Mezzo and Micro practice
interventions geared towards benefitting family, small groups and individuals.
practice is performed in a case by case basis, generally in clinical settings and is used to solve psychosocial problems of families, individuals and groups
takes place with small groups and families and focuses on communicating, educating and bringing people together.
clients perception of the issue or difficulties he has been experiencing which has caused him to seek help.
exploring factors that maybe relevant to the clients problem, concern or request including legal mandates, health, safety, signs, sypmtoms duration, duration frequency individuals, systems and consequences.
guidelines for conducting a competent assessment
narrow your focus by emphasizing information that is relevant to the clients problem, concern or request and to the type of help you can offer the client. Address top priorties, (legal mandates, health, safety)) Gather information froma variety of sources, Recognize the uniqueness of the client, Adopt strenghts perspective,Be aware of factors that can affect a clients responses (malingering, defensiveness, view assessment as both a product and process.
Independent assessment and clinical team approaches
in some setting, social worker makes an independent assessment ,this is generally completed in one to three sessions. In other settings the social worker is part of a clinical team that makes an assessment. In the team approach the social workers role is to complete the social history of client and assessment may take several weeks.
Interviewing skills for eliciting presenting problems
start where the client is. respond empathically, use reflective opening, make statements that allow client to choose her own direction, aske open ended questions and close ended questions, seek clarification
additional clues for eliciting the presenting problem
problem checklist: a list of problems,concerns commonly reported by a group of clients
problem search: is an agreement between you and a client to spend up to three sessions exploring situation in more depth.
factors that my affect disclosure
clients may test you before disclosing the real problem. This may stem from experiences with discrimination. A voluntary client may exagerate the complexity of the problem. an involuntary client may withhold information and/or minimize the presenting problem.
clients problems usually \stem from a poor fit between those needs and resources in the environment. This includes lack of access to available resources. Sometimes resources are Non existent or unresponsivetto the clients needs. S.W most respond promptly to address a clients basic needs.
are often related to a person's developmental stage an the tasks and transitions associated with it; it is critical to take into account a persons developmental stage when identifying their needs.
Presenting Problems and Needs
the presenting problem often reveal only surface needs.careful exploration is required in order to identify needs that the client may be unaware of.
Planning intervention based upon needs
a clients unmet needs or wants can be translated into goals when you plan the intervention.
History of the problem
clarify's the magnitude of the problem, identies factors contributing to the problem and identifies the clients current level of functioning and motivation for change.
components of the problem history
onset, progression and severity of the client's problem, its precipitants, its environmental antecedents and consequences, factors maintaining the problem, its effects on the clients functioning, clients ideas about its causes, whats been been done to try to solve the problem, whats works and what hasnt worked.
Onset, progression and severity
addresses when the problem began, under what circumstances, was there a specific precipitating event or change in the clients life. how long has it been going on. Is the problem chronic, or episodic, how often does it occur, how intense if the problem or symptom.
Stressor Affecting the Problem
a current/recent psychosocial stressor may have precipitated the clients problem or may be exacerbating the problem to understand the role you should explor how the psychosocial stressor is affecting the client and family. what is the duration of the stressor. what coping skills have the client used.
Degree of Impairment in functioning
How much has the problem affected the clients functioning. Has it affected the clients personal relationships, is it interfering with work, school, home and in what ways. Does client have problems perfomr activities of daily living. Has an interest in pleasuralbe activities changed.
clients belief about the problem
a clients belief or assumption about what causes a behavior can sometimes serve to maintain a behavior.also identifying the clients emotional reaction to the problem is important as emotions can have a potent effect on behavior. emotions can cause behavior that intensifies a problem.
Family, Work, Educational, and Legal Histories
this information is collected in order to formulate a complete description of a clients problem, including understanding how the problem fits into the wider context o fher life.
Assessessment of Social Functioning
collection of data to determine how one's need meeting activities and social role performance-the information can be used to draw conclusions aobut current level of soical functioning including strengths and deficits,
When applied to an individividual refers to the ability/capacity;motiviation and opportunity to meet her basic needs such as well as to perform role expectations defined by her community and culture.
Key aspects of social functioning
Fundamentals of independent living, personal appearance/hygiene, housing and housekeeping, Nutrition adn health care, adjustmetns to physical disability;coping with problems-mental health, addiction, spirituality/religion, family life, citizenship adn legal concerns, friendships social supports, sof of community resources, interaction with community,education, education and training, employment and job performance, money management adn consumer awareness, recreational and leisure acitivity.
Adopt an ecological Perspective
when assessing clients in their environment focus on transactions between the person and the environment and determine the "goodness of fit" - are there access and opportunities or barriers and obstacles
Helps you to understand a clients belief system and resources and it can help provide a wider range of appropriate interventions fro addressing her problem.
during interview, SW should attend to how client describes her mood and emotional functioning. In addtion SW should pay observe clients behavior (verbal and non-verbal) and appearance.
difficulties with emotional regulation involve either expressing too much emotion (volatility, excessive irritability) SW can determine appropriateness by examining if he emotions is appropriate and proportionate to the triggering stimulus. also observe clients level of subjective distress.
describes one who is in touch with his emotions and can express them spontaneously as she feels them in response to specific situations emotional or situational stimuli.
a persons emotions does not match the situaion or stimuli ex. a person laughs when she learns of the death of a loved one.
Emotional blunting/flat affect
is muted or apathetic response to stimuli that would normally evoke a stronger response. emotional blunting may indicate a mental disorder eg. depressionor schizophrenia.
Conventional or typical antipsychotics include Thorazine, Permitil and Prolixin, Narvaneand Haldol. These drugs alleviate hallucination, delusions and other postive symptoms of Schizophrenia.
The atypical (novel) include Clozaril, Risperidal, Zyprexa and Seroquel. These drugs are used to treat schizophrenia and other disorders with psychotic symptoms. Atypicals alleviate both positive and negative symptoms of schizophrenia.
Amitriptyline (Elavil, Endep),Doxepin ( Sinequan, Adapin) Imipramine (Tofranil) and clomipramine (Anafranil). TCA's are most effective for depressions that involve decreased appetite and weight loss, early moring awakening and other sleep disturbances, psychomotor retardation and anhedonia. Particulary are useful with alleviating vegetative states of depression
SSRIs (Selective Serotonin reuptake inhibitiors)
Fluoxetine(Prozac), Fluvoxamie (Floxyfral), Paroxetine (Paxil), sertraline (Zoloft) and Escitalopram Oxalate (Lexapro). SSRI's exert their effects by blocking reuptake of serotonin. Use of SSRI in conjuntion with MAOI can resutl in a serious condtion called serotonin syndrome
Citalopram (Celexa) is an SSRI with a chemical structure unrelated to that of other SSRI's or other available antidepressant drugs. it is used to treat major depression and is also effective for treating anxiety.
MAOI's ( Monoamine oxidase inhibitors)
Isocarboxazid (Marplan), Phenelzine (Nardil) and Tranylcypromine (Parnate). MAOI's are useful in treating nonendogenous and atypical depressions that involve anxiety, reversed vegetative symptoms (eg. hypersomnia, hyperphagia) and interpersonal sensitivity
Bupropion (Wellbutrin) is a norepinephrine dopamine reuptake inhibitor (NDRI) used to treat major derpression and the depressive phase of bipolar disorder. Under the name of Zyban, this medication is used to facilitate smoking cessation) Bupropion has fe anticholinergic side effects and is less cardiotoxic than the TCA's and it does not cause sexual dysfunction
SNRI (Selective Serotonin Norepinephrine Reuptake Inhibitor
Menlafaxine (Effexor) is used to treat major depression, OCD, generalized anxiety disorder. It is less dangerous inthe overdose than the TCA's and may have a faster onset of therapeutic effects because it can increase blood pressure, frequent monitoring is required.
SARIs (Serotonin-2 antagonists/reuptake inhibitors
Nefazodone (Serzone) and Trazodone (Desyrel) these drugs are used to treat major depression and the depressive phase of biplor disorder. Common side effects of nefazodone are dry mouth, nausea and somnolence, etc.
Mental Health Status Examination
Is the psychiatric equivalent of of the physcial examintation in medicine. It includes a comprehensive evaluation of the patient's appearance, thinking and speech patterns. In conducting a MHSE SW focus on appearance and attitude, motor activity, thougth and speech, mood and affect, perception, orientation, memory
the most common perceptual abnormalities are hallucintations: abnormal sensory perceptions in the absence of an actual stimulus
This includes oreitnation to time, place and person. Does the client know what what day it is, year, where he is residing, his name and identity.
the term mood refers to an emotional attitude that is relatively sustained: it is typically determined throught the patitient's own self-report, althought some inferences can be made from the patient's facial expression. Mood is neutral, euphoric, depressed, anxious, or irritable. Aff
Is inferred from emotional responses that are usually triggered by some stimulus. Affect refers to the way that a patient conveys his or her emotional state, as perceived by others.
Rapid Assessment Instruments
RAI are useful in demonstrating that a client's condition warrants treatments because of the conditions effects on the client. RAIs are short, self administered and easily scored. Useful in managed care arena. Two RAIs used to demonstrate treatment necessityt are *SF-36 Health Survery and SF-12 Health Survey these assess clients health and effects on functioning
Beck Depression Inventory-II
measures the depth of clients depression or severity of complaints, symptoms, and concerns related to her currentl level of depression. This instrument is designed for psychiatrically diagnosed individuals age on clients 13 and older with atleast an 8th grade reading level.
Child Behavior Checklist
assesses a child's behavior via parent report and is useful for planning, monitoring and outcome of assessments. It describes problem behaviors and symptoms experienced by children 6--18.
Conners Rating Scales
Can be used to evaluate problem behavior in youth age 3-17. They include the Parent rating scale revised and the Teacher Rastinc Scale revised and the Conners-
Wells Adolescent Self Report Scale, which may be completed b clients ages 12-17
Behavior Assessment System for Children BASC-2
Assesses emotions and behaviors of youth ages 2 years through 21, 11 months.
Child and Adolescent Functional Assessment Scale (CAFAS)
A clinician -rated measure that assesses the degree of impairment in youth ages 7-17
Behavioral and Emotional Rating Scale (BERS)
measures functioning in youth ages 11-18 across five areas and is based on a strengths perspective.