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Psychiatry/Mental Health

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Team Dynamics During Patient Escalation

Nationwide Children's Hospital

Riley is a young patient who is experiencing agitation while in the emergency department. The case will revolve around managing their agitation through team-based approach.

Emergency Medicine Internal Medicine Psychiatry/Mental Health

Riley is a young patient who is experiencing agitation while in the emergency department. The case will revolve around managing their agitation through team-based approach.

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider
Specialty: Emergency Medicine, Internal Medicine, Psychiatry/Mental Health
Author: Nationwide Children's Hospital
Language: English
Room size: 12x12
Setting: Emergency Department
Patient ect:
Patient Gender: Female, Male
Tags: agitation management, closed-loop communication, communication skills, De-escalation, emergency department, emergency response, patient escalation, role delegation, team dynamics, teamwork in healthcare,

Virtual Manikin™ — Outpatient Soft Skills

SimX

The moderator has options to choose the setting location and the virtual manikin patient. Moderator can choose patient diagnosis, treatment, and will have control over the patient's physiology throughout the scenario. The conditions available are obesity, traumatic brain injury, language disorders, Parkinson’s disease, hearing loss, type 2 diabetes, and malnutrition.

Advanced EMT Community/Public Health Emergency Medicine EMT Fundamentals Internal Medicine Neurology Paramedic Psychiatry/Mental Health

The moderator has options to choose the setting location and the virtual manikin patient. Moderator can choose patient diagnosis, treatment, and will have control over...

Case Information:
Bundles:
Learner Population: Nursing, EMS/Prehospital, Physician/Advanced Practice Provider, Social Worker
Specialty: Emergency Medicine, Internal Medicine, Neurology, Advanced EMT, Community/Public Health, EMT, Fundamentals, Paramedic, Psychiatry/Mental Health
Author: SimX
Language: English
Room size: 16x16
Setting: Outpatient Clinic, Other
Patient ect:
Patient Gender: Female, Male
Tags: ambulatory care, communication skills, diabetes management, healthcare simulation, outpatient care, Parkinson's disease, patient assessment, soft skills training, traumatic brain injury, Virtual Manikin,

Difficult Client

Georgian College

You are meeting with Michael on a one-to-one basis after he has just received some unexpected news that he will be remaining in the hospital, involuntarily.

Emergency Medicine Family Medicine Internal Medicine Leadership Psychiatry/Mental Health

You are meeting with Michael on a one-to-one basis after he has just received some unexpected news that he will be remaining in the hospital,...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider, Social Worker
Specialty: Emergency Medicine, Internal Medicine, Family Medicine, Leadership, Psychiatry/Mental Health
Author: Georgian College
Language: English
Room size: 20x20
Setting: Other
Patient ect:
Patient Gender: Male
Tags: client interactions, communication, De-escalation, escalating patient behaviors, safety precautions, setting limits,

De-escalation of Agitated Patient

College of St. Scholastica

30-year-old female named Eleanor is found in the community agitated and brought to the emergency department by EMS. Medical history is unknown. The RNs and APRNs will work together with an interdisciplinary approach to de-escalate the client.

Emergency Leadership Psychiatry/Mental Health

30-year-old female named Eleanor is found in the community agitated and brought to the emergency department by EMS. Medical history is unknown. The RNs and...

Case Information:
Bundles:
Learner Population: Nursing
Specialty: Emergency, Leadership, Psychiatry/Mental Health
Author: College of St. Scholastica
Language: English
Room size: 17x17
Setting: Emergency Department
Patient ect:
Patient Gender: Female
Tags: communication, De-escalation, interdisciplinary team,

EMS Combative—Suicidal Intent

VALOR Program

Learner arrives on-scene to find a 40-year-old female patient with a history of PTSD who is intoxicated and expressing both suicidal and homicidal ideation. The patient refuses to talk to police at the beginning of the case. Police ask the EMS providers to help convince the patient to be transported...

Emergency Medicine Psychiatry/Mental Health

EMS Combative—Suicidal Intent

EMS Bundle

Learner arrives on-scene to find a 40-year-old female patient with a history of PTSD who is intoxicated and expressing both suicidal and homicidal ideation. The...

Case Information:
Bundles: EMS Bundle
Learner Population: EMS/Prehospital, Physician/Advanced Practice Provider, Social Worker
Specialty: Emergency Medicine, Psychiatry/Mental Health
Author: VALOR Program
Language: English
Room size: 16x14
Setting: Ambulance, Home
Patient ect:
Patient Gender: Female
Tags: Alcohol Intoxication, De-escalation, EMT, Firearm Safety, Homicidal Ideation, Military, Paramedic, psychiatric, psychiatry, ptsd, scene safety,

Non-Fatal Suicide Attempt in an Adult

Southeastern Illinois College

A 20 year-old female is admitted to a psych unit from the ED with a diagnosis of suicide attempt and depression. She is accompanied by her mother. Initially, the participant should perform a mental health assessment for a client in a short-term mental health setting, exhibit professional caring attitude, and...

Emergency Medicine Family Medicine Internal Medicine Interprofessional Psychiatry/Mental Health

A 20 year-old female is admitted to a psych unit from the ED with a diagnosis of suicide attempt and depression. She is accompanied by...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider, Social Worker
Specialty: Emergency Medicine, Internal Medicine, Family Medicine, Interprofessional, Psychiatry/Mental Health
Author: Southeastern Illinois College
Language: English
Room size: 14x13
Setting: MedSurg
Patient ect:
Patient Gender: Female
Tags: anxiety, college age, Depressions, mental health, mental health assessment, mood disorder, overdose, personality disorder, substance abuse, suicidal ideation, suicide attempt, therapeutic communication, wound care,

Interprofessional Gender-Affirming Care in an Adult

George Mason University

Katarina Washington an African American, 18-year-old, female came to the clinic complaining of irregular heartbeat, feeling faint, and overall fatigue. Katarina hesitantly admits she hasn’t eaten much in the last three days because she’s been sleeping in a friend’s car after being “kicked out” of the house. The RN notices...

Cardiac/Telemetry Community/Public Health Family Medicine Internal Medicine Interprofessional Psychiatry/Mental Health SDOH

Katarina Washington an African American, 18-year-old, female came to the clinic complaining of irregular heartbeat, feeling faint, and overall fatigue. Katarina hesitantly admits she hasn’t...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider, Social Worker
Specialty: Internal Medicine, Cardiac/Telemetry, Community/Public Health, Family Medicine, Interprofessional, Psychiatry/Mental Health, SDOH
Author: George Mason University
Language: English
Room size: 15x13
Setting: Outpatient Clinic
Patient ect:
Patient Gender: Transgender
Tags: anxiety, BPSS, depression, Dietetics, GAD-7, Gender-Affirming Care, Nutrition, PHQ-9, Social Work, Transgender,

Workplace Violence & De-escalation

George Mason University

You are a hospital employee who receives a handover of care. Shortly after walking into your patient’s room, you see a relative standing near the bed who starts to get annoyed and angry. You and other hospital employees are asked to help. Formerly Known As: VR Interprofessional Simulation Training on...

Cardiology Critical Care Emergency Medicine Family Medicine Internal Medicine Interprofessional Leadership OB/GYN Psychiatry/Mental Health

You are a hospital employee who receives a handover of care. Shortly after walking into your patient’s room, you see a relative standing near the...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider, Social Worker
Specialty: Cardiology, Critical Care, Emergency Medicine, Internal Medicine, OB/GYN, Family Medicine, Interprofessional, Leadership, Psychiatry/Mental Health
Author: George Mason University
Language: English
Room size: 15x15
Setting: MedSurg
Patient ect:
Patient Gender: Female
Tags: communication, De-escalation, non-verbal cues, OODA loop, verbal cues, verbal techniques, Workplace Violence,

Social Determinants of Health Bundle

SimX

This bundle focuses on the holistic approach to patient care, concentrating on the social determinants of health and health equity. Through these virtual patient encounters, learners experience various scenarios that highlight the complex social, environmental, and psychological factors affecting patient health. Each scenario is meticulously crafted to challenge the learner...

Cardiac/Telemetry Cardiology Community/Public Health Critical Care Emergency Medicine Internal Medicine Neurology OB/GYN Pediatrics Psychiatry/Mental Health SDOH Surgery Trauma

Social Determinants of Health Bundle

Social Determinants of Health

This bundle focuses on the holistic approach to patient care, concentrating on the social determinants of health and health equity. Through these virtual patient encounters,...

Case Information:
Bundles: Social Determinants of Health
Learner Population: Nursing, Chiropractor, EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Cardiology, Critical Care, Emergency Medicine, Internal Medicine, Neurology, OB/GYN, Pediatrics, Cardiac/Telemetry, Community/Public Health, Psychiatry/Mental Health, SDOH, Surgery, Trauma
Author: SimX
Language:
Room size:
Setting:
Patient ect:
Patient Gender:
Tags:

Suicidal Risk Assessment

Mount Saint Mary's University

In this scenario, the learner must treat a 38-year-old female with a historyof bipolar disorder who is admitted overnight in the behavioral unit of the hospital due to suicidal ideation. The patient exhibits rapid and pressured speech, fear, and despair in their voice. The learner should use open ended questions...

Psychiatry/Mental Health

Suicidal Risk Assessment

SimX Nursing Bundle
Social Determinants of Health

In this scenario, the learner must treat a 38-year-old female with a historyof bipolar disorder who is admitted overnight in the behavioral unit of the...

Case Information:
Bundles: SimX Nursing Bundle, Social Determinants of Health
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Mount Saint Mary's University
Language: English
Room size: 20x17
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: bipolar disorder, depression, mental health, psychiatry, suicide,

Brief Psychotic Disorders

Indiana University School of Nursing

Sam is a 45-year-old caucasian female who was brought to the ER by her brother. Her brother reported that Sam was acting strange over the past couple of weeks; in particular, he noticed poor hygiene, bizarre behaviors, and interrupted sleep patterns. He also believes she has auditory and visual hallucinations....

Emergency Medicine Interprofessional Psychiatry/Mental Health

Brief Psychotic Disorders

Social Determinants of Health

Sam is a 45-year-old caucasian female who was brought to the ER by her brother. Her brother reported that Sam was acting strange over the...

Case Information:
Bundles: Social Determinants of Health
Learner Population: Nursing, Physician/Advanced Practice Provider, Social Worker
Specialty: Emergency Medicine, Interprofessional, Psychiatry/Mental Health
Author: Indiana University School of Nursing
Language: English
Room size: 12x12
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: ativan, mental health, nursing students, psych rotation, psychiatric, psychiatric medications, psychosis,

Domestic Violence

Indiana University East School of Nursing and Health Sciences

Farrah Essa is a 20-year-old middle eastern woman that arrived at the emergency department with her husband. She has arrived for acute burns to both arms and hands and a bath towel is wrapped around both of her arms. The patient is reluctant to talk and her husband is anxious...

Emergency Psychiatry/Mental Health SDOH

Domestic Violence

SimX Nursing Bundle
Social Determinants of Health

Farrah Essa is a 20-year-old middle eastern woman that arrived at the emergency department with her husband. She has arrived for acute burns to both...

Case Information:
Bundles: SimX Nursing Bundle, Social Determinants of Health
Learner Population: Nursing
Specialty: Emergency, Psychiatry/Mental Health, SDOH
Author: Indiana University East School of Nursing and Health Sciences
Language: English
Room size: 15x15
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: bruising, burns, communication skills, domestic violence, mid-eastern, non accidental trauma,

Violent Adolescent Drug Abuse

Indiana University East School of Nursing and Health Sciences

Samuel is a 15-year-old male arriving on a Wednesday evening to the Anger and Substance Abuse Clinic. Samuel has been in the foster care system for thirteen years and with his current family for a year. The learner will have the chance to speak to the foster parents alone and...

Pediatrics Psychiatry/Mental Health SDOH

Violent Adolescent Drug Abuse

Social Determinants of Health

Samuel is a 15-year-old male arriving on a Wednesday evening to the Anger and Substance Abuse Clinic. Samuel has been in the foster care system...

Case Information:
Bundles: Social Determinants of Health
Learner Population: Nursing
Specialty: Pediatrics, Psychiatry/Mental Health, SDOH
Author: Indiana University East School of Nursing and Health Sciences
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: adolescent anger, adolescent drug abuse, marijuana, patient violence, security, violent adolescent,

PSY 12 – Gwen Harrison – Older Adult Abuse

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 12 - Gwen Harrison - Older Adult Abuse on the Elsevier Evolve Platform Gwen Harrison is an 84-year-old Caucasian female with a history of Parkinson disease. She was admitted to the inpatient medical-surgical unit as a direct admission with unresolved symptoms of...

Geriatric/Palliative Care Psychiatry/Mental Health SDOH

PSY 12 – Gwen Harrison – Older Adult Abuse

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 12 - Gwen Harrison - Older Adult Abuse on the Elsevier Evolve Platform Gwen Harrison is an...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Geriatric/Palliative Care, Psychiatry/Mental Health, SDOH
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: elder abuse, iv antibiotics, older adult abuse, parkinson disease, social services, uti,

PSY 11 – Tessa Walker – Personality Disorder

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 11 - Tessa Walker - Personality Disorder on the Elsevier Evolve Platform Tessa Walker is a 24-year-old white female admitted to the psychiatric unit after being treated in the emergency department for a suicide attempt. The patient cut both wrists superficially with...

Psychiatry/Mental Health

PSY 11 – Tessa Walker – Personality Disorder

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 11 - Tessa Walker - Personality Disorder on the Elsevier Evolve Platform Tessa Walker is a 24-year-old...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 19x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: borderline personality disorder, coping skills, personality disorder, psychiatric, self harm, suicide attempt, suicide precautions, therapeutic communication,

PSY 10 – Ri Liang – Dementia

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 10 - Ri Liang - Dementia on the Elsevier Evolve Platform Ri Liang is a 68-year-old Chinese male with a 2-year history of Alzheimer disease. He was admitted to the inpatient psychiatric unit for evaluation and possible placement. Ri has increasing confusion...

Geriatric/Palliative Care Psychiatry/Mental Health

PSY 10 – Ri Liang – Dementia

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 10 - Ri Liang - Dementia on the Elsevier Evolve Platform Ri Liang is a 68-year-old Chinese...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Geriatric/Palliative Care, Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: agitation, alzheimer disease, dementia, inpatient, memory loss, psychiatric, therapeutic communication,

PSY 09 – Marcie Anderson – Obsessive Compulsive Disorder

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 09 - Marcie Anderson - Obsessive Compulsive Disorder on the Elsevier Evolve Platform Marcie Anderson is a 32-year-old white female who was brought to the emergency department by her friend and subsequently admitted to the psychiatric unit for evaluation and treatment. Marcie...

Psychiatry/Mental Health

PSY 09 – Marcie Anderson – Obsessive Compulsive Disorder

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 09 - Marcie Anderson - Obsessive Compulsive Disorder on the Elsevier Evolve Platform Marcie Anderson is a...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 19x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: compulsive behavior, coping strategies, obsessive compulsive disorder, ocd, psychiatric, therapeutic communication,

PSY 08 – Jessie Hernandez – Post-traumatic Stress Disorder

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 08 - Jessie Hernandez - Posttraumatic Stress Disorder on the Elsevier Evolve Platform Jessie Hernandez is a 26-year-old Hispanic female who returned 3 months ago from her second deployment in the Middle East. Jessie was brought to the emergency room by her...

Psychiatry/Mental Health

PSY 08 – Jessie Hernandez – Post-traumatic Stress Disorder

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 08 - Jessie Hernandez - Posttraumatic Stress Disorder on the Elsevier Evolve Platform Jessie Hernandez is a...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 19x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: anxiety, posttraumatic stress disorder, psychiatric unit, ptsd, therapeutic communication,

PSY 06 – Charlotte Lewis – Schizophrenia, Psychosis

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 06 - Charlotte Lewis - Schizophrenia Psychosis on the Elsevier Evolve Platform Charlotte Lewis is a 44-year-old African American female admitted from the emergency department with auditory hallucinations, delusions, and reported lack of self-care. During this scenario, learners must assess, intervene, and...

Psychiatry/Mental Health

PSY 06 – Charlotte Lewis – Schizophrenia, Psychosis

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 06 - Charlotte Lewis - Schizophrenia Psychosis on the Elsevier Evolve Platform Charlotte Lewis is a 44-year-old...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English, Spanish
Room size: 19x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: auditory hallucinations, caseworker, delusions, paranoid schizophrenia, psychiatric unit, psychosis, schizophrenia, therapeutic communication,

PSY 05 – Tyler Morgan – Drug Abuse

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 05 - Tyler Morgan - Drug Abuse on the Elsevier Evolve Platform Tyler Morgan is an 18-year-old white male admitted to the psychiatric unit with a diagnosis of depression and substance abuse. Learners are asked to obtain answers to the admission history...

Psychiatry/Mental Health

PSY 05 – Tyler Morgan – Drug Abuse

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 05 - Tyler Morgan - Drug Abuse on the Elsevier Evolve Platform Tyler Morgan is an 18-year-old...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 19x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: cocaine, depression, drug abuse, patient education, psychiatric unit, substance abuse, therapeutic communication,

PSY 04 – Jodie Bennett – Bipolar/Mania

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 04 - Jodie Bennett - Bipolar Mania on the Elsevier Evolve Platform Jodie Bennett is a 34-year-old white female with a history of bipolar disorder who was admitted to the psychiatric unit. Upon admission, the patient reported that she had stopped taking...

Psychiatry/Mental Health

PSY 04 – Jodie Bennett – Bipolar/Mania

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 04 - Jodie Bennett - Bipolar Mania on the Elsevier Evolve Platform Jodie Bennett is a 34-year-old...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 19x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: acute mania, bipolar disorder, bipolar mania, psychiatric unit, sbar, therapeutic communication,

PSY 03 – Indira Desai – Anxiety/Stress Management

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 03 - Indira Desai - Anxiety Stress Management on the Elsevier Evolve Platform Indira Desai is a 49-year-old Indian female with a history of generalized anxiety disorder. She presented to the emergency department after being bit by a dog with redness and...

Psychiatry/Mental Health

PSY 03 – Indira Desai – Anxiety/Stress Management

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 03 - Indira Desai - Anxiety Stress Management on the Elsevier Evolve Platform Indira Desai is a...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 15x15
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: anxiety, cellulitis, generalized anxiety disorder, hamilton anxiety rating scale, iv antibiotics, lorazepam, medsurg, panic, sbar, stress management,

PSY 01 – Cecil Whitver – Depression

Elsevier

This Simulated Patient Encounter maps to Scenario PSY 01 - Cecil Whitver - Depression on the Elsevier Evolve Platform Cecil Whitver is a 78-year-old African-American male with a history of depression diagnosed after the death of his wife 2 months ago. He was admitted to the inpatient medical-surgical unit and...

Geriatric/Palliative Care Psychiatry/Mental Health

PSY 01 – Cecil Whitver – Depression

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PSY 01 - Cecil Whitver - Depression on the Elsevier Evolve Platform Cecil Whitver is a 78-year-old African-American...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Geriatric/Palliative Care, Psychiatry/Mental Health
Author: Elsevier
Language: English
Room size: 15x15
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: dehydration, depression, escitalopram, inpatient, major depression, medsurg, psychology, sbar, therapeutic communication,

COM 10 – Tyler Morgan – Vulnerable Populations – Mental Health

Elsevier

This Simulated Patient Encounter maps to Scenario COM 10 - Tyler Morgan - Vulnerable Populations on the Elsevier Evolve Platform Tyler Morgan is a 28-year-old Caucasian male with a history of mental illness, drug abuse, and incarceration for drug trafficking. He came into the clinic 6 months ago for flu-like...

Community/Public Health Psychiatry/Mental Health SDOH

COM 10 – Tyler Morgan – Vulnerable Populations – Mental Health

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario COM 10 - Tyler Morgan - Vulnerable Populations on the Elsevier Evolve Platform Tyler Morgan is a 28-year-old...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Community/Public Health, Psychiatry/Mental Health, SDOH
Author: Elsevier
Language: English
Room size: 16x16
Setting: Outpatient Clinic
Patient ect:
Patient Gender: Male
Tags: antiretroviral therapy, community health, drug abuse, hiv, homelessness, mental health, therapeutic communication, vulnerable populations,