It is very important for all mental health professionals to take very detailed and thorough historical information from their patients. This information should include an adequate social history, complete medical history, and a full mental status examination with a probable treatment plan. Describe three reasons it is important to gather detailed and extensive information from any patient before you counsel him/her or make medication suggestions.  Use evidence-based research to support your position. Define malingering.  Discuss two ways to differentiate between malingering and a DSM5 diagnosis.  Use evidence-based research to support your position.

A Downward Spiral: A Case Study in HomelessnessTerri LaCoursiere Zucchero, PhD, RN, FNP-BC, and Pooja Bhalla, MSN, RNNational Health Care for the Homeless Council Learning Objectives: At the end of this activity, you will be able to:Analyze at least three issues contributing to homelessness. Describe barriers to health care for individuals who are homeless. Identify key characteristics of quality health care for the homeless. Description: Thirty-six-year-old John may not fit the stereotype of a homeless person. Not long ago, he was living what many would consider a healthy life with his family. But when he lost his job, he found himself in a downward spiral, and his situation dramatically changed. John’s story is a fictional composite of real patients treated by Health Care for the Homeless. It illustrates the challenges homeless people face in accessing health care and the characteristics of high-quality care that can improve their lives. Case: Married with two young children, John and his wife rented a two-bedroom apartment in a safe neighborhood with good schools. John liked his job as a delivery driver for a large food service distributor, where he had worked for more than four years. His goal was to become a supervisor in the next year. John’s wife was a stay-at-home mom.John had always been healthy. Although he had health insurance through his job, he rarely needed to use it. He smoked half a pack of cigarettes each day and drank socially a couple times a month.One afternoon, John’s company notified him that it was laying him off along with more than a hundred other employees. Though he was devastated about losing his job, John was grateful that he and his wife had some savings that they could use for rent and other bills, in addition to the unemployment checks he would receive for a few months.John searched aggressively for jobs in the newspaper and online, but nothing worked out. He began to have feelings of anger and worry that led to panic. His self-esteem fell, and he became depressed. When John’s wife was hired to work part-time at the grocery store, the couple felt better about finances. But demoralized by the loss of his job, John started to drink more often.Two beers a night steadily increased to a six-pack. John and his wife started to argue more often. Then, about six months after losing his job, John stopped receiving unemployment checks. That week, he went on a drinking binge that ended in an argument with his wife. In the heat of the fight, he shoved her. The next day, John’s wife took the children and moved in with her parents. No longer able to pay the rent, John was evicted from the apartment.John tried to reconcile with his wife, but she said she’d had enough. Over the next few months, John “couch surfed” with various family members and friends. At one point, he developed a cold, and when it worsened over a few weeks, he sought care at the emergency department. Hospital staff told him that he would be billed because he didn’t have insurance. John agreed, and a doctor diagnosed him with a sinus infection and prescribed antibiotics. With no money to spare, John could not get the prescription filled.John continued to live with family and friends, but his heavy drinking and anger only got worse, and his hosts always asked him to leave. He went from place to place. Finally, when John ran out of people to call, he found himself without a place to stay for the night and started sleeping at the park.One night when John was drunk, he fell and got a cut on his shin. The injury became red and filled with pus. John was embarrassed about his poor hygiene and didn’t want a health care provider to see him. But when he developed a fever and pain, he decided to walk to the nearest emergency department. He saw a provider who diagnosed him with cellulitis, a common but potentially serious bacterial skin infection, and gave him a copy of the patient instructions that read “discharge to home” and a prescription for antibiotics. John could not afford the entire prescription when he went to pick up the antibiotics, but he was able to purchase half the tablets.Winter arrived, and it was too cold for John to sleep outside, so he began staying at a shelter run by the church. Each morning, he had to leave the shelter by 6 AM. He walked the streets all day and panhandled for money to buy alcohol. One evening, some teenage boys jumped John in park, stealing his backpack and kicking him repeatedly. An onlooker called 911, and John was taken to the emergency department. Later that evening, the hospital discharged John. He returned many times to the emergency department for his health care, seeking treatment for frequent colds, skin infections, and injuries. Providers never screen him for homelessness and always discharge him back to “home.” One day at the park, an outreach team from the local Health Care for the Homeless (HCH), one of about 250 such non-profit organizations in the United States, approached John. The team, including a doctor, nurse, and case worker, introduced themselves and asked John, “Are you OK?” John didn’t engage. They offered him a sandwich and a warm blanket. John took the food without making eye contact. The team visited John for the next several days. John started making eye contact and telling the team about his shortness of breath and the cut on his arm. The team began seeing John frequently, and he began to trust them. A couple weeks later, John agreed to go the HCH clinic. It was the first time in years that John went to a health clinic. Upon his arrival, the staff at the clinic registered him and signed him up for health insurance through Medicaid and food benefits. John felt comfortable in clinic, and he saw some of the people who also stayed at the shelter and spent their days in the park. They were happy to see him and told John about how the clinic staff care and would be able to help.John began going to the HCH clinic on a regular basis. He saw a primary care provider, Maggie, a nurse practitioner. In John’s words, she treated him like a real person. In addition to primary care, the clinic offered behavioral health services. Both scheduled appointments and walk-in care was available. John connected with a therapist and began working on his depression and substance abuse. A year later, John’s health has improved. He rarely needs to go to the emergency room. He is sober and working with a case manager on finding housing. Terri Zucchero is the Family Team Director at Boston Health Care for the Homeless Program and an Assistant Professor at the Graduate School of Nursing, University of Massachusetts Worcester. Pooja Bhalla is the Chief Operating Officer at Boston Health Care for the Homeless Program. For more information on health care for the homeless, please visit the National Health Care for the Homeless Council and Boston Health Care for the Homeless Program.Questions: What were some of the barriers John faced in accessing health care? Why do you think the emergency department was the first place John thought to go for care? How might the emergency department improve care for patients like John? Why do you think John wouldn’t make eye contact with the HCH team at first? How would you build a trusting relationship with a person like John? What aspects of the HCH care do you think represent high-quality care for the homeless? How do you think Maggie made John feel like he was a “real person?” In your own experience, have you encountered a homeless individual? What was that like? Do you recall what you were thinking? Remember some of these questions are Two questions in One. Ensure you answer all completely (detailed) but does not need to be a novel. (300+ words)

Presentation Imagine that you volunteer for an interdisciplinary health team whose mission is to improve global health outcomes. The SNHU Humanitarian Aid Foundation has offered your team a grant of $100,000 for a humanitarian aid trip pending their approval. Your task is to propose a humanitarian aid trip (approximately 2 weeks in length) addressing a particular health challenge for a targeted population. First, select an option from the list below that you are most interested in researching: Option 3 is traveling to a location in Cambodia - malnutrition among women, infants, children, and adolescents. Your attention was drawn to this health issue after reading the scholarly paper “Trip Trouble. ”Your poster presentation should include a title slide, a slide that captures the full view of your poster, slides that “zoom in” to the various sections of your poster, a reference slide, and speaker notes to accompany each, as needed. Additionally, you should refrain from using the first person ( “I”) in order to maintain objectivity and professionalism in your presentation.Note that all the claims in your presentation should be evidence-based. Your citations should be from your independent research (not from the scenario or textbook) of credible sources and be current within the last five years. Many of the criteria below require a specific number of scholarly sources to substantiate each claim; however, these sources are not mutually exclusive. In other words, you can reference the same source to support multiple, different claims in your presentation. You are required to cite a minimum of ten sources overall. Refer to the Shapiro Library Guide: Nursing—Graduate located in the Start Here section of the course for additional support.To complete your poster presentation, be sure to include the following elements: Introduction: Begin by introducing your audience to the selected location and health challenge. Specifically, address the following: Overview: Provide a brief, evidence-based overview, including a description of the geographic region, its socioeconomic and demographic profile, and the prevalent health concerns within the population. Purpose and Value: Clearly state the goal of this trip, including a general identification of the intervention that will be proposed. Defend the proposed value of this venture by discussing the extent to which this humanitarian aid trip will promote health equity, human rights, and social justice. Analysis: In this next section of your presentation, analyze the specific determinants of health that drive the population’s health outcomes. Specifically, address the following: Resource Availability: Evaluate the impact of resource availability (including water, sanitation, food, and air) as a determinant of health for the population. Provide specific evidence from at least three scholarly sources to support your claims. Access to Care and Quality of Health Services: Analyze the impacts of access to care and quality of health services on morbidity and mortality for the population. Provide specific evidence from at least three scholarly sources to support your claims. Cultural Context: Describe how the specific cultural context influences their perceptions of health and disease. How do these perceptions impact health issues and outcomes for the population? Provide specific evidence from at least three scholarly sources to support your claims. Other Determinants: Identify any other environmental, biological, or social determinants of health relevant for the population. Provide specific evidence from at least three scholarly sources to support your claims. Evaluation: Building on your analysis, shift your focus to the larger systems and policy landscape. What are the organizational mechanisms that can be leveraged to address the determinants identified in your analysis section? Specifically, address the following: Policies: Assess the impact of relevant health and nonhealth policies on healthcare access, equity, and social justice. How are the existing policies contributing to negative health outcomes or disparities for the target population? Provide specific evidence from at least three scholarly sources to support your claims. Systems: Evaluate the impacts of the healthcare infrastructure and systems on healthcare access, equity, and social justice. How are the existing systems contributing to negative health outcomes or disparities for the target population? Provide specific evidence from at least three scholarly sources to support your claims. Recommendations: Synthesize your analysis and evaluation to develop specific, feasible interventions that could be delivered in a humanitarian aid trip. At this stage, you should focus on your strategy and methods rather than your budget, but know that your funding source is limited. The budget details will be worked out at a later stage upon approval of the concept. Be sure to address the following: Intervention: Explain the nature and requirements of your intervention. What, specifically, do you propose to do and how would you implement your intervention within the context of a humanitarian aid trip? You do not need a line-item budget for the $100,000 grant, but you should include considerations of overall cost. Be sure to address the following aspects: How does your intervention address the environmental, biological, and sociocultural aspects discussed in your analysis section? Draw specific connections between your research and your proposed intervention. How does your intervention address the political and systemic aspects discussed in your evaluation section? Draw specific connections between your research and your proposed intervention. Social Justice: Defend your recommendation in terms of the extent to which your plan applies social justice and human rights principles. Provide specific evidence from at least three scholarly sources to support your claims. Strengthen Communities and Reduce Health Disparities: Defend your recommendation in terms of the extent to which your plan will strengthen communities and reduce health disparities for marginalized and vulnerable populations. Provide specific evidence from at least three scholarly sources to support your claims. Effectiveness and Sustainability: Defend your recommendation in terms of the evidence that supports the effectiveness and sustainability of your plan for the target population. Provide specific evidence from at least three scholarly sources to support your claims.