Assessment and Intervention Planning

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Identifying issues, concerns and presenting problems in Social Work practice and developing a treatment plans, goals and intervention.

Mezzo and Micro practice

interventions geared towards benefitting family, small groups and individuals.

Micro

practice is performed in a case by case basis, generally in clinical settings and is used to solve psychosocial problems of families, individuals and groups

mezzo practice

takes place with small groups and families and focuses on communicating, educating and bringing people together.

macro practice

indirect practice activities that influence change in communities and organizations.

phases of assessment

consistsof data collection and organizing and studying data.

presenting problem

clients perception of the issue or difficulties he has been experiencing which has caused him to seek help.

problem assessment

exploring factors that maybe relevant to the clients problem, concern or request including legal mandates, health, safety, signs, sypmtoms duration, duration frequency individuals, systems and consequences.

guidelines for conducting a competent assessment

narrow your focus by emphasizing information that is relevant to the clients problem, concern or request and to the type of help you can offer the client. Address top priorties, (legal mandates, health, safety)) Gather information froma variety of sources, Recognize the uniqueness of the client, Adopt strenghts perspective,Be aware of factors that can affect a clients responses (malingering, defensiveness, view assessment as both a product and process.

Independent assessment and clinical team approaches

in some setting, social worker makes an independent assessment ,this is generally completed in one to three sessions. In other settings the social worker is part of a clinical team that makes an assessment. In the team approach the social workers role is to complete the social history of client and assessment may take several weeks.

Interviewing skills for eliciting presenting problems

start where the client is. respond empathically, use reflective opening, make statements that allow client to choose her own direction, aske open ended questions and close ended questions, seek clarification

additional clues for eliciting the presenting problem

problem checklist: a list of problems,concerns commonly reported by a group of clients
problem search: is an agreement between you and a client to spend up to three sessions exploring situation in more depth.

factors that my affect disclosure

clients may test you before disclosing the real problem. This may stem from experiences with discrimination. A voluntary client may exagerate the complexity of the problem. an involuntary client may withhold information and/or minimize the presenting problem.

unmet needs

clients problems usually \stem from a poor fit between those needs and resources in the environment. This includes lack of access to available resources. Sometimes resources are Non existent or unresponsivetto the clients needs. S.W most respond promptly to address a clients basic needs.

Basic needs

must be met for adaptive physical and mental functioning.(food, clothing, shelter,

needs

are often related to a person's developmental stage an the tasks and transitions associated with it; it is critical to take into account a persons developmental stage when identifying their needs.

Presenting Problems and Needs

the presenting problem often reveal only surface needs.careful exploration is required in order to identify needs that the client may be unaware of.

Planning intervention based upon needs

a clients unmet needs or wants can be translated into goals when you plan the intervention.

History of the problem

clarify's the magnitude of the problem, identies factors contributing to the problem and identifies the clients current level of functioning and motivation for change.

components of the problem history

onset, progression and severity of the client's problem, its precipitants, its environmental antecedents and consequences, factors maintaining the problem, its effects on the clients functioning, clients ideas about its causes, whats been been done to try to solve the problem, whats works and what hasnt worked.

Onset, progression and severity

addresses when the problem began, under what circumstances, was there a specific precipitating event or change in the clients life. how long has it been going on. Is the problem chronic, or episodic, how often does it occur, how intense if the problem or symptom.

Stressor Affecting the Problem

a current/recent psychosocial stressor may have precipitated the clients problem or may be exacerbating the problem to understand the role you should explor how the psychosocial stressor is affecting the client and family. what is the duration of the stressor. what coping skills have the client used.

Degree of Impairment in functioning

How much has the problem affected the clients functioning. Has it affected the clients personal relationships, is it interfering with work, school, home and in what ways. Does client have problems perfomr activities of daily living. Has an interest in pleasuralbe activities changed.

clients belief about the problem

a clients belief or assumption about what causes a behavior can sometimes serve to maintain a behavior.also identifying the clients emotional reaction to the problem is important as emotions can have a potent effect on behavior. emotions can cause behavior that intensifies a problem.

Family, Work, Educational, and Legal Histories

this information is collected in order to formulate a complete description of a clients problem, including understanding how the problem fits into the wider context o fher life.

Assessessment of Social Functioning

collection of data to determine how one's need meeting activities and social role performance-the information can be used to draw conclusions aobut current level of soical functioning including strengths and deficits,

Social Functioning

When applied to an individividual refers to the ability/capacity;motiviation and opportunity to meet her basic needs such as well as to perform role expectations defined by her community and culture.

Key aspects of social functioning

Fundamentals of independent living, personal appearance/hygiene, housing and housekeeping, Nutrition adn health care, adjustmetns to physical disability;coping with problems-mental health, addiction, spirituality/religion, family life, citizenship adn legal concerns, friendships social supports, sof of community resources, interaction with community,education, education and training, employment and job performance, money management adn consumer awareness, recreational and leisure acitivity.

Environment

The social and physical contexts in which one lives.

Adopt an ecological Perspective

when assessing clients in their environment focus on transactions between the person and the environment and determine the "goodness of fit" - are there access and opportunities or barriers and obstacles

Spirituality Assessment

Helps you to understand a clients belief system and resources and it can help provide a wider range of appropriate interventions fro addressing her problem.

Emotional functioning

during interview, SW should attend to how client describes her mood and emotional functioning. In addtion SW should pay observe clients behavior (verbal and non-verbal) and appearance.

Emotional control

difficulties with emotional regulation involve either expressing too much emotion (volatility, excessive irritability) SW can determine appropriateness by examining if he emotions is appropriate and proportionate to the triggering stimulus. also observe clients level of subjective distress.

Anheodonia

inability to feel joy or express many pleasurable emotions.

Appropriate affect

describes one who is in touch with his emotions and can express them spontaneously as she feels them in response to specific situations emotional or situational stimuli.

inappropriate affect

a persons emotions does not match the situaion or stimuli ex. a person laughs when she learns of the death of a loved one.

gallows laughter

refers to laughter occurring when discussing painful material.

Emotional blunting/flat affect

is muted or apathetic response to stimuli that would normally evoke a stronger response. emotional blunting may indicate a mental disorder eg. depressionor schizophrenia.

Antipshychotic drugs

these are known as major tranquilizers and neuroleptics

Tradtional Antipsychotics

Conventional or typical antipsychotics include Thorazine, Permitil and Prolixin, Narvaneand Haldol. These drugs alleviate hallucination, delusions and other postive symptoms of Schizophrenia.

Atypical Antipsychotics

The atypical (novel) include Clozaril, Risperidal, Zyprexa and Seroquel. These drugs are used to treat schizophrenia and other disorders with psychotic symptoms. Atypicals alleviate both positive and negative symptoms of schizophrenia.

Antidepressant

trycyclics, SSRI, MAOI and several other drugs recently introduced

Tricyclics (TCA)

Amitriptyline (Elavil, Endep),Doxepin ( Sinequan, Adapin) Imipramine (Tofranil) and clomipramine (Anafranil). TCA's are most effective for depressions that involve decreased appetite and weight loss, early moring awakening and other sleep disturbances, psychomotor retardation and anhedonia. Particulary are useful with alleviating vegetative states of depression

SSRIs (Selective Serotonin reuptake inhibitiors)

Fluoxetine(Prozac), Fluvoxamie (Floxyfral), Paroxetine (Paxil), sertraline (Zoloft) and Escitalopram Oxalate (Lexapro). SSRI's exert their effects by blocking reuptake of serotonin. Use of SSRI in conjuntion with MAOI can resutl in a serious condtion called serotonin syndrome
Citalopram (Celexa) is an SSRI with a chemical structure unrelated to that of other SSRI's or other available antidepressant drugs. it is used to treat major depression and is also effective for treating anxiety.

MAOI's ( Monoamine oxidase inhibitors)

Isocarboxazid (Marplan), Phenelzine (Nardil) and Tranylcypromine (Parnate). MAOI's are useful in treating nonendogenous adn atypical depressions that involve anxiety, reversed vegetative symptoms (eg. hypersomnia, hyperphagia) and interpersonal sensitivity

New Antidepressants

Bupropion (Wellbutrin) is a norepinephrine dopamine reuptake inhibitor (NDRI) used to treat major derpressio adn the depressive phase of bipolar disorder. Under the name of Zyban, this medication is used to facilitate smoking cessation) Bupropion has fe anticholinergic side effects ans is less cardiotoxic than the TCA's and it does not csue sexual dysfunction

SNRI (Selective Serotonin Norepinephrine Reuptake Inhibitor

Menlafaxine (Effexor) is used to treat major depression, OCD, generalized anxiety disorder. It is less dangerous inthe overdose than the TCA's and may have a faster onset of therapeutic effects because it can increase blood pressure, frequent monitoring is required.

SARIs (Serotonin-2 antagonists/reuptake inhibitors

Nefazodone (Serzone) and Trazodone (Desyrel) these drugs are used to treat major depression and the depressive phase of biplor disorder. Common side effects of nefazodone are dry mouth, nausea and somnolence, etc.

Mental Health Status Examination

Is the psychiatric equivalent of of the physcial examintation inmedicine. It includes a comprehensive evaluation of the patient's appearanc, thinkingand speech patterns. In conducting a MHSE SW focus on appearance and attitude, motor activity, thougth and speech, mood and affect, perception, orientation, memory

Perception

the mostb common perceptual abnormalities are hallucintations: abnormal sensory perceptions in the absence of an actual stimulus

Orientation

This includes oreitnation to time, place and person. Does the client know what what day it is, year, where he is residing, his name and identity.

Mood

the term mood refers to an emotional attitude that is relatively sustained: it is typically determined throught the patitient's own self-report, althought some inferences can be made from the patient's facial expression. Mood is neutral, euphoric, depressed, anxious, or irritable. Aff

Affect

Is inferred from emotional responses that are usually triggered by some stimulus. Affect refers to the way that a patient conveys his or her emotional state, as perceived by others.

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