Seminar Detail

High Risk Clients: Effectively Handle Five of the Most Critical Scenarios You’ll Face as a Clinician

Monday, April 15, 2019 at 8:00 AM - 4:00 PM

This event is not currently available for purchase.

For more information: Call (800) 844-8260
Course Description:

Crises are never scheduled, convenient or easy. But they do happen and you will face them. Clients at risk for crisis often present with so many symptoms and issues, it’s hard to know where to start. Many clinicians, anxious about how to proceed, often miss or avoid asking the right questions to effectively intervene and keep clients (and themselves) safe.

As a clinician, have you ever felt:
  • Worried about the safety of your clients, even feared for their lives, but felt unprepared to handle the situation?
  • Unsafe in the clinical environment, or unsure of how to handle situations where someone connected to your client might be in danger?
  • Caught off guard when you’re wrapping up a session and a client discloses suicidal thoughts?
  • Unsure if a client was using drugs, and ill equipped to identify the signs and symptoms of drug abuse?
  • Concerned that you’re doing more harm than good for traumatized clients, despite your best intentions?
Join Paul Brasler, LCSW, as he navigates you through five of the most difficult scenarios in mental health today. Through real-life examples and live role plays, Paul will share the concrete strategies that he’s used over the last two decades to safely and effectively intervene in the challenging, urgent, and sometimes alarming situations that mental health professionals face. Full of practical tools and tips, this seminar will teach you to how to make crises situations more manageable, overcome your worries, and improve your readiness to handle mental health emergencies related to suicide, violence, substance abuse, trauma, and medical issues. Better still, instruction on professional liability management techniques, tips for documentation, and detailed reproducible assessment forms will have you feeling confident that you can focus on doing what’s best for your clients without fear of litigation. And, Paul’s guidance is applicable to your work regardless of your setting or clinical background.

Leave this seminar equipped to help your most vulnerable clients with the real-life skills and knowledge they don’t teach in graduate school!

  1. Complete a comprehensive mental health assessment that encompasses a multitude of clinical concerns including mental status, lethality, substance abuse and trauma.
  2. Identify signs of and risk factors for suicidal ideation in clients and effectively respond in order to ensure the safety of the client.
  3. Recognize indicators of substance intoxication, withdrawal and overdose in clients and establish protocol for responding appropriately.
  4. Assess for risk of violence in a clinical setting and develop skills to effectively and safely intervene during an acute crisis.
  5. Examine ways in which client responses to trauma are often misdiagnosed as mental health disorders and consider the clinical implications of this.
  6. Create accurate and comprehensive documentation of clinical crises to protect all parties involved and minimize liability risks.

Client Assessment: Ask the Right Questions
  • Conducting comprehensive assessments
  • Mini mental status exam
  • Lethality assessment: Suicide and homicide
  • Substance use assessment
  • Trauma assessment
  • Tips and strategies for eliciting the right information
The Suicidal Client: More than 13 Reasons Why
  • High-risk populations—who is most at risk?
  • Implicit and explicit expressions of suicidal ideation and intent
  • Self-injurious behavior and suicidal ideation
  • Suicide assessment and interviews: Ideation, plans, means, intent
  • What do I do now? —Disposition & safety planning
  • Why “No-Harm Contracts” are harmful
  • Breaking client confidentiality
  • When in doubt, do what?
  • Hospitalization process
  • After the ER: When clients are not admitted
  • Case studies:
    • Michelle - Teenager experiencing suicidal ideation
    • William - The intersection of substance use, mental illness and suicidality
The Violent Client: Manage Dangerous Situations
  • Dealing with our fears: Clinicians’ safety concerns
  • When the clinician is the target
  • When others are the target
  • De-escalation techniques
  • Preventative planning
  • Office layout
  • Keeping good boundaries
  • Police involvement before a crisis
  • Safety planning
  • When to call 911
  • Hospitalization process
  • Duty to warn
  • Case studies:
    • George - Handle a violent client
    • Dale - Practice Duty to Warn
The Addicted Client: What ALL Clinicians Need to Know
  • How misdiagnosis harms clients
  • Signs of intoxication
  • Imminent risk: Signs and symptoms of overdose
  • Identify withdrawal syndromes
  • Accurate diagnosis and treatment matching
  • Drug basics that clinicians should know:
    • Opioids and the opioid crisis (heroin, fentanyl and emerging drugs)
    • Stimulants (cocaine, “bath salts,” methamphetamine)
    • Cannabinoids (“shatter,” spice)
    • Other chemicals (DXM, “Special K,” Ayahuasca)
  • When and how to refer to a higher level of care
  • Case studies:
    • Percy - Opioid crisis in the waiting room
    • Cathy - Bipolar disorder? Think again
The Traumatized Client: Help Without Hurting
  • Recognize trauma in clients
  • The risk of misdiagnosis
  • Dangers of improper treatment
  • Strategies for trauma-informed care
    • First and foremost: Safety inside and outside the clinic
    • The role of mindfulness
    • Go slow…but go
  • Understanding levels of safety
  • Triune brain model and trauma
  • Bereavement: Not always trauma
  • The intersection of trauma, mental health, substance abuse and medical problems
  • Case studies:
    • Brian - Trauma missed
    • Mick - “How deep can I bury this?”
Medical vs. Psychiatric Problems: Limiting Harm
  • “What could kill the patient first?”
  • Collaborative care with primary physician
  • Medical emergencies that present with psychological symptoms
  • Signs and Symptoms: Limit client harm by recognizing a medical emergency
    • Medication-related disorders
    • Traumatic Brain Injury (TBI)
    • Neurocognitive disorders
    • Other neurological illnesses
  • Case studies:
    • Steven and the Zombies - Organic disorders
    • “Granny has schizophrenia!”
High Risk Clinicians: After the Crisis
  • Protect your license and manage liability
  • Documentation: What you need to know
  • Debriefing and supervision
  • Vicarious trauma
  • Addressing compassion fatigue
  • Case study:
    • Dave and me
Limitations and Potential Risks
  • Limited controlled studies
  • Seek supervision when necessary
  • Weigh out risk of intervening versus not intervening
Target Audience

  • Counselors
  • Social Workers
  • Psychologists
  • Case Managers
  • Addiction Counselors
  • Marriage & Family Therapists
  • Nurses
  • Nurse Practitioners
  • Other Mental Health Providers


Paul Brasler, MA, LCSW, has worked in the social work field for the past 22 years. He is the head of behavioral health for Daily Planet Health Services, a Federally Qualified Health Center that provides comprehensive and integrated healthcare and mental health services (including medication-assisted opioid treatment). Paul is also president of Providence Consulting & Education, L.L.C., through which he provides clinical supervision and professional education services.

Paul has extensive experience in working with people with substance use disorders. After finishing school, Paul went to work at an adolescent residential treatment program, where he developed a treatment track for adolescents with substance use disorders. In 2003, he became a senior clinician in the Chesterfield Country Juvenile Drug Court and provided individual, family, adolescent group and multifamily group therapies. After working at the drug court for seven years, Paul moved on to conduct psychiatric and substance misuse evaluations in emergency departments in the Greater Richmond, Virginia area. Paul has also served as adjunct faculty in the school of social work at Virginia Commonwealth University, where he developed a graduate course in substance abuse treatment.

Paul has been a PESI presenter since 2016, and he has presented classes on mental health emergencies and high-risk clients across the country. He recently released his first book, High-Risk Clients: Evidence-Based Assessment & Clinical Tools to Recognize and Effectively Respond to Mental Health Crises (PESI Publishing; 2019).

Speaker Disclosures:

Financial: Paul Brasler is in private practice. He receives a speaking honorarium from PESI, Inc.

Nonfinancial: Paul Brasler has no relevant nonfinancial relationship to disclose.
Credits listed below are for full attendance at the live event only. After attendance has been verified, pre-registered attendees will receive an email from PESI Customer Service with the subject line, “Evaluation and Certificate” within one week. This email will contain a link to complete the seminar evaluation and allow attendees to print, email or download a certificate of completion if in full attendance. For those in partial attendance (arrived late or left early), a letter of attendance is available through that link and an adjusted certificate of completion reflecting partial credit will be issued within 30 days (if your board allows). Please see “live seminar schedule” for full attendance start and end times. NOTE: Boards do not allow credit for breaks or lunch.

If your profession is not listed, please contact your licensing board to determine your continuing education requirements and check for reciprocal approval. For other credit inquiries not specified below, or questions on home study credit availability, please contact or 800-844-8260 before the event.

Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

The planning committee and staff who controlled the content of this activity have no relevant financial relationships to disclose. For speaker disclosures, please see speaker bios.

PESI, Inc. offers continuing education programs and products under the brand names PESI, PESI Healthcare, PESI Rehab and Psychotherapy Networker.

Addiction Counselors
This course has been approved by PESI, Inc., as a NAADAC Approved Education Provider, for 6.0 CE in the skill group. NAADAC Provider #77553. PESI, Inc. is responsible for all aspects of their programming. Full attendance is required; no partial credit will be awarded for partial attendance.

Counselors (NBCC)
High Risk Clients: Effectively Handle Five of the Most Critical Scenarios You’ll Face as a Clinician has been approved by NBCC for NBCC credit. PESI, Inc. is solely responsible for all aspects of the program. NBCC Approval No. SP-SP3180. PESI is offering this activity for 6.5 clock hours of continuing education credit.

Massachusetts Counselors: CE credit is available. This program has been approved for 6.25 Category I MaMHCA/MMCEP hours for re-licensure, in accordance with 262 CMR. Expires: 3-21-20. Full attendance is required; no partial credits will be offered for partial attendance.

Marriage & Family Therapists
This activity consists of 380 minutes of continuing education instruction. Credit requirements and approvals vary per state board regulations. You should save this course outline, the certificate of completion you receive from the activity and contact your state board or organization to determine specific filing requirements.

Massachusetts Marriage & Family Therapists: This activity has been certified by NEAFAST on behalf of the Massachusetts Board of Registration of Allied Mental Health & Human Services Professions, for LMFT professional continuing education. Full attendance at this activity qualifies for 6.0 contact hours. Certification #: PC-PC- 040064.

Nurses, Nurse Practitioners, and Clinical Nurse Specialists
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PESI, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Nurses in full attendance will earn 6.3 contact hours. Partial contact hours will be awarded for partial attendance.

This activity consists of 6.0 clock hours of continuing education instruction. The following state psychologist boards recognize activities sponsored by PESI, Inc. as an approved ACCME provider: Alaska, Arkansas, California, Colorado, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Pennsylvania, South Carolina and Wisconsin. Certificates of attendance will be issued for you to submit to your state licensing board to recognize for continuing education credit.

PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PESI, Inc. designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Social Workers
PESI, Inc., #1062, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. PESI, Inc. maintains responsibility for this course. ACE provider approval period: January 27, 2017 - January 27, 2020. Social Workers completing this course receive 6.25 Clinical Practice continuing education credits. Course Level: Intermediate. Full attendance is required; no partial credits will be offered for partial attendance. A certificate of attendance will be awarded at the end of the program to social workers who complete the program evaluation.

Other Professions
This activity qualifies for 380 minutes of instructional content as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific requirements.

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