focus on guiding clients through treatment and recovery. To prepare: Review the Learning Resources on experiences of living with an eating disorder, as well as social and cultural influences on the disorder. Read the case provided by your instructor for this week’s Discussion. Post a response in which you address the following: Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months. Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis. Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services. Explain how you would use the client’s family to support recovery. Include specific behavioral examples. Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan. Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder.     Resources:               American Psychiatric Association. (2013g). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm10                  Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5(20), 1–12. doi:10.1186/s40337-017-0145-3    Case studyThe Case of DiamondIntake Date: August 2019DEMOGRAPHIC DATA: This was a voluntary intake for this 28-years-old single African American female. Diamond lives with a 24-years-old female roommate in New York City. She has a bachelor’s degree in Art History and is employed by a major New York museum. Diamond was born and raised in Virginia and moved to New York 4 years ago for employment.  CHIEF COMPLAINT: “My roommate suggested I go to therapy.  I do not agree. I can handle my life, but she threatened to move out and I cannot afford the apartment by myself.”  HISTORY OF PRESENT ILLNESS:  Diamond admitted to purging and frequent use of laxatives to try and keep her weight down.  Diamond reported her weight was being monitored by a nutritionist and she had lab work done to be sure she remained healthy. Diamond reports that she was much heavier as a teenager and wants to confirm she doesn’t get like that again. Diamond reported that she has a very stressful job. She stated that approximately one month ago she started to have difficulty concentrating at work.  She had several altercations with coworkers as well. Several weeks ago Diamond reported that a coworker “said something nasty and I lost it.” Diamond reported that she was angry and “hit everything I knew I could—but that did not help.” Diamond also reported being under stress due to applying for her master’s degree in art history and difficulties with her boyfriend. Diamond complained of depression with insomnia and sleeping only a few hours per night, feeling confused, decreased concentration, irritability, anger, and frustration. She admitted to suicidal ideation. She complained of feeling paranoid over the past few weeks and believed the police were after her and that she heard them outside her door. This was another reason her roommate wanted her to seek treatment.  Diamond reported she was emotionally abused as a child and suffered from post-traumatic stress disorder, but she denied a history of flashbacks or nightmares or any avoidance of the person who she says emotionally abused her. Diamond noted that at times over the past year she has very strange experiences of being overwhelmed with fear.  At these times she begins sweating, has chest pains and chills, and thinks she is going crazy.  It concerns her terribly that these may happen at inappropriate times.   Reluctantly, Diamond admitted to bingeing several times per month since she was 17-years-old. PAST PSYCHIATRIC HISTORY:  Diamond denies any history of psychiatric problems in the past.  Diamond admits to using alcohol periodically but rarely to excess.  MEDICAL HISTORY: Diamond is allergic to penicillin and has a lactose intolerance. She wears glasses for reading. PSYCHOSOCIAL AND DEVELOPMENTAL HISTORY: Diamond’s parents were married when her mother was 19-years-old, and Diamond was born the following year. Two years later, Diamond’s sister was born.  Diamond reports her mother stated Diamond’s personality changed; she became stubborn and difficult. Diamond’s mother said that Diamond began biting, having temper tantrums, and has been moody since then. Diamond states she “adores her father” because he was never the disciplinarian. When Diamond was 12-years-old, her parents separated for 2 weeks. Diamond reported her mother quit college after Diamond’s birth and returned to college after her sister’s birth. She said her father worked all the time, and there was a housekeeper who cared for the children. Diamond reports that when she was in high school, her maternal aunt, who was dying of cancer, came to live with the family and this was very stressful for the family. During those years, Diamond told the school counselor that her mother was abusive, and school officials visited the family. During the visit, Diamond had a temper tantrum and there was no further investigation. Diamond reports she was always an above-average student who rarely studied. She said she was always hyperactive and had difficulty sitting in school. Diamond stated that in college she had a 3.8 GPA and was on the Dean’s list. Diamond is currently applying for admission to graduate school and has taken some courses toward her master’s degree. Currently, Diamond is friendly with her roommate but does not have many other friends. “I don’t trust anybody.” Diamond states that when she lived in Connecticut during college, she had many friends. Diamond worked during summer vacation while in high school. She baby sat during college and worked as a graduate assistant. Since graduating from college, Diamond has been employed by a museum. Diamond reports she currently has financial problems due to living in New York. MENTAL STATUS EXAMINATION: Diamond presented as a slightly overweight, somewhat disheveled, African-American female. She was relaxed but very restless during the interview. Her facial expression was mobile. Her affect during the initial interview was constricted and her mood dysphoric. Diamond’s  speech was pressured, and she spoke in a loud voice. At times, her thinking was logical; and at other times, it was illogical. Diamond denied hallucinations but complained of hearing policemen outside her sometimes. She denied homicidal ideation. She initially admitted to suicidal ideation but then denied it. Diamond was oriented to person, place, and time. Her fund of knowledge was excellent. Diamond was able to calculate serial sevens easily and accurately. Diamond repeated 7 digits forward and 3 in reverse. Her recent and remote memory was intact, and she recalled 3 items after five minutes. Diamond was able to give appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment was appropriate. Diamond’s three wishes were: “To be skinny, to have a big house where I can take in all the stray cats, and for a million more wishes.” When asked how she sees herself in 5 years, Diamond replied, “Hopefully graduating from graduate school.” If Diamond could change something about herself, she would “make myself thin.” Example of how to diagnosisHow to Write a Diagnosis According to the DSM-5An Aid for MSW StudentsAs you write a diagnosis, keep in mind that “[there] are specific recording protocols forthese diagnostic codes...to insure consistent, international recording” (American Psychiatric Association, 2013, p. 23).Writing a DiagnosisA diagnosis is written as a simple list in order of priority to the current treatment needs.F33.1 Major depressive disorder, moderate, recurrent, with seasonal pattern F41.1 Generalized anxiety disorderZ60.3 Acculturation difficultyEach diagnosis needs an ICD code that is written before the name of the diagnosis. The older (DSM-IV-TR) names of some disorders can sometimes be found after the current name. However, to avoid confusion, only use the current name for the illness in a diagnosis.ICD CodesThe DSM-5 includes codes for the International Classification of Diseases. Both ICD-9 and ICD-10 are included in the DSM-5. Always ignore the ICD-9 codes and use onlythe ICD-10-CM codes in diagnosis.The ICD-10-CM codes are listed inside the parentheses in the screen shot below.HOW TO CODEFor mental health conditions, codes always start with a letter (usually F), followed by 2–6 digits. A code is not valid unless it has been coded to the full number of digits required. A code with only the first three digits is used only if that condition is not further subdivided within the DSM-5.For example, for schizophrenia, there are no additional characters in spaces 4, 5, 6, and 7.F20.9 SchizophreniaIn other cases, numbers must be added in the 4th, 5th, or 6th spaces to individualize a condition. Spaces 4–6 provide greater detail of causes, location details, and severity. For example, here are two codes for mania:F30.10  Manic episode without psychotic symptoms, unspecifiedF30.11  Manic episode without psychotic symptoms, mild ?Many disorders have more than one ICD code when there are common, clearly identified subtypes to the illness. The diagnostic criteria box always tells you if a code must be subdivided.If you do not see a code at the top of the diagnostic criteria box, look for the correct codes at the bottom of the box. Often the box prompts for further individualization by saying “Specify if” or “Specify whether.” You may also be asked to set a severity level.The wording “specify whether” tells you that the subtypes that follow are mutually exclusive.For example, here are two subtypes for schizoaffective disorder:F25.0  Schizoaffective disorder, bipolar typeF25.1  Schizoaffective disorder, depressive typeAlways check for coding notes for further directions. For example, in addition to our subtypes for schizoaffective disorder, if catatonia is present, an additional code is found in the coding note.Now our diagnosis looks like this:F25.0 Schizoaffective disorder, bipolar typeF06.1 Catatonia (associated with another mental disorder)After the subtype for schizoaffective disorder is identified, the diagnostic box requires even more individualization: “Specify if” is followed by “Specify current severity.”These terms prompt the clinician to further detail the course of the illness and the way to measure the severity of a presentation.F25.0 Schizoaffective disorder, bipolar type, multiple episodes, currently in acute episode, symptom severityF06.1 Catatonia (associated with another mental disorder)Some disorders such as the substance/medication-induced disorders have more complex codes for their subtypes. When this happens, there is always a table and a coding note found at the bottom of the diagnostic criteria box.Be aware that some diagnoses use the same code because the ICD has limitations that are already being updated for ICD-11. Always check the Centers for Medicare andMedicaid Services (CMS) and the National Center for Health Statistics for updated coding on those disorders that share a code.HOW TO LIST MULTIPLE CODESFormal DSM-5 diagnosis combines into one list all relevant mental disorders, including personality disorders, disabilities, and other relevant medical diagnoses. The DSM-5also expands the psychosocial stressors that a patient might be experiencing. Theseare now called “other conditions that are a focus of treatment,” and most of them begin with the letter “Z.” These conditions, which are critical to psychosocial treatment (formerly known as the V codes), are found on p. 715 in the manual.In a diagnostic list, always place the principal diagnosis first (the reason for the visit, if in an outpatient setting). Other mental health co-morbid diagnoses follow in order of priority to the treatment or focus of attention.RULE A: In this diagnostic list, a mental disorder was the reason for the visit, with the client experiencing an additional medical condition unrelated to the mental disorder diagnosis. Other psychosocial factors relevant to the service are listed after mental health conditions and physical conditions:F40.00 AgoraphobiaK7030 Alcoholic cirrhosis of liver without ascites (by patient report) Z60.3 Acculturation difficultyZ72.0 Tobacco use disorder, mild (nicotine use)The order of priority above is (a) principal mental health diagnosis, (b) medical factors, and (c) psychosocial needs.RULE B: If the client above has a clinical diagnosis of a mental health problem as the principal diagnosis (all F codes), with the presence of a second, additional mental disorder but without the medical problem of cirrhosis, the diagnosis looks like this:F40.00 AgoraphobiaF50.01 Anorexia nervosa, restricting subtype Z60.3 Acculturation difficulty.Z72.0 Tobacco use disorder, mild (nicotine use)3. RULE C: An exception to rules A and B occurs only when the “other medical condition” is thought to be causing the mental disorder. In such cases, the medical condition should be listed first. Here, damage to the liver is also causing a neurocognitive disorder.K7030 Alcoholic cirrhosis of liver without ascites F10.988 Mild neurocognitive disorder, without alcohol useZ60.3 Acculturation difficultyZ72.0 Tobacco use disorder, mild (nicotine use)OTHER CONVENTIONSIn diagnosis, a clinician must first rule out if the condition is being caused by a physical illness, then if it is caused by a substance use problem, and only then are mental disorders investigated.A diagnosis should only be provided once a comprehensive assessment has been completed. The DSM-5 has online assessment measures to help in diagnosis.In older diagnostics, clinicians used “diagnosis deferred” (799.9 in ICD-9) when they were not ready to assign a diagnosis. There is no analogous code in the ICD-10;instead, a clinician should use “provisional” or “other specified disorder,” when appropriate.A provisional diagnosis is preferred for mental health conditions, if the reason for delaying diagnosis is that sufficient criteria to meet diagnostic category is not documentable because of limited assessment. The APA (2013) tells clinicians to use aprovisional diagnosis “when you have a strong ‘presumption’ that the full criteria willultimately be met for a disorder but not enough information is available to make a firm diagnosis” (p. 23). The word provisional simply follows the full diagnostic label:F40.00 Agoraphobia, provisionalWhen symptoms are present but do not meet all the criteria needed for a diagnosis, such as when symptoms are mixed or below the diagnostic threshold but are causing significant distress, most chapters in the DSM-5 have an “Other Specified Disorder”category. If used, the clinician then specifies the presentation according to specifiers provided in the diagnostic box. For example, there are several options for F28 Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, one of example of which is shown below:F28 Other specified schizophrenia spectrum disorder, persistent auditory hallucinationsWhile each chapter in the DSM-5 has an “UNSPECIFIED” code, clinicians are asked not to use this in routine treatment situations. Insurance carriers have variable rules about this label. The CMS actually designed the term for situations in which there is insufficient information to make a diagnosis—for example, in settings like emergency rooms. If you are using “UNSPECIFIED,” be prepared for many insurance carriers to deny services and payments on the basis that there is no “medical necessity” present.While all social workers need to know how to read and interpret diagnoses, state laws determine if you can provide a direct diagnosis yourself. In most states, Licensed Clinical Social Workers do assess and diagnose. Please look up your state laws.ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.American Psychiatric Association. (2018). DSM–5 frequently asked questions. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/feedback- and-questions/frequently-asked-questionsCenters for Disease Control and Prevention. (2017a). ICD-10-CM official guidelines for coding and reporting: FY 2017 (October 1, 2016–September 30, 2017).Retrieved from http://www.cdc.gov/nchs/data/icd/10cmguidelines_20...Centers for Disease Control and Prevention. (2017b). International classification of diseases, tenth revision, clinical modification (ICD-10-CM). Retrieved fromhttps://www.cdc.gov/nchs/icd/icd10cm.htmCenters for Medicare and Medicaid Services. (2017). Provider resources. Retrieved from https://www.cms.gov/Medicare/Coding/ICD10/Provider...Material in this guide has been adapted from the referenced materials by Dr. Diane H. Ranes, PhD, LCSW.

Practicum ProjectYour final Practicum Project asks you to evaluate/assess yourself in your efficacy in the role of the nurse educator. Did you progress as you had hoped to? Are you excited about your achievements? Given your response, consider the goals you will set for yourself in the upcoming Practicum II.In your Practicum Project you will evaluate/assess yourself addressing the self-evaluation criteria below. You will create a 6–8-page paper according to APA format (excluding title page, references, and appendices) addressing all eight items.Submit this assignment to the Submissions Area by the due date assigned.Self-Evaluation Criteria1. Breed an environment of excitement for learning through motivation and leadership.2. Articulate clear expectations, goals, objectives/learning outcomes, and course requirements.3. Communicate effectively with learners as well as colleagues to meet learning outcomes.4. Facilitate learning experiences with teaching strategies that are appropriate for diverse learning preferences/learning needs and where learners are actively engaged in the learning process.5. Seek, inquire, and implement current evidence-based best practices and proven instructional strategies in learner settings.6. Adopt standards-based learner assessment and evaluation practices to measure students’ levels of achievement.7. Facilitate effective learning through timely and meaningful feedback.8. Create learning experiences where learner’s prior experience and knowledge are both acknowledged and built on.