. She is no longer with
the father of Robby, her firstborn. She indicates "pretty serious partying" with the likely father of
the baby. By pretty serious partying she means 10-12 drinks per occasion, one to two times per
week, plus intermittent methamphetamine use.
• Which clinical information would be most critical for you to collect in the first visit?
• What are the greatest risk factors for substance use disorder for this patient?
• Which harm reduction strategies would you recommend?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W6 Toneika
After studying Module 6: Lecture Materials & Resources, discuss the following:
Tomeika is a three-year-old girl. She was recently diagnosed with autism spectrum disorder
(ASD).
Tomeika is able to make many vocalizations and is able to say one recognizable word. Tomeika
will say “juice”, which she pronounces as “oos.” Throughout the day, Tomeika cries and falls to
the floor to gain access to food, obtain a favorite toy, or when she wants to be picked up. Her
parents, Mr. and Mrs. Williams, would like for Tomeika to communicate her desires with words,
but do not know how to help her. Tomeika recently began attending an early childhood special
education classroom for learners with ASD in the County Public School System for six hours a
day, four days a week. On Wednesdays, Tomeika and her peers do not go to school. Instead, on
this day, Tomeika’s interventionist, Mrs. Dell, has parent conferences in her students’ homes.
[https://stu.instructure.com/courses/50346/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-5-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-6-lecture-materials-and-resources)
During the conferences, Mrs. Dell discusses educational programming, learner progress, areas of
concern, and also provides training to parents.
• Which diagnostic information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient’s family problem based on
current US clinical practice guidelines?
• Which complementary and alternative medication treatments would you recommend?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W7 Hip Fracture
After studying Module 7: Lecture Materials & Resources, discuss the following:
The patient is a 71-year-old widowed man who is seen regularly in the clinic for health
maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for
triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been
reporting frequent episodes of losing his balance and falling, and eight weeks ago was
hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this
visit, he also complains of becoming increasingly confused.
• What information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient?
• Identify potential obstacles for change. Which educational approach would the PMHNP
provide to overcome these obstacles?
• How would you teach the patient about the Beers list and Halcion?
• Discuss a medication in detail that could be safely substituted to treat insomnia in
geriatric patients.
[https://stu.instructure.com/courses/50346/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-7-lecture-materials-and-resources)
**## NUR650Wk4response.pdf**
Reply Charlotte Torp
Richard is Motivated
Diagnostic Information
The first diagnostic information to collect from Richard during the first visit should start
with his psychiatric history. Richard mentions that he has a history with bipolar disorder. More
information should be collected on the type of bipolar disorder and the severity of his depressive
and manic episodes, as well as the frequency at which he has been getting symptoms. Richard
should also be asked more information relating to his depressive episodes, including any suicidal
ideations he gets, previous attempts at suicide, and any self-harm behavior he has engaged in.
Information about the potential triggers to manic or depressive episodes as well as sleep
problems, psychosis, delusions, and hallucinations that he has ever experienced should also be
gathered.
The provider should also ask Richard to provide information about any mood stabilizers
and antidepressants that he has been prescribed for his bipolar disorder diagnosis. If he has had
poor adherence, information about the different causes of nonadherence should also be noted.
This will help to identify if he stopped taking his medication because of side effects or because
of other factors. Information about his substance use history must also be collected during the
first visit. Richard mentioned using alcohol and cocaine as part of his manic episodes. He should
also be asked about any other substance that he has used before, including the amount, duration,
and frequency of use. Richard should also ask about any symptoms he gets when he is not
consuming alcohol or cocaine and if the use of substances affects his mood in any way.
Diagnostic Measures
The recommended diagnostic measures for the case of Richard should start with a
structured diagnostic interview. This involves collecting proper information that will help
identify an accurate diagnosis for Richard. The diagnostic interview will help identify a formal
DSM-5 diagnosis and reveal the additional testing that Richard will need because of his current
severity (Schneider et al., 2022). Another diagnostic measure should be the Young Mania
Severity Scale, which would help to measure the severity of the manic symptoms that Richard is
experiencing (Rabinowitz et al., 2024). The mood disorder questionnaire can also be used to
confirm his bipolar disorder diagnosis (Chang et al., 2025). Richard should also be screened
using a substance use tool. The recommended substance abuse screening tools for Richard’s case
would include the alcohol use disorder identification test and the drug abuse screening test.
These will help identify the use, severity, and potential risks from the use of substances. If
Richard admits to also experiencing ideation for suicide, the Columbia Suicide Severity Rating
Scale should be used to assess any risky behaviors, intentions, and plans that he has (Nam et al.,
2024). This will ensure an accurate diagnosis that will also affect the treatment plan that will be
selected.
Harm Reduction Strategies
The first harm reduction strategy that should be used in Richard’s case should be
psychoeducation on the relationship between substance use and bipolar disorder. He needs to
know about how substances affect his mood and how they can even trigger manic and depressive
episodes in the context of bipolar disorder (Anona et al., 2023). Education should also involve
the risks that come from using multiple types of substances like alcohol and cocaine at the same
time (Anona et al., 2023). Since he shows great interest in getting proper control of his bipolar
disorder and substance use, inpatient management can also be another harm reduction strategy.
This will ensure that he does not have to undergo risky withdrawal side effects from his alcohol
and cocaine use. Through inpatient management, Richard can also be enrolled in a gradual
reduction plan that is consistent and will help him gain sobriety more effectively. This can even
involve medication-assisted treatment for his alcohol and cocaine usage.
Patient Referrals
The agencies in Miami, Florida, which would best suit Richard, include South Miami
Recovery Outpatient Treatment Center, Summer House Detox Center, and Agape Behavioral
Healthcare. I would refer Richard to South Miami Recovery Outpatient Treatment Center
because it focuses on providing substance use care in an outpatient setting. This is suitable in the
case Richard is not ready to be admitted for inpatient services. It can also be a suitable means for
him to start with before transitioning to inpatient management. Agape Behavioral Healthcare is a
suitable referral because it not only focuses on substance abuse but also focuses on mental
health. This means that Richard will get assistance for his substance abuse and bipolar disorder at
the same time in a holistic manner. Summer House Detox Center also provides mental health and
addiction treatment in an inpatient and outpatient manner. This gives Richard another alternative
for treatment in the event he does not prefer to go with the first option.
Reply from Sergio Pereira
Richard is Motivated
Richard presents a dual diagnosis of bipolar disorder and substance use disorder, which
provides a complex clinical challenge to the healthcare team. The connection between mood
disturbance and increased use of alcohol or drugs, or the worsening of mood disturbance with
substance use, creates a cycle of dysfunction. In Richard's case, the depressive and manic
episodes that he experiences appear to be tied to the use of alcohol and cocaine. Richard's desire
to reconnect with his adult children is a positive motivator for his recovery from both disorders.
A comprehensive evaluation of both co-occurring disorders, implementation of harm-reduction
methodology, and connection to community-based resources will be necessary to help Richard
address both disorders effectively. Structured clinical interventions will provide clinicians with
valuable insights into Richard's needs, enabling them to establish a treatment strategy that will
target both of his conditions.
Data Needed at the First Visit
At the first visit, data will be collected to provide a comprehensive first assessment of how
co-occurring bipolar disorder & substance abuse interact. Clinicians need to document the timing
and frequency (how often) of mood episodes or substance use; the severity (how intense) of both
mood episodes and substance use; and the duration (how long) of all mood episodes and
substance use. Research shows that co-occurring disorders lead to more functional impairment
and complicate treatment. Evaluation of assessments must include the patient's psychiatric
history, substance use history, family history, and present life stressors, as these are used to
predict prognosis and plan for treatment (Sperry & Lippard, 2025). Medication adherence,
medical health status & the patient's risk of suicide also need to be evaluated, as those
experiencing unstable mood states may have increased risk of self-harm as a result of withdrawal
from substances. Understanding the patient’s reasons for seeking treatment and their past
experiences with treatment can help the clinician to support the patient in remaining engaged
with their healthcare provider.
Clinical Guidelines and Diagnostic Tools
Clinical guidelines recommend that clinicians utilize validated assessment tools for
patients with co-occurring bipolar substance use disorders, such as the CANMAT and the ISBD
guidelines, to assist in the comprehensive screening of a patient’s mood symptoms, substance use
patterns, and activities of daily living. Use of standardized scales that assess depression and
mania allows the clinician to assess the severity of a patient’s mood symptoms and track the
patient’s progress (Keramatian et al., 2023). Clinical guidelines emphasize that attention to the
co-occurrence of psychiatric or medical conditions is critical to understanding a patient’s
treatment outcome. Furthermore, the use of combined methods to assess the symptoms of either
bipolar or substance use disorders helps treat a patient’s other condition by correctly identifying
the patient’s bipolar symptoms from his or her substance-related symptoms.
Evidence-Based Harm Reduction Interventions
Harm reduction strategies aim to help reduce the negative impact of substance use on a
patient by encouraging gradual changes in behavioral patterns. Patients receiving integrated care
will benefit most from addressing both their mental illness and their addiction (Minkoff &
Covell, 2022). Coordinated care models have been documented as effective due to the
collaboration and continuity of mental health and addiction services to improve clinical
outcomes.
The second strategy that has proven to be effective among individuals who are ambivalent
to change behavior is motivational interviewing in combination with cognitive behavioral
therapy. Ghaderi et al. (2022) disclose that motivational interviewing coupled with cognitive
behavioral therapy can potentially raise the rate of treatment compliance and reduce adverse
lifestyle practices that cause mental illnesses. Such plans, in the case of Richard, may include
determining the triggers behind mood changes, strengthening the coping process, and reducing
the consumption of substances over time without aggravating the psychiatric status.
Community Resources
Ellie Mental Health is a mental health facility in Pembroke Pines and is situated at 9050
Pines Boulevard, Suite 305, Pembroke Pines, Florida 33024, and may be contacted at 754 400
4805. This clinic offers personal therapy, family therapy, couples therapy, and medication
management to people with mental health issues. The clinic is appropriate for Richard, as it can
provide integrated psychotherapy services; the services cover mood disorders and substance-
related behaviors in an outpatient environment. Counseling and medication management would
facilitate continued monitoring of the bipolar symptoms, as Richard can cultivate coping
mechanisms that will enable him not to rely heavily on alcohol or cocaine.
Serenity Community Mental Health Center is located at 12542 Pines Boulevard, Pembroke
Pines, Florida 33027, and can be contacted at 954-391-9478. It is an outpatient mental health
clinic that offers full behavioral health care, such as psychiatric assessment, treatment planning,
and treatment of mood disorders and other mental illnesses. The facility is interested in the
emotional state and improvement of family functioning through the utilization of supportive and
structured care. The facility manages various psychiatric disorders such as bipolar disorder and
depressive disorders and is therefore suitable for people with complicated mental health issues.
This center is the right option for Richard because it offers professional care in the aspect of
mental health treatment within a supportive outpatient facility where he will be assisted in the
management of the bipolar symptoms, as the clinicians will be in a position to monitor the
impact of the use of substances on his mental health.
The Center of Psychological Counseling Services is situated at 5124 Hollywood Blvd,
Hollywood, Florida 33021, and can be reached at 954-894-1174. It is an organization offering
scheduled outpatient therapy to the residents of the entire Broward County, such as Pembroke
Pines and Miramar. The center has psychotherapy programs that will help resolve mood
disorders and behavioral health issues in a friendly clinical setting. This facility will be suitable
in the case of Richard since the structured outpatient treatment can involve regular therapeutic
support and allow support from family and social networks.
**## NUR650Diss1-7.pdf**
NUR650 Discussions
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in the current APA style
Provide support for your work from at least 2 academic sources less than 5 years old.
Wk1 Tom’s Parents are Fighting
After studying Module 1: Lecture Materials & Resources, discuss the following:
Tom is a 16-year-old who comes to you to evaluate his lack of attention because his grades are
progressively getting worse. When you ask about stress in his life, he notes that his parents are
always fighting, and this upsets him. He believes that they fight more when they have been
drinking, and he believes that his father is the heavier drinker of the two, but he cannot quantify
either parent's use.
• What information would be most critical for the group leader to collect in the first visit?
• What is the primary goal for group treatment of this patient’s family problem based on
US group therapy best practices?
• Which harm reduction strategies would you recommend?
• Identify your city. Then refer this patient to three support groups near you that promote
positive health outcomes for this patient. What was your rationale for choosing these
three agencies?
W2 Harriet Needs Surgery
After studying Module 2: Lecture Materials & Resources, discuss the following:
Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has
been attending AA and NA meetings regularly and does not report urges to drink or use drugs
during the 4 years you have been her psychiatric mental health nurse practitioner. She needs
carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.
• What information would be most critical for the group leader to collect in the first visit?
• What is the primary goal for the treatment of this patient’s family problem, based on the
US clinical guidelines?
[https://stu.instructure.com/courses/50346/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-1-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-2-lecture-materials-and-resources)
• Discuss one curative factor the group would observe during the initial, middle and
termination phases in group therapy?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in past
discussion posts). What was your rationale for choosing these three agencies?
W3 Motivational Interview with Mary
After studying Module 3: Lecture Materials & Resources, discuss the following:
Mary is 27 years old and has had a history of alcohol dependence for several years. Mary has a
daughter Kylie, aged 3 years, who displays signs of fetal alcohol syndrome. Social work services
have been involved with Mary and Kylie since her birth, culminating in Kylie being looked after
by the local authority as a result of Mary arriving to collect Kylie from the local nursery while
significantly under the influence of alcohol. Mary has demonstrated ambivalence regarding her
ability to control her alcohol use. Mary has referred herself to a local counseling agency as
suggested by the social worker and her PCP.
• Discuss how you might use the principles of motivational interviewing with Mary.
• Provide a detailed overview of how the interview may progress. Include each step of
motivational interviewing in your discussion.
• Describe how a provider would recognize this patient is ready to change. Use principles
of motivational interviewing to support your answer.
W4 Richard is Motivated
After studying Module 4: Lecture Materials & Resources, discuss the following:
Richard is a 62-year-old single man who says that his substance dependence and his bipolar
disorder both emerged in his late teens. He says that he started to drink to “feel better” when his
episodes of depression made it hard for him to interact with his peers. He also states that alcohol
and cocaine are a natural part of his manic episodes. He also notes that coming off the cocaine
and binge drinking contribute to low mood, but he has not responded well to referrals to AA and
past inpatient stays have led to only temporary abstinence. Yet, Richard is now trying to forge a
closer relationship with his adult children, and he says he is especially motivated to get a better
handle on both his bipolar disorder and his substance use. He has been more compliant with his
mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual
diagnoses addressed with psychotherapy.
• What diagnostic information would be most critical to collect in the first visit?
[https://stu.instructure.com/courses/50346/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-3-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-4-lecture-materials-and-resources)
• Which diagnostic measures are recommended by the US clinical guidelines for the
treatment of this patient’s family problem?
• Which evidence based harm reduction strategies would you recommend to treat this
patient?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W5 Pretty Serious Partying
After studying Module 5: Lecture Materials & Resources, discuss the following:
Jackie is a 31-year-old pregnant patient (2nd child, two different fathers) single mother of a 6-
year-old who is coming for prenatal care since she suspects she is pregnant. She is no longer with
the father of Robby, her firstborn. She indicates "pretty serious partying" with the likely father of
the baby. By pretty serious partying she means 10-12 drinks per occasion, one to two times per
week, plus intermittent methamphetamine use.
• Which clinical information would be most critical for you to collect in the first visit?
• What are the greatest risk factors for substance use disorder for this patient?
• Which harm reduction strategies would you recommend?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W6 Toneika
After studying Module 6: Lecture Materials & Resources, discuss the following:
Tomeika is a three-year-old girl. She was recently diagnosed with autism spectrum disorder
(ASD).
Tomeika is able to make many vocalizations and is able to say one recognizable word. Tomeika
will say “juice”, which she pronounces as “oos.” Throughout the day, Tomeika cries and falls to
the floor to gain access to food, obtain a favorite toy, or when she wants to be picked up. Her
parents, Mr. and Mrs. Williams, would like for Tomeika to communicate her desires with words,
but do not know how to help her. Tomeika recently began attending an early childhood special
education classroom for learners with ASD in the County Public School System for six hours a
day, four days a week. On Wednesdays, Tomeika and her peers do not go to school. Instead, on
this day, Tomeika’s interventionist, Mrs. Dell, has parent conferences in her students’ homes.
[https://stu.instructure.com/courses/50346/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-5-lecture-materials-and-resources)
[https://stu.instructure.com/courses/50346/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-6-lecture-materials-and-resources)
During the conferences, Mrs. Dell discusses educational programming, learner progress, areas of
concern, and also provides training to parents.
• Which diagnostic information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient’s family problem based on
current US clinical practice guidelines?
• Which complementary and alternative medication treatments would you recommend?
• Identify your city. Then refer this patient to three agencies near you that would support
positive health outcomes for this patient. (These agencies must not have been used in
past discussion posts). What was your rationale for choosing these three agencies?
W7 Hip Fracture
After studying Module 7: Lecture Materials & Resources, discuss the following:
The patient is a 71-year-old widowed man who is seen regularly in the clinic for health
maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for
triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been
reporting frequent episodes of losing his balance and falling, and eight weeks ago was
hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this
visit, he also complains of becoming increasingly confused.
• What information would be most critical for you to collect in the first visit?
• What is the primary goal for the treatment of this patient?
• Identify potential obstacles for change. Which educational approach would the PMHNP
provide to overcome these obstacles?
• How would you teach the patient about the Beers list and Halcion?
• Discuss a medication in detail that could be safely substituted to treat insomnia in
geriatric patients.
[https://stu.instructure.com/courses/50346/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/50346/pages/module-7-lecture-materials-and-resources)
**## NUR650Wk4response.pdf**
Reply Charlotte Torp
Richard is Motivated
Diagnostic Information
The first diagnostic information to collect from Richard during the first visit should start
with his psychiatric history. Richard mentions that he has a history with bipolar disorder. More
information should be collected on the type of bipolar disorder and the severity of his depressive
and manic episodes, as well as the frequency at which he has been getting symptoms. Richard
should also be asked more information relating to his depressive episodes, including any suicidal
ideations he gets, previous attempts at suicide, and any self-harm behavior he has engaged in.
Information about the potential triggers to manic or depressive episodes as well as sleep
problems, psychosis, delusions, and hallucinations that he has ever experienced should also be
gathered.
The provider should also ask Richard to provide information about any mood stabilizers
and antidepressants that he has been prescribed for his bipolar disorder diagnosis. If he has had
poor adherence, information about the different causes of nonadherence should also be noted.
This will help to identify if he stopped taking his medication because of side effects or because
of other factors. Information about his substance use history must also be collected during the
first visit. Richard mentioned using alcohol and cocaine as part of his manic episodes. He should
also be asked about any other substance that he has used before, including the amount, duration,
and frequency of use. Richard should also ask about any symptoms he gets when he is not
consuming alcohol or cocaine and if the use of substances affects his mood in any way.
Diagnostic Measures
The recommended diagnostic measures for the case of Richard should start with a
structured diagnostic interview. This involves collecting proper information that will help
identify an accurate diagnosis for Richard. The diagnostic interview will help identify a formal
DSM-5 diagnosis and reveal the additional testing that Richard will need because of his current
severity (Schneider et al., 2022). Another diagnostic measure should be the Young Mania
Severity Scale, which would help to measure the severity of the manic symptoms that Richard is
experiencing (Rabinowitz et al., 2024). The mood disorder questionnaire can also be used to
confirm his bipolar disorder diagnosis (Chang et al., 2025). Richard should also be screened
using a substance use tool. The recommended substance abuse screening tools for Richard’s case
would include the alcohol use disorder identification test and the drug abuse screening test.
These will help identify the use, severity, and potential risks from the use of substances. If
Richard admits to also experiencing ideation for suicide, the Columbia Suicide Severity Rating
Scale should be used to assess any risky behaviors, intentions, and plans that he has (Nam et al.,
2024). This will ensure an accurate diagnosis that will also affect the treatment plan that will be
selected.
Harm Reduction Strategies
The first harm reduction strategy that should be used in Richard’s case should be
psychoeducation on the relationship between substance use and bipolar disorder. He needs to
know about how substances affect his mood and how they can even trigger manic and depressive
episodes in the context of bipolar disorder (Anona et al., 2023). Education should also involve
the risks that come from using multiple types of substances like alcohol and cocaine at the same
time (Anona et al., 2023). Since he shows great interest in getting proper control of his bipolar
disorder and substance use, inpatient management can also be another harm reduction strategy.
This will ensure that he does not have to undergo risky withdrawal side effects from his alcohol
and cocaine use. Through inpatient management, Richard can also be enrolled in a gradual
reduction plan that is consistent and will help him gain sobriety more effectively. This can even
involve medication-assisted treatment for his alcohol and cocaine usage.
Patient Referrals
The agencies in Miami, Florida, which would best suit Richard, include South Miami
Recovery Outpatient Treatment Center, Summer House Detox Center, and Agape Behavioral
Healthcare. I would refer Richard to South Miami Recovery Outpatient Treatment Center
because it focuses on providing substance use care in an outpatient setting. This is suitable in the
case Richard is not ready to be admitted for inpatient services. It can also be a suitable means for
him to start with before transitioning to inpatient management. Agape Behavioral Healthcare is a
suitable referral because it not only focuses on substance abuse but also focuses on mental
health. This means that Richard will get assistance for his substance abuse and bipolar disorder at
the same time in a holistic manner. Summer House Detox Center also provides mental health and
addiction treatment in an inpatient and outpatient manner. This gives Richard another alternative
for treatment in the event he does not prefer to go with the first option.
Reply from Sergio Pereira
Richard is Motivated
Richard presents a dual diagnosis of bipolar disorder and substance use disorder, which
provides a complex clinical challenge to the healthcare team. The connection between mood
disturbance and increased use of alcohol or drugs, or the worsening of mood disturbance with
substance use, creates a cycle of dysfunction. In Richard's case, the depressive and manic
episodes that he experiences appear to be tied to the use of alcohol and cocaine. Richard's desire
to reconnect with his adult children is a positive motivator for his recovery from both disorders.
A comprehensive evaluation of both co-occurring disorders, implementation of harm-reduction
methodology, and connection to community-based resources will be necessary to help Richard
address both disorders effectively. Structured clinical interventions will provide clinicians with
valuable insights into Richard's needs, enabling them to establish a treatment strategy that will
target both of his conditions.
Data Needed at the First Visit
At the first visit, data will be collected to provide a comprehensive first assessment of how
co-occurring bipolar disorder & substance abuse interact. Clinicians need to document the timing
and frequency (how often) of mood episodes or substance use; the severity (how intense) of both
mood episodes and substance use; and the duration (how long) of all mood episodes and
substance use. Research shows that co-occurring disorders lead to more functional impairment
and complicate treatment. Evaluation of assessments must include the patient's psychiatric
history, substance use history, family history, and present life stressors, as these are used to
predict prognosis and plan for treatment (Sperry & Lippard, 2025). Medication adherence,
medical health status & the patient's risk of suicide also need to be evaluated, as those
experiencing unstable mood states may have increased risk of self-harm as a result of withdrawal
from substances. Understanding the patient’s reasons for seeking treatment and their past
experiences with treatment can help the clinician to support the patient in remaining engaged
with their healthcare provider.
Clinical Guidelines and Diagnostic Tools
Clinical guidelines recommend that clinicians utilize validated assessment tools for
patients with co-occurring bipolar substance use disorders, such as the CANMAT and the ISBD
guidelines, to assist in the comprehensive screening of a patient’s mood symptoms, substance use
patterns, and activities of daily living. Use of standardized scales that assess depression and
mania allows the clinician to assess the severity of a patient’s mood symptoms and track the
patient’s progress (Keramatian et al., 2023). Clinical guidelines emphasize that attention to the
co-occurrence of psychiatric or medical conditions is critical to understanding a patient’s
treatment outcome. Furthermore, the use of combined methods to assess the symptoms of either
bipolar or substance use disorders helps treat a patient’s other condition by correctly identifying
the patient’s bipolar symptoms from his or her substance-related symptoms.
Evidence-Based Harm Reduction Interventions
Harm reduction strategies aim to help reduce the negative impact of substance use on a
patient by encouraging gradual changes in behavioral patterns. Patients receiving integrated care
will benefit most from addressing both their mental illness and their addiction (Minkoff &
Covell, 2022). Coordinated care models have been documented as effective due to the
collaboration and continuity of mental health and addiction services to improve clinical
outcomes.
The second strategy that has proven to be effective among individuals who are ambivalent
to change behavior is motivational interviewing in combination with cognitive behavioral
therapy. Ghaderi et al. (2022) disclose that motivational interviewing coupled with cognitive
behavioral therapy can potentially raise the rate of treatment compliance and reduce adverse
lifestyle practices that cause mental illnesses. Such plans, in the case of Richard, may include
determining the triggers behind mood changes, strengthening the coping process, and reducing
the consumption of substances over time without aggravating the psychiatric status.
Community Resources
Ellie Mental Health is a mental health facility in Pembroke Pines and is situated at 9050
Pines Boulevard, Suite 305, Pembroke Pines, Florida 33024, and may be contacted at 754 400
4805. This clinic offers personal therapy, family therapy, couples therapy, and medication
management to people with mental health issues. The clinic is appropriate for Richard, as it can
provide integrated psychotherapy services; the services cover mood disorders and substance-
related behaviors in an outpatient environment. Counseling and medication management would
facilitate continued monitoring of the bipolar symptoms, as Richard can cultivate coping
mechanisms that will enable him not to rely heavily on alcohol or cocaine.
Serenity Community Mental Health Center is located at 12542 Pines Boulevard, Pembroke
Pines, Florida 33027, and can be contacted at 954-391-9478. It is an outpatient mental health
clinic that offers full behavioral health care, such as psychiatric assessment, treatment planning,
and treatment of mood disorders and other mental illnesses. The facility is interested in the
emotional state and improvement of family functioning through the utilization of supportive and
structured care. The facility manages various psychiatric disorders such as bipolar disorder and
depressive disorders and is therefore suitable for people with complicated mental health issues.
This center is the right option for Richard because it offers professional care in the aspect of
mental health treatment within a supportive outpatient facility where he will be assisted in the
management of the bipolar symptoms, as the clinicians will be in a position to monitor the
impact of the use of substances on his mental health.
The Center of Psychological Counseling Services is situated at 5124 Hollywood Blvd,
Hollywood, Florida 33021, and can be reached at 954-894-1174. It is an organization offering
scheduled outpatient therapy to the residents of the entire Broward County, such as Pembroke
Pines and Miramar. The center has psychotherapy programs that will help resolve mood
disorders and behavioral health issues in a friendly clinical setting. This facility will be suitable
in the case of Richard since the structured outpatient treatment can involve regular therapeutic
support and allow support from family and social networks.