Social Work Licensing Exam

STUDY
PLAY

Terms in this set (...)

What are the 3 areas to identify with each question?
(Hint: PPL)
Problem
Person
Last Sentence-guide to answer
What Are The Key Words To Look For?
-Person/Client "hot seat"
-SAFETY Red Flags-suicide, abuse, life-threatening, unexplained, unexplained marks, alcohol, recent loss
-Strong words/adjectives
-Age
-Diagnosis
-Symptoms/Duration
-Setting (medical, school, community, etc...)
-Where are you in terms of number of sessions?
-Quotations
-Direct requests/concerns
-Qualifiers (First, Next, Best)
What are common distractors?
FARM GRITS ROAD=Answers that look appealing at first glance, but are often wrong-ELIMINATE! Exam is here and now. GO WITH MOST INCLUSIVE ANSWER.
What does FARM GRITS ROAD stand for?
F=Focus on unresolved issues/past
A=Advice giving/judging
R=Recommend "to a support group"
M=Make an appointment
G=Give pamphlets/literature
R=Recommend a session
I=Inform parents/speak to parents (when child or teen)
T=Terminate (exceptions: moving, client reaches goals/no new crisis, client doesn't pay)
S=Speak to supervisor (except transference/counter transference)
R=Respect self-determination (if mentally unstable)
O=Offer contract as a reminder
A=Allow the clients to lead the session
D=Do nothing/say nothing
How do you answer first/next questions?
90% of exam is SAFETY FIRST!
How does the exam want you to have a CLEAR understanding of client's issues?
Assess before Action
What does RUSAFE stand for?
R=Rule out medical condition
U=Under the influence/delusional/hallucinating DO NOT TREAT!
S=Save lives. Safety first (Answers: duty to warn, report child/elder abuse, 911, mobile crisis, ER)
A=Assess before action (Answers: Assess, Ask, Dice-Determine, Identify, Clarify, Explore)
F=Feelings (Answers: acknowledge person's feelings. Concerns (AID: Assist, Inform client, Discuss concerns)
E=Empower if client is mentally stable/alert. (Answers: Respect client's decisions)
*Try to guess what you think the answer is first, if you know, go!
*Go back and delete the distractor
*Think about the role of the social worker, role of the client, time in treatment, safety, etc....
Drug Classifications
1. Antipsychotics (schizophrenia)
2. Mood Stabilizers (bi-polar meds)
3. Anti-Anxiety Meds (ptsd, ocd, gad)
4. Antidepressants (ssri, atypical, tri-cyclics, maoi)
Anti-psychotics (schizophrenia)
A.Neuroleptics-Help people towards reality acceptance
B. Haldol, Prolixin, Thorazine, Risperadol, Abilify-also used for bipolar
C. Tardive Dyskinesia-muscle disorder
D. Clozapine-atypical, increased risk for agranulocytosis
Mood Stabilizers (bipolar meds)
A. Live To Dream Always=Lithium, Tegretol, Depakote, Abilify
*kidney problems, liver problems, monitor blood work
Anti-Anxiety Meds (ptsd, ocd, gad)
A. Benzodiazepines-subclass of anti anxiety meds
B Valium, Klonipin, Xanax (View Karen's X-rays)
C. Short acting and addictive
D. Impaired muscle coordination and impairment of short term memory
Antidepressants
Subtypes:
A. SSRI's=prozac, luvox, zoloft, lexapro, celexa, paxil, zyprexa
B. Atypical=wellbutrin, effexor, cymbalta, remeron
C. Tri-cyclic=elavil, sinequan, vivactil, pamelor
D. MAOI's=nardil, parnate, marplan
Antabuse
Medication for alcohol, AVERSION THERAPY
What is Supervision?
Supervision is the relationship between supervisor and supervisee that promotes the development of responsibility, skill knowledge, attitudes and ethical standards in the practice of clinical social work.
What are the 3 functions of supervision?
1. Administrative
2. Educational
3. Supportive
Supervisor Key Concepts
1. Supervisor is there to EDUCATE the social worker and IMPROVE job performance.
2. Supervisor is in charge of social worker's and/or intern's caseloads.
3. TRANSFERENCE/COUNTERTRANSFERENCE
4. Supervisor DOES NOT EXPLORE social worker's inner feelings
5. Main purpose-advance agency goals and improve service to clients.
What is the top priority of supervision?
Accountability for client care within the parameters and ethical standards of the social work profession.
What should a supervisor do?
The Supervisor should COMMEND work performance, also point out inappropriate performance when it occurs.
What is Administrative Supervision?
Administrative supervision is oriented towards agency policy and public accountability, assign cases to most appropriate social worker, discuss the assessment and intervention plan, review the social worker's ongoing contact with the client.
What is Educational Supervision?
Educational supervision is oriented towards professional concerns and specific cases, help supervisee better understand agency policy and philosophy, become more self aware, know the agency and community resources, establish activity priorities, refine knowledge skills.
What is the difference between consultation and supervision?
-Consultation information and recommendations are voluntarily followed and clinical suggestions can either be accepted or rejected. The relationship is not regulated by legal statute.
-The consultant provides expert advice but the legal responsibility lies with the social worker completing the task.
-Consultation is limited in authority and often does not meet requirements for credentialing bodies or insurance companies.
Broker
SW is involved in the process of making referrals to link a family or person to needed resources.
Advocate
SW fights for the rights of others and work to obtain needed resources by convincing others of the legitimate needs and rights of members of society.
Case Manager
SW involved in locating services and assisting their clients to access those services.
Educator
SW involved in teaching people about resources and how to develop particular skills such as budgeting, the caring discipline of children, effective communication, the meaning of medical diagnosis, and the prevention of violence.
Facilitator
SW is involved in gathering groups of people together for a variety of purposes including community development, self-advocacy, political organization, and policy change. Social Workers are involved as group therapists and tasks group leaders.
Organizer
SW is involved in many levels of community organization and action including economic development, union organization, and research and policy specialists.
Manager
SW, because of their expertise in a wide variety of applications, are well suited to work as managers and supervisors in almost any setting.
Medical Social Worker: Setting=Hospital
-Primary role is to develop safe discharge plans before discharging patients (referral and linking to resources)
-Focus on short-term community reintegration
-Psych-education about illness and treatment
-Collaboration with medical team
Crisis Social Worker: Crisis Intervention
-Assist the person in distress to resolve immediate problem and regain emotional equilibrium=GOAL IN FIRST SESSION, EMPHASIS ON COPING MECHANISMS
-Crisis intervention not long term treatment
-Assessment of suicidal ideations and homicidal ideations
-Assess health and mental health especially psychosis
-Referrals for immediate care (police, hospital ER, etc...)
Community Organization Social Worker
-NOT direct practice, indirect practice
-SW role is to work WITH THE community, not directly for them
-No individual counseling or family counseling
-Empower members to strengthen community to prevent future dilemmas.
-Members must have a COMMON INTEREST-KW's consensus, agreements
-Advocate for disadvantaged
-ADVOCACY and social justice.
-In any circumstance, when client can do something for themselves, but with support, that is the right answer!
School Social Worker
-Issues that affect the learning of the student
-mental health, parents, bullying, abuse/neglect, cultural differences.
Executive Directors
-Create policies, pursue funding, strategic planning for organizations
-Works with the Board of Directors
-DOES NOT manage staff; refer to direct supervisors for staff intervention.
DSM 5: CHANGES
-Note DURATION/ONSET of symptoms (Ex: Major Depressive Disorder has to be 2 weeks; if following a trauma, it could be adjustment disorder up to 6 months)
-NO 4 Axis or GAF score
-Instead, specifiers of varying intensity/components i.e. bipolar has with anxious distress specifier instead of GAD and bipolar.
Intellectual Disabilities (instead of mental retardation/developmental disability)
-Deficit in intellectual functions, adaptive functions, onset during developmental period.
-Diagnosed with clinical assessment and standardized testing
Autism Spectrum Disorder
-Qualitative impairment in social interaction, communication, restricted repetitive and stereotyped patterns of behavior, interest and activities.
-No eye contact, unaware of others, perseverative play and strong reaction to minor changes.
ADHD
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with or development as characterized by Inattention and/or Hyperactivity that has persisted for MORE THAN 6 MONTHS.
Schizophrenia Spectrum
Delusions, hallucinations, disorganized thinking (speech), catatonia, negative symptoms.
Delusional Disorder
-Presence of delusions for A MONTH OR LONGER. -Criteria for schizophrenia has not been met
-Functioning is not markedly affected, brief manic or major depressive moods if any
Brief Psychotic Disorder
-Presence of 1 OR MORE: delusions, hallucinations, disorganized speech, disorganized or catatonic.
-Duration of episode is AT LEAST ONE DAY, BUT NOT MORE THAN A MONTH.
-Disturbance not better explained by major depressive disorder or bipolar disorder.
Schizophreniform Disorder
-TWO OR MORE OF THE FOLLOWING: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.
-Episodes lasts AT LEAST 1 MONTH, BUT LESS THAN 6 MONTHS
-Schizoaffective disorder and depressive or bipolar have been ruled out.
Schizophrenia
TWO OR MORE OF THE FOLLOWING: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
-Above symptoms present for A SIGNIFICANT PORTION OF TIME DURING A 1 MONTH PERIOD.
-Level of functioning in one or more major areas is markedly below
-Continuous signs of the disturbance persist for AT LEAST 6 MONTHS
Schizoaffective Disorder
-Uninterrupted period of illness during which there is a major mood episode concurrent with Criterion A of Schizophrenia.
-Delusions or hallucinations for 2 OR MORE WEEKS in the absence of a major mood episode.
-Symptoms that meet criteria for a major mood episode are present for a MAJORITY OF THE TIME.
Bipolar I
Manic episode lasting at least A WEEK. Major depressive episode present during 2-WEEK PERIOD.
Bipolar II
-Meets criteria for Hypomanic Episode (4 DAYS) AND MAJOR DEPRESSIVE EPISODE.
-Never been a manic episode
Cyclothymic Disorder
-AT LEAST 2 YEARS, numerous periods of hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
-During the 2 year period, the hypomanic and depressive periods have been present for AT LEAST HALF THE TIME AND HAVE NOT BEEN WITHOUT SYMPTOMS FOR MORE THAN 2 MONTHS AT A TIME.
Manic Episode
-Elevated, expansive, irritable mood, increased goal-directed activity or energy lasting AT LEAST A WEEK AND PRESENT MOST OR ALL DAY.
-THREE OR MORE OF THE FOLLOWING: grandiosity, decreased need for sleep, more talkative, flight of ideas or thoughts racing, distractibility, increased goal-directed activity, excessive involvement in activities.
Major Depressive Episode
FIVE OR MORE OF THE FOLLOWING: Depressed mood most of the day, nearly every day, diminished interest or pleasure in activities, significant weight loss, insomnia, psychomotor agitation or retardation, fatigue, feeling worthless, can't concentrate, recurrent thoughts of death.
Hypomanic Episode
Elevated, expansive, irritable mood, increase goal-directed activity or energy lasting 4 CONSECUTIVE DAYS 3 OR MORE SYMPTOMS OF MANIC EPISODE CRITERIA B
Disruptive Mood Dysregulation Disorder
-Severe recurrent outburst, verbally or behaviorally, on average 2 OR 3 TIMES PER WEEK.
-Criteria PRESENT FOR 12 MONTHS
Persistent Depressive Disorder (Dysthymia)
Major depression for 2 years; during which symptoms have always been present except for no more than 2 months.
Separation Anxiety Disorder
Developmentally inappropriate and excessive fear or anxiety concerning separation from attachment figures.
Selective Mutism
-Consistent failure to speak in specific social situations where expected.
-Disturbance is at least 1 month
Specific Phobia
-Specific fear about specific object or situation.
-Almost always provokes anxiety
Social Anxiety Disorder
Fear or anxiety about one or more social situations.
Panic Disorder
-Recurrent unexpected panic attacks
-Palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, feeling dizzy, chills or heat sensations, fear of losing control or going crazy.
Agoraphobia
Fear or anxiety about 2 OR MORE OF THE FOLLOWING: Public transportation, open spaces, enclosed places, standing in line, or being in a crowd, being outside of the home alone.
Obsessive-Compulsive Disorder
-Presence of obsession, compulsion, or both: Obsessions are defined as recurrent and persistent thoughts, urges, or images that are unwanted and cause anxiety or distress.
-The individual attempts to ignore or neutralize them some other thought or action i.e. performing a compulsion.
-Compulsions are defined by repetitive behaviors and those behaviors are aimed at preventing or reducing anxiety or preventing some dreaded event or situation.
-The obsessions or compulsions are time-consuming.
Body Dysmorphic Disorder
-Preoccupation with one or more perceived defects in physical appearance that are not observable by others.
-At some point the person has performed repetitive behaviors such as mirror checking.
Hoarding Disorder
-Persistent difficulty discarding or parting with possessions, regardless of their actual value
-Difficulty is due to perceived need to save the items and the distress associated with discarding them.
Trichotillomania (Hair Pulling) Disorder
-Recurrent pulling out of one's hair, resulting in hair loss. -Repeated attempts to decrease or stop hair pulling.
Excoriation (Skin Picking) Disorder
-Recurrent skin picking resulting in skin lesions.
-Repeated attempts to decrease or stop skin picking.
Pica
-Persistent eating of nonnutritive, nonfood substances over a period of AT LEAST A MONTH.
-The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.
Rumination Disorder
Repeated regurgitation, re-chewing of food without the apparent nausea or disgust.
Avoidant/Restrictive Food Intake Disorder
-Eating disturbances associated with significant weight loss, nutritional deficiency, dependence on enteral feeding or nutritional supplements, marked interference with psychosocial functioning, lack of food or culture-based characteristic does not explain difficulty, not exclusively anorexia nervosa or bulimia nervosa and no disturbance in view of body weight/shape, not accounted for by another condition.
Anorexia Nervosa
An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat.
Bulimia Nervosa
-An eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise.
-Sense of loss of control over eating.
Binge-Eating Disorder
Significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa.
Enuresis
-Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
-At LEAST TWICE A WEEK FOR AT LEAST 3 CONSECUTIVE MONTHS.
Encopresis
Repeated passage of feces into inappropriate places whether involuntary or intentional.
Oppositional Defiant Disorder
-A pattern of negativistic, hostile, and defiant behavior lasting AT LEAST 6 MONTHS.
-Often loses temper, argues with adults, actively defies, deliberately annoys people, blames others, easily annoyed, angry, resentful, spiteful, vindictive.
Intermittent Explosive Disorder
-Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following: Verbal aggression or physical aggression toward property, animals, or other individuals.
-THREE BEHAVIORAL OUTBURSTS involving damage or destruction of property and or physical assault involving physical injury against animals or other individuals occurring within a 12 MONTH PERIOD.
Conduct Disorder
-A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
-Bullies, threatens, intimidates others.
-Initiates physical fights; has used a weapon that can cause serious harm.
Pyromania
-Deliberate and purposeful fire setting on more than one occasion.
-Tension or affective arousal before the act.
-Fascination with, interest in, curiosity about, or attraction to fire and its situational context.
Kleptomania
Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
Neurocognitive Disorders
-Impairment in cognition or memory that is substantial from previous level of functioning.
-The symptoms are direct physiological consequences of a medical condition.
-Also, these disorders fall into the category of mental disorders due to a general medical condition and/or substance induced mental disorder.
Delirium
-Disturbances in attention and cognition, changes develop over a short period of time, evidence of direct physiological consequence of another medical condition, reduced level of awareness and understanding, temporary impairment, language disturbance.
-5 SPECIFIERS: Substance intoxication delirium, substance withdrawal delirium, medication-induced delirium, delirium due to another medical condition, delirium due to multiple etiologies.
Minor Neurocognitive Disorder
-Modest cognitive decline from previous level, cognitive deficits are insufficient to interfere with independence, cognitive deficits do not occur exclusively in the context of a delirium.
-Cognitive deficits are not primarily attributable to another mental disorder.
Major Neurocognitive Disorder
-Substantial cognitive decline, decline in neurocognitive performance, typically involving test performance in the range of 2 or more standard deviations below appropriate norms.
-Deficits are sufficient to interfere with independence.
-Cognitive deficits are not primarily attributable to another mental disorder.
Major and Minor Neurocognitive Specifiers
-Alzheimer's, vascular neurocognitive, frontotemporal, traumatic brain injury, Lewy Body dementia, Parkinson's disease, HIV infection, substance-induced, Huntington's disease, Prion disease or to any other neurocognitive disorder not elsewhere classified.
Substance Use/Abuse DSM 5 Updates
-Name=substance-related and addictive disorders.
-NO differentiation between use and abuse
-Criteria and terminology DSM-5 does not separate the diagnoses of substance abuse and dependence as in DSM-IV.
-Rather, criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance/medication-induced disorders, and unspecified.
Gambling Disorder (included in DSM5)
-An important departure from the past diagnostic manuals is that the substance-related disorders chapter has been expanded to include gambling disorder.
-This change reflects the increasing and consistent evidence that some behaviors, such as gambling, activate the brain reward system with effects similar to those of drugs of abuse and that gambling disorder symptoms resemble substance use disorders to a certain extent.
Substance Use/Abuse Continued
-The DSM-IV recurrent legal problems criterion for substance abuse has been deleted from DSM-5, and new criterion, craving or a strong desire or urge to use a substance, has been added.
-In addition, the threshold for substance use disorder diagnosis in DSM-5 is set at two or more criteria, in contrast to a threshold of one or more for a diagnosis of DSM-IV substance abuse and three or more for DSM-IV substance dependence.
-Cannabis withdrawal is new for DSM-5, as is caffeine withdrawal.
Substance Use/Abuse Continued
-Of note, the criteria for DSM 5 tobacco use disorder are the same as those for other substance use disorders.
-By contrast, DSM IV did not have a category for tobacco abuse, so the criteria in DSM 5 that are from DSM IV abuse are new for tobacco in DSM 5.
-Severity of the DSM 5 substance use disorders is based on the number of criteria endorsed: 2-3 criteria indicate a mild disorder; 4-5 criteria, a moderate disorder; and 6 or more, a severe disorder.
Substance Use/Abuse Continued
-Early remission from a DSM 5 substance use disorder is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving), and sustained remission is defined as at least 12 months without criteria (except craving).
-Additional new DSM 5 specifiers include "in a controlled environment" and "on maintenance therapy" as the situation warrants.
Substance Dependence
Increased tolerance, withdrawal symptoms
Substance Abuse
Abuse interferes with obligations; causes social, legal, medical problems
Methadone
Synthetic narcotic for Opiate use
Addicts Defense Mechanisms
Denial and Rationalization
Family Members Role With Addicts
Enablers, allow for addictions to continue/progress
Techniques To Use With Established Clients With Addictions
Confrontation
Addict Withdrawal Symptoms
May require medical intervention
Signs of Alcohol Use
Slurred speech, odor or alcohol on breath, unsteady gait, coordination problems, staggering
Strongest Predictor For Developing An Alcohol Problem
Family history of alcoholism
Alcohol Withdrawal
Seizures and tremors
Signs of Cocaine Use
Talkative, pale, hyperactive, thin, loss of appetite
Cocaine Withdrawal
Depression, vomiting, fatigue
Heroin Withdrawal
Bone pain, anxiety, muscle spasms, restlessness
Hallucinogen Use
Hallucinations, confusion, anxiety, suspicion
Hallucinogen Withdrawal
Non-existent with hallucinogens (LSD, PEYOTE, ECSTASY)
Group Therapy Key Concepts
1. Group members SHARE A COMMON PROBLEM
2. Group members are there to SUPPORT EACH OTHER
3. Therapist there to ALLOW THE GROUP to come to resolutions and resolve conflicts.
4. Therapist intervenes only if there is threat of violence
5. Therapist must acknowledge feelings of an individual in crisis
6. Therapist must ALLOW confrontation when there is denial or rationalization.
7. Contraindications-clients in crisis, suicidal, need for attention, psychotic, paranoid
Group Polarization
Discussion strengthens a dominant point of view, group shifts to this extreme viewpoint.
Groupthink
Group cohesion and loyalty undermines decision making in order to maintain the we-ness.
Irvin Yalom M.D.
-Pioneer in group therapy
-Universality-helps people see what they are going through is universal, not alone.
-Catharsis-venting feelings to group members to relieve pain, guilt, stress
Domestic Violence
Can be physical, sexual, or emotional; know how to detect each; frequent injury, absences, phone calls, fear of partner, failing, personality changes, submissive, isolation from friends and family, insufficient resources to live alone, depression, making excuses, denying severity.
Child Abuse
Report of reasonable suspicion, even if against supervisor, vignette will try and dissuade you from reporting.
Indicators of Abuse
Physical signs/injuries, behavioral signs-oppositional defiant symptoms, interest in sexual activity, school performance problems and difficulties.
What Defense Mechanism Is Mostly Used By Survivors Of Child Abuse?
Denial
Displacement
Place unwanted/unpleasant feelings onto someone less threatening or innocent bystander (ex: angry at boss, take it out on spouse)
Dissociation
-A person often loses track of time or themselves and their usual thought processes and memories.
-People who have a history of any kind of childhood abuse often suffer from some form of dissociation.
Projection
Taking your emotions and placing it on others (ex: all of my coworkers are greedy, but I am not)
Introjection
To incorporate someone else's emotions into one's self, internalized beliefs of others.
Idealization
Overestimation of an admired aspect or attribute of another
Identification
A person patterns oneself after a significant other
Identification With The Aggressor
Mastering anxiety by identifying with a powerful aggressor
Isolation Of Affect
Expressing no emotionality when confronted with difficult events.
Projective Identification
BPD clients. Unconsciously perceiving other's behavior as a reflection of one's own identity.
Reaction Formation
Turning unwanted or dangerous thoughts, feelings, or impulses into their opposites (ex: person with a sudden loss shows a happy mood)
Regression
Return to infantile patterns of thinking/being.
Sublimation
Maladaptive behavior/impulses diverted to more socially acceptable channels, healthy redirection of emotion.
Turning Against The Self
Defense to deflect hostile aggression or other unacceptable impulse from another to self.
Splitting
Also clients with BPD-identify a person as either all good or all bad.
Denial
Refusal to acknowledge external reality that are intolerable (ex: I am not a shopaholic, but credit cards are maxed out.
Repression
Unconsciously wipes out, "forgets" painful feelings/memories.
Suppression
Consciously put painful thoughts/feelings memories to the side
Undoing
Taking back unwanted behaviors through praise/gifts. (Ex: buying gifts, obsessively washing hands to deal with obsessive thoughts. OCD)
Compensation
Enables one to make up for real or fancied deficiencies (Ex: short man becomes cocky)
Conversion
Repressed urge is expressed as a disturbance of body function (Ex: pain, deafness, blindness)
Social Work Process
Purpose, Knowledge, Values, and Sanctions
Stages In The Helping Relationship
1. Beginning, Middle, Ending Phases
2. Contact, Contract, Action, Termination
Problem-Solving Process
1. Engaging
2. Assessing
3. Planning
4. Intervening
5. Evaluating
6. Terminating
Interventive Roles
1. Consultant
2. Advocate
3. Case Manager
4. Catalyst
5. Enabler
6. Broker
7. Mediator
8. Facilitator
9. Instructor
10. And Other
Interventive Skills
1. Relationship
2. Communication (listening, observing, interviewing, verbal, nonverbal, etc....)
3. Helping/Problem-Solving
4. Resource finding, linking, developing
5. Professional use of self
6. Working with different systems (individual, groups, institutions, communities)
The Referral Process
1. CLARIFYING the need or purpose
2. RESEARCHING resources
3. DISCUSSING & SELECTING options with clients
4. PLANNING for initial contact
5. INITIAL CONTACT between client and referral source
6. Follow Up to see if need was met
*Keep in mind client's right to self-determination
Ventilation
Technique in supervision to air out feelings
Beginning Phase of Treatment
1. Engagement
2. Assessment (biopsychosocial, strengths, weaknesses) Assessment is a continuous phase of treatment.
3. Planning how to achieve goals
4. Addressing confidentiality/insurance
5. Contract-Client/Worker roles and responsibilities, problems to be worked on, goals, interventions to be implemented, evaluation, time/place/fee
Middle Phase Of Treatment
1. Intervention
2. Universalization, clarification, confrontation, interpretation, reframing, labeling
3. Worker can be an advocate or mediator
4. Modifying thoughts/actions
End Phase
1. Evaluate-the degree to which client's goals have been attained
2. Cope with issues of ending process/relationship
3. Plan steps client may take relevant to the problem that do not involve SW
4. Discharge planning
5. Termination
Reflection
Reflecting clients feelings back to them-YOU SEEM TO BE OVERWHELMED
Exploring Silence
Being attentive and remaining silent during the time when client is silent. SILENCE EQUALS SILENCE.
Partialization
Taking client's OVERWHELMING feelings and breaking them down into smaller more manageable parts.
Confrontation
-Challenging an ESTABLISHED CLIENT to think about DISCREPANCIES in what he/she says/does.
-Can be used with addictions/perpetrators or resistance to treatment. (ex: changes subject, always late, denial, rationalization, cancellations).
-Not aggressive
Cultural Competence
Self-awareness about one's own attitudes, values, beliefs, about cultural differences; but safety will always trump cultural consideration. (Answer is usually "explore" unless safety is indicated)
Code of Ethics: Ethical Responsibilities Towards Clients
1. Client's best interests are primary
2. Respect/promote right to self-determination if client is mentally alert/stable, NOT unstable/intoxicated/psychotic
3. Informed consent, written agreement by client to undergo treatment, risks/benefits/costs disclosed
4. Avoid conflicts of interest (Things that interfere with SW's impartial judgment/discretion)
5. DO NOT promote individual therapy sessions with people who have a relationship with each other (except couples, family, group treatment). Provide family members with appropriate referrals
6. Avoid dual/multiple relationships
7. Avoid bartering (unless common practice in community)
8. Obtain a professional translator FIRST if client does not speak the language of SW.
9. Do not disclose client information without consent unless required by law.
10. Provide client with reasonable access to records (First explore/discuss reason for request). Follow laws of state.
11. Ensure CONTINUITY of services
12. NO relations with clients past or present
Mandated Reporting
SW's are required and responsible for reporting any instances of abuse that is suspected. Abuse includes physical, emotional, sexual, neglect, CHILD AND ELDER ABUSE.
Duty To Warn
SW's MUST WARN a threatened victim of any harm that his/her client may cause where there is a REAL INTENT OR PLAN.
HIV Decisions
NO DUTY TO WARN! 3 OPTIONS:
1. FIRST urge client to disclose to partner
2. FIRST encourage client to engage in safe sex
3. Research/follow state laws as needed
Court Subpoena
SW may be required by law to disclose confidential information
Code of Ethics: Ethical Responsibilities To Colleagues
1. Refer to colleague who may be better trained in an area than SW. SW can take client but must be COMPETENT.
2. When CONSULTING with a colleague, disclose the least amount of information
3. FIRST speak to a colleague to discourage/prevent/correct unethical behavior
4. AVOID relationships with colleagues (conflict of interest)
Code of Ethics: Ethical Responsibilities In Practice Setting
1. Accurately document services in client's records while keeping best interests in mind.
2. Maintain records securely for a period of time consistent with state laws.
Code of Ethics: Ethical Responsibilities As Professionals
1. MONITOR/EVALUATE policies and implementation of programs.
2. ADVOCATE when necessary
Generalist Framework Theory
"Eclectic approach" uses a variety of theories/models/methods of treatment
Problem Solving Theory
To solve one problem at a time, assist clients with COPING SKILLS.
Task-Centered Theory
Focuses on accomplishing tasks. Assist client with identifying goals first.
Feminist Framework Theory
Gender or sex role stereotyping and discrimination, women's rights.
Sigmund Freud's Structural Theory
1. ID=pleasure principle, unconscious source of basic desires.
2. EGO=reality principle, seeks to satisfy basic desires in socially acceptable way
3. SUPEREGO=Moral/ethical ability to choose right from wrong
Double Blind
Interaction in which one person demands a response to a message containing mutually contradictory signals while the other person is unable to either comment on the incongruity or escape from the situation.
Dynamic Equilibrium
Refers to interplay of forces in an open system which may give the appearance of being at rest, but is forever changing. (Ex: Family System)
Ego-Dystonic
Ideas, impulses, behaviors that are incompatible/unacceptable to the ego
Ego-Syntonic
-The person's characteristics are compatible with the person's self-image and therefore are not easily seen as problems.
-The person's ideas or impulses are acceptable to the ego and compatible with the ego's principles.
Equifinality
A particular end state may be reached from different means
Extinction
-A term in "classical conditioning" repeated presentation of a conditioned stimulus without the conditioned stimulus and the resulting gradual decrease in the conditioned response.
-In "Operant Conditioning" occurs when reinforcement is withheld following performance of a previously reinforced response.
Gestalt Therapy
-The natural course of a biological and psychological development of the organism, entails a full awareness of physical sensations and psychological needs.
-Concerned primarily with perceptual processes.
Individuation
-A process of differentiation, having for its goal of the development of the individual personality; development of the psychological individual as a differentiated being from the general collective psychology.
-Identified with Jungian Therapy; also Margaret Mahler
Negative Reinforcement
-Any behavior which increases the probability of a response by terminating or withdrawing an unpleasant stimulus.
-Always increases the likelihood of the future occurrence of the behavior it follows.
Operant Conditioning
-A type of learning in which responses are modified by their consequences.
-The correct response is reinforced and more likely to occur again.
-Reinforcement increases the likelihood of future occurrences of the reinforced response.
-Punishment and extinction decreases the likelihood of the future occurrences of symptoms.
Paradoxical Intention
-A therapeutic strategy in which the client is instructed to engage in or magnify the behaviors of concern.
-A therapeutic practice sometimes known as prescribing the symptoms.
Reactive Attachment
Lack of attachment to caregiver (ex: foster care kids)
Secondary Prevention
-Also called "screening". Refers to measures that detect disease before it is symptomatic.
-The goal of secondary prevention is to identify and detect disease in its earliest stages, before noticeable symptoms develop, when it is most likely to be treated successfully.
Tertiary Prevention
Focus on people already affected by disease and attempt to reduce resultant disability and restore functionality.
Primary Prevention
-The inhibition of the development of disease before it occurs
-To protect against disease and disability, such as getting immunizations, ensuring the supply of safe drinking water
-General action to promote health is the other category of primary prevention measures.
HMO Insurance/ Short-Term Care/ Managed Care
1. Emphasizes short-term, discourages long term treatment
2. Cases assigned to case manager to whom provider must justify necessity for treatment for payment and services.
3. More precise diagnosis=greater likelihood of reimbursement
4. Encourages cognitive behavioral short term treatment
5. Contracts are INFLEXIBLE. Abide by rules to receive reimbursement.
Piaget's Theory of Cognitive Development
*Birth-2=SENSORIMOTOR-Experiencing the world through senses and actions. Object permanence. Stranger Anxiety.
*2-6 PREOPERATIONAL-Representing things with words and images. Pretend play. Egocentrism. Language development
*7-11 CONCRETE OPERATIONAL-Thinking logically about concrete events and grasping concrete analogies. Conservation. Mathematical Transformation
*12-adulthood FORMAL OPERATIONAL-Thinking about hypothetical scenarios and processing abstract thoughts. Abstract logic; Potential for mature moral reasoning
Erikson's Stages of Psychosocial Development
*Infant-18mos=Trust vs mistrust
*18mos-3 years=Autonomy vs Shame & Doubt
*3-5years=Initiative vs Guilt
*5-13years=Industry vs Inferiority
*13-21 years=Identity vs Role Confusion
*21-39 years=Intimacy vs Isolation
*40-65 years=Generativity vs Stagnation
*65 and older=Ego Integrity vs Despair
Freud's Psychosexual Stages of Development
*ORAL=The mouth sucking, swallowing, etc=EGO develops
*ANAL=The anus withholding or expelling feces=EGO develops
*PHALLIC=The penis or clitoris; masturbation=SUPEREGO develops
*LATENT=Little or no sexual motivation present=SUPEREGO develops
*GENITAL=The penis or vaginal-sexual intercourse=SUPEREGO develops
***Orphan Annie Pretty Little Girl easy to remember.
Kohlberg
Moral development
Mahler
Attachment and individuation
Bowlby
Attachment
Minuchin
Structural family therapy
Eric Berne
-Game theory, founded TRANSACTIONAL ANALYSIS
-Parent adult child theory is still being developed
-Social life is a series of transactions, invoking other transactions.
The female client comes to see a social worker to discuss her relationship issues. According to the psychosocial perspective, the social worker should:
Have her tell you about the issues affecting her life
As a new clinical social worker you find yourself being told by your supervisor you need to be more confrontational. This seems at odds with the social work mission, until your supervisor explains the primary purpose of confrontation is to:
Make a client aware of inconsistencies
You have been hired, by a private, non-profit agency, which works with the HIV/AIDS population. The primary function of your unit is to educate sexually active individuals about the disease and to help them understand the importance of testing, life-style changes and treatment if necessary. What is the BEST way to describe your agency's type of prevention?
Secondary Prevention (measures that detect disease before it is symptomatic)
You have been hired as a social work case manager for an urban based agency. Your mission is to assess the needs of the client, the client's family, and to arrange for, coordinate, monitor, evaluate, and advocate for a package of multiple services to meet the specific client's complex needs. Social work case management is distinct from other forms of case management because it addresses all of the following EXCEPT:
The need for the client to accept the services provided because they are identified as necessary by the social work case manager.
You are sitting in a case staffing meeting at your agency while several other social workers are discussing their new cases and receiving feedback and suggestions. Of the four following situations, which one WOULD NOT lend itself to family therapy...?
A 17 year old son who needs to separate psychologically from his family.
Terri showed up for his appointment very upset and anxious. She stated she is frightened because she has begun hearing voices again. The voices that tell her she should kill herself. She has been hearing these voices for approximately 5 years and has two prior suicide attempts over this time. She states that the voices have become stronger over the past week. She says she had received a call from her mother that a friend from high school had completed a suicide attempt. Your FIRST intervention should be....
Begin a complete suicide risk assessment
Obsessive-Compulsive Disorder appears to have a genetic component. Numerous studies have identified components of the disorder, including obsessive thoughts which often produce anxiety and by which the individual uses repetitive actions to reduce the anxiety. Which of the following statements DOES NOT describe our knowledge of this disorder?
We have discovered the specific genetic etiology of this disorder.
You have begun working with a family in which there is a verified history of incestuous relationships. Of the following characteristics, which one is MOST often found in families in which incestuous relationships have occurred?
Enmeshment of family members
You accept a referral from an agency on 65-year old male client. During the initial interview you learn that he has been physically abusive to his wife or 40 years and he appears very depressed. He relates that two of his children will not talk to him and did not call him for his birthday last year. You quickly find you dislike this client intensely and have difficulty feeling any empathy for this client and his situation. That evening after the session, you realize he reminds you of your spouse's step-father who was abusive to your spouse during their childhood. You should....
Talk to your supervisor about your reactions toward this client
You have been asked to work with a family with a known history of father-daughter incest. As you evaluate this family system, you should expect to see all of the following concerns in relationships EXCEPT.....
Highly supportive and sharing daughter-mother relationship
You are seeing a client who brings in a plastic bag full of prescription bottles. Most are empty but you locate one which is half full. You realize, from this prescription the client probably is being treated for a seizure disorder. The medication you discovered was....
Depakote
You work for a local mental health agency and have been seeing a client for 11 sessions in individual therapy. At the beginning of your next session the client reveals they are sexually attracted to you and have been having sexual fantasies about you for several sessions. They tell you they cannot imagine not coming in to see you. You are caught completely off guard and do your best to try to process the information with the client. It becomes clear that the client is fixated on the admission. Your BEST response is to....
Stop the session and bring your clinical supervisor into the room.
You have been asked by a colleague to consult with a young couple who have two children, ages 6 and 2. They have recently been told, their 6-year old child has an Affective Disorder. The diagnosis was made after a school referral to a clinical social worker. The FIRST thing you should do for this couple is....
Empower the parents through education about the disorder.
You have been working with a client who has been describing a behavior which causes them to feel uncomfortable, distressed, and burdened. According the tenets of Ego psychology, this type of behavior would be BEST described as...
Ego Dystonic
You are working with an adult female who is experiencing difficult relationships plagued by feelings of abandonment, idealization, and devaluation of others with high positive regard and heavy disappointment or dislike. You believe this problem with relationships deals with unstable childhood experiences. Of the following treatment models, which would provide the BEST chance of success in therapy.
Dialectical Behavioral Therapy
You have accepted a position working in a sheltered workshop. You will be trained by the last social worker before she leaves her post for a new job. The workshop is specifically designed to help individuals suffering from a developmental delay. You would expect the social worker training you to use a primarily focused on a behavioral approach. Of the following interventions, which would she be LEAST LIKELY to use to train you?
Assess current familial relationships
Of the following drugs prescribed by a psychiatrist, which would be most likely prescribed for a diagnosis which included psychosis?
Risperdol (Risperidone)
You are evaluating an agency you intend to use as a referral agency. You are looking first and foremost at their use of evidenced-based practice models. This is MOST IMPORTANT because you need to....
Verify that services are provided in the most verifiable manner and with the best client outcomes.
Marco is a clinical social worker who has just taken a position with a community mental health agency which primarily serves Latino families in a 30 mile radius. When dealing with families referred to the agency, Marco should be concerned FIRST with....
Determine the degree of assimilation into American culture.
A social work colleague is having problems addressing the resistance a client (who was referred by the court system) is giving them during therapy. They ask you for help. Your BEST response is to tell them....
Explore the feelings underlying the resistance.
You have been asked to consult with another social worker who is working with a 15 year old girl. During her first visit the youth stated, "I wish I could convince my parents to take me to a plastic surgeon". She presented with the following issues. She is preoccupied with her "large" jaw, "small" breasts and "uneven" skin and will ask her mother whether she looks okay at least a dozen times per day. She has begun to use heavy makeup and has also started wearing long sleeves and pants at all times in order to cover her skin. Her appearance concerns are so time-consuming and distressing that she has ceased to spend time with her friends and has dropped extracurricular activities. What is her probable diagnosis according to the DSM-IV or DSM-IV-TR symptoms?
Body Dysmorphic Disorder
You have just began an initial session with a battered woman who is just starting to tell you about the story and history of abuse. The BEST thing you can do as a therapist is....
Simply listen to her story and do not offer advice or suggestions.
It is your fourth session with a client and they arrive 22 minutes late. Upon seating themselves on the couch they say, "I know I'm late, I got stuck at work today and could not get away from my desk". This is the third time they are late to a session. You decide it is time to address the situation. Your BEST response it to say....
Maybe we need to explore what it means to you to come here for our sessions.
You have been working with a client for six sessions and they are covered by BCBS insurance. They have elected to pay in cash rather than use their insurance benefits. Their insurance company sent you a letter requesting information about the client's progress and the current focus of therapy. Your BEST response is to...
Send the requested information only with the client's written authorization.
According to LaFromboise, Teresa D., Joseph E. Trimble, Gerald V. Mohatt, effective counseling strategies with Native American populations include all of the following EXCEPT:
Providing therapy in a "value-free" environment.
You are a school social worker called to a teacher's room because they have a 6 year old child who has scrapes on his knees and shins. At the classroom, the teacher states that this is not the first time the child has come to school with scrapes on his legs. As a mandated reporter, your next BEST step is to...
Question the teacher about past incidents.
You are finishing your work with a client. As you begin the process of termination, your PRIMARY goal is....
Summarize the progress and goals you have achieved.
You are working for an agency that takes walking referrals. In the middle of your shift, you have a walking referral concerning a female who is a battered woman. She presents as scared and paranoid. Of the following actions, which intervention should you complete first?
Obtain referrals for immediate safety.
You are working with a new client who has just come into your office and has begun a very detailed description of the events which have culminated in her current crisis and the need for your services. During her description, which of the following behaviors are NOT considered appropriate?
Encouraging her with phrases like "go on" and "um-hum".
You are writing a proposal to your agency to begin a group therapy project. As you are listing the different aspects of the group, you realize the most important aspect you should consider for establishing membership in the therapy group is....
Client diagnosis
You are in your fourth session with a man who is 32 years old, who's been married for six years. He and his wife have two small children. He states to you that he recently had a homosexual experience, and now realizes that he has been gay all of his life. He wants to talk to his wife but he is afraid she will become angry and he will not be able to see his children. Your BEST NEXT course of action would be?
Explore with the client the possible outcomes of his revelation, and the possible issues he will face in the future.
You are a clinical social worker being trained in the use of cognitive behavioral therapy. Which of the following BEST describes the progress achieved as a result of CBT intervention...
Behavior that client exhibits.
Of the following medications, which is MOST LIKELY to be used for the treatment of bipolar disorder?
Abilify (also known as Aripiprazole)
A common complication of alcohol dependence is elevated pulse and blood pressure, often in the hypertension range. The BEST description for this is...
Direct toxicity to striated muscle
Excessive drinking may interfere with the absorption, digestion, metabolism, and utilization of nutrients, particularly vitamins. Alcoholics often use alcohol as a source of calories instead of obtaining calories from food sources. This behavior may lead to a nutrient deficiency and malnutrition. The BEST description of the damage done is...
Direct toxic effects of alcohol on the small bowel; Malnutrition, malabsorption, and ethanol toxicity; Severe neurological damage.
You have begun working with a number of clients who are classified as dual-diagnosed. This means they have a mental health and a substance abuse diagnosis. The first thing you realize is the great variety of client presentation during your sessions. When working with this population, you should plan on focusing on which diagnosis FIRST?
The diagnosis with the most severe symptoms.
Of the following, which statement is NOT TRUE about alcohol dependence in women, as compared to alcohol dependence in men...
Neurophysiology is more compromised in alcoholic men than women.
While the use of marijuana only has little impairment on a driver, mixing even small amounts of alcohol with marijuana has severe impact on driving skills. According to the National Highway Traffic Safety Administration's National Center for Statistics and Analysis, which represents the MOST accurate percent of traffic fatalities which are alcohol related?
About 1/3 (one-third)
Ethical codes are based on the ethical principles of a profession. These codes outline the values of the profession. They also create a guide to steer the behaviors of the profession. Of the four overall ethical domains below, which one DOES NOT apply to the social work profession?
Behaviors of the client to the professional
Ethics are beliefs about what constitutes correct or proper behavior. The principles of "right conduct" and "how to live as a good person" are basic elements in the ethical principles of our profession. Our ethical code reflects one's obligations or duties. These basic elements are principles common to the helping professions. When one talks about "The Duty to Keep A Promise" they are referring to the concept of...
Fidelity
You solicit information about a client via an email request. The colleague sends you an email response with a summary of therapy. The email is not encrypted. You are concerned that the client's confidentiality may have been violated because you were not expecting an email response. The LEAST chance of the email being intercepted is when....
You print the email for the client's file.
You are a clinical social worker with an on-line presence on a social media platform. You receive a request to be connected to or befriended by a client. The issue which should bring you the GREATEST concern regarding whether to accept the invite or not is....
The concept of dual relationships.
You are a clinical social worker providing services to a client. During a routine search of your social media account, you run across your client's profile and there is information posted by the client which contradicts information the client has given you. Given your ethical duty surrounding the use of the information. You decide you should only use the information once you figure out how it's use would promote the well-being and welfare of the client. Your actions are BEST described by the ethical concept of...
Beneficence (the duty to do good)