223 terms

Social Work Licensing Exam


Terms in this set (...)

Last Sentence-guide to answer
What are the 3 areas to identify with each question?
(Hint: PPL)
-Person/Client "hot seat"
-SAFETY Red Flags-suicide, abuse, life-threatening, unexplained, unexplained marks, alcohol, recent loss
-Strong words/adjectives
-Setting (medical, school, community, etc...)
-Where are you in terms of number of sessions?
-Direct requests/concerns
-Qualifiers (First, Next, Best)
What Are The Key Words To Look For?
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 are common distractors?
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
What does FARM GRITS ROAD stand for?
90% of exam is SAFETY FIRST!
How do you answer first/next questions?
Assess before Action
How does the exam want you to have a CLEAR understanding of client's issues?
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....
What does RUSAFE stand for?
1. Antipsychotics (schizophrenia)
2. Mood Stabilizers (bi-polar meds)
3. Anti-Anxiety Meds (ptsd, ocd, gad)
4. Antidepressants (ssri, atypical, tri-cyclics, maoi)
Drug Classifications
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
Anti-psychotics (schizophrenia)
A. Live To Dream Always=Lithium, Tegretol, Depakote, Abilify
*kidney problems, liver problems, monitor blood work
Mood Stabilizers (bipolar meds)
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
Anti-Anxiety Meds (ptsd, ocd, gad)
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
Medication for alcohol, AVERSION THERAPY
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 is Supervision?
1. Administrative
2. Educational
3. Supportive
What are the 3 functions of supervision?
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.
4. Supervisor DOES NOT EXPLORE social worker's inner feelings
5. Main purpose-advance agency goals and improve service to clients.
Supervisor Key Concepts
Accountability for client care within the parameters and ethical standards of the social work profession.
What is the top priority of supervision?
The Supervisor should COMMEND work performance, also point out inappropriate performance when it occurs.
What should a supervisor do?
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 Administrative 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 Educational 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.
What is the difference between consultation and supervision?
SW is involved in the process of making referrals to link a family or person to needed resources.
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.
SW involved in locating services and assisting their clients to access those services.
Case Manager
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.
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.
SW is involved in many levels of community organization and action including economic development, union organization, and research and policy specialists.
SW, because of their expertise in a wide variety of applications, are well suited to work as managers and supervisors in almost any setting.
-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
Medical Social Worker: Setting=Hospital
-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...)
Crisis Social Worker: Crisis Intervention
-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!
Community Organization Social Worker
-Issues that affect the learning of the student
-mental health, parents, bullying, abuse/neglect, cultural differences.
School Social Worker
-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.
Executive Directors
-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.
-Deficit in intellectual functions, adaptive functions, onset during developmental period.
-Diagnosed with clinical assessment and standardized testing
Intellectual Disabilities (instead of mental retardation/developmental disability)
-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.
Autism Spectrum Disorder
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.
Delusions, hallucinations, disorganized thinking (speech), catatonia, negative symptoms.
Schizophrenia Spectrum
-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
Delusional 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.
Brief Psychotic Disorder
-TWO OR MORE OF THE FOLLOWING: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.
-Schizoaffective disorder and depressive or bipolar have been ruled out.
Schizophreniform Disorder
TWO OR MORE OF THE FOLLOWING: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
-Level of functioning in one or more major areas is markedly below
-Continuous signs of the disturbance persist for AT LEAST 6 MONTHS
-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.
Schizoaffective Disorder
Manic episode lasting at least A WEEK. Major depressive episode present during 2-WEEK PERIOD.
Bipolar I
-Meets criteria for Hypomanic Episode (4 DAYS) AND MAJOR DEPRESSIVE EPISODE.
-Never been a manic episode
Bipolar II
-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.
Cyclothymic Disorder
-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.
Manic 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.
Major Depressive Episode
Elevated, expansive, irritable mood, increase goal-directed activity or energy lasting 4 CONSECUTIVE DAYS 3 OR MORE SYMPTOMS OF MANIC EPISODE CRITERIA B
Hypomanic Episode
-Severe recurrent outburst, verbally or behaviorally, on average 2 OR 3 TIMES PER WEEK.
Disruptive Mood Dysregulation Disorder
Major depression for 2 years; during which symptoms have always been present except for no more than 2 months.
Persistent Depressive Disorder (Dysthymia)
Developmentally inappropriate and excessive fear or anxiety concerning separation from attachment figures.
Separation Anxiety Disorder
-Consistent failure to speak in specific social situations where expected.
-Disturbance is at least 1 month
Selective Mutism
-Specific fear about specific object or situation.
-Almost always provokes anxiety
Specific Phobia
Fear or anxiety about one or more social situations.
Social Anxiety 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.
Panic Disorder
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.
-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.
Obsessive-Compulsive 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.
Body Dysmorphic 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.
Hoarding Disorder
-Recurrent pulling out of one's hair, resulting in hair loss. -Repeated attempts to decrease or stop hair pulling.
Trichotillomania (Hair Pulling) Disorder
-Recurrent skin picking resulting in skin lesions.
-Repeated attempts to decrease or stop skin picking.
Excoriation (Skin Picking) Disorder
-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.
Repeated regurgitation, re-chewing of food without the apparent nausea or disgust.
Rumination 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.
Avoidant/Restrictive Food Intake Disorder
An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat.
Anorexia 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.
Bulimia Nervosa
Significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa.
Binge-Eating Disorder
-Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
Repeated passage of feces into inappropriate places whether involuntary or intentional.
-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.
Oppositional Defiant 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.
Intermittent Explosive 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.
Conduct Disorder
-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.
Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
-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.
Neurocognitive Disorders
-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.
-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.
Minor 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 Neurocognitive Disorder
-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.
Major and Minor Neurocognitive Specifiers
-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.
Substance Use/Abuse DSM 5 Updates
-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.
Gambling Disorder (included in DSM5)
-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 Use/Abuse Continued
Increased tolerance, withdrawal symptoms
Substance Dependence
Abuse interferes with obligations; causes social, legal, medical problems
Substance Abuse
Synthetic narcotic for Opiate use
Denial and Rationalization
Addicts Defense Mechanisms
Enablers, allow for addictions to continue/progress
Family Members Role With Addicts
Techniques To Use With Established Clients With Addictions
May require medical intervention
Addict Withdrawal Symptoms
Slurred speech, odor or alcohol on breath, unsteady gait, coordination problems, staggering
Signs of Alcohol Use
Family history of alcoholism
Strongest Predictor For Developing An Alcohol Problem
Seizures and tremors
Alcohol Withdrawal
Talkative, pale, hyperactive, thin, loss of appetite
Signs of Cocaine Use
Depression, vomiting, fatigue
Cocaine Withdrawal
Bone pain, anxiety, muscle spasms, restlessness
Heroin Withdrawal
Hallucinations, confusion, anxiety, suspicion
Hallucinogen Use
Non-existent with hallucinogens (LSD, PEYOTE, ECSTASY)
Hallucinogen Withdrawal
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 Therapy Key Concepts
Discussion strengthens a dominant point of view, group shifts to this extreme viewpoint.
Group Polarization
Group cohesion and loyalty undermines decision making in order to maintain the we-ness.
-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
Irvin Yalom M.D.
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.
Domestic Violence
Report of reasonable suspicion, even if against supervisor, vignette will try and dissuade you from reporting.
Child Abuse
Physical signs/injuries, behavioral signs-oppositional defiant symptoms, interest in sexual activity, school performance problems and difficulties.
Indicators of Abuse
What Defense Mechanism Is Mostly Used By Survivors Of Child Abuse?
Place unwanted/unpleasant feelings onto someone less threatening or innocent bystander (ex: angry at boss, take it out on spouse)
-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.
Taking your emotions and placing it on others (ex: all of my coworkers are greedy, but I am not)
To incorporate someone else's emotions into one's self, internalized beliefs of others.
Overestimation of an admired aspect or attribute of another
A person patterns oneself after a significant other
Mastering anxiety by identifying with a powerful aggressor
Identification With The Aggressor
Expressing no emotionality when confronted with difficult events.
Isolation Of Affect
BPD clients. Unconsciously perceiving other's behavior as a reflection of one's own identity.
Projective Identification
Turning unwanted or dangerous thoughts, feelings, or impulses into their opposites (ex: person with a sudden loss shows a happy mood)
Reaction Formation
Return to infantile patterns of thinking/being.
Maladaptive behavior/impulses diverted to more socially acceptable channels, healthy redirection of emotion.
Defense to deflect hostile aggression or other unacceptable impulse from another to self.
Turning Against The Self
Also clients with BPD-identify a person as either all good or all bad.
Refusal to acknowledge external reality that are intolerable (ex: I am not a shopaholic, but credit cards are maxed out.
Unconsciously wipes out, "forgets" painful feelings/memories.
Consciously put painful thoughts/feelings memories to the side
Taking back unwanted behaviors through praise/gifts. (Ex: buying gifts, obsessively washing hands to deal with obsessive thoughts. OCD)
Enables one to make up for real or fancied deficiencies (Ex: short man becomes cocky)
Repressed urge is expressed as a disturbance of body function (Ex: pain, deafness, blindness)
Purpose, Knowledge, Values, and Sanctions
Social Work Process
1. Beginning, Middle, Ending Phases
2. Contact, Contract, Action, Termination
Stages In The Helping Relationship
1. Engaging
2. Assessing
3. Planning
4. Intervening
5. Evaluating
6. Terminating
Problem-Solving Process
1. Consultant
2. Advocate
3. Case Manager
4. Catalyst
5. Enabler
6. Broker
7. Mediator
8. Facilitator
9. Instructor
10. And Other
Interventive Roles
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)
Interventive Skills
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
The Referral Process
Technique in supervision to air out feelings
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
Beginning Phase of Treatment
1. Intervention
2. Universalization, clarification, confrontation, interpretation, reframing, labeling
3. Worker can be an advocate or mediator
4. Modifying thoughts/actions
Middle Phase Of Treatment
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
End Phase
Reflecting clients feelings back to them-YOU SEEM TO BE OVERWHELMED
Being attentive and remaining silent during the time when client is silent. SILENCE EQUALS SILENCE.
Exploring Silence
Taking client's OVERWHELMING feelings and breaking them down into smaller more manageable parts.
-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
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)
Cultural Competence
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
Code of Ethics: Ethical Responsibilities Towards Clients
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.
Mandated Reporting
SW's MUST WARN a threatened victim of any harm that his/her client may cause where there is a REAL INTENT OR PLAN.
Duty To Warn
1. FIRST urge client to disclose to partner
2. FIRST encourage client to engage in safe sex
3. Research/follow state laws as needed
HIV Decisions
SW may be required by law to disclose confidential information
Court Subpoena
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 To Colleagues
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 In Practice Setting
1. MONITOR/EVALUATE policies and implementation of programs.
2. ADVOCATE when necessary
Code of Ethics: Ethical Responsibilities As Professionals
"Eclectic approach" uses a variety of theories/models/methods of treatment
Generalist Framework Theory
To solve one problem at a time, assist clients with COPING SKILLS.
Problem Solving Theory
Focuses on accomplishing tasks. Assist client with identifying goals first.
Task-Centered Theory
Gender or sex role stereotyping and discrimination, women's rights.
Feminist Framework 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
Sigmund Freud's Structural Theory
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.
Double Blind
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)
Dynamic Equilibrium
Ideas, impulses, behaviors that are incompatible/unacceptable to the ego
-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.
A particular end state may be reached from different means
-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.
-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.
Gestalt Therapy
-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
-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.
Negative Reinforcement
-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.
Operant Conditioning
-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.
Paradoxical Intention
Lack of attachment to caregiver (ex: foster care kids)
Reactive Attachment
-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.
Secondary Prevention
Focus on people already affected by disease and attempt to reduce resultant disability and restore functionality.
Tertiary 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.
Primary Prevention
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.
HMO Insurance/ Short-Term Care/ Managed Care
*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
Piaget's Theory of Cognitive 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
Erikson's Stages of Psychosocial 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.
Freud's Psychosexual Stages of Development
Moral development
Attachment and individuation
Structural family therapy
-Game theory, founded TRANSACTIONAL ANALYSIS
-Parent adult child theory is still being developed
-Social life is a series of transactions, invoking other transactions.
Eric Berne
Have her tell you about the issues affecting her life
The female client comes to see a social worker to discuss her relationship issues. According to the psychosocial perspective, the social worker should:
Make a client aware of inconsistencies
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:
Secondary Prevention (measures that detect disease before it is symptomatic)
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?
The need for the client to accept the services provided because they are identified as necessary by the social work case manager.
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:
A 17 year old son who needs to separate psychologically from his family.
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...?
Begin a complete suicide risk assessment
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....
We have discovered the specific genetic etiology of this disorder.
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?
Enmeshment of family members
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?
Talk to your supervisor about your reactions toward this client
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....
Highly supportive and sharing daughter-mother relationship
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.....
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....
Stop the session and bring your clinical supervisor into the room.
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....
Empower the parents through education about the disorder.
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....
Ego Dystonic
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...
Dialectical Behavioral Therapy
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.
Assess current familial relationships
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?
Risperdol (Risperidone)
Of the following drugs prescribed by a psychiatrist, which would be most likely prescribed for a diagnosis which included psychosis?
Verify that services are provided in the most verifiable manner and with the best client outcomes.
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....
Determine the degree of assimilation into American culture.
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....
Explore the feelings underlying the resistance.
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....
Body Dysmorphic Disorder
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?
Simply listen to her story and do not offer advice or suggestions.
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....
Maybe we need to explore what it means to you to come here for our sessions.
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....
Send the requested information only with the client's written authorization.
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...
Providing therapy in a "value-free" environment.
According to LaFromboise, Teresa D., Joseph E. Trimble, Gerald V. Mohatt, effective counseling strategies with Native American populations include all of the following EXCEPT:
Question the teacher about past incidents.
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...
Summarize the progress and goals you have achieved.
You are finishing your work with a client. As you begin the process of termination, your PRIMARY goal is....
Obtain referrals for immediate safety.
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?
Encouraging her with phrases like "go on" and "um-hum".
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?
Client diagnosis
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....
Explore with the client the possible outcomes of his revelation, and the possible issues he will face in the future.
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?
Behavior that client exhibits.
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...
Abilify (also known as Aripiprazole)
Of the following medications, which is MOST LIKELY to be used for the treatment of bipolar disorder?
Direct toxicity to striated muscle
A common complication of alcohol dependence is elevated pulse and blood pressure, often in the hypertension range. The BEST description for this is...
Direct toxic effects of alcohol on the small bowel; Malnutrition, malabsorption, and ethanol toxicity; Severe neurological damage.
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...
The diagnosis with the most severe symptoms.
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?
Neurophysiology is more compromised in alcoholic men than women.
Of the following, which statement is NOT TRUE about alcohol dependence in women, as compared to alcohol dependence in men...
About 1/3 (one-third)
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?
Behaviors of the client to the professional
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?
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...
You print the email for the client's file.
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....
The concept of dual relationships.
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....
Beneficence (the duty to do good)
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...