LMSW EXAM - Assessment and Intervention Planning
Terms in this set (132)
(1) improve the effectiveness and efficiency of service provision and (2) bring about changes in policies, programs, or budgets,
(3) changes in communities and organizations.
(4) policy development, program planing, program evaluation, administration, and intervention with communities.
Using Biopsychosocial Approach
1. Multidimensional framework
2. Risk factor
3. Person-in-environment framework
4. Ecosystems theory
(1) examine the full range of possible causes and explanations of a client's functioning.
(2) Gathering information and theory from the biophysical,psychological, and social dimensions.
When working to identify potential causal factors, SW consider precipitants (activating situations) to the problems.
(1) understand the client's situation from this framework
(2) Consider the client as part of an environmental system
It concerned with the study and description of human beings and other living systems and the transactions between them, and it proposes that psychological prepossess are manifestations of interaction between and among biological, interpersonal, cultural political, economic, legal, and organizational forces and that theses forces interact continually and influence a persons' behavior during her entire lifespan.
The phases of Assessment
1. Data collection - avoid jumping to conclusions about the nature or causes of the client's problem at this time.
2. Organizing and Studying the data - should include client's strengths and deficiencies
The presenting problem
Consists of symptoms and issues, or difficulties
"I have trouble forming relationships with men"
"I'm so depressed"
"My husband and I can't stop fighting"
Problems may also include others such as family members, coworkers.
Questions to explore in problem assessment
1. problems and concerns
2. Legal mandates
3. Health or safety issues
4. signs and symptoms - it is something observed by you rather than reported by the client
5. individuals/ systems
9. where, when and frequency
11. emotional reactions
13. developmental stage or life transition
14. other issues
15. coping skills
16. skills, strengths, resources
17. cultural, social and social class
18. support system
19. external resources
Guidelines for conducting a competent assessment
1. Follow the principles of relevance and salience - limited sessions under managed care.
2. Address top priorities FIRST
3. Gather information from a variety of sources
4. Recognize the uniqueness of the client - Should not draw final conclusions about client.
5. Adopt a strengths perspective
6. Be aware of factors that can affect a client's response - Malingering / defensiveness
7. View assessment as both a product and a process
Address top priorities FIRST
1. Start where the client is - "What the client sees as her primary problem or concern?"
2. Legal mandates - should be addressed at the begining
3. Health /Safety concerns
Independent assessments vs Clinical Team approach
Independent assessment - assessment completed in 1-3 sessions/ the worker may consult with colleagues or professionals when the client's case situation is complicated
Clinical team approach - SW role is to compile a social history off the client.
Skills for eliciting the presenting problem
1. "Start where the client is"
2. Make statements that allows client to choose her own direction
3. Ask Open-Ended questions
4. Seek clarification
Start where the client is
1. allow a client to speak freely about the concerns - speak upto 10 or 15 minutes
2. if the client is upset - FIRST, reducing her distress or negative feelings - "Responding Emphatically" or "Reflective Opening"
Responding empathically to the client's feelings and communicating your understanding and acceptance.
"Somethings, it can be difficult to get started"
" You seems upset today"
Make statements that allow client to choose her own direction
"Tell me about your problem", "How can I help you?"
Allow the client to present her own view of the problem
"When was your most recent psychical exam?" or simple "Yes" or "No" answers
You should ask the client to clarify any descriptive terms such as depressed, confused, fed up.
If a client may test your competency and trustworthiness before disclosing the real problem....
this client maybe
○ a member of a minority group
○ from her experiences with discrimination.
Which clients may exaggerate the complicity, seriousness, and/or urgency of her presenting problem, concern, or request?
A voluntary client
Which clients may hold information and/or minimize the presenting problems?
○ An involuntary client
In the situation
○ SW try engaging the client in an exploration of her life situation.
Needs are often related to persons's developmental stage and the tasks and transitions associated with it. It is critical to take into account a client's developmental stage when attempting to identify her needs.
Antecedents vs consequences
These are events that precede, or come before, a behavior and are thought to influence it.
What model/approach is often use for exploring antecedents and consequences?
Internal vs. External locus of control
Sense of self-efficacy
In which cases that an immediate medical referral needed?
3. Long-standing depression
4. Abrupt personality change
5. Sudden change in intellectual or behavioral functioning in a child
6. Known or suspected heavy or long-term alcohol use or other drug use
7. Known or suspected serious eating disturbance
8. Suspicion of HIV disease
9. Any other recent loss or alteration of physical functioning
Which clients should pay attention to have any signs or symptoms of dementia?
1. In an elderly clients
2. A client with advanced HIV disease
Symptoms of serious eating disturbance
Emaciated appearance, dizziness, excessive use of laxatives or diuretics, dental erosion, mood swings
If client is concerned about or distressed by medication side effects symptoms,
SW should encourage her to see a medical professional as soon as she can.
If the client has signs or symptoms of a potentially dangerous medication side-effect such as tardive dyskinesia,
SW should encourage her to see a medical professional as soon as possible, or SW should be active in arranging for her to do so.
If the client who is taking too little or too much of her medication, mixing her medication with alcohol or other drugs, or otherwise misusing her medication,
SW should be referred for an evaluation by a physician or psychiatrist.
III. Assessment Methods and Techniques
Refer to a Medical Doctors
any client presenting with psychological symptoms who has not had one in the past year
Consultation and direct client contact with physician *
when you suspect alcohol abuse or other drugs or a serious health problems such as physical side-effect.
is a MD who diagnose or treat nervious system including disease of the brain, spinal cord, nerves, and muscles
Consult with nerologist
when client may have ---> change in mental status, forgetfulness, a change in bowel or bladder function, difficulty swallowing, dizziness, double vision, fainting, headaches, numbness, pain in the neck or back, seizures, slurred speech, tingling, and weakness.
Neurological test required for certain mental disorders
learning disorders, autism, ADHD, Tourett's disorder, Tic disorder, delirium, dementia, and amnestic disorders
Refer to a psychiatrist
when a client who is taking psychotropic medication reports that
(1) the drug is not having the desired effect
(2) complains of side-effects caused by the medication
** Should consult with any psychiatrist who has treated the clinet
Refer to a Psychologist
for psychological testing and/or consult with a psychologist who has evaluated or treated the client in the past.
a technique that allows you to create a situation in which you can observe client's interactions directly.
E. Clinical tools for understanding the client and her situation
1. Life history grid
Used to graphically depict significant events in the client's life and the development of significant problems over time.
2. Life cycle matrix
Used to graphically depict the developmental stage of all individuals in a household.
a. Tools for social assessment
b. Clinet's family historical patterns and history - at least three generations
a. Tools for social assessment
b. understanding of her social context : school, workplace, community
5. Dual perspective worksheet
a. Tools for social assessment
b. a worksheet that depicts the location of both supports and barriers or problems
6. Social network map and Social network grid
a. Tools for social assessment
b. collecting information about key people
a. Tools for social assessment
b. identify and illustrate a client's friends, associates and enemies by diagramming
F. Behavioral Assessment
1. Behavioral observation
(1) Naturalistic Observation
observed in the environment
(2) Controlled Observation
force the target behavior in a simulated manner (role-playing, enactment)
you ask the client record information about the frequency and conditions surrounding the target behaviors.
G. Mental Status Exam (MSE)
a. Consciousness and cognition
b. PERSON, PLACE, TIME, SITUATION (OBJECTS, OTHERS)
If you use psychological testing, you should be aware that clients have the right to know the purpose, name, rationales, and results of the testing
(1) Brief Symptom-Focused Instruments
a. Rapid Assessment Instrument (RAIs) - useful in the age of manged care
b. Two RAIs
(a) SF-36 Health Survey
(b) SF-12 Health Survey
c. Brief Symptom Inventory (BSI) - self-report instrument
d. Back Depression Inventory-II (BDI-II) - the depth of depression
(a) Beck Hopelessness Scale (BHS)
(b) Beck Scale for Suicidal Ideation
(2) Youth Assessment Instrument
a. Child Behavior Checklist (CBCL) - parent report for child's behavior, age 6 - 18
b. Conner's Rating Scales-Revised - evaluate problem behavior in age 3-17
c. Other Youth Assessment Instrument
(a) Behavior Assessment System for Children-2 (BASC-2) - emotions and behaviors from 2-21
(b) AIMS Assessment tool - emotional assessment from birth to 5
(3) Screening Instruments for Substance Abuse
a. CAGE and T-ACE - screen for alcoholism
b. CAGE-AID (Adopted Include Drugs) - all types of substances
(4) Neropsychological Screening Tests
a. Mini Mental State Exam - age over 18
(5) Self-Report Measures to Aid in Treatment Planning and Tracking Progress
a. Outcome Questionnaires-45 (OQ-45)
b. Butcher Treatment Planning Inventory (BTPI)
c. Behavior and Symptom Identification Scare (BASIC-32)
(6) Personality Test
a. Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
b. Millon Clinical Multiaxial Inventory (MCMI-III)
c. The Rorschach - protective personality test, 5- adult
4. Intelligence Test
(1) Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)
a. 16-90 years
(2) Stanford-Binet Intelligence Scale, Fifth Edition
a. 2-85 years
b. measure of general cognitive ability, psychoeducational evaluation, developmental disabilities and exceptionalities
(3) Denver Developmental Screening Test II
a. Infant and Preschool Test
5. Assessment of Mental Retardation
(1) Vineland Adaptive Behavior Scales
a. birth to age 90,
b. evaluate personal and social skills of individuals with mental retardation, autism, ADHD, dementia
AAMR Adaptive Behavior Scale
a. assess adaptive functioning
b. age 3-21
6. Assessment of Learning Disabilites
(1) Illinois test of Psycholinguistic Abilities (ITPA-III)
a. age 5-12
b. evaluate linguistic abilites
(2) Wide-Range Achievement Test (WRAT3)
a. age 5-75
b. reading, spelling, arithmetic
7. Measures for People With Physical Disabilties
(1) Columbia Mental Maturity Scale
a. age 3-10
b. cerebral palsy, brain damage, mental retardation, speech impairments, hearing loss, limited English proficiency
(2) Haptic Intelligence Scale
a. blind and partially sighted age 16 and older
(3) Hiskey-Nebraska Test
a. blind and partially sighted
b. age 16 and older
(4) Raven's Progressive Matrics
a. general intelligence
8. Neuropsychological Tests
(1) Halstead-Reitan Neuropsychological Battery
(2) Luria-Nebraska Neuropsychological Battery
(3) The Wechsler Memory Scale
(4) Other Neuropsychological Tests
9. Interest Inventorues
(1) Kuder Test
(2) Career Assessment Inventory
(3) Self-Directed Search
Computer generated interpretive statements may not describe a client accurately.. They may contain misleading or incorrect statements. SW must use her clinical judgement and other client data to identify which statements apply to the client.
2 examples of client-focused measure
(1) Individualized rating scale
(2) goal attainment scale
identifying the frequency and duration of a client's problems and the circumstances
SW and client better understand the nature of the presenting problem
It contains a specific measurement
Spousal / Partner Abuse
If both partners have come to your agency or office,
- interview the client and her abusive partner separately.
- Be area that the batterer may try to prevent his partner from speaking to you outside of his presence.
Explain confidentiality issue, espeically when the client has been referred by the legal system
Identify the current level of danger
- SW must assess danger in the relationship
- Evaluate the types of danger - additional abuse, suicide, homicide, risk to children living in the client's household
Duty to report spousal abuse ?
No. If the client is at risk for further abuse, you should tell her about available resources such as a shelter and the police and help her develop an escape plan so that she can be safer from harm while making decisions about her life.
If the client minimize the seriousness of her abusive situation,
- Explain the cycle of violence
- all her to move past the minimization at own her pace
If the client is clearly is in danger but insists that she isn't
you can label her as "battered" to offset her minimization and encourage her to consider taking steps to better protect herself from further abuse
Assessment of partner abuse
1. if both partner come to agency ---> separately assess
2. Explain ---> confidentiality issues
3. Identify ---> the current level of danger in the relationship
4. Address ---> minimization
5. Ask ----> specific questions about the most recent battering incident and carefully document
6. Assess the batterer ---> substance abuse and dependence
Assessment of Elder Abuse
2. If the family is not involved with reporting, ---> advocate specific action and mobilize support system for the family
3. Obtain medical attention for the abused elder
- Activities of daily living
Suicide Risk Factor
1). Gender - 4-5 time as many men
2). Age - adult and age 65 over
3). Race - White
4) Psychiatric disorder - Major depression, bioploar
5) Family History - When a family member has committed suicide
Mental diseases that must evaulate for suicide risk
1) Major depressive disorder
2) bipolar disorder
4) alcohol abuse and dependence
5) PTST or acute stress disorder
6) borderline personality
Direct assessment of suicide
Low lethality - talk
High lethaltiy - no -suicide contract or notify to support system like family
Very high - hospitalization (voluntary or invaluntary)
Prevention and intervention with a dangerous client
Duty to warn
- If a dangerous person unable to control --> Hospitalization
- call for police protection
unhealthy boundary, overly diffuse, allowing too much communication with other subsystems
too rigid,not allowing adequate communication between subsystems
Differentiation of self
Refers to a person's ability to separate her intellectual and emotional functioning from the functioning of other family mebmbers
relatively permeable boundary allowing interaction with the outside community while maintaining the integrity of the family system
Organizing assessment Data; 4P's
Problem; person; place; process
Roles (parents, spouse); Reactions (client's reaction) ; Relationships (client's relationship) ; Resources
Motivation (client's); Meaning (ethnic, cultural); Management (best use time, energy to help client); Monitoring (how will you monitor client)
How to find Primary problem with clients seen by social worker?
1. concern expressed by the client
2. greatest impact on the client's situation
3. Most negative and extensive consequences
4. greatest interest to the client
5. with an involuntary client - the referral
acute suicidal or dangerous to others; individual therapy, group therapy, medication monitoring
Intensive outpatient program
group therapy two to five times a week; individual therapy; therapeutic group setting
DETOXIFICATION; imminent danger to self;
Client factors affecting the choice of intervention strategies
Motivation; Capacity; Opportunity
"Client's readiness for change" by Prochaska and DiClemente; people pass through a series of six stages when changing a behavior
1. Precontemplation Stage; unaware of problems, unwilling to change
2. Contemplation Stage; aware of problem, possibility to change; the client's "SELF-EFFICACY" for change
3. Determination Stage; ready and determined to change
4. Action Stage; specific actions
5. Maintenance Stage;
6. Relapse Stage
An intervention model in which the client participates concurrently in both individual therapy AND group therapy
SW treats family and couple by meeting WITH members or partners
Seeing different members of a family or client system SEPARATELY in individual sessions
Two or more Social Workers treat ONE member of family
Issues commonly addressed in INDIVIDUAL thearpy
Adjustment reactions (chronic disease, DV victim, homeless, marriage, divorce,relocation, phsycial change, losses) ; Developmental issues; life span issues; personality features; mental disorders; mourning
1. benefit from family issues, cycles;
2. contraindications (NOT appropriate) for family therapy
(1) key family members are unavailable or unwilling to participate; (2) one family member is so severely disturbed that her behavior makes family treatment impossible; (3) one family member's disturbance is the reason from outside the home; (4) an adolescent in the family is trying to separate psychologically from her family
Conditional family thearpy
1. when couple decide divorce, the needs of their children first
2. psychological disturbance ( apply FT after medication and hospitalization)
3. NO Family therapy for DOMESTIC VIOLENCE
4. secret such as infidelity, homosexuality, criminal behavior, history of sexual abuse
for communication difficulties; couple and marital life cycle changes; cultural, racial or religious differences, infidelity; one partner is symptomatic; premarital counseling; separation and divorce counseling or medation; sexual dysfufnction
one partner is symptomatic
1. acting-in symptom: their emotion and their energy inwards --> conjoint sessions
2. acting-out symptom : express anger and abusive behavior toward others --> be coerced into treatmetn by their spouse, emplyers or agencies
for clients who defensive and manipulative such as substance abuse, sexual offenses and related crimes, domestic abuse, incest and other forms of sexual abuse
Not appropriate (contraindications) for group therapy
significant deviancy from other group members, no tolerance the group setting; psychosis, brain damage, sociopathy, denial, somatization, low self esteem, low IQ; low motivation to change; in ACUTE CRISIS
Duration of treatment
voluntary client - 6-12 sessions
involuntary client - follow a mandated function such as the court
types and purposes of work with small group
1. group treatment approach (remedial model)
2. growth/development and training group
3. self-help group
4. other groups : interactional model (SW role is a mediator between group members; emphasis on client's self-determination); Task group agency boards, committees, staff meetings, community planning groups)
1. homogeneous group- more cohesive, immediate support to group members, better attendance, less conflict
2. treatment group - same level of intelligence, developmental level
3. safety for group - exclude exhibiting bizarre or dangerous behavior, high risk of suicidal, using illicit drugs members
4. closed-group- being and end with same group members; open-group - allow new members to join and leave