LMSW EXAM – BOOTCAMP 2023 NEW SOLUTION GUIDE QUESTIONS AND ANSWERS GRADED A

LMSW EXAM – BOOTCAMP 2023 NEW SOLUTION GUIDE QUESTIONS AND ANSWERS GRADED A 3 Areas to identify in each question (PPL) - 1. Problem 2. Person 3. Last Sentence (guide to answer question) Key words - 1. Person/Client "hot seat" 2. SAFETY Red Flags - suicide, abuse, life-threatening, unexplained marks, alcohol, recent loss 3. Strong words/adjectives 4. Age 5. Diagnosis 6. Symptoms/Duration 7. Who are you? 8. Where are you in session? 9. Quotations 10. Direct requests/concerns 11. Qualifiers (First/Next/Best) Distractors - FARM GRITS ROAD - Answers that look appealing at first glance but are often wrong - ELIMINATE! Exam is here and now DO NOT CHOOSE FARM GRITS ROAD - 1. FOCUS on unresolved issues/past 2. ADVICE - giving/judging 3. RECOMMEND "to a support group" 4. MAKE an appt. 5. GIVE pamphlets/literature 6. RECOMMEND a session 7. INFORM parents/speak to parents (when child/ado) 8. TERMINATE (Exceptions: Moving, client reaches goals/no new crisis, client does not pay) 9. SPEAK to supervisor (except transference/counter) 10. RESPECT self-determination (If mentally UNSTABLE) 11. OFFER contract as a reminder 12. ALLOW the clients to lead the session 13. 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. RUSAFE - 1. RULE out medical 2. UNDER the influence/delusional/hallucinating Do Not Treat 3. SAVE Lives - Safety first (Answers: Duty to warn, report child/elder abuse, 911, mobile crisis, ER) 4. ASSESS before action - (Answers: ASSESS, ASK or DICE - Determine, Identify,Clarify, Explore) 5. FEELINGS - (Answers: ACKNOWLEDGE person's feelings) CONCERNS (AID ASSIST, INFORM client, DISCUSS concerns) 6. EMPOWER - If client is mentally stable/alert (Answers: Respect client's decisions) COE: 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 to ppl who have a relationship w/ 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 w/out consent unless req'd 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 req'd 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 when there is a REAL INTENT (PLAN) HIV Decisions - NOT 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 Subpoena by the court - SW may be req'd by law to disclose confidential information COE: 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 colleague, disclose least amount of information 3. FIRST speak to a colleague to discourage/prevent/correct unethical behavior 4. AVOID relationships with colleagues (conflict of interest) COE: Ethical responsibilities in practice settings - 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 COE: Ethical responsibilities as professionals - 1. MONITOR/EVALUATE policies and implementation of programs 2. ADVOCATE when necessary 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 TX. 5. Contracts are INFLEXIBLE, abide by rules to receive reimbursement Disorders in Infancy, Childhood, Adolescence - Autism, ADHD, Oppositional Defiant Disorder, Conduct Disorder, Enuresis, Separation Anxiety Disorder Adult Disorders - Delirium, Dementia, Amnestic/Cognitive Disorders, Schizophrenia and other Psychotic Disorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders, Factitious Disorders Autistic Disorder - 1. Deficits in social interaction and nonverbal COMMUNICATION 2. Lack of peer relationships. eye contact, abnormal body movement, 3. Restricted, repetitive patterns of behavior 4. Inflexibility to routine, Fixed interests Attention Deficit Hyperactivity Disorder - 1. Symptoms at least 6 months 2. Inattentive: Difficulty focusing, staying on task follow-through, listening, easily distracted, loses things, forgetful 3. Hyperactive: Impulsive, fidgeting, running around, talking excessively 4. Several symptoms present prior to age 12 5. Must occur in 2 or more settings 6.. Behaviors can increase/decrease based on settings. 7. TX: Behavior modification Oppositional Defiant Disorder - At least 6 months - Angry, irritiable, defiant, talking back to adults, rebellious behavior, attitude, blames others, cursing, lying - NO SERIOUS VIOLATIONS OF OTHERS RIGHTS Conduct Disorder - 1. Violates other's rights, bullies, shoplifts, truancy, DX up to age 17 2. TX: Family, schools, community, client, parent/child behavior modificationq skills Enuresis - 1. Repeatedly urinating during day/night 2. Up to 5 years old 3. Rule out medical first Separation Anxiety Disorder - 1. Excessive distress when separated from major attachment figures. 2. Clinging, school refusal, sleep refusal 3. School Phobia is a form of separation anxiety. 4. Brought on when leaving home/family members to attend school. 5. At least 1 month of symptoms Impulse control disorders - Trichotillomania, Intermittent Explosive Disorder, Gambling, Kleptomania, Pyromania, Delirium - 1. Disoriented 2. Short period of time 3. Sometimes due to medical condition/substance use: DEHYDRATION, HEAD TRAUMA Dementia - 1. Slow onset 2. Deterioration of memory/cognition 3. Alzheimer's, HIV, Parkinson's Amnestic Disorders - Memory impairment w/out cognitive impairment Korsakoff's Syndrome - Chronic alcoholism causes inability to recall previously learned information Schizophrenia - 1. Hallucinations, delusions, disorganized speech, disordered/catatonic behavior, impaired thinking, negative symptoms (diminished emotional expression or avolition) THOUGHT DISORDER 2. Duration at least 1 month, but more than 6 months 3. TX = Medication and ego-supportive therapy (No INSIGHT therapy!) Schizophreniform - 1. Same symptoms of schizophrenia 2. DURATION is at least 1 month, but less than six months 2. Triggered by turmoil/high stress 3. TX = Mediation and supportive therapy Delusional Disorder - 1. NON-BIZARRE/IRRATIONAL beliefs/delusions 2. Hallucinations absent or not prominent 3. Persecutory/Jealous Types of delusions 4. NO IMPAIRED FUNCTIONING Brief Psychotic Disorder - 1. 1 Symptoms of criterion A Schizophrenia 2. DURATION LESS THAN 1 MONTH Psychotic symptoms may also occur during which other conditions? - Bipolar 1 Disorder, Major Depression, Substance Induced Mental Disorders, Mental disorders due to a medical condition (ex. Amphetamine induced psychotic disorder with delusional features), Delusional Disorder, Borderline Personality Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder Differential diagnosis Schizophrenia and Delusional Disorder - 1. Delusions occur in both 2. Schizophrenia experience other symptoms (hallucinations, bizarre delusions) 3. DD less functional impairment schizoaffective disorder - Same symptoms of schizophrenia with a major depressive episode, manic episode, or mixed episode Disruptive Mood Dysregulation Disorder - a childhood disorder (diagnosed after age 6, before age 18) marked by severe recurrent temper outbursts along, persistent irritable or angry mood, 3 or more times per week period of 12 months Major Depressive Disorder - 1. Symptoms: (most of day, nearly every day for 2 weeks) -Depressed mood -Lack of pleasure -weight loss/gain -insomnia/hypersomnia, -psychomotor agitation -sad/empty/worthlessness -suicidal ideation - fatigue - difficulty concentrating - excessive guilt MDD and bereavement differences- excessive guilt, anhedonia, suicidality Dysthymic Disorder - 1. MDD symptoms but LESS SEVERE 2. Chronic 3. Duration more than 2 years (Children 1 year) 4. Symptoms cannot be absent for longer than 2 consecutive months Bipolar 1 Disorder - 1. One or more manic episodes (Elevated, expansive, irritable mood, or excessive mood and increased energy) usually accompanied by a major depressive episode) 2. Symptoms may last at least 1 week to a few months 3. 3 or more manic symptoms 4. Impaired functioning Manic symptoms - Inflated self-esteem, decreased need for sleep, loud/rapid speech, restlessness, racing thoughts, increased sociability and goal-directed activity, impairment of normal activities/relationships Bipolar II Disorder - - 1 or more depressive episodes with at least 1 or more hypomanic episode - NO manic episodes or mixed episodes Depressive Symptoms - Sadness, loss of interest in usual activities, sleep/appetite disturbance, feelings of worthlessness/guilt, difficulty concentrating, suicidal thoughts/death Neurovegetative symptoms of depression - changes in appetite of weight, sleep disturbances, fatigue, decrease in sexual desire/function Rapid Cycling - 4 or more manic episodes of illness over 12-month period Mixed State - Both depression and Mania occur at the same time Children and Adolescents with Bipolar Disorder - 1. Can occur, more likely if parents have illness 2. Children/Ados may experience very fast mood swings b/t depression and mania in one day 3. Children with mania likely to be irritable and prone to tantrums than to be overly happy 4. Bipolar difficult to tell apart from other problems in this age group Hyperthyroidism can mimic - Mania Hypothyroidism can mimic - Depression Mood disorder - Refers to a disturbance of mood and other symptoms that occur together for a minimal duration of time and not due to physical/mental illness Panic Disorder - 1. Brief, recurrent, panic attacks 2. Followed by persistent worry of another panic attack and behavior change 2. TX = Desensitization techniques social anxiety disorder - intense fear of social situations, leading to avoidance of such Generalized Anxiety Disorder - 1. Excessive worry and physical symptoms (restlessness, fatigue, headache, stomachache) 2. Ex. client reports frequently irritable and unable to focus, tension, insomnia 3. At least six months 4. Worry impedes functioning Panic attack or depression caused by substance - Substance Induced Anxiety Disorder or Mood Disorder Panic attack caused by medical illness - Anxiety or Mood disorder caused by General Medical Condition Somatoform Disorders - Disorders characterized by physical complaints that appear to be medical in origin but that cannot be explained in terms of physical disease (emotional connection) obsessive-compulsive disorder - An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). Body Dysmorphic Disorder - 1. Excessive preoccupation with one body part 2. Severe, impairment in functioning 3. Cause of decline = obsessing about defect Conversion Disorder - Involuntary loss of voluntary function, however client does not control or produce them voluntarily Factitious vs. Malingering - 1. Intentionally produced symptoms, differing incentives 2. Malingering fakes symptoms for external gain/goal 3. Factitious produces symptoms due to need to be "sick patient" Munchausen's Syndrome - Faking an illness/producing symptoms to receive sympathy as patient Munchausen's By Proxy - Abuse of another (typically a child) in order to seek attention for the abuser PTSD - 1. Exposure and response to life-threatening event 2. Arousal, intrusive, avoidance symptoms (distressing memories, dreams, dissociations, 3. LAST A MONTH AND BEYOND 4. Impairment to functioning/life pursuits acute stress disorder - PTSD symptoms that appear for a month or less Reactive Attachment Disorder - 1. Disorder caused by lack of attachment to caregiver - NEGLECT 2. Adjustment disorder - a disorder in which a person's response to a common stressor, is maladaptive and occurs within 3 months of the stressor Disinhibited Social Engagement Disorder (DSED) - a trauma-related attachment disorder characterized by indiscriminate, superficial attachments and desperation for interpersonal contact Somatization Disorder - Recurrent/multiple somatic complaints that cannot be explained medically of several years. STRESS. Substance related Disorder - Drug/Alcohol Intoxication and Withdrawal, Drug/Alcohol Abuse and Dependence Disorders that are chronic - All personality disorders, Schizophrenia (> 6 months), Dysthymic and Cyclothymic (> 2 years), Generalized Anxiety Disorder (> 6 months), Hypochondrias (> 6 months), Somatization Disorder (several years) Paraphilias vs. Sexual Sexual Dysfunction - Inappropriate sexual object or practice vs. inhibition of sexual response Parasomnias vs. Dyssomnia - Abnormal event that occurs during sleep, b/t sleep/waking VS. disturbance in amount/timing of sleep Personality Disorders - 1. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture 2. 2 or more areas (cognition, affectivity, interpersonal functioning, impulse control) Cluster A personality disorders - odd/eccentric paranoid, schizoid, schizotypal Schizoid PD - LONER, introverted, withdrawn, detachment from social relationships, RESTRICTED RANGE OF EMOTIONAL EXPERIENCE AND EXPRESSION, NO DESIRE FOR FOR SOCIAL RELATIONSHIPS Paranoid PD - Interpreting actions of others as deliberately threatening or demeaning, distrustful and suspicious Schizotypal - Odd/strange/bizarre behavior/beliefs/mannerisms and interpersonal/social deficits due to fear/paranoia Magical thinking - ideas that one's thoughts or behaviors have control over specific situations ideas of reference - The false impression that outside events have special meaning for oneself. Cluster B personality disorders - dramatic, emotional, erratic antisocial, borderline, histrionic, narcissistic antisocial personality disorder - 1. Disregard for the rights of others, Impulsive/irresponsible/callous 2. Must be > 18 (symptoms can occur at 15) Borderline PD - 1. Unstable in interpersonal relationships, behavior, mood, and selfimage. 2. Abrupt and extreme mood changes 3. Stormy interpersonal relationships 4. Fluctuating self-image 5. self-destructive actions Narcissistic PD - Exaggerated self-importance, absorbed fantasy for success, seek constant attention/admiration, oversensitive to failure Histrionic PD - Melodramatic, attention-seeking, excessive emotionality, sexually seductive Cluster C personality disorders - Anxious, fearful avoidant, dependent, obsessive compulsive Avoidant PD - Hypersensitive to rejection, unwilling to be involved, fear of not being liked Dependent PD - Pattern of dependent and submissive behavior Obsessive Compulsive PD - preoccupation with perfection, control, and orderliness Multiple Personality Disorder - Dissociative Identity Disorder Mental Status Exam - Structured way of observing and describing current state of mind - appearance, attitude, affect, behavior, cognition, insight, judgment, mood, perception, speech, thought process, thought content 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 behaviors/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. 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 - pain, deafness, blindness 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, cancelations. Not aggressive. Rational Emotive Behavioral Therapy REBT - Confrontational approach, assists clients to discontinue negative/irrational thoughts Paradoxical Directive - Instructing clients to continue their maladaptive behaviors with the goal of bringing awareness and change. ex. Couples bickering in couples therapy. Crisis Intervention - - Assist the person in distress to resolve immediate problem and regain emotional equilibrium = GOAL IN FIRST SESSION, emphasis on coping mechanisms Narrative therapy - 1. Therapist co-constructs alternative positive stories with client 2. Externalizing the problem, problem-saturated stories, mapping problem's domain, unique outcomes, spreading the news Ecological/Life Model - Environmental pressures, focus on life transitions, Fit between individual/family and environment Gestalt - Assist client with awareness of here/now - ex. Empty chair - Heightened awareness - Not good for impulsive clients Behavior Modification - Techniques to modify behaviors, ex. positive reinforcement Behaviorist - Observe/measure the way clients respond to certain triggers Operant techniques - Positive reinforcement - add praise, Negative reinforcement - take away shock, Positive punishment - add spanking, Negative punishment - take away something desirable Classical conditioning - Pavlov's dog, stimulus response approach to behavior Shaping - Technique to train a new behavior by prompting and reinforcing successive behaviors In vivo desensitization - Exposure from least to most anxiety situation - REAL LIFE SETTING Systemic desensitization - Anxiety producing stimulus paired with relaxing response Flooding - Anxiety reduced by prolonged real or imagined exposure to high-intensity feared stimuli Modeling/Observational learning - Learning by observing others Operant conditioning - Events precede behaviors which in turn are followed by consequences Cognitive therapy - Identifying and changing dysfunctional negative THOUGHTS, change thoughts to change behaviors Strengths perspective - Identify strengths and build on to empower clients Psychoanalysis - Long term treatment, resolve inner, unresolved conflicts of past Family Therapy - - Treats whole family system and identifies the individual symptom bearer as indicative of a problem in the family as a whole, identify client in crisis/hot seat Couple Therapy - Treats couples to understand and resolve conflicts to improve their relationship. To communicate better, negotiate differences, problem solve in a healthier way Margaret Mahler - Process of separation-individuation, All Small Dogs Practice Reaching Out Autistic - Attachment Phase - Newborn to 1st month, infant focused on self Symbiotic Stage - Attachment Phase - 1 to 5 months, breaks out of autistic shell, feels unity with mother, begins to understand mother as a separate being Differentiation - Separation-Individuation Phase - 6 to 9 months - Inward focus to outward focus, separates from caregiver by crawling, stranger anxiety 6-8 months Practicing - Separation-Individuation Phase - 9 to 14 months - crawls/walks freely, explores, becomes distant from mother, separation anxiety 12 months Rapprochement - Separation-Individuation Phase - 14 to 24 months - Desires to be independent, moves away from mother but returns regularly, prolonged separation anxiety 18 months Object constancy - Object Constancy Phase - After 24 months, capacity to recall mother despite absence, sees mother as separate individual Anti-psychotic Medications - 1. Neuroleptics - Help Zany People Towards Reality Acceptance Soon 2. Haldol, Zyprexa, Prolixin, Thorazine, Risperdal, Abilify, Seroquel - Also used for bipolar 3. Tardive Dyskinesia - muscle disorder 4. Clozapine - atypical, increased risk for agranulocytosis Bipolar Medications - Live To Dream Always Towards Top, Lithium Tegretol, Depakote, Abilify Trileptal Topamax- kidney problems, liver problems, monitor blood work Anti-Anxiety Meds - 1. Benzodizepines, View Karen's X-rays After Ballet 2. Valium, Klonopin, Xanax, Ativan, Busbar 3. Short acting and addictive 4. Impaired muscle coordination and impairment of short term memory, PAM Antabuse - medication for alcohol, form of AVERSION THERAPY ADHD Disorders - 1. Amphetmines/SPEED - CAR speed, Paradoxical effect 2. Concerta, Aderall, Ritalin 3. Non-Amphetimine - Strattera - can not be abused, 2 to 4 weeks for effective Anti-Depressants - 1. SSRI's, People's Zoom Power, Will ,Never, Cure, Everything, Except, Little, Tiny, Cats 2. Prozac, Zoloft, Paxil, Wellbutrin, Celexa, Effexor, Lexapro,Trazadone Cymbalta 3. Often causes loss of libidinal desire, several weeks to be effective, 4. PRAM, INE, Atypical Anti-depressants - 1. Eat Clean Worms 2. Effexor, Cymbalta, Wellbutrin Tricyclic Anti-depressants - 1. ET= Tricycle - Elavil, Trofanil 2. Can cause dry mouth MAOI's - 1. Antidepressants 2. Hypertension if high dose taken 3. TCA/Stimulant taken 4. Dietary restriction: Foods with high levels of Tyramine - avoid beer, wine, cheese, smoked/pickled fish, etc. Community Organization Key Points - 1. NOT direct practice, indirect practice 2. SW role is to work WITH THE community, not directly for them 3. No individual counseling or family counseling 4. Empower members to strengthen community to prevent future dilemmas 5. Members must have a COMMON INTEREST - KW's consensus, agreements 6. Advocate for disadvantaged Locality Development, Model of Community Organizational Practice - 1. Purpose: Join efforts to solve a common problem with community/local level 2. SW Role: Enabler - help members use own resources to problem solve/empower 3. Broker: Mediates/Negotiates b/t community groups, links community with services Social Planning Model of Community Organizational - 1. Purpose: Determine a range of solutions to problems. Develops programs 2. SW Role: Expert, gather data and facts used to resolve problems, Ex. planning homeless shelters and after school recreation programs Social Action, Model of Community Organizational - 1. Purpose: Clients who NEED assistance and disadvantaged, take action, confrontation 2. SW Role: ADVOCATE, represent disadvantaged and ACTIVIST, bargaining and confrontation, Ex. Tenant Association, Landlord/Tenants, women's rights mov't Social Reform, Model of Community Organizational - 1. Purpose: Work with other organizations. Form coalitions 2 SW Role: Organizer, joins groups and institutions together to take joint action towards specific goals, ex. improve economic development and resolve unemployment problems 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 - client 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 ppl see what they are going through is universal, not alone, Catharsis - Venting feelings to group members to relieve pain, guilt, stress Boston Model, People Perceive Information Differently Separately - 1. Preaffiliation: Ambivalence, leader must establish authority/discuss guidelines and review philosophy 2. Power/Control: Struggle over control of the group, conflict among subgroups 3. Intimacy: Conflicts diminish, sense of "we-ness" increases and COHESION 4. Differentiation: Personal expression, improved group skills in analyzing and working through problems 5. Separation: Achieve termination Administration Key Concepts - 1. Key Words's = TEAM WORK, CONVENE STAFF MEETINGS & BROAD BASED COMMITTEES 2. Admin. establishes a broad based "committee" that brings together all segments of the agency, including staff and sometimes clients to develop methods for assessing the problem, decision making, proposing solutions The Board of Directors - 1. NOT on SW's TREATMENT TEAM 2. Executive directors are concerned with funding NOT with immediate staff issues 3 functions of supervision - Administrative, Educational, Supportive Supervisor Key Concepts - 1. Supervisor there to EDUCATE the SW and IMPROVE job performance 2. Supervisor is in charge of SW's and or intern's caseloads 3. TRANSFERENCE/COUNTERTRANSFERENCE 4. Supervisor DOES NOT EXPLORE sw's inner feelings 5. Main purpose - advance agency goals and improve service to clients. Culture Bound Syndrome - Appendix 1 in DSM-IV: A client's cultural beliefs and how they impact the interviewer while assessing their behaviors Ex. Ataque de nervios - Hispanic Culture Native Americans and Alaskan Natives - 1. Tradition of oral story telling 2. Great respect for elders, hand down traditions 3. Spiritual healers are traditional leaders (shaman/medicine man) 4. Value listening and comfortable with silence 5. High degrees of suicide and alcoholism 6. Avoid eye contact as a sign of respect Latino - Hispanic - 1. Mostly roman catholic and extended family system 2. Demonstrate shame when seeking mental health assistance 3. Excessive emotionality when confronted with crisis - ataque de nervios Asian/Pacific Islander - 1. Obligation to parents and respect to elders 2. Elders are family decision makers 3. Resolve conflicts within the family 4. Less emotional expressiveness 5. Use alternative healing methods (ex. coining, acupuncture, homeopathic TX) Elderly Clients - 1. Remain patient and respectful - do not use aggressive approach 2. Mr. or Mrs. as a sign of respect 3. Frequent appts. may be needed during beginning of treatment - home visits 4. Respect self-determination if they are mentally alert 5. Client is Frail/medical issues - assess their abilities, r/o medical FIRST Gender, Identity Clients - gay, lesbian, transgender - 1. Be aware that clients have concerns about your values 2. Support client in understanding their own sexual orientation prior to sharing with family/friends 3. Be aware of your own values/cultural competence with ALL DIVERSE clients Clients with Disabilities - 1. Explore your clients need for SPECIAL ACCOMMODATIONS first 2. Respect self-determination if mentally stable 3. Do not challenge clients who have lower level of functioning 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 Technique 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, dilated pupils, restlessness Cocaine withdrawal - Depression, vomiting, fatigue Mild Mental Retardation - -60-69 Borderline Intellectual Functioning - -70-84 Tourette's Disorder - Multiple motor tics and one or more vocal tics - BOTH TICS! Reactive Attachment - Lack of attachment to caregiver (ex. foster care kids) Trichotillomania - Compulsive urge to pull out one's hair leading to hair loss Schizophrenia subtypes: - 1. Catatonic (immobility) 2. Disorganized (disorganized speech/behavior) 3. Paranoid (Persecutory) 4. Undifferentiated (Delusions/Hallucinations) 5. Residual (Absence psychotic features) Cyclothymic - Mood Disorder, chronic, fluctuating mood with many hypomanic and many depressive symptoms Obsessive-compulsive disorder - Intrusive recurrent thoughts or compulsive behaviors Phobia - 1. Fear of specific objects/situations 2. Ex. Acrophobia, fear of heights 3. TX - Desensitization Techniques Dissociative identity disorder - Multiple personality disorder, 2 or more personalities Dissociative Fugue - Sudden and unexpected travel from home, Memory eventually returns, FUGITIVE Depersonalization Disorder - Feeling detached from/observe one's mental processes or body Intellectualization - Using logic to avoid dealing with emotions Active listening - A technique focused on both verbal and nonverbal communication Paraphrasing - Re-statement of client's issues to show understanding of what client says. C: Whenever I go to the nursing home to visit my mother, I start to cry and feel like I can't breathe. SW: It sounds lil you are saying that your mother in the nursing home is very difficult for you. Clarification - Encouraging questions to be more explicit and expand what he says. Helping obtain understanding of issues. C: I don't want to give up the baby. I want to find him a family that can give him everything he wants. SW: Are you saying that you want to keep the baby but you don't think you can afford it? 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 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 Fixated (unresolved) Personality Types - ORAL: Infantile, Demanding, Dependent ANAL: Stinginess and Inflexibility PHALLIC: Exploits others sexually with no regard for needs/concern Signs of Heroin Use - Drowsiness, euphoria, and slow breathing Heroin withdrawal - Bone pain, Anxiety, muscle spasms, restlessness Hallucinogen use - Hallucinations, confusion anxiety, suspicion Hallucinogen withdrawal - Non-existent with Hallucinogens (LSD, PEYOTE, ECSTASY) Social work process - Purpose, knowledge, values, and sanctions Stages in the Helping Relationship ** - 1. Beginning, Middle, Ending phases 2. Contact, Contract, Action, Termination Problem S0lving 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 and SELECTING options with clients 4. PLANNING for initial contact 5. INITIAL CONTACT b/t client and referral source 6. Follow Up to see if need was met *Keep in mind client's right to self-determination! Maslow's Hierarchy of Needs - Assumptions: Optimism, human nature is trustworthy, rational-movement towards self-fulfillment, full functioning, personal adequacy, or selfactualization 5 Levels of Maslow's Hierarchy of Needs - 1. Physiological needs (Basic needs) 2. Safety needs (Basic needs) 3. Love and Belonging needs (Growth needs) 4. Esteem Needs (Growth needs) 5. Self-actualization (Growth needs) A person must satisfy lower level needs before moving on to meet higher-level growth needs. After meeting lower levels of needs, a person scan reach the highest level of self-actualization, Physiological Needs - Biological needs such as food, water, oxygen, constant body temperature. Safety needs - Feel safe from harm, danger, threat, or destruction. Need regularity, some predictability (origin of cognitive needs - to understand, makes sense of world) Love and Belonging Needs - Assurance that one is loved, is worthy, is acceptable because he is accepted. Love needs unconditional acceptance. Ego/Esteem Needs - People need stable, firmly-based level of self-respect and respect from others. Self-actualization Needs - Need to be oneself, to act consistently with whom one is. Stranger Anxiety - 6-8 months Separation Anxiety - 12 months Prolonged separation anxiety - 18 months Ventilation - Technique in supervision to air out feelings. How long should you store records? - Number of years dictated by law. Bright but unmotivated student - May indicate a learned problem, refer to educational psychologist Confidentiality - Important to discuss issues of confidentiality and the factors that would cause disclosure Privileged communication - Legal rights, under certain circumstances, that protect clients from having the communications revealed in court w/out permission Ecomap - Identifies systems that are part of a family's life Institutionalized vs. Residual Care - Residual welfare - in place purely for the poorer in society, providing a safety net for those otherwise unable to cope financially. Institutional welfare - needs are a part of everyday life, welfare should be provided as a public service. Risk factors for suicide - 1. History of attempts - best indicator 2. family history of suicide 3. severe hopelessness 4. substance abuse 5. losses 6. A person who was depressed an instantly becomes brighter, "not depressed" Medical necessity commitment for involuntary commitment to a hospital - Danger to self, danger to others, inability to care for self. SW must get a release from client before releasing medical information to managed care company. 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 - opp. defiant symptoms, interest in sexual activity, school performance problems and difficulties Beginning Phase of Treatment - 1. Engagement 2. Assessment - biopsychosocial - strengths and weaknesses 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 Ending 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 2. Termination Cognitive dissonance - arises when a person has to choose between 2 contradictory attitudes and beliefs Congruence - matching awareness, experience, and communication - all essentially for a relationship Double bind - offering two contradictory messages and prohibiting the recipient from noticing Feedback - How one's behavior has affected his or her internal states and surroundings Limit setting - Boundaries, good for clients who do not feel safe or accepted in a completely permissive environment Symmetrical relationship - two have equal power Complementary relationship - one-up/one down position, unequal power Thought broadcasting - The belief that other's can be aware of hear one's thoughts What is most important for group functioning? - Participants level of functioning, often can be a wide range of diagnoses, family status, intellectual capacity and functioning Ex. Suicide patient, inexperienced student SW - In situations where a SW requires expert information that he/she lacks it is always prudent to see supervisor guidance Systems Theory - 1. Framework for analyzing problems 2. Interaction among parts of the system - all parts affect the the system 3. Focus on environment Homeostasis - Steady state order necessary for movement Equifinality - capacity to receive identical results from different initial condition Psychosocial Approach - - Used past experiences to understand present action Ego Psychology - Assessment of ego functions, reality testing, ego strengths/weaknesses Self Psychology - Mirroring - validates child's sense of self Idealization - identifies with someone more capable Twinship - sense of belonging Alfred Adler - Holistic theory on personality, striving for perfection Institutionalized discrimination - discriminatory attitudes that can occur on a institutional level Way to evaluate progress in treatment - Compare client's current level of functioning in relation to original treatment goals Family life cycle crisis - SW helps family resolve crisis by addressing life cycle issues and preparing family to manage future problems Structural family therapy - 1. Stresses family organization, worker joins the family in an effort restructure it 2. Boundaries Paradoxical Instruction - prescribe symptomatic behavior so client realizes they can control it, use strength of resistance to change to move towards goals Prison culture - Environmental influence does not promote participant self-disclosure Court mandated services - Provide limitations of disclosure in writing, protects confidentiality of child and addresses mom's request Lack of community awareness of a problem - Use multiple media communication techniques to bring awareness First task of multidisciplinary team - discuss, clarify, and commit to overall purpose Principle goal of an agency - Goal of improved services, computer program can help standardize information that could in turn be used to evaluate services MDD - at least 2 weeks of symptoms First task with involuntary clients - Meet parent's needs First step to analyze new social welfare policy that may affect the community - research history of problems that led to policies Only time you can present client's info without consent - Request from SW's supervisor Middle childhood life crisis - Industry vs. inferiority, 6 to 12 Problem solving planning phase - identification of goals and potential solutions Common Psychological Tests - 1. WAIS - adult intelligence scale 2. WISC-R - Intelligence scale for children 3. Standford-Binet - Intelligence test children 4. Draw-a-person test - children's self image 5. MMPI - predominant personality traits/behavior 6. Projective tests - Rorshach, TAT Cycle of abuse - Abuse is often used as an effort to retain control Social Exchange theory - Totaling potential benefits and losses to determine behavior. ex. Women remains in an abusive relationship because of the high cost of leaving. Domestic Violence - - Medical/Safety issues priority - SW not under legal obligation to report DV, but should encourage victim to protect herself - Provide education, information, resources, support, DEVELOP A SAFETY PLAN, make referrals to shelter, attorney physician - Safety, trust, validation, re-empowerment collateral observers - sources who are close to a situation but not directly impacted by it, witnesses of abuse First step in program evaluation - Determining goals and objectives Immediate concern if client is being evicted - Help to appeal to housing authority first - losing home!!! Basic needs Quasi-experimental - Most practical research design for conducting agency program evaluation - comparison of control group with an experimental group Single subject design - Study of a single individual Poor generalizability 1. pre/post - AB 2. pre/treatment/removal - ABA Reversal design Independent variable - Variable being manipulated or controlled - treatment Dependent variable - Variable affected by I.V., outcome Validity - Are we measuring what we think we are measuring? External validity - Can results be generalized? Internal validity - Did the experiment make a difference in outcome? Reliability - Can you get the same answer repeatedly? Client does not pay fees - According to COE's, services can be discontinued if a client has not paid fees and after ensuring safety Key step in resolving ethical dilemmas - Analize the impact of each principle, look to COE, identifying ethical standards to see what has been violated Board of directors handles: - Broad-agency wide, gov't issues, financial reports - not day to day operations/staffing Sexual harrassment - Document complaints and follow-up with agency policy, LEGAL ISSUES Preferred goal of Permanency Planning foster care: - Family reunification Sustaining procedures - activities that strengthen the SW to client relationship such as reassurance, encouragement, and acceptance for effective case work If an argument occurs b/t parent and child during an intake: - Help facilitate the dev'p of a process for conflict resolution How to determine program effectiveness? - - How well are goals being met - How well are programs reaching targeted population Continuous reinforcement - Target behavior is reinforced each time it occurs Crisis Theory - coping mechanisms Cojoint therapy - Both partners seen by TWO therapists Conscious use of self - Way in which worker influences the client Ethnocentric - Viewing the world soley from the perspective of their own culture, culture is superior Stratification - Structured inequality of entire categories of people who have unequal access to social rewards Pluralism - Diverse members maintain own tradition while cooperatively working together and seeing other's traits as valuable Problem solving process - 1. Acknowledge the problem 2. Analyze/Define the problem 3. Generate possible solutions/brainstorm 4. Evaluate each option 5. Implement the option of choice 6. Evaluate outcome of problem solving process Keep basic concepts in mind when working with individuals, policy, or task group. Alfred Adler - Early cognitive theorist, worked directly with Freud: 1) individual's personality is best perceived as a whole 2) social relationships drive behavior more than sexual motivations 3) current beliefs and thoughts play a far greater role in human behavior than is suggested via psychoanalytic theory Kohlberg's stages of morality - Pre-conventional - Stage 1, punishment/avoidance - Stage 2, Rewards, Conventional, - Stage 3, Good boy/bad girl, - Stage 4, Law and Order, Post-conventional, - Stage 5 - Moral vs. Legal Right - Stage 6 - Individual state of concsiousness 4 A's of Schizophrenia - Affect, associations, ambivalence, and autism. 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. Enmeshment - The inappropriate closeness of family members Father-daughter incest - Daughter-Father communication will be distorted and symbolic, family structure is very strict, with highly moralistic expectations, reversal between mother-daughter roles and expectations CBT - Changing thoughts to change behaviors, individual intervention, seeking behavioral change Dual Diagnosis - Focus on the most severe symptoms first. In adult survivors of childhood sexual abuse, the most frequently encountered defense mechanism is - Denial Age 0-1 - Oral - mouth fixation, Sensory motor stage - 0-2, lack of language, Trust vs. mistrust Age 2-3 - Bowel movement/toilet training, Preoperational age 2 to 7, preschool years, egocentric, absolutes, Autonomy vs. selfdoubt Age 3-6 - Phallic - explore sexual organs, Preoperational, Initiative vs. Self-doubt Age 6-11 - Latency - basic desires are repressed and expressed in socially acceptable ways, Concrete Operational age 7 to 11, logic and rules, Industry vs. inferiority - SCHOOL, MIDDLE childhood Age 11 and 12 to 18 - Genital - Puberty onward, No longer driven by instant gratification only and is independent and has concern for others, has relationships and responsibilities, Concrete Operational age 11 and onward, Abstract thought, Identity vs. Role Diffusion Age 18 to young adulthood - Intimacy vs. Isolation Age 30 to 50 - Generativity vs. Stagnation Age 50+ - Ego Integrity vs. Despair 5 Stages of Death and Dying - DABDA 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance *Hope is not a separate stage Cultural Competence for EXAM - Self-awareness about one's own attitudes, values, beliefs, about cultural differences Acculturation - The process of adopting the attitudes, values, beliefs, language of a a new or dominant culture Assimilation - Identify only with dominant culture Integration - Identify with both cultures Separation - Identify only with ethnic culture Marginality - Do not identify with either cultures Basis for Social Power - Coercive - power from control of punishments, Reward - power from control of rewards, Expert - power from superior knowledge, Referent - power from acceptance/likeability, Legitimate - power from having legitimate authority, Informational - power from content of messages leading to new cognitions Stages of Change, People Cook Pineapple Avocado Mango Recipes - Precontemplation Contemplation Preparation Action Maintenance Relapse