• 38th Annual Training Institute on Behavioral Health & Addictive Disorders

    February 13 - 16, 2017
    Clearwater Beach, Florida

    This conference has ended, please see our Distance Learning options for recorded sessions from this conference.

    Sponsors

    • American Addictions-670x120

      American Addiction Centers

    Participating Sponsors

    • Palm Healthcare-320x80
    • The Guest House Ocala
    • Crossroads Centre Antigua
    • 320x80_integrative
    • 320x80_HCI
    • 320x80_cmag

    Exhibitors

    • Test Drive
    • Lakeview Health
    • ZenCharts
    • Summit BHC
    • HopeWay 2
    • MedDisposables
    • Retreat Premier - 150x80
    • Topaz-150x80
    • Feel Good-150x80
    • Civilian Corps -150x80
    • TP tampa
    • 150x80_pinegrove
    • 150x80_sunspire
    • North Tampa Behavioral-150x80
    • 150x80_Fairwinds
    • 150x80_bio_sound_healing
    • Valley Hope updated

    5:30 - 7:30pm

    Early Conference Registration at Hilton

     

    7:45am  - Conference Registration

    7:45am  - Continental Breakfast
     
    8:50am  - Opening and Welcome

    9:00–10:00am   
    What We Have Learned: Four Decades of Addiction, Neurobiology, and Treatment Research
    Mark S. Gold, MD

    Mark Gold is a translational researcher, author and inventor best known for his work on the brain systems underlying the effects of opiate drugs, cocaine and food. He has published over 1000 peer reviewed scientific articles, texts, and practice guidelines, including citation classics in cocaine neurobiology, opioid addiction neurobiology and treatment, food and process addictions. Dr. Gold has been called a groundbreaking researcher, father of medication assisted recovery, the first to translate rat experiments into theory and treatments for human addicts. He is currently Chairman of Rivermend Health’s Scientific Advisory Boards. Dr. Gold was a Professor, Eminent Scholar, Distinguished Professor, Distinguished Alumni Professor, Emeritus Eminent Scholar, and Chairman during his 25 years at the University of Florida. He is currently Adjunct professor at Washington University.     

    This presentation explores the evolution of drug, tobacco, and alcohol addiction research over the past forty years, where we are today with understanding how drugs affect the body and brain, how addictions—once thought untreatable—are successfully treated, and what the future may look like in this changing field.

    10:00–10:30am    Refreshment Break

    10:30–11:30am   
    We Were Never Designed for This: The Psychological Toxicity of Modern Life (and What You Can Do  About It)
    Stephen Ilardi, PhD

    Has served on the faculties of the University of Colorado and (presently) the University of Kansas. The author of over 50 scholarly articles on mental illness, Dr. Ilardi is a nationally recognized expert on depression. His work has been honored by the American Psychological Association’s prestigious Blau Award for early career contributions to the field, and his research on the neuroscience of depression has been funded by the National Institutes of Mental Health (NIMH). He has also been invited to give two recent TEDx talks on his work, and is the author of The Depression Cure: The 6-Step Program to Beat Depression Without Drugs. Recently, he was selected from a pool of over 2,000 instructors at KU as the recipient of the school’s highest instructional honor, the HOPE Award for teaching excellence. He also maintains a clinical practice.

    Our ancestors lived for countless millennia in a world far different from the one we now inhabit, and our genes, bodies, brains, and minds remain largely calibrated to that ancient way of life. Simply put: We were never designed for the sedentary, indoor, socially isolated, sleep-deprived, fast-food-laden, frenzied 24/7/365 pace of modern American life. The result is an epidemic of mental illness that shows no signs of abating despite the fact that one in five Americans is now on psychiatric medication. But it is possible to reclaim several healing habits of the past—many of which have effects on neurochemistry—and weave them into the fabric of 21st-century life.

    11:30–12:30pm     
    Thou Shalt Not: The Crossroads between Moral Injury and PTSD/Trauma
    Judy Crane, LMHC, CAP

    Her presentations and seminars on Trauma, Resilience, PTSD and sexual trauma resolution are widely known, and she has 3 decades of experience working in both residential and out-patient settings. In 2003 she created The Refuge-A Healing Place.  In 2008 Spirit2Spirit Healing was created offering Trauma Retreats and a nationally renowned certification training curriculum. Most Recently, Judy has created a luxury treatment center, The Guest House in Ocala, FL that focuses on healing trauma and treating addiction simultaneously.

     This presentation will correlate the phenomenon of relapse as a survival mechanism to provide relief, respite, avoidance, medicating or numbing feelings of pain, remorse, guilt or shame surrounding trauma and PTSD as well as explore the crossroads with Moral Injury, the Soul Wound. Additionally research, case studies, and exercises will be provided to define a deeper understanding of trauma, PTSD and its Soul Sister, Moral Injury. Relapse will be defined as relapse in substance and alcohol addiction, process addictions, mental health diagnoses and relapse in self-defeating behaviors. The history of Moral Injury, codes of religious dogma, spiritual beliefs and codes of honor will be described.

    2:00–3:30pm - Concurrent Workshops
    My Career in Eating Disorders & Food Addiction Research: How We Got Here and Where We Are Going
    Mark S. Gold, MD

    Can certain foods hijack the brain in ways similar to drugs and alcohol?  Terms like “chocoholic” and “food addict” are part of popular lore, some popular diet books discuss the concept of addiction, and there are food addiction programs with names like Food Addicts in Recovery Anonymous. Clinicians who work with patients often hear the language of addiction when individuals speak of irresistible cravings, withdrawal symptoms when starting a diet, and increasing intake of palatable foods over time. But what does science show, and how strong is the evidence that food and addiction is a real and important phenomenon?  This presentation covers Dr. Gold’s extensive research over the years in understanding eating disorders and food addiction and diagnostic and treatment considerations.

    Lifestyle-Based Strategies for  Healing Depression
    Stephen Ilardi, PhD

    Despite a 300% increase in antidepressant use since the 1990s, the staggering toll of depressive illness keeps rising. As the research evidence keeps pouring in, a sad reality has come sharply into focus: medications alone do not deliver a complete and lasting recovery for the majority of depressed individuals who take them. Fortunately, modern neuroscience reveals that the way we live also has a profound impact on brain function, and myriad simple changes in lifestyle have shown a powerful ability to help heal depression. In this workshop, we will examine 7 lifestyle-based strategies that can be integrated into any depression treatment regimen.

    Making Decisions in the Face of Fear: Human Behaviors of “Yes” and “No”
    Julia Buckey, PhD

    For 25 years she has served individuals and families in inpatient and outpatient health and mental health settings at the direct, supervisory, and managerial levels.   She founded Decision Dynamics Consulting, Inc., Lake Mary, FL.  An award-winning researcher, published educator, and trainer of professional clinicians, she brings credibility and perspective to her work with the goal of building win-win environments based on mutual trust, respect, and understanding. 

    Examining the rationale behind fear as an element of decision-making, this workshop defines fear and then examines four (4) evidentiary behavioral responses to fear in the human quest for certainty in an uncertain world. Coupled with recent findings from neuroscience, therapists, counselors, and other helping professionals can use multiple tools to assess fear-based client behaviors indicating “yes” and “no” when making life-altering decisions.  

    Reel Grief: Effectively Counseling Clients Experiencing Loss
    Michael Kahn, LPC, JD

    Presents training workshops on ethics, grief, implicit bias, self-care and other topics for mental health professionals in the U.S. and abroad, including for the US military in Germany and Japan. He wrote the chapter “Saying Goodbye: Loss and Bereavement” in Cinemeducation, Volume 2: Using Film and Other Visual Media in Graduate and Medical Education. He is among the forefront in his field on the use of film in therapy and workshops. In his free time, Michael makes documentary films.

    Grief and loss are common therapeutic themes even though not always identified as such, particularly when non-death related. Elizabeth Kubler-Ross and her five stages were long held up as the standard model for working through grief and loss. Fortunately, “one size fits all” models no longer are the standard.  We will discuss new ways to describe the impact that grief has on our clients, including discussions on resilience and posttraumatic growth. We will also identify interventions using the visual arts and film. We will watch clips from theatrical films to illustrate and expand on the issues.

    4:00–5:30pm - Concurrent Workshops
    Intoxicated by Love—It’s the New Drug
    Dug McGuirk

    He is an accomplished entrepreneur, musician, producer and inspirational speaker. He ran his own production company for 10 years, was a partner in an international hardware and software computer company, toured the United States as musician and a top speaker/trainer for Tony Robbins. He was a contributing author in the book Multiple Streams of Inspiration and a Master Practitioner and Trainer of NLP (neuro linguistic programming) and certified in Neo Ericsonian Hypnosis. Dug serves as VP of Training and Development for Palm Healthcare in Delray Beach Florida.

    An interactive workshop unpacking a model for how we experience and process love and other emotions. Through this experiential workshop participants will walk away with new tools to work with clients and on themselves. We will uncover our values and rules that create our model of the world in the context of Love and Relationships.

    Experiential Therapy with PTSD/Addiction Clients
    Judy Crane, LMHC, CAP

    Experiential therapy in its many forms is an exciting aspect of treatment that allows the client to create new ways of coping with and handling their trauma and addiction(s).  Experiential Therapy provides a framework for catharsis, or release, of stored visceral memory, often trauma memory.  Experiential techniques can achieve a deeper level of resolution as the therapy moves beyond the cognitive and into both emotional and spiritual states allowing a client to create a healthier sense of self and a more refined and mature ego state as the result of this depth of work. The participant will see and experience a variety of therapies that create new and synergistic healing for trauma survivors and addicts. Presented will be aspects of a number of these therapies that the participant will be able to utilize in their own practice and expand the strategies and metaphors that clinicians use in their work helping clients heal.

    Reel Diversity: Recognizing Personal Bias and Deepening Your Cultural Humility
    Michael Kahn, LPC, JD

    In this workshop we will explore how the therapist’s cultural identity, background and past experiences can affect interactions with people who are different from them in various ways, including and especially their clients. We will discuss bias as it applies to many “categories,” such as race, gender, religion, sexual orientation, age and physical condition. Of course, the goal of this workshop is not to eliminate biases, an impossible task, but to increase awareness of them so that they do not interfere with the client’s progress. Multiple film and video clips will be used to illustrate the issues .

    “What Can I Do?”: Strategies to Minimize Medical Errors
    *(Please note this Medical Errors session will extend until 5:50 pm to meet License Requirements)
    Julia Buckey, PhD, ACSW
    This course examines medical errors (ME), its causes and methods used to reduce and prevent medical errors in medical/health and mental health settings. From describing the impact of ME on patient health and safety, the course examines the root-cause analyses (RCA) process and its use and presents effective communication and education methods targeting improvement in professional and healthcare organizational practices to enhance and contribute to patient safety. It further identifies the range of consequences experienced by health/mental health professionals causing medical errors.

    5:30pm Monday Evening
    Reception and Networking Overlooking the Beach

    8:00–8:45am Continental Breakfast Sponsored by American Addiction Centers
        
    9:00–10:00am    
    Effective Trauma Treatment: A Review of the Latest Evidence
    Christine Courtois, PhD, ABPP

    Recently retired from Private Practice in Washington DC, Dr. Courtois had specialized in the treatment of trauma, particularly for adults experiencing the effects of childhood incest and other forms of sexual, physical and emotional abuse. She has worked with these issues for 30 years and has developed treatment approaches for complex post traumatic and dissociative conditions for which she has received international recognition. Past President of Division 56 (Psychological Trauma) of the American Psychological Association and a Founding Associate Editor of the Division’s journal, Psychological Trauma: Theory, Research, Practice, & Policy, she has recently served as Chair of the APA Clinical Practice Guidelines for PTSD in Adults and Professional Practice Guidelines for the treatment of Complex PTSD for the APA Division 56 and for the International Society for the Study of Trauma and Dissociation. Co-author of The Treatment of Complex Trauma and co-editor of Treating Complex Trauma: Scientific Foundations and Therapeutic Models and Treating Complex Trauma in Children and Adolescents, all with Dr. Julian Ford, and a number of other books on trauma treatment.

    No clinical area has undergone more rapid development or benefited more from new research than the field of psychological trauma. The veritable flood of information had made it virtually impossible for therapists to stay on top of all the current research and clinical writing, learn about newest findings and techniques, investigate controversies and debates, and sort out results that matter from those that don’t. This keynote is an opportunity to examine the clinical implications of the latest evidence. It includes an overview of the recommendations of the Clinical Practice Guidelines of various organizations and discusses other issues in trauma treatment, including the role of clinical judgment and competence.

    10:30–11:30am    
    Mindfulness and Recovery: Quenching the Thirst for Wholeness
    Rokelle Lerner

    An international speaker and trainer on addiction, trauma and women’s issues. She is the Senior Clinical Advisor for Crossroads Centre Antigua.  For the past eighteen years Rokelle has been the co-founder and clinical director of Spring Workshops in London, UK. She was also co-founder of Children Are People, Inc., a program used in thousands of schools throughout the US and Europe. Recipient of numerous awards for her work including Esquire magazines “Top 100 Women in the US Who are Changing the Nation” and the National Association of Children of Alcoholic’s Lifetime Achievement Award. She is the author of several books including The Object of My Affection is in My Reflection: Coping with Narcissists and the recently released Inkspirations for Recovery: A Coloring Companion Celebrating Recovery.  

    The thirst for alcohol can be compared to men and women’s thirst for wholeness and a hunger for the sacred. One often self-medicates in an effort to escape the present moment, numb their pain or avoid the “void” in their soul. Unfortunately the inability to be in the present moment doesn’t change because someone went to treatment. This lecture will explore the topic of mindfulness in recovery and offer tools that will allow recovering addicts to embrace their birthright of serenity and wellbeing.

    11:30–12:30pm    
    Slipping Through The Cracks:  Intervention Strategies For Clients With Multiple Addictions And Disorders
    Mark Sanders, LCSW, CADC

    His most recent book is Slipping Through the Cracks: Intervention Strategies for Clients with Multiple Addictions and Disorders. He is a lecturer at the University of Chicago and conducts a private practice. Mark provides trainings nationwide to audiences of mental health clinicians and addiction counselors.

    Many chemically dependent clients have multiple addictions and disorders, which, if unaddressed, lead to chronic recidivism. They include hidden psychiatric disorders, unresolved trauma, unresolved grief, and process addictions, including sex, relationships, romance, gambling, shopping, and religion. In this presentation participants will leave with strategies that will help them effectively address multiple addictions and disorders common among chemically dependent clients.

    2:00–3:30pm  - Concurrent Workshops
    15 Strategies for Engaging the Most Difficult-To-Reach Clients With Substance Use Disorders
    Mark Sanders, LCSW

    Participants will leave this workshop with tools that will enable them to increase programmatic retention, decrease premature termination, and facilitate change more effectively with difficult-to-reach clients with substance use disorders. A partial list of topics includes: The Use of Naturally Therapeutic Qualities to Engage Difficult-to-reach Clients in Treatment; 6 Strategies for Engaging Clients in the First Five Minutes of Contact; How to Turn a Mandated Client into a Voluntary Client; 15 Strategies for Engaging Clients with Substance Use Disorders in Counseling; Strategies to Ensure that Countertransference Does Not Impact Client Engagement; and much more!

     “Good Enough” Endings*: Termination Issues in Psychotherapy
    Christine Courtois, PhD ABPP

    Just as “good enough” beginnings are important attachment relationships, so are “good enough” endings. In psychotherapy, endings can occur for a wide variety of reasons, among them, the client’s circumstances and wishes, forces outside of the treatment (agency policies, insurance reimbursement), and changes in the therapist’s circumstances, including illness/disability/death, location changes, and retirement. Therapists might also end a therapy prematurely and unilaterally if he or she determines the work is not going well, the client is not making progress or is unmotivated to change, or the therapist does not have the necessary competence to treat. Endings can occur on a planned or unplanned basis, and whatever the case, there are strategies for the therapists to consider and have in place before their occurrence. Endings are also affected by the length of treatment and the therapist’s orientation. Above all else, professional standards require that therapists not abandon their clients. A planned termination that is discussed and prepared for and that provides closure to the process is obviously preferred. This presentation is designed to address many issues that arise as psychotherapy ends, including attention to the effect on the therapist. We will discuss risk-management issues as well as practical ways to approach endings in ways that are good enough for therapist and client. *Title of book edited by Jill Salberg.

    Ethical and Professional Issues for Therapists: Reel Therapy 1
    Michael Kahn, LPC, JD

    Research has shown that a significant factor leading to successful clinical outcomes is the therapeutic relationship. The primary tool we have toward developing that relationship is ourselves. The challenge is in deciding whether or how much of ourselves to bring to any given therapeutic moment. This session will focus on the differences between boundary violations and crossings using entertaining and provocative film clips. Issues discussed will include self-disclosure, dual relationships and touch.

    From Disempowerment to Healthy Relationships: A New Paradigm for Recovery
    Rokelle Lerner

    In order to move from reactivity to integrity in relationships, couples need to remain connected to their courage, truth and power without being consumed by another. This workshop will provide a different look at how couples become distracted by their partners instead of allowing the ‘best’ of themselves to come forward in their relationships. Drawing on the work of Gottman, Schnarch, Perel and others, this lecture will move beyond description of the problem and show a new paradigm of relational recovery.

    4:00–5:30pm  - Concurrent Workshops
    Interfacing Reality Therapy and Mindfulness: Practical Demonstrations
    Robert Wubbolding, EdD, LPCC

    Psychologist, internationally known teacher, author of 13 books and practitioner of Reality Therapy, has taught choice theory and reality therapy in the United States, Europe, Middle East, Africa and Asia. He also served as Director of Training for the William Glasser Institute for 23 years.

    This practical presentation shows the connectedness between mindfulness and reality therapy. The WDEP (Wants, Direction, Evaluation, Plan) system of reality therapy and the principles of mindfulness interconnect in concrete ways. Simulated role-play demonstrations will illustrate the relationship between these two systems.

    Reel Therapy 2: More Ethical and Professional Issues for Therapists
    Michael Kahn, LPC, JD

    As with Reel Therapy 1, this workshop will discuss ethical and professional issues using entertaining and provocative film clips. Issues discussed will include managing termination and self-care as an ethical mandate.

    Relational Healing for Relational Injury in the Treatment of Complex Trauma
    Christine Courtois, PhD, ABPP

    Individuals with histories of early, severe childhood abuse and neglect and those who suffer extreme and cumulative forms of interpersonal trauma experience a wide range of difficulties, now referred to as complex trauma. These difficulties often have their origins in disturbed and disrupted primary attachment relationships, abuse and neglect within these relationships, and the additive effects of multiple experiences of trauma. These, in turn, cause considerable psychological damage, both personally and interpersonally.  A therapeutic relationship is a primary intervention and context for distress of this sort, offering a secure base from which to examine and rework attachment difficulties, process the trauma, learn essential life and relational skills, and increase the capacity necessary for constructive relationships; however, developing a therapeutic relationship with complex trauma patients offers numerous challenges. This presentation will identify relational issues that arise in the treatment of this population and strategies for their identification and management. Ethics within the therapy relationship, vicarious trauma and countertransference responses and posttraumatic growth in the therapist will be discussed.

    Moving from Perfection to Excellence in the Clinical Relationship
    Mark Sanders, LCSW, CADC

    This topic focuses on the fact that many clients have been given the message since childhood, through their family, school, religion, and the media, that you have to be perfect. They either numb themselves through self-harming behavior, drugs, etc., or procrastinate, because perfection is impossible. The workshop focuses on how to help clients move beyond perfection and offers suggestions for clinicians who also have a tendency toward perfection and who become frustrated if their clients do not progress quickly enough.  

    7:00–8:30pm Tuesday Evening
    Wisdom Recovery & Heart Reconnection Therapy
    Mary Faulkner, MA

    A pioneer in the field of mind and body healing as a teacher and psychotherapist in private practice for the last 30 years. Mary is a co-founder of Integrative Life Center in Nashville and the originator of Hypnotherapy for Healing Trauma and she certifies therapists in its use. She has published eight books in the topics of spirituality and recovery and is coordinating the book for Heart Reconnection Therapy.

    Holly Cook, LPC
    Holly brings 25 years’ experience in the addictions and mental health fields to the Integrative Life Center. She received trainings over the years with several “masters” including Jay Haley, Chloe Madanes, Luigi Boscolo and William Glasser. Holly has managed several programs and received numerous awards for her leadership in the U.S. and Germany, and has provided training on various topics such as trauma and addiction, Motivational Interviewing, adolescent development and treating adolescent substance abuse, developing trauma-informed services and creating effective treatment systems for women on welfare.

    A ceremonial circle honoring our wisdom and longing for deeper connection on the healing journey we are walking together. This special evening gathering is a time to come together as community and share the skills that nurture life and healing. Drawing from a variety of traditions and modalities, we will engage in conversations and ritual designed to open our hearts and minds to a new way of experiencing ourselves, others, and life itself.

    9:00–10:00am   
    Two-Eyed Seeing: Integrating Indigenous Knowledge with Brain Science for Psychotherapy.
    Lewis Mehl-Madrona, MD, PhD

    Graduated from Stanford University School of Medicine and trained in family medicine, psychiatry, and clinical psychology.  He has been studying traditional healing and healers since his early days and has written about their work and the process of healing.  His goal is to bring the wisdom of indigenous peoples about healing to transform medicine and psychology.  He has been on the faculty of several medical schools.  He is the author of Coyote Medicine, Coyote Healing and Coyote Wisdom, a trilogy of books on what Native culture has to offer the modern world. His most recent book, with Barbara Mainguy, is Remapping Your Mind: the Neuroscience of Self-Transformation through Story. 

    Throughout the world, indigenous people are becoming educated and entering into the modern world. Initially, the only choice available was to accept conventional academic explanations despite their being contradictory with indigenous perspectives.  A new idea of explanatory pluralism is emerging which allows the indigenous perspective to co-exist with Western scientific ideas.  Within psychotherapy, brain science is converging with the indigenous perspective in such areas as speaker-listener neurocoupling, the audience effect, social brain theory and the importance of community, the dialogical self with the Lakota concept of the nagi, the interconnectedness of everything through rhythm with the dendritic gap junction coherence theory of consciousness.  We will explore how both sides can further enrich the other for the practice of psychotherapy.

    10:30–11:30am    
    Neurobiology of Addiction for Counselors
    Howard Wetsman, MD

    The New Orleans-based, Chief Medical Officer for Townsend Addiction Treatment Centers and author of QAA: Questions and Answers on Addiction. He is Board Certified in General Psychiatry and certified in Addiction Medicine by the American Board of Addiction Medicine. Dr. Wetsman is a Clinical Assistant Professor at LSU School of Medicine and a frequent lecturer on topics including Genetics and Addiction and the Neurobiology of Addiction. 

    Addiction has been historically seen as a moral failing, a weak will or even long term damage from substance use. Models of the biology of addiction have been able to explain parts of the addiction and recovery experience, but to date, none of these models have been able to predict all the phenomena seen. Dr. Wetsman will present a biological model of addiction, consistent with the ASAM definition that explains, among other things, why some people need medical treatment and some do not. Other phenomena explained include Most Effective Reward, effect of social interactions, medications for MAT, and many others.

    11:30–12:30pm   
    What “Expert” Psychotherapists Do:  A Take Home TO DO List
    Don Meichenbaum, PhD

    Distinguished Professor Emeritus, University of Waterloo, Ontario, Canada, and Research Director, The Melissa Institute of Violence and Prevention and the Treatment of Victims of Violence, Miami, FL, author of Roadmap to Resilience.

    Research indicates the equivalence of various treatment approaches, while some psychotherapists obtain significant better lasting treatment outcomes. This presentation will provide a practical user-friendly description of what “expert” psychotherapists do that you can use right away in your clinical work.

    2:00–3:30pm  - Concurrent Workshops
    Remapping the Mind
    Lewis Mehl Madrona, MD, PhD and Barbara Mainguy, MA

    Her main interests include doing psychotherapy with people who have been diagnosed as psychotic, working with people who are having chronic pain, and exploring the interface between art and psychotherapy and healing.  She has written a book with Lewis Mehl-Madrona, entitled Remapping Your Mind: the Neuroscience of Self-Transformation through Story.

    In the Lakota worldview, our identity is formed by a swarm of all the stories that have influenced us coupled with bits of the tellers of those stories, centered on our bodies, called the nagi. This worldview is similar to the dialogical self-theory of Hubert Hermans. In our approach to psychotherapy, we make maps of the stories and their tellers to help us understand the dialogue occurring within our minds. We identify the stories being told and who is telling them so as to understand our internal conflicts, anxieties, and stresses.  We make visual representations of the stories and their tellers.  Then we facilitate a change or re-mapping by strengthening some characters, adding new characters and stories, and forming coalitions among characters.

    Family Therapy Updated for the Digital Age: Understanding the Role of Social Media and Digital Technology in the Lives of Our Clients
    Robert Weiss, LCSW, CSAT-S

    Author, international lecturer, and expert on the relationship between digital technology and human sexuality; Senior Vice President of Clinical Development with Elements Behavioral Health; founder of Sexual Recovery Institute, Los Angeles. He is an author and media expert who has appeared on CNN, The Oprah Winfrey Network, Dr. Drew, and the Today Show. Author of Sex Addiction 101: A Basic Guide to Healing from Sex, Porn and Love Addiction and the upcoming Out of the Doghouse (HCI Books Jan 2017).

    While much fear and hype has been created in the past decade by well-meaning clinicians and the media, the actual role and effect of digital media on American family life has yet to be fully understood and researched. So what can a useful, caring counselor or therapist offer today to families struggling with issues such as digital boundaries, cyberbullying and tech stressors, as well as problems like online gaming, gambling and sexuality? This timely, engaging talk, by a clinical thought leader and author of several books related to our evolving digital world and its’ effect on the therapy space, gives attendees a chance to revisit, reshape and challenge their beliefs about how digital technology is affecting family life, relationships, school and the workplace. Blending current research with historical references, this talk will provide clarity in an area where we clinicians sometimes feel under-informed or even downright confused.

    Ways to Enhance Compassion Toward Oneself and Others
    Don Meichenbaum, PhD

    Compassion is a positive emotion that enhances the recovery process from trauma exposure and victimization experiences. This presentation will consider a variety of intervention strategies designed to enhance compassion toward self, others, and where indicated, toward God. These strategies include forgiveness activities, gratitude exercises, loving-kindness meditation, engaging in meaning-making activities and altruistic behaviors. Specific interventions that address guilt, shame, anger, and moral injuries will be considered.

    Answering the Questions, “Why Do They Do What They Do?” and “What Can I Say to Them?”
    Robert Wubbolding, EdD, LPCC

    Participants will learn 5 human motivators that drive all behavior and how to help clients become more aware of the motivations. Dr. Wubbolding will demonstrate practical skills for intervening in an empathic and direct manner with emphasis on dealing with excuses and will explain the Cycle of Counseling.

    4:00–5:30pm - Concurrent Workshops
    Managing Depression: Raising Energy and Changing Cognitions
    Margaret Wehrenberg, PsyD

    Author of six books, including The 10 Best Ever Anxiety Management Techniques, The 10 Best Ever Depression Management Techniques, and Anxiety and Depression. She earned her M.A. studying psychodrama and bioenergetics, and has years of experience as a certified drug and alcoholism counselor, especially working with adults who were traumatized as children, before earning her PsyD and beginning a private psychotherapy practice, in Naperville, IL.

    Depression creates low physical and mental energy and those symptoms keep people stuck in a self-reinforcing state of depression. Thoughts and beliefs magnify the symptoms of hopelessness and helplessness. This session will focus on the therapy techniques that get clients moving out of depression and change the cognitions that keep them stuck.

    Facing Client Resistance with Paradoxical Techniques and the “Indirect Asset”
    Robert Wubbolding, EdD, LPCC

    The WDEP (Wants, Direction, Evaluation and Plan) system has incorporated paradoxical techniques and the Ericksonian principle “sometimes the solution seems to have nothing to do with the problem.” The presenter will demonstrate how to use paradoxical techniques and will discuss their ethical contraindications. He will also clarify with a demonstration the Ericksonian principle describe above which he calls the “indirect asset.”

    Ways to Treat Clients with Prolonged and Complicated Grief
    Donald Meichenbaum, PhD

    Following a significant loss, whether it is of a loved one or some other form of loss (financial or job loss, loss of property due to natural disasters, physical capacity due to injury, cultural or spiritual loss due to victimization), the severity of bereavement often subsides. In a minority of cases (10%–20%), some individuals evidence prolonged and complicated grief that interferes with their daily functioning. This presentation will consider what distinguishes this effected group and ways to assess and intervene at the individual, familial and community levels. A variety of interventions will be considered to help the bereaved to reengage and reconnect.

    Sex Addiction 101:  The Basics
    Robert Weiss, LCSW, CSAT-S

    In the real world, tens of thousands of men and women daily voluntarily choose to attend sexual addiction 12 step programs and related therapies. Yet in the clinical world, the DSM 5 does not acknowledge the issue (Hypersexual Disorder), while many consider it a joke, a form of social control or simply “an excuse” for bad behavior. This talk is designed to offer realistic, useful insight into the problem of compulsive/addictive porn use, infidelities and other sexual acting out (on and offline). The talk will provide insight into the process addictions, their treatment and the empathic insight required to view this problem for what it is—the adult expression of early complex trauma and attachment loss.

    Improv Therapy—You Gotta be Kidding!
    Margot Escott, LCSW

    She is a licensed clinical social worker with a private practice in Naples for 32 years. She is a graduate of NYU School of Social Work and has worked in a variety of healthcare settings­­—from psychiatric and addictions rehabs to hospice. Several years ago she began acting classes (a childhood dream). She was introduced to Improvisational Comedy and became hooked on Improv. She has been performing, teaching to youth and adults, giving workshops for community groups and healthcare settings on the art of Improv.

    Psychotherapists are recognizing the therapeutic benefits in applying life skills from Improv games to personal challenges. Improv Comedy is not about telling jokes or being funny. It is about being in the “here and now”, learning to listen and understanding that there is no “wrong way” to improvise. Everyone constantly needs to improvise when life throws curve balls. Improv Comedy techniques teach how to improvise in life, especially in dealing with daily anxieties.  Although this is an experiential workshop, participants are free to observe or join the games.


    7:00–9:00pm Wednesday Evening
    Out of the Doghouse: Healing Relationships Affected by Digital Infidelity
    Robert Weiss, LCSW, CSAT-S

    What defines cheating today in our age of webcams, online porn and “adult friend finder apps”? “Out of the Doghouse is designed to help attendees gain insight into the meaning and experience of relationship infidelity in the digital age-for both ‘cheater’ and spouse. Today, clinicians and hurting couples need new language and revised skillsets to get beyond 20th century, “analog-understandings” of cheating” to actively help such couples rebuild relationship trust. Sadly, those who repeatedly betray their deepest relationship commitments (online and in-person) are often both intimacy- and empathy-challenged, lacking the mature concrete insight and the related skills needed to help revitalize a wounded relationship. These tools are especially important, “after the affair” when anger and emotional instability tend to rule the roost. This talk provides a reset for professionals working with those acting out their needs and desires in a digital world, while offering new views toward addressing sexual and romantic acting out- via social media and the web. With new clarity regarding what defines ‘cheating’ today, we can help couples find the empathy, honesty and lasting behavior change required to grow relationship intimacy. This discussion will offer an overview of the problem along with specific empathy, and relationship rebuilding skills.

    8:45–10:15 am    
    The Purpose of Worry and How to Manage It
    Margaret Wehrenberg, PsyD

    Anxiety is a normal human emotion, but many people experience unnecessary distress from unrelenting worry. Unless a person knows how to handle life’s worries and prevent them from becoming an anxiety disorder, worry can dominate life and rob it of joy. Learn how to recognize and change unproductive worry, reduce its negative impact, and help people break free from anxious misery.

    10:30–12:00pm  - Concurrent Workshops
    The Ultimate Domestic Violence Training: Inside the Minds of Men Who Batter and the Women Who Love Them
    (Please note this Domestic Violence session will extend until 12:10pm to meet License Requirements.)
    Susan McMillan, LMHC, CAP
    Matt McMillan, JD

    Susan and Matt McMillan have been pioneers in the field of domestic violence and are the co-founders of Men’s Work and the Domestic Abuse Intervention Project, the first certified batterers’ intervention program in Florida. They have served as faculty of the Florida prosecuting Attorney’s Association, and have trained thousands of therapists, attorneys, probation officers and counselors across the state of Florida. Their batterers program has given over 10,000 men and women the tools to have healthy relationships based upon equality and respect. They over-see 7 licensed counseling offices, specializing in substance abuse and domestic violence.

    This program presents critical information about domestic violence in an unusual and exciting learning format. The award-winning husband and wife instructors (a former police officer, prosecutor and judge; and a former victim, licensed psychotherapist and jury trial consultant), will engage the audience by sharing their personal and professional experiences in a dynamic fashion that impresses a new-found understanding regarding the myths and realities of domestic violence, the confounding role of substance abuse, the children harmed through exposure, and how this tragic and perplexing interdependence within our society affects us all.

    The Anxious Brain: A Look at the Neurobiology and Treatment of Anxiety
    Margaret Wehrenberg, PsyD

    “It’s all in your head!” turns out to be a truer statement than anyone could have imagined before the availability of neurobiological research. In straightforward language, Dr. Wehrenberg will present recent findings on the neurobiological causes of anxiety disorders and the practical therapeutic applications of this research. You will be immediately able to apply this knowledge to improve your work with the behavior and cognitive symptoms of your anxious clients.

    DSM V at the Movies
    Margot Escott, LCSW

    There are many changes in the DSM V that are significant for therapists. Participants will understand three (3) major changes in DSM V from DSM IV related to Substance Abuse.  Through media examples participants will be able to identify three changes in DSM V substance abuse/addiction, gambling disorder and how these changes impact our field.

    Loading
    Loading
    Loading Login
    Loading

    Please login to access Handouts.

    What is the Training Institute on Behavioral Health and Addictive Disorders?

    It is a premier training event, specializing in the core issues facing the mental health and the addictions field. It is where a unique combination of nationally recognized faculty address a wide variety of today’s most relevant topics. The result is a highly acclaimed national training event featuring customized training opportunities for developing new treatment strategies and the sharing of research advances for clinicians and counselors.

    Program Focus and Goals

    US Journal Training, Inc. and The Institute for Integral Development present an exceptional combination of inspiring speakers and trainers, addressing today’s most relevant topics. This year’s Training Institute tackles the issues of behavioral health and addictions using an integrated approach which considers the complex emotional, social and spiritual dimensions of each individual. Trauma Treatment, Psychological Toxicity and Modern Life, Neurobiology and Addiction, Treating Depression, Co-occurring Disorders, Resilience, Neuroscience and Therapy, Expertise in Therapy, The Brain and Addiction, ethics, medical errors and other issues will be explored.

    Who Should Attend?

    Enjoy networking with those working in the areas of:

    • Mental Health
    • Addictions Counseling
    • Marriage and Family Therapy
    • Psychology
    • School Counseling
    • Registered Nursing
    • Courts and Corrections
    • Prevention
    • Employee Assistance
    • Pastoral Counseling
    • And Other Fields

     Participants will be able to:

    1. Identify treatment approaches and develop counseling skills for a range of issues in mental health, behavioral health, addictions and co-occurring disorders.

    2. Identify the neuropsychological and neurobiological underpinnings of addictive disorders, compulsive behaviors and other problematic behavior and the therapeutic implications of these findings.

    3. To discern symptoms and characteristics manifested in these addictive/behavioral disorders and to diminish/correct their negative impact on the client’s interpersonal and family relationships.

    4. Identify symptoms of trauma and PTSD and appropriate therapeutic treatment for these
    issues.

     Limited Number of Exhibit Spaces Available   


    For more information contact:

    Lorrie Keip Cositore  

    1-800-851-9100 x220
    lorriek@hcibooks.com

    Join Us on Clearwater Beach

    Conference Site
    Hilton Clearwater Beach Resort
    400 Mandalay Avenue, Clearwater Beach, FL  33767
    Phone: (727) 461-3222 or (800) 753-3954

    Spanning 10 acres along the Gulf of Mexico’s shimmering coastline, we invite you to discover the Hilton Clearwater Beach and indulge in a modern, vibrant setting for this conference. US Journal has reserved a block of rooms for registrants until January 12, 2017. There is a strong possibility that the room block will fill prior to that date. Room rates at the Hilton Clearwater Beach Resort are: $199.00 single/double (plus tax). Children under 18 are free. Reservations must be guaranteed with a credit card. For reservations contact the hotel directly. To receive conference rate mention hotel code IID (i–i-d).  Please be aware of hotel’s cancellation policy.

    Getting to Clearwater Beach
    From Tampa Airport: The Super Shuttle transportation  for the Hilton Clearwater Beach Resort is currently  $25.00 one-way or $46.00 round trip if booked on line ($28.00 and $52.00 if booked by phone). Prices are  subject to change. Call (800) 282-6817 or (727) 572-1111 to make reservations or you may also make reservations online at www.supershuttle.com  (24 hour advance notice is required for return to airport).

    Alternate Lodging  (2½ blocks from Hilton)
    Pier House 60 Clearwater Beach Marina Hotel
    101 Coronado Drive, Clearwater Beach, FL 33767
    Phone: (727) 683-0002 or toll free: (855) 859-2952
    Room rates are $189/night with parking of $10/day until January 11, 2017.  Rooms may sell out before this date. To reserve rooms, please contact Pier House 60 directly and mention USJ17.
    Faculty
    Julia Buckey, PhD, ACSW
    For 25 years she has served individuals and families in inpatient and outpatient health and mental health settings at the direct, supervisory, and managerial levels.   She founded Decision Dynamics Consulting, Inc., Lake Mary, FL.  An award-winning researcher, published educator, and trainer of
    Read More...
    Holly Cook, LPC
    Holly brings 25 years experience in the addictions and mental health fields to the Integrative Life Center. She received trainings over the years with several “masters” including Jay Haley, Chloe Madanes, Luigi Boscolo and William Glasser. Holly has managed several programs and received numerous awa
    Read More...
    Christine Courtois, PhD, ABPP
    Recently retired from Private Practice in Washington DC, Dr. Courtois had specialized in the treatment of trauma, particularly for adults experiencing the effects of childhood incest and other forms of sexual, physical and emotional abuse. She has worked with these issues for 30 years and has de
    Read More...
    Judy Crane, LMHC, CAP
    Her presentations and seminars on Trauma, Resilience, PTSD and sexual trauma resolution are widely known, and she has 3 decades of experience working in both residential and out-patient settings. In 2003 she created The Refuge-A Healing Place.  In 2008 Spirit2Spirit Healing was created offering
    Read More...
    Margot Escott, LCSW
    She is a licensed clinical social worker with a private practice in Naples for 32 years. She is a graduate of NYU School of Social Work and has worked in a variety of healthcare settings­­—from psychiatric and addictions rehabs to hospice. Several years ago she began acting classes (a childhood
    Read More...
    Mary Faulkner, MA
    Mary Faulkner, M.A., holds a master’s degree in Religious Education with a focus in Pastoral Counseling and Spiritual Direction. She is a pioneer in the field of mind and body healing as a teacher and psychotherapist in private practice for the last 30 years. Mary is a co-founder of Integrative Li
    Read More...
    Mark Gold, MD
    Mark Gold is a translational researcher, author and inventor best known for his work on the brain systems underlying the effects of opiate drugs, cocaine and food. He has published over 1000 peer reviewed scientific articles, texts, and practice guidelines, including citation classics in cocaine
    Read More...
    Stephen Ilardi, PhD
    Stephen Ilardi, PhD, has served on the faculties of the University of Colorado and (presently) The University of Kansas. The author of over fifty scholarly articles on mental illness, Dr. Ilardi is a nationally recognized expert on depression. He is the author of The Depression Cure: The Six-Step Pr
    Read More...
    Michael Kahn, LPC, JD
    Presents training workshops on ethics, grief, diversity, self-care and other topics for mental health professionals throughout the U.S. and abroad. He wrote the chapter “Saying Goodbye: Loss and Bereavement” in Cinemeducation, Volume 2: Using Film and Other Visual Media in Graduate and Medical Educa
    Read More...
    Rokelle Lerner
    An international speaker and trainer on addiction, trauma and women’s issues. She is the Senior Clinical Advisor for Crossroads Centre Antigua. For the past eighteen years Rokelle has been the co-founder and clinical director of Spring Workshops in London, UK. She is also co-founder of Children Are
    Read More...
    Barbara Mainguy, MA
    Her main interests include doing psychotherapy with people who have been diagnosed as psychotic, working with people who are having chronic pain, and exploring the interface between art and psychotherapy and healing.  She has written a book with Lewis Mehl-Madrona, entitled Remapping Your Mind:
    Read More...
    Dug McGuirk
    He is an accomplished entrepreneur, musician, producer and inspirational speaker. He ran his own production company for 10 years, was a partner in an international hardware and software computer company, toured the United States as musician and a top speaker/trainer for Tony Robbins. He was a co
    Read More...
    Matt McMillan, JD
    Susan and Matt McMillan have been pioneers in the field of domestic violence and are the co-founders of Men’s Work and the Domestic Abuse Intervention Project, the first certified batterers’ intervention program in Florida. They are Board approved continuing education providers, have served as facul
    Read More...
    Susan McMillan, LMHC, CAP
    Susan and Matt McMillan have been pioneers in the field of domestic violence and are the co-founders of Men’s Work and the Domestic Abuse Intervention Project, the first certified batterers’ intervention program in Florida. They are Board approved continuing education providers, have served as facul
    Read More...
    Lewis Mehl-Madrona, MD, PhD
    Graduated from Stanford University School of Medicine and trained in family medicine, psychiatry, and clinical psychology.  He has been studying traditional healing and healers since his early days and has written about their work and the process of healing.  His goal is to bring the wisdom of i
    Read More...
    Donald Meichenbaum, PhD
    Distinguished professor emeritus, University of Waterloo, Ontario, Canada, from which he took early retirement 17 years ago. Dr. Meichenbaum is presently research director of the Melissa Institute for Violence Prevention, Miami, Florida. He is one of the founders of cognitive behavior therapy. In a
    Read More...
    Mark Sanders, LCSW, CADC
    Mark Sanders, LCSW, CADC, is an international speaker in the behavioral health field whose presentations have reached thousands throughout the United States, Europe, Canada, and the Caribbean Islands. He is coauthor of Recovery Management and author of Relationship Detox: How to Have Healthy Relatio
    Read More...
    Margaret Wehrenberg, PsyD
    Author of The Anxious Brain, The Neurobiological Basis of Anxiety Disorders and How to Effectively Treat Them, The 10 Best-Ever Anxiety Management Techniques, The 10 Best-Ever Depression Management Techniques and The 10 Best-Ever Anxiety Management Techniques Workbook. She earned her M.A. studying p
    Read More...
    Robert Weiss, LCSW, CSAT-S
    Robert Weiss LCSW, CSAT-S is a digital-age intimacy and relationships expert specializing in infidelity and addictions—in particular sex, porn, and love addiction. An internationally acknowledged clinician, he has served as a subject expert for multiple media outlets including The Oprah Winfrey Netw
    Read More...
    Howard Wetsman, MD
    The New Orleans-based, Chief Medical Officer for Townsend Addiction Treatment Centers and author of QAA: Questions and Answers on Addiction. He is Board Certified in General Psychiatry and certified in Addiction Medicine by the American Board of Addiction Medicine. Dr. Wetsman is a Clinical Assistan
    Read More...
    Robert Wubbolding, EdD, LPCC
    Psychologist, internationally known teacher, author of 13 books and practitioner of Reality Therapy, has taught choice theory and reality therapy in the United States, Europe, Middle East, Africa and Asia. He also served as Director of Training for the William Glasser Institute for 23 years.
    Read More...

    Board Approvals

    Professional Credits:

     

     A maximum of 24 contact hours are available for this conference. 21 core credit hours (6 hours for M, T, W, 3 hours for Th) and 1.5 optional evening hours for Tuesday’s Evening Session and 1.5 optional evening hour for Wednesday Evening’s session.  This training includes 3 hours of Ethics and Boundaries and 2 hours of Medical Errors. (This Medical Errors course is approved by State of Florida Agency for Health Care Administration for Mental Health Counselors, Clinical Social Workers and Marriage Family Therapists but not for Florida Board of Psychologists.)

    American Psychological Association (APA)
    Psychologists: U.S. Journal Training, Inc. is approved by the American Psychological Association (APA) to sponsor Continuing Education for psychologists. U.S. Journal Training, Inc. maintains responsibility for this program and its content. APA meets requirements for MCEP/CA psychologists.

    Association of Social Work Boards Approved Continuing Education (ACE)
    US Journal Training, Inc., #1143 is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB www.aswb.org through the Approved Continuing Education (ACE) Program. US Journal Training, Inc., maintains responsibility for the program. ASWB approval period: 12/5/16-12/5/18. Social workers should contact their regulatory board to determine course approval for continuing education credits.

    California Board of Behavioral Sciences (CBBS)
    California Board of Behavioral Sciences Provider #PCE 78—Course meets the qualifications for 24 hours of continuing education credit for MFTs and/or LCSWs as required by the CA Board of Behavioral Sciences.(not exceeding maximum credit hours for the conference).

    California Consortium of Addiction Programs and Professionals (CCAPP-E1)
    California Consortium of Addiction Programs and Professionals, Provider approved by CCAPP-E1. Provider number OS-86-057-0518 FOR 24CEHs.

    Canadian Addiction Counselors Certification Federation (CACCF)
    Canadian Addiction Counselors Certification Federation (CACCF).

    EAP Association/EACC Program
    EAP Association/EACC-program approved for PDHs not exceeding maximum credit hours for the conference.

    Florida Board of Nursing
     Florida Board of Nursing. Provider #50-2076

    Florida Certification Board
     Florida Certification Board, Inc. Provider #17A.

    Florida Board of Clinical Social Work, Marriage/Family Therapy and Mental Health Counseling
    State of Florida Agency for Health Care Administration for Mental Health Counselors, Clinical Social Workers and Marriage/Family Therapists. Provider #50-2076.

    National Association of Alcoholism and Drug Abuse Counselors (NAADAC)
    National Association of Alcoholism and Drug Abuse Counselors (NAADAC). Approved Education Provider Program #10069.

    National Board for Certified Counselors (N0. 5130)
    U.S. Journal Training, Inc. has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5130. Programs that do not qualify for NBCC credit are clearly identified. US Journal Training Inc. is solely responsible for all aspects of the programs.

    Full-Time conference attendees who complete all required evaluation and attendance documentation are eligible to receive the maximum number of contact hours. Daily registrants can receive credit for each day in attendance.
     
    Note: If you are seeking continuing education credit for a specialty not listed above, it is your responsibility to contact your licensing/certification board directly to determine eligibility of this training to meet your CEU requirement.
     
     ADA accommodations will be made in accordance with the law. If you require ADA accommodations, please indicate your needs by January 10, 2017. We cannot ensure the availability of appropriate accommodations without prior notification.


    Full-Time Registration (February 13-16, 2017)
    up to 21 hours
    Tuition: $465.00
    Register Now Group Registration

    Daily Registration Mon, February 13, 2017
    6 core CEs
    Tuition: $170.00
    Register Now Group Registration

    Daily Registration Tues, February 14, 2017
    6 core CEs
    Tuition: $170.00
    Register Now Group Registration

    Daily Registration Wed, February 15, 2017
    6 core CEs
    Tuition: $170.00
    Register Now Group Registration

    Daily Registration Thurs, February 16, 2017
    3 core CEs
    Tuition: $90.00
    Register Now Group Registration


    Early Registration Rate:
    Registrations received or processed by midnight (EST) January 16, 2017 will qualify for the early rate. (EXTENDED)

    Group Discount:
    Groups of TWO or MORE registrations, entered on one order, receive a 10% Discount per registration! This offer applies to conference registrations only and cannot be combined with other discounts/coupon offers.

    REGISTRATION POLICIES: Check, credit card information or agency purchase order must be attached to this registration form. All registration fees are refundable, less a $50.00 processing fee, when requests for cancellation are submitted in writing and postmarked by January 24. No refunds are available after January 24.
     
    Other ways to register:

    By Phone: 800-441-5569 or 954-360-0909. Please have your MC/Visa/AMEX number ready. (Business Hours are M-F, 8:30 am - 5:00 pm ET)

    By Fax: 954-360-0034. Registration by fax requires credit card information or agency purchase order accompanied by a completed registration form. Get Registration Form: Include MC/Visa, AMEX number, exp. date, security code and signature.

    By Mail: Registration by mail requires check, credit card information or agency purchase order accompanied by a completed registration form. Get Registration Form Please make checks payable to: U.S. Journal Training, Inc.

    Mail to:
    U .S. Journal Training/Clearwater Beach
    3201 SW 15th St
    Deerfield Beach, FL 33442-8190

    When you provide a check for payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day you make your payment, and you will not receive your check back from your financial institution. For inquiries please call 954-360-0909.

    Your name and address will be added to our mailing list unless otherwise requested.

    ADA accommodation will be made in accordance with the law. If you require ADA accommodations, please indicate your needs no later than 5 weeks prior to the conference start date, USJT phone 800-851-9100. We cannot ensure the availability of appropriate accommodations without prior notification.