LCSW Exam Prep Questions

Denial (defense mechanism)

Refusing to acknowledge that an event has occurred. The person affected act as as if nothing has happened, behaving in ways that others may see as bizarre.

defense mechanisms

Mental processes that protect individuals from strong or stressful emotions and situations. Coping techniques to reduce anxiety resulting from undesired impulses. All defense mechanisms share two common properties: 1. Appears unconsciously 2. Distorts, transforms, or otherwise falsifies reality.

Sublimation (defense mechanism)

Occurs when a person chooses to divert their desires that are consciously intolerable and cannot be directly realized into creative activities that are acceptable. Sublimation channels this energy away from destructive acts and into something that is socially acceptable and/or creatively effective.

Repression (defense mechanism)

Placing uncomfortable thoughts in relatively inaccessible areas of the subconscious mind. Thus, when things occur that we are unable to cope with now, we push them away, either planning to deal with them later or hoping that they will fade away on their own accord.

Rationalization (defense mechanism)

When something happens that we find difficult to accept and we make up a logical reason why it has happened.

A client who has a stable, well-paying job tells a social worker that she plans to quit in the coming weeks. The client states that she is miserable, but is not able to specify what she does not like about her current employment. The social worker feels that the client is making a poor decision which could have serious ramifications for her financial well-being. In order to handle this situation appropriately, the social worker must FIRST: a. Acknowledge the client's right to make her own decisions about her life b. Assess whether there have been changes in the client's life recently which are impacting on this decision c. Warn the client about the potential consequences of her decision so she has all necessary information to make an informed choice d. Assist the client with looking for another job quickly so she is able to meet her basic financial needs

a. Acknowledge the client's right to make her own decisions about her life Explanation Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may only limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others. Limitation should not be made when social workers feel that clients are simply making poor choices or the actions could have negative ramifications for their well-being, but these consequences are not serious, foreseeable, and imminent. Test-Taking Strategies Applied The question contains a qualifying word—FIRST. There may be more than one appropriate action by the social worker to the case scenario, but each must be done after recognition that this decision is ultimately to be made by the client. Despite the social worker's belief that the decision is a poor one, the client must not be judged and instead should be supported throughout the process. The decision by the client to leave her employment does not meet the threshold of causing serious, foreseeable, and imminent harm. The social worker may assess whether changes in the client's life have influenced this decision, help the client to understand the consequences of her decision, and assist the client with locating new employment. However, these actions should occur after the right of the client to make such a choice is acknowledged. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Development and Use of Self (Competency); Client/Client System Competence and Self-Determination (e.g., Financial Decisions, Treatment Decisions, Emancipation, Age of Consent, Permanency Planning) (KSA)

Current guidelines concerning social workers' duty to disclose confidential information without client consent to protect third parties from harm were initially established in: a. Case law b. Constitutional law c. Regulatory law d. Executive order

a. Case law Explanation Many ethical issues in social work—although certainly not all—require some legal knowledge. In addition, the NASW Code of Ethics (2008) requires social workers to consult laws that are relevant to ethical decisions. In the United States, three branches of government create laws: legislative, executive, and judicial. Statutory laws, regulatory laws, case laws, the U.S. Constitution, and executive orders often have profound implications when social workers make ethical decisions. Statutory law is enacted by Congress (federal) and legislatures (state). Statutes govern social workers' obligation to report suspected abuse and neglect of children, elders, and other vulnerable people; minors' right to consent to mental health counseling and to drug and alcohol abuse treatment; protection of school social workers' confidential records; and federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) laws. Regulatory law is promulgated by federal and state government agencies, such as the U.S. Department of Health and Human Services and state human service, child welfare, and mental health agencies. Under our system of law, federal and state agencies have the authority to establish enforceable regulations. Public agencies must follow strict procedures when they create regulations (e.g., providing public notice and opportunity for public comment about drafts of regulations). Once enacted, federal and state regulations have the force of law. Case law is created in the context of litigation and judicial rulings. For example, a judge may need to interpret the meaning or application of existing law, resolve conflicts between laws, or fill gaps in existing laws. Such rulings by appellate courts become legal precedent or case law. Constitutional law is dictated by the Constitution and includes numerous provisions that pertain to social work practice. Examples concern Fourth Amendment guidelines concerning citizens' right to privacy and protections against improper search and seizure (important in residential treatment programs) and Eighth Amendment protections against cruel and unusual punishment (important in juvenile and adult correctional facilities). Executive orders may be issued by chief executives in federal, state, and local governments. This authority usually is based in federal and state statute. Executive orders resemble regulations. Test-Taking Strategies Applied This question requires social workers to be familiar with a landmark California court case related to duty to warn. Current guidelines concerning social workers' duty to disclose confidential information without client consent to protect third parties from harm were initially established by Tarasoff v. Board of Regents of the University of California. In 1976, the California Supreme Court ruled that mental health clinicians have a duty to protect potential victims if their clients make threats or otherwise behaved as if they presented a "serious danger of violence to another." In its ruling, the court determined that the need for mental health clinicians to protect the public was more important than protecting client confidentiality. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Legal and/or Ethical Issues Regarding Confidentiality, Including Electronic Information Security (KSA)

All of the following are true about delirium and dementia EXCEPT: a. Delirium is characterized by slow and gradual onset while dementia is not. b. Delirium is often reversible while dementia is generally irreversible. c. Delirium can develop in clients with dementia, but is often undiagnosed. d. In both delirium and dementia, cognition is disordered, but dementia affects mainly memory and delirium affects mainly attention.

a. Delirium is characterized by slow and gradual onset while dementia is not. Explanation Delirium and dementia are the most common causes of cognitive impairment. Delirium and dementia are separate disorders but are sometimes difficult to distinguish. One of the differences between delirium and dementia is that the former emerges suddenly with a definite beginning point whereas the latter's onset is slow and gradual, making it difficult to determine the exact date on which dementia started. Knowledge Area Unit II - Assessment, Diagnosis, and Treatment Planning (Content Area); Biopsychosocial History and Collateral Data (Competency); Symptoms of Neurologic and Organic Disorders (KSA)

Which of the following consent procedures BEST informs clients of the nature and expectations of the social worker/client relationship, including confidentiality? a. Discussing written policies throughout the problem-solving process b. Providing clients with copies of all signed written consent and other forms c. Asking clients to sign written consent forms prior to initial meetings d. Ensuring that written policies are updated regularly and signed by clients

a. Discussing written policies throughout the problem-solving process Explanation Informed consent is most often thought of in the context of the contracting stage with a client, which comes at the beginning of the professional relationship. To be effective, informed consent should be seen as an ongoing process. Informed consent can be integrated into each session with a client, or at regular/periodic intervals throughout a professional relationship. As the goals of the relationship change, informed consent should be revisited. Informed consent is the process through which social workers discuss with clients the nature of the social worker/client relationship. Through informed consent, the social worker and client outline what the client can expect from the professional relationship, as well as what the social worker expects from the client's participation. Informed consent often includes a discussion of basic protocols, such as how to make or cancel appointments, or the best way to contact the social worker. The process should also involve outlining what work will be done with and for the client, and what expectations there are for client involvement. Integral to the informed consent process is a discussion of client confidentiality. Using simple language, appropriate to the developmental and language needs of the client, the social worker needs to explain to the client that he or she will generally keep information private, but that there are specific instances when the social worker is required to break client confidentiality. It is at this point that the social worker should highlight that if he or she suspects child maltreatment based on information received from the client, the social worker must break client confidentiality to make a report of the suspicion to child protective services. In some agencies or practice settings, informed consent involves the client signing a form that acknowledges receipt of certain information. Although a written tool is a good idea, it is important that there be additional methods for ensuring informed consent. In all cases, with or without written informed consent tools, the social worker and client should discuss, face-to-face, expectations for confidentiality and when confidentiality will be breached. The social worker should use language the client can understand. As with other forms of communication with clients, it is important to ensure that the client understands what is said with regard to informed consent. Test-Taking Strategies Applied The qualifying word—BEST—indicates that more than one listed answer may be informative or useful, but the correct one is that which most effectively "informs clients of the nature and expectations of the social worker/client relationship." None of the incorrect answers speak to exchanges between social workers and clients about consent policies. They simply provide clients with, or have clients sign, written materials, which is not sufficient for informed consent. Clients should have the opportunity to ask questions and have policies explained in clear, concise ways which are easy to understand. The correct answer also acknowledges that informed consent is an ongoing process and does not just occur at intake. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Values and Ethical Issues (Competency); The Principles and Processes of Obtaining Informed Consent (KSA)

When engaging in structural family therapy, social workers may use which of the following techniques to understand and diagnose structures that maintain families' dysfunctional interactions? a. Enactments b. Confrontation c. Journaling d. Collateral information

a. Enactments Explanation Structural family therapy is based on the premise that there is an overall structure or organization that maintains family dysfunction. Restructuring is based on observing and manipulating interactions within therapeutic sessions. Enactments are suggested by social workers as ways to diagnose structure and provide openings for restructuring interventions. Knowledge Area Unit III - Psychotherapy, Clinical Interventions, and Case Management (Content Area); The Intervention Process (Competency); Family Therapy Models, Interventions, and Approaches (KSA)

A counseling agency charges the same amount to all clients enrolled in its group treatment program. Given a recent bequest, the board of directors proposes providing a standard subsidy to all group therapy clients to reduce their fees by a set amount. A social worker in the agency advocates for these subsidies to be proportional, with clients having the lowest incomes receiving the highest subsidies. The social worker argues that some clients can afford to pay the actual cost while those who have lower incomes cannot and should receive the subsidies. The social worker's recommendation for resource allocation promotes: a. Equity b. Sustainability c. Equality d.Fidelity

a. Equity Explanation Social workers must be aware of the effects policies, procedures, regulations, and laws have on practice. Many of these impacts concern choices made based on equality and equity. While there is a common misconception that equity and equality mean the same thing and that they can be used interchangeably, they cannot as there is an important distinction between them. The ideal of equality is that everyone should receive the same treatment and opportunities, a notion that is fundamental to democracy and the belief that everyone should benefit from the fruits of a good society. However, when a society is stratified into poles of advantage and disadvantage, with the inevitable consequences of privilege and exclusion, the notion of equal access is just an ideal and does not exist in reality. Fair access, then, may take on a different meaning than equal access and opportunity. Rather than fairness occurring from uniform distribution (equality), where there is an entitlement to the same amount, there may be a need to level the playing field. In other words, equity is concerned with fairness by remedying historic injustices that have prevented or diminished access in the first place. Policies aimed at ensuring that everyone can have access to the same opportunities (equity) provide more resources to those who need them. Sustainability is the ability to continue over time. Fidelity is the quality of being loyal or faithful. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding the values used in making decisions about policies, procedures, regulations, and laws. It requires knowing the definitions of each of the words listed as response choices. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Service Delivery and Management of Cases (Competency); The Effects of Policies, Procedures, Regulations, and Legislation on Social Work Practice and Service Delivery (KSA)

A social worker is developing a contract with a client who has been mandated for treatment. All of the following actions by the social worker aim to promote the client's self-determination EXCEPT: a. Explaining directives contained in the court order to the client b. Advocating for clinically appropriate modifications to mandates based on client wishes c. Eliciting input from the client about the methods of intervention to be used d. Setting goals that the client wants to pursue

a. Explaining directives contained in the court order to the client Explanation Self-determination is a cornerstone of the social work profession. Self-determination is built on the values of autonomy and respect for the dignity and worth of all people. So, given the primacy of self-determination, it is necessary to examine how its mandate can be met when working with clients who are mandated to receive services. Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others (NASW Code of Ethics, 2008—1.02 Self-Determination). Posing "a serious, foreseeable, and imminent risk to themselves or others" typically applies to situations of suicidal or homicidal ideation. Thus, the NASW Code of Ethics is giving priority to the principle of protecting life over the principle of respecting self-determination. This could include initiating processes that may result in involuntary admission for psychiatric treatment as a last resort. This ethical standard does not say social workers may ignore self-determination. It says they may limit self-determination. Implicit in this language is the notion of the "least intrusive" course of action. In instances when clients are receiving services involuntarily, social workers should provide information about the nature and extent of services and about the extent of clients' right to refuse service (NASW Code of Ethics, 2008—1.03 Informed Consent). This standard recognizes that, even though involuntary clients are being pressured into services, they still have certain rights. First, social workers need to inform clients about the services being offered. For instance, social workers should inform them about the purpose and goals of the services, models of intervention used, research about benefits and risks, and expectations as participants in services. Social workers should inform clients about the extent of their right to refuse services. Social workers should also help clarify the consequences if clients do not fulfill what has been mandated. Self-determination is not simply an either/or situation. Honoring self-determination as much as possible may be more difficult with some clients than with others. Although social workers should recognize that self-determination may be imperfect for involuntary clients, workers are able to enhance self-determination through various intervention strategies: Social workers can empower clients by helping them set goals and objectives that they genuinely want to pursue—even if they did not initially choose to participate in services. Social workers may be able to offer clients a range of choices about which methods of intervention will be used (e.g., individual vs. family counseling). Social workers may be able to have clients pick their choice of practice modality (cognitive vs. narrative therapy). In addition, social workers must engage clients by empathizing and acknowledging pressures placed on them, building trust, and validating concerns, so clients are more willing to participate in services. In appropriate instances, social workers can advocate with authorities to honor client wishes and revise court orders or other mandates in attempts to promote self-determination. Test-Taking Strategies Applied The question contains a qualifying word—EXCEPT—that requires social workers to select the response choice which would not promote client self-determination during planning in the problem-solving process. When EXCEPT is used as a qualifying word, it is often helpful to remove it from the question and eliminate the three response choices which must be done as per ethical standards. This approach will leave the one response choice which is not required. In the case scenario, the social worker is "developing a contract." A contract is another name for an intervention or service plan and outlines goals, objectives, time frames for completion, and so on. It is done during the planning step of the problem-solving process, following engagement. While it is important for a mandated client to understand the contents of a court order related to treatment, such a review usually occurs prior to planning, such as part of the informed consent process at the onset of the therapeutic relationship. In addition, explaining directives contained in the order to the client does not "promote self-determination," which is the lens through which each response choice must be evaluated. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Development and Use of Self (Competency); Client/Client System Competence and Self-Determination (e.g., Financial Decisions, Treatment Decisions, Emancipation, Age of Consent, Permanency Planning) (KSA)

Which of the following statements is TRUE about the blending and braiding of resources in human service programs? a. Federal categorical limitations make blending and braiding of resources difficult to administer. b. Blending of resources is preferred by funders over braiding due to administrative efficiencies. c. Braiding of resources is seen as advantageous by administrators due to ease of implementation. d. Blending and braiding of resources allows collective reporting on how monies are spent overall.

a. Federal categorical limitations make blending and braiding of resources difficult to administer. Explanation Enhanced coordination of client services can be achieved through the use of alternative funding approaches. Blending or braiding funding across related programs and across multiple agencies is a basic way that state and local agencies can more effectively serve the holistic needs of clients, more efficiently target high-priority performance goals, and streamline administrative requirements. Blending and braiding of fiscal resources aim to enhance service coordination to meet the holistic needs of clients. Some jurisdictions, particularly at the local level, have successfully used blended and braided funding, but federal categorical limitations make taking this concept to a larger scale difficult. The terms "blending" and "braiding" are used frequently, often together, and generally with little definition. However, they refer to two very different approaches to fiscal coordination. Blending funding involves comingling the funds into one "pot" where social workers can draw down service dollars, personnel expenses can be paid, or other program needs can be met. When funding is blended, it goes into the "pot," and when it is pulled back out to pay for an expense, there is no means for the fiscal manager to report which funding stream paid for exactly which expense. Blending funding is politically challenging. Some funding streams cannot be blended. Other funding streams will require the funder to allow an exception to how the reporting normally functions. Instead of usual reporting, funders can opt to accept reports on services and outcomes across the population being served, rather than exactly which children, youth, and families received services with their dollars. To blend funding, social workers need to work closely with funders and ensure that reporting requirements are met. Though it is challenging politically, once funders are on board, blended funding is less challenging to implement than braided funding. There is significantly less workload, as the tracking and accountability happens across all of the funding streams. Rather than reporting to funders on their funding stream alone, reporting is done on how the collective funds are used. Blended funding can allow you to pay for services that may not be allowable with more categorical funding approaches. However, for many funders, the flexibility associated with blending makes it seem too "risky" as it often looks like supplanting, and they end up with less detailed information about how each of their dollars have been spent. Braided funding involves multiple funding streams utilized to pay for all of the services needed by a given population, with careful accounting of how every dollar from each funding stream is spent. The term "braiding" is used because multiple funding streams are initially separate, brought together to pay for more than any one funding stream can support, and then carefully pulled back apart to report to funders on how the money was spent. Braided funding is often the only option. Federal funding streams require careful tracking of staff time and expenses to ensure that a federal funding stream only pays for those things directly associated with the intent of the funding. Consequently, when multiple funding streams are paying for a single program or system, the system will need to be carefully designed to allow for sufficient reporting to ensure each funding stream is only paying for activities eligible under that funding stream. Braided funding requires significant effort to create the systems for tracking how funding is utilized. The design of a braided funding system that can respond to the individualized needs of many types of clients will require social workers to decide which services will be paid for by which funding streams. Ideally, this decision happens after the needs of the individual or family being served is identified, so that the funding does not drive the services being provided. This type of braided model requires a clear understanding of the eligible populations and the eligible services, so that decisions on how to fund the services can be made post hoc, rather than prior to discussing service needs with the families. The design of a braided funding program is simpler than the design of a braided funding system. Programs typically have clearly defined services that are provided and sometimes have very defined populations who are eligible for services. Test-Taking Strategies Applied The question contains a qualifying word—TRUE. It is even capitalized to assist with identifying the distinguishing factor of the correct response from the rest. Each statement must be read carefully and evaluated as to its accuracy. The correct answer is identified through the process of elimination, with each false assertion being excluded. Blending is often not preferred by funders as they receive less detail about how monies are spent, while braiding is frequently not seen as possible due to the burden of the tracking associated with its implementation. It requires detailed reporting to ensure each funding stream is only paying for eligible activities. Thus, only the first statement is true as both blending and braiding are difficult to administer due to federal categorical limitations. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Service Delivery and Management of Cases (Competency); Methods of Service Delivery (KSA)

A social worker has been working with an 8-year-old girl for over a year. The client's mother, who is going through a divorce, states that she is going to ask if the social worker can be appointed to supervise visits with the father. The need for supervised visitation has already been determined by the court. The mother feels strongly that the social worker is the best choice given the presence of a strong relationship with the child. The social worker should: a. Inform the mother that this additional role would not be possible b. Determine the child's feelings about the mother's request since the child is the client c. Request to meet with the father to determine if he feels comfortable with the arrangement d.Explore with the mother the impacts of the divorce on the child

a. Inform the mother that this additional role would not be possible Explanation Professional objectivity in social worker-client relationships is critical. This objectivity can be compromised if there is a conflict of interest in relationships with clients. A conflict of interest is a situation where regard for one duty may lead to disregard of another. When faced with potential or actual conflicts of interest, it is important that social workers consider the perceptions of others (clients, colleagues, the community, employers, etc.). It is important, therefore, that social workers are proactive in avoiding conflicts of interest and discuss any actual conflicts of interests with supervisors or employers so that they can be resolved. Dual relationships should never be entered into knowingly even if social workers feel that they can manage the potential conflicts or feel that there are no significant issues. Test-Taking Strategies Applied While the mother in this case scenario has considerable confidence in the child's social worker, there is an apparent conflict of interest for the social worker in supervising the child's visits with the father. The social worker will be expected to provide feedback to the court concerning the need for ongoing supervision of the dad's contact with his daughter. The objectivity in writing the report may actually be or could be perceived as being impaired by virtue of the preexisting treatment role with the child. Thus, even if the child and father are comfortable with the social worker taking on this additional role, it is inadvisable for legal and ethical reasons. The divorce may have a profound impact on the child, but exploring the effects is not related to the request at hand, so the last answer is a distractor. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Development and Use of Self (Competency); Professional Objectivity in the Social Worker-Client/Client System Relationship (KSA)

With regard to client privacy, privilege is BEST defined as the: a. Legal rule that protects communications from compelled disclosure in court proceedings b. Mandate to obtain written consent from clients when information is to be disclosed c. Duty to report concerns of child abuse and neglect to appropriate authorities d. Requirement to keep treatment information of minors confidential even from their parents

a. Legal rule that protects communications from compelled disclosure in court proceedings Explanation Privileged communication is a legal right, existing by statute or common law, that protects the client from having his or her confidences revealed publicly from the witness stand during legal proceedings. Certain professionals, including social workers, cannot legally be compelled to reveal confidential information they received from their clients. The privilege protects clients, and the right to exercise privilege belongs to clients, not to professionals. There are four conditions that are generally accepted as being necessary for a communication to be considered privileged: 1. The communication must originate in the confidence that it will not be disclosed. 2. The element of confidentiality must be essential to the full and satisfactory maintenance of the relationship between the parties. 3. The relationship must be one that in the opinion of the community ought to be fostered. 4. The injury to the relationship caused by disclosure must be greater than the benefit gained through disclosure for the correct disposal of litigation. The landmark Supreme Court decision on the protection of psychotherapist-client privilege is Jaffee v. Redmond, 518 U.S. 1 (1996). The case created by common law the right for federal litigants and witnesses to keep their private psychotherapy records out of the courtroom, rejecting an approach that would have permitted federal judges to review and weigh the value of the potential evidence excluded under the privilege. The Jaffee decision is notable in several respects. For social workers, it is a landmark ruling recognizing the professionalism and relevance of social workers providing psychotherapy in today's mental health treatment milieu. For trial lawyers and their clients, Jaffee presented a new rule of evidence, drawing a bright line around a certain type of evidence that is inaccessible for legal probing. For mental health clients, the case bolsters the wall of protection afforded to the intimacy of the therapeutic relationship. Jaffee has also contributed to the treatment of health privacy in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. Although Jaffee is only directly applicable to cases filed in federal court, many states have had occasion to review the Jaffee decision as they decide similar matters under their jurisdiction. Test-Taking Strategies Applied The question contains a qualifying word—BEST. While all of the response choices relate to client privacy, only the correct answer mentions privilege being a legal term which aims to keep communication from being disclosed in court proceedings. It is best practice for social workers to get clients' written consent when releasing information, though verbal consent is acceptable in certain situations. Social workers must report suspected child abuse and neglect, but such a mandate is not related to the definition of privilege, making the third answer listed incorrect. Lastly, often treatment information of minors cannot be withheld from parents, though laws vary across states given the ages of minors and types of treatment received. This answer is also incorrect as it is not related to privilege, but concerns instead another important privacy topic. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Legal and/or Ethical Issues Regarding Confidentiality, Including Electronic Information Security (KSA)

Fee splitting is unethical in social work practice because it: a. Represents a conflict of interest, which can adversely impact client care b. Establishes rates, which do not consider what clients can afford to pay c. Creates prohibited dual relationships, which are boundary violations d. Occurs without client consent, which is mandatory for all treatment decisions

a. Represents a conflict of interest, which can adversely impact client care Explanation Social workers must be familiar with ethical standards related to payment for services. There are many practices which are not ethical such as setting unreasonable fees, bartering in most instances, and soliciting extra fees from clients when services can be provided by agencies at no additional cost. In addition, an arrangement where social workers accept a percentage of other independent providers' fees for professional services that they have not directly provided is not ethical. Receiving money for referrals made to other professionals constitutes "fee splitting" and is strictly prohibited. Costs of social work services should be established at market value and paid per agreement or contract with clients for services actually received. "Fee splitting" represents a conflict of interest which may adversely affect client care and well-being. For example, clients may not necessarily be referred to the most appropriate professionals, but instead those with whom referring social workers have "fee splitting" or commission payment type arrangements. Fee splitting is not only prohibited for social workers, but other professionals as well. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding the ethical issues regarding payment for services, and specifically the term "fee splitting." Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Values and Ethical Issues (Competency); Legal and/or Ethical Issues Related to the Practice of Social Work, Including Responsibility to Clients/Client Systems, Colleagues, the Profession, and Society (KSA)

In a sociogram, the intensity of interpersonal relationships is indicated by: a. Types of lines b. Arrows which may point one or both ways c. Shading of circles d. Shapes of diagrams

a. Types of lines Explanation A sociogram is a graphic representation which serves to reveal and analyze the relationships of a person with his or her family or social circle, or to visualize the relationships within the family or of certain members of the family with their external environment such as health and education services, leisure time activities, work, friends, or place in the extended family. A genogram gives information about the composition of families and the interactions and influences between generations, but it does not show the nature of the relationships within a family nor those with the exterior environment, which may be very useful in certain situations. Sociograms are used to illustrate human resources and networks that can be mobilized to support clients. A client is born within a family, with parents who protect him, a family circle, and a specific environment. This is known as the belonging group, with which, in one way or another, a client maintains a lifelong tie. A human group, whatever its nature, always presents a particular character, with specific values, distinct cultural tastes, a dynamic, and an ideology which make it unique. The persons, groups, or organizations which serve as role models for a client's moral, religious, or political conduct is the reference group. The sociogram can target either one or the other of these groups. In this graphic representation, as in the genogram, the intensity of the ties is indicated by a code of lines: a dotted line indicates a weak relationship, and as the dots get weaker, the relationship is weaker. Arrows pointing one or both ways show whether a relationship is reciprocal or only one-way, where one person is providing and the other person is not allowed/able to give back. Circles with names inside, big or small, represent the different members of a family based on the importance they have in the family. The shading of circles or shapes of diagrams do not have any intrinsic meaning. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding techniques and instruments used in assessment. While knowledge about sociograms may not be as robust as that about genograms, many of the features are the same. Usually relationships are depicted as lines. Intensity does not directly relate to direction, so arrows can be eliminated. Shapes and shading do not also intuitively have to do with connections, which are the essence of relationships. Often the correct answer in recall questions happens through the process of elimination. Knowledge Area Unit II—Assessment, Diagnosis, and Treatment Planning (Content Area); Biopsychosocial History and Collateral Data (Competency); Techniques and Instruments Used to Assess Clients/Client Systems (KSA)

An adult who was abused by a parent during childhood who now has no recollection of the events, but has trouble forming relationships. This is an example of: a. repression b. denial c. sublimation d. rationalization

a. repression

The primary goal of interdisciplinary service collaboration is to: a. Reduce duplication in order to avoid wasting scarce resources b. Address the holistic needs of clients across life domains c. Develop innovative strategies for addressing social problems d. Increase effectiveness of assistance provided to clients

b. Address the holistic needs of clients across life domains Explanation Interdisciplinary collaboration is a necessary, yet challenging social work activity. When multiple agencies which work with clients act independently of each other, the result is that clients are subject to fragmented services, none of which address clients as whole individuals. A shared vision among collaborators facilitates strategies to achieve common goals. The biggest benefit of collaboration among agencies is the improved well-being of clients. Collaboration among agencies is the key to preventing fragmentation. In addition to reducing the likelihood of clients falling through the cracks between disparate and unconnected agencies, collaboration fosters a more holistic view of clients. With effective collaboration, service providers recognize differing viewpoints through their contact with professionals with expertise in different areas. In addition to decreasing paperwork and minimizing fragmentation, this process could help to strengthen linkages and communication among various agencies providing different services to meet clients' varying needs. Test-Taking Strategies Applied The question contains a qualifying word—PRIMARY—though it is not capitalized. While the benefits listed in the incorrect response choices may result from collaborations between service providers, the correct answer to any question on the examination is always the one which speaks to enhancing the well-being of clients. Interdisciplinary service collaborations can reduce duplication, foster innovation, and lead to enhanced effectiveness. However, they predominantly exist to bring together professionals from different professions or disciplines. The multifaceted training and experience of these providers helps to ensure that all client needs are addressed. The correct answer is the only one that references the needs of clients across life domains, which is the principal reason for taking an interdisciplinary approach. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Consultation and Interdisciplinary Collaboration (Competency); The Process of Interdisciplinary and Intradisciplinary Team Collaboration (KSA)

At the conclusion of the sixth session, a client states that her attorney would like to speak to the social worker. When the social worker asks about the nature of the request, the client states that she does not know and the social worker will need to contact the attorney to find out. The social worker should: a. Contact the attorney immediately with the assurance that all legal matters will be discussed with the client in future sessions b. Decline the request until the social worker's role is clarified and the client's expectations are better understood c. Explore with the client why she is not being forthcoming about the reasons for the attorney request d. Arrange a time for the client to be present during the social worker-attorney conversation to ensure that the client is aware of what is disclosed

b. Decline the request until the social worker's role is clarified and the client's expectations are better understood Explanation Policies, procedures, regulations, and laws can have a profound impact on social work practice. Social workers who treat clients involved with the legal system must be aware of problems that can arise prior, during, and after the delivery of services. Many of these issues can be avoided by clarifying and defining the nature of a social worker's role. For example, some clients may be uncertain about what to expect from psychotherapy or have unrealistic hopes. Ethically, a social worker is expected to work jointly with clients in the development of treatment plans. By discussing what can and cannot be provided, clients are offered realistic portrayals of what may be expected from therapy, which may assist in deciding whether to work with a particular social worker. Test-Taking Strategies Applied In this case scenario, the client appears to be directing the social worker and her behavior suggests that she believes the social worker is obligated to contact the attorney. In fact, the social worker would have no such obligation and would be wise to decline the client's request, in order to clarify the social worker's role and to better understand the client's expectations. If the social worker elects to contact the attorney prior to discussing the specifics and implications with the client, there is a risk that the client may interpret the social worker's action as an implied agreement to become involved in the legal matter. If the social worker and client ultimately determined that the client's expectations were inconsistent with the social worker's understanding of his or her role, there may be a need for a referral to another professional who is better suited to the client's needs. The incorrect answers all focus on contacting the attorney or viewing the client's lack of information as resistance to discussing the legal matter. There is no indication that the client is being resistant and to assume so is adding material to the question. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Values and Ethical Issues (Competency); Legal and/or Ethical Issues Related to the Practice of Social Work, Including Responsibility to Clients/Client Systems, Colleagues, the Profession, and Society (KSA)

Which attribute is NOT a negative symptom of Schizophrenia? a. Diminished feelings of pleasure in everyday life b. Experiencing sensory experiences in the absence of a stimulus c. Difficulty beginning and sustaining activities d. Reduced speaking

b. Experiencing sensory experiences in the absence of a stimulus Explanation Schizophrenia is a brain disorder that affects how clients think, feel, and perceive. The hallmark symptom of Schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs). Clients with the disorder may hear voices or see things that are not there. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can be scary and upsetting to clients with the illness and make them withdrawn or extremely agitated. It can also be scary and upsetting to others around them. Clients with Schizophrenia may sometimes talk about strange or unusual ideas, which can make it difficult to carry on a conversation. They may sit for hours without moving or talking. Sometimes clients with Schizophrenia seem perfectly fine until they talk about what they are really thinking. The symptoms of Schizophrenia fall into three broad categories: positive, negative, and cognitive symptoms. Positive symptoms are psychotic behaviors not generally seen in healthy people. Clients with positive symptoms may "lose touch" with some aspects of reality. For some, these symptoms come and go. For others, they stay stable over time. Sometimes they are severe, and at other times they are hardly noticeable. The severity of positive symptoms may depend on whether a client is receiving treatment. Positive symptoms include the following: - Hallucinations are sensory experiences that occur in the absence of a stimulus. These can occur in any of the five senses (vision, hearing, smell, taste, or touch). "Voices" (auditory hallucinations) are the most common type of hallucination in Schizophrenia. Many clients with the disorder hear voices. The voices can either be internal, seeming to come from within one's own mind, or they can be external, in which case they can seem to be as real as another person speaking. Sometimes clients with Schizophrenia talk to the voices that they hear. Clients with Schizophrenia may hear voices for a long time before family and friends notice the problem. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near. - Delusions are strongly held false beliefs that are not consistent with a client's culture. Delusions persist even when there is evidence that the beliefs are not true or logical. Clients with Schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. - Thought disorders are unusual or dysfunctional ways of thinking. One form is called "disorganized thinking." This is when a client has trouble organizing his or her thoughts or connecting them logically. He or she may talk in a garbled way that is hard to understand. - Movement disorders may appear as agitated body movements. A client with a movement disorder may repeat certain motions over and over. In the other extreme, a client may become catatonic. Catatonia is a state in which a client does not move and does not respond to others. Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following: - "Flat affect" (reduced expression of emotions via facial expression or voice tone) - Diminished feelings of pleasure in everyday life - Difficulty beginning and sustaining activities - Reduced speaking Clients with negative symptoms may need help with everyday tasks. They may neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by Schizophrenia. For some, the cognitive symptoms of Schizophrenia are subtle, but for others, they are more severe; clients may notice changes in their memory or other aspects of thinking. Similar to negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when specific tests are performed. Cognitive symptoms include the following: - Poor "executive functioning" (the ability to understand information and use it to make decisions) - Trouble focusing or paying attention - Problems with "working memory" (the ability to use information immediately after learning it) - Poor cognition is related to worse employment and social outcomes and can be distressing to clients with schizophrenia. Test-Taking Strategies Applied The question contains a qualifying word—NOT—that requires social workers to select the response choice that does not contain a negative symptom of Schizophrenia. When NOT is used as a qualifying word, it is often helpful to remove it from the question and eliminate the three response choices which are negative symptoms. This approach will leave the one response choice which is NOT a negative symptom. This question is particularly tricky as all the response choices are, in fact, symptoms of Schizophrenia. However, the correct answer is a positive symptom—not a negative one. It is necessary to know the difference between negative, positive, and cognitive symptoms of Schizophrenia in order to answer correctly. Experiencing sensory experiences in the absence of a stimulus is referred to as hallucinating and is classified as positive as it is "added on" to a client's experience as a result of having the illness. Knowledge Area Unit II—Assessment, Diagnosis, and Treatment Planning (Content Area); Assessment and Diagnosis (Competency); The Use of the Diagnostic and Statistical Manual of the American Psychiatric Association (KSA)

A social worker is conducting an assessment with a client who has been living with a chronic disease for many years. The client has been able to manage the symptoms of her illness successfully with no reported negative impact on her daily life. She has just learned that she will need to begin a complicated medication regimen in the coming weeks in order to slow the illness's progression. The client is very worried about ensuring that the drug administration does not adversely affect her current routine. The client's needs can BEST be met by the provision of: a. Case management b. Psychoeducation c. Behavioral intervention d. Psychotherapy

b. Psychoeducation Explanation Prevention includes a wide range of activities—known as "interventions"—aimed at reducing risks or threats. Primary, secondary, and tertiary prevention are three terms that describe the range of possibilities. Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return clients to their original health and function to prevent long-term problems. Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping clients manage long-term, often-complex health problems and injuries (e.g., chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life, and their life expectancy. Test-Taking Strategies Applied The question contains a qualifying word—BEST. In the case scenario, the client "is very worried about ensuring that the drug administration does not adversely affect her current routine." Her concern is the presenting problem and the social worker can assist the client to better understand what will be required by ensuring that she receives accurate and complete information about what is required. Psychoeducation is often used to help clients learn how to slow the progression of a disease or limit its long-term impacts through diet, medication, or exercise. She is in need of a tertiary prevention intervention. The client may be worrying unnecessarily. Thus, providing information is the most effective strategy for determining whether there will be any impact to her current daily routine. There is nothing in the case scenario that indicates that the client needs help navigating multiple service delivery systems, thereby making the provision of case management futile at this point. The client also does not need to make behavioral changes, so interventions aimed at such are not warranted. Lastly, psychotherapy aims to facilitate change and confront barriers that interfere with emotional and mental well-being. Support may be needed to assist the client while she understands changes in her medication regimen, but there is no indication that she needs psychotherapy due to her most pressing concern. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); The Intervention Process (Competency); Primary, Secondary, and Tertiary Prevention Strategies (KSA)

A mandated client questions the confidentiality of specific documentation that is generated as part of treatment. The social worker should: a. Suggest the client speak to legal counsel to determine whether this material is privileged b. Review the court order with the client to determine what documents have to be released c. Seek supervision and/or consultation to better understand specific confidentiality standards d. Explain that consent will be obtained prior to generating any documents to maximize client confidentiality

b. Review the court order with the client to determine what documents have to be released Explanation Social workers must be knowledgeable about legal documents related to confidentiality of client information. Confidentiality of mandated clients is particularly tricky as documents may be subject to release without client consent. Social workers have a duty to claim privilege on behalf of their clients when asked to release any information without client permission. Privilege is a right owned by clients to prevent their confidential information from being used in legal proceedings. The NASW Code of Ethics requires social workers to wait until ordered by the court before disclosing information in legal proceedings, absent client consent or an imminent threat of harm. A subpoena is a mandate to provide evidence or testimony—but is not a final ruling or order by a court on the legal requirement to provide information or admissibility of the evidence. A subpoena is not a court order. Most subpoenas are issued by attorneys. The NASW Code of Ethics provides that when a court-ordered disclosure could cause harm to the client, the social worker should request that the court withdraw or limit the order or keep the records under seal. It is not clear how a social worker can meaningfully implement this provision. The social worker could refuse to obey a court's order as a matter of conscience, but this should be done only if she is prepared to be found in contempt of court and face time in jail, a fine, or both. The need to be aware of court or legal mandates is the cost of doing business in a profession where clients can be involved in legal disputes or matters. Test-Taking Strategies Applied Clients who are mandated to receive services may also be referred to as involuntary or court-ordered clients. All of these terms indicate that clients did not voluntarily choose or consent to receipt of services. There is legal authorization to mandate the receipt of treatment. Thus, there may also be a similar mandate to get access to documentation related to the receipt of services. The extent of what will need to be disclosed can vary and social workers are advised to be aware of these limits before the onset of treatment and review them with clients in their initial meetings. In the case scenario, it is the social worker's responsibility to understand the extent to which documentation is privileged, so there is no need to have the client see a lawyer. The social worker should be aware of any specific limits to confidentiality before the onset of services, so seeking supervision and/or consultation to understand them is problematic. Documentation associated with treatment needs to be generated according to practice standards. It would not be appropriate to forgo keeping notes which are essential to continuity of care just because they may be released. Also, promising the client that he or she will be able to consent to information release when mandated by the court can be misleading. The court order and any relevant legal documents should be obtained by the social worker and consulted whenever there are questions related to the service provision and/or reporting. Social workers have legal mandates to comply with court orders once they are appointed to be providers of services and agree to the terms. If there is concern about mandates in court orders, social workers should try to get them changed or be removed as treating professionals by the appointing courts. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Legal and/or Ethical Issues Regarding Confidentiality, Including Electronic Information Security (KSA)

A social worker who wants to afford a client the greatest confidentiality protections should store psychotherapy notes: a. In a section of the client's file so that they will not get disconnected from other key documents b. Separate from the rest of the client's medical or clinical record with restricted access c. At home as they are intended only for the social worker's use d. According to agency policy so that administrative standards provide additional client protections

b. Separate from the rest of the client's medical or clinical record with restricted access Explanation The Health Insurance Portability and Accessibility Act of 1996 Medical Privacy Regulations (known as the HIPAA Privacy Rule) has important implications for the confidentiality of psychotherapy notes. The HIPAA Privacy Rule recognizes the unique characteristics of "psychotherapy notes" and defines them as notes that are: Recorded (in any medium) by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session; and Separated from the rest of the individual's medical or clinical record. Thus, any additional privacy protection that may be available to clients' psychotherapy notes depends on whether the notes are maintained separately from the rest of the clinical file. This has been interpreted to mean in a separate file (paper or electronic), rather than a subsection of a file. The underlying rationale is that the notes are intended primarily for use by social workers. Access to the notes should be limited to primary clinicians. Under the Privacy Rule, the definition of "psychotherapy notes" does not include session start and stop times, modalities and frequency of treatment, medication monitoring, clinical tests, or summaries of diagnosis, prognosis, treatment plan, or progress. If a social work practice decides to maintain separate psychotherapy notes, all of the previously listed excluded material would be maintained in the primary client file or "medical record," while the psychotherapy notes would be kept elsewhere. Thus, the primary client chart would include, as applicable: - Medication prescription and monitoring - Counseling sessions' start and stop times - The modalities and frequencies of treatment furnished - Results of clinical tests - Any summary of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date - Intake information - Billing information - Formal evaluations - Notes of collateral contacts; - Records obtained from other providers The previous information would be considered the "medical record" for HIPAA purposes and subject to disclosure with a general consent or authorization to release information, as required by the 2008 NASW Code of Ethics. Under the Privacy Rule, in order for separately maintained psychotherapy notes to be released, the client must sign a separate authorization form. This means clients will be more aware as to when such a specific request has been made, and clinicians can provide clients an opportunity to consider whether or not they wish to sign a separate authorization for release of psychotherapy notes. Thus, if a clinician receives a request for "all records" or the "complete medical record," along with a signed authorization, this is not sufficient to release separately maintained psychotherapy notes. A separate signed authorization, specific to the psychotherapy notes, is required. This provides additional protection from routine disclosure of the notes to third parties, such as insurers. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding confidentiality standards concerning psychotherapy notes. Storing them in a section of a client's file does not afford them "the greatest confidentiality protections" under HIPAA. Social workers should never take client information home where there is a greater likelihood of confidentiality breaches. Additionally, such actions violate trust as clients are unlikely to think that their personal information is leaving the security of professional offices. Lastly, agency policy will not provide additional protections if separate files are not maintained for psychotherapy notes. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Legal and/or Ethical Issues Regarding Confidentiality, Including Electronic Information Security (KSA)

A man who hears that his wife has been killed, and yet refuses to believe it, still setting the dinner table for her every evening. This is an example of: a. repression b. denial c. sublimation d. rationalization

b. denial

A social worker receives a referral from a high school guidance counselor for a student who has received a full scholarship to college, but decided not to attend due to family responsibilities at home. Both school officials and the social worker feel that the student is making a mistake as it is unlikely that she will be able to attend college without the current scholarship opportunity. In order to effectively work with the student, the social worker must: a. Understand the extent of the family responsibilities that prevent her attendance b. Determine the short- and long-term career goals of the student c. Acknowledge the differences in values that may exist between the student and school personnel d. Identify the natural and other supports that are available to the student and her family

c. Acknowledge the differences in values that may exist between the student and school personnel Explanation A social worker's own values and beliefs can greatly influence the social worker-client relationship. Culture, race, and ethnicity are strongly linked to values. Social workers must have self-awareness about their own attitudes, values, and beliefs and a willingness to acknowledge that they may be different than those served. Differences in values and beliefs are very common when working with diverse populations. A social worker is responsible for bringing up and addressing issues of cultural difference with a client and is also ethically responsible for being culturally competent by obtaining the appropriate knowledge, skills, and experience. Social workers should: Move from being culturally unaware to aware of one's own heritage and the heritage of others Value and celebrate differences of others rather than maintaining an ethnocentric stance Have an awareness of personal values and biases and how they may influence relationships with clients Demonstrate comfort with racial and cultural differences between themselves and clients Have an awareness of personal and professional limitations Acknowledge their own attitudes, beliefs, and feelings Test-Taking Strategies Applied The question acknowledges that "both school officials and the social worker feel that the student is making a mistake." Thus, it is critical for the social worker to acknowledge the differences in values between the professionals involved and the student as she is choosing family responsibilities over pursuit of her education. This choice is based on the personal principles and tenets that are important to her. The incorrect answers may be useful, but the correct one is essential for the formation of a social worker-client relationship built on the core values of the profession, including the student's right to self-determination. Despite the extent of the existing responsibilities, her career goals, and/or the supports available, the student may value the needs of her family over furthering her own education. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Development and Use of Self (Competency); The Influence of the Social Worker's Own Values and Beliefs on the Social Worker-Client/Client System Relationship (KSA)

A social worker formats client case records into distinct sections representing all relevant information, issues to be addressed, and activities that need to be undertaken, respectively. Which model of case recording is this social worker MOST likely using? a. Narrative b. SOAP c. DAP d. APIE

c. DAP Explanation There are many formats for the recording of case notes. Case notes document activity and client progress. They help social workers identify effective and ineffective treatment strategies. In addition, if auditors, advocates, or supervisors look at files, they need to be able to get clear pictures of clients, and learn what has been done, what is working, and what areas need attention. In addition, without good, clear case notes, it can be next to impossible for successful client transition to other professionals should it be needed. Narrative notes are summaries about client interactions which provide an overview of what occurred during meetings or conversations. There are no means for organizing these notes and they may vary in specificity and topic, depending upon the pressing issues. While they are open-ended, social workers should make sure that they contain all relevant information, summarizing what has occurred and what will be the focus of treatment in the future. Subjective, objective, assessment, plan (SOAP) is a format used predominantly in health care facilities. The subjective section includes clients' reported symptoms and the objective section contains test and exam results. The assessment section includes conclusions and impressions based on the first two sections. The plan section explains the next steps, including the need for treatment, medication, and/or further testing. Another format is referred to as DAP. This format is similar to SOAP except that both subjective and objective data are included in the same section. DAP is an acronym that stands for data, assessment, and plan. The data section includes contact information for clients, subjective and objective data, and observational notes. Subjective data is a summary of information given by clients and may include direct quotes. Objective data includes information often gleaned from direct observation or other sources, including body movements, facial expressions, test results, and so on. The assessment is a summary based on subjective and objective information collected. The last section is the treatment plan, including any referrals or interventions that have been completed or are recommended. Another popular problem-based case recording format is assessed information, problem addressed, interventions provided, and evaluation (APIE). The first section includes documentation of assessed information with regard to clients' problems while the second is an explanation of problems that are to be addressed. These sections are followed by intervention descriptions and plans and evaluations of problems once interventions are complete, respectively. Test-Taking Strategies Applied The question contains a qualifying word—MOST. While the client may be using another model, the case scenario only describes three distinct sections, making DAP the probable model. Narrative recording does not have distinct sections, but is an overall summary of the details which are thought to be important. SOAP includes both the assessment and plan as separate sections, but also separates the subjective information from the objective data. Therefore, there are four separate components of a case record. APIE contains information on evaluation findings, which are not mentioned in the social worker's notes in this question. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Service Delivery and Management of Cases (Competency); The Principles of Case Recording, Documentation, and Management of Practice Records (KSA)

When completing a functional behavioral assessment, a social worker should FIRST: a. Determine why an intervention is needed now b. Identify antecedents which are hypothesized to cause the behavior c. Define a problem behavior in measurable terms d. Explain the limits of confidentiality which govern service delivery

c. Define a problem behavior in measurable terms Explanation A functional behavior assessment is a comprehensive and individualized strategy to identify the purpose or function of a client's problem behavior(s), develop and implement a plan to modify variables that maintain the problem behavior, and teach appropriate replacement behaviors using positive interventions. While there are a variety of techniques available to conduct a functional behavioral assessment, the first step in the process, regardless of technique, is to define the behavior in concrete terms. Before a functional behavioral plan can be implemented, it is necessary to pinpoint the behavior causing problems and to define that behavior in concrete terms that are easy to communicate and simple to measure and record. Behavior must be in specific, observable, and measurable terms. Simply stating that a client is aggressive is too vague. Instead, for example, a social worker should specify that a client pokes, hits, and kicks other students with her feet or hands during lunch period. It may be necessary to carefully and objectively observe client behavior in different settings and during different types of activities, and to conduct interviews with others in order to pinpoint the specific characteristics of a behavior. Once a problem behavior has been defined concretely, it is possible to devise a strategy for determining the functions of this behavior. Test-Taking Strategies Applied The question contains a qualifying word—FIRST. While there may be more than one appropriate action by a social worker listed, the correct answer is the initial step in conducting a functional behavioral assessment. Determining why intervention is needed now and explaining the limits of confidentiality occur during engagement with a client. Engagement occurs prior to assessment in the problem-solving process. However, the question is asking about the first action taken "when completing a functional behavioral assessment"—not ever with a client. When doing a functional behavioral assessment, a problem behavior is defined in measurable terms; data is collected and analyzed; a hypothesis is formulated; and an intervention plan is developed, implemented, and monitored, respectively. Thus, the first action taken by a social worker is to define a problem behavior in measurable terms. Identifying antecedents may be important if an operant approach is being used, but this action would occur after the behavior has been defined and data has been collected. Knowledge Area Unit II—Assessment, Diagnosis, and Treatment Planning (Content Area); Biopsychosocial History and Collateral Data (Competency); Techniques and Instruments Used to Assess Clients/Client Systems (KSA)

A purpose of a forensic interview with a child is to: a. Identify emotional and psychological strengths to be used in successfully coping with abuse and trauma b. Gather abuse or trauma histories when making sentencing recommendations for juvenile offenders c. Determine the occurrence of abuse or trauma based on information that can be used for prosecution of perpetrators d. Assess whether abuse or trauma has led to the perpetration of violent acts against others

c. Determine the occurrence of abuse or trauma based on information that can be used for prosecution of perpetrators Explanation A forensic interview of a child is a developmentally sensitive and legally sound method of gathering factual information regarding allegations of abuse or exposure to violence. This interview is conducted by a competently trained, neutral professional, such as a social worker, utilizing research and practice. The forensic interview is one component of a comprehensive child abuse investigation, which includes, but is not limited to, the following disciplines: law enforcement and child protection investigators, prosecutors, child protection attorneys, victim advocates, and medical and mental health practitioners. Forensic interviewing is a first step in most child protective services investigations, one in which a professional interviews a child to find out if he or she has been maltreated. In addition to yielding the information needed to make a determination about whether abuse or neglect has occurred, this approach produces evidence that will stand up in court if the investigation leads to criminal prosecution. Properly conducted forensic interviews are legally sound in part because they ensure the interviewer's objectivity, employ nonleading techniques, and emphasize careful documentation of the interview. A fuller understanding of forensic interviewing and its role in child welfare can be gained by comparing it with social work interviewing, another type of interviewing commonly used by child welfare workers. The social work interview allows social workers to assess and identify a family's strengths and needs and develop a service plan with the family. This broad, versatile approach incorporates the use of a variety of interviewing techniques. Social work interviewing is used at every step of child welfare, from intake through case closure; it is used with individuals and groups, children and adults. Although it employs some of the same techniques as the social work interview, such as open-ended and forced choice questions, the forensic interview is much more focused. Generally, it is used only during the assessment portion of an investigation, and involves only the children who are the subject of the investigation. Test-Taking Strategies Applied Forensic denotes the scientific methods and techniques used in the investigation of crime. Its use relates to the collection of evidence used for prosecution. This question requires social workers to be knowledgeable about legal terms and the distinction between forensic and social work interviewing. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Legal and/or Ethical Issues Regarding Mandatory Reporting (e.g., Abuse, Threat of Harm, Impaired Professionals, etc.) (KSA)

A client reports feeling very frustrated by his wife's behavior. She becomes upset when he is quiet at the dinner table, but constantly criticizes him when he speaks. The client is experiencing a: a. Paradoxical directive b. Negative feedback loop c. Double bind d. Metacommunication

c. Double bind Explanation Therapy requires recognizing a client as part of a family system. Additionally, it focuses on studying the role that a client has in a family dynamic. Sometimes client problems arise due to dysfunctional communication within the family. Disturbed communication in families resulted in enormous pressure being felt by one or more members of that family system. A double bind is a dilemma in communication in which an individual (or group) receives two or more conflicting messages, with one message negating the other; this is a situation in which successfully responding to one message means failing with the other and vice versa, so that the person will automatically be put in the wrong regardless of response. And the person can neither comment on the conflict, nor resolve it, nor opt out of the situation. Contradictory messages result in the "victim" feeling powerless and trapped in a "damned if you do and damned if you don't" double bind. A paradoxical directive involves prescribing the very symptom the client wants to resolve. It is often equated with reverse psychology. The underlying principle is that a client engages in a behavior for a reason, which is typically to meet a need (rebellion, attention, a cry for help, etc.). In prescribing the symptom, a social worker helps a client understand this need and determine how much control (if any) he or she has over the symptom. By choosing to manifest the symptom, a client may recognize that he or she can create it, and therefore has the power to stop or change it. A negative feedback loop is information that flows back into the family system to minimize deviation and continue functioning within prescribed limits. It helps to maintain homeostasis or keep things stable or the same over time. A metacommunication is an implicit, nonverbal message that accompanies verbal communication. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding communication patterns within families so that they can assist in addressing them when they interfere with effective functioning. Often roles within family units can be identified through assessing both verbal and nonverbal communication. Much of social work intervention focuses on helping clients with enhancing their expressive and receptive communication skills. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); The Intervention Process (Competency); Family Therapy Models, Interventions, and Approaches (KSA)

In the provision of mental health counseling, the primary purpose of social workers' case notes is to: a. Serve as documentation by which supervisors can evaluate worker performance and skill b. Provide evidence of service receipt for reimbursement by third-party insurers c. Ensure continuity of care as well as means by which to evaluate client progress d. Comply with agency and regulatory requirements which exist to ensure service quality

c. Ensure continuity of care as well as means by which to evaluate client progress Explanation Central to required social work documentation are case notes. Case notes are an integral and important part of practice. Record-keeping practices have an impact on client outcomes such that poor case notes can result in poor decision making and adverse client outcomes. A case note is a chronological record of interactions, observations, and actions relating to a particular client. The guiding principle for deciding what information should be included in case notes is whether it is relevant to the service or support being provided. Case notes can include, but are not limited to: Biopsychosocial, environmental, and systemic factors Considerations of culture, religion, and spirituality Risk and resilience present Facts, theories, or research underpinnings that impact on assessments and/or treatment Summaries or all discussions and interactions Persons/services involved in the provision of supports including referral information, telephone contacts, and email/written correspondence Attendance/nonattendance at scheduled sessions Discussions of legal and ethical responsibilities (client rights, responsibilities, and complaints processes; parameters of the service and support being offered and agreed to; issues relating to informed consent, information sharing, confidentiality, and privacy; efforts to promote and support client self-determination and autonomy) Details of reasons for and outcomes leading up to or following the termination or interruption of a service or support Test-Taking Strategies Applied The question contains a qualifying word—PRIMARY. Unlike other questions, the qualifying word in this question is not capitalized. Qualifying words may be capitalized or not, so it is important to read questions carefully. While case notes may have multiple functions, the correct answer is the one that highlights their usefulness in ensuring efficient and effective client care. Using case records for worker development, reimbursement, and/or regulatory compliance is not the main reason that social workers keep case or progress notes. These notes are used mainly by social workers to help them recall what was done in prior meetings or sessions so that future work can pick up there. It helps to ensure that time is not wasted talking about issues that were already resolved. Additionally, by reviewing case notes prior to sessions, social workers reduce the likelihood that important next steps in discussions take place and therapeutic gaps do not emerge. Case notes also help social workers look back to initial and other past sessions to see progress made. This progress should be regularly reviewed with clients. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Service Delivery and Management of Cases (Competency); The Principles of Case Recording, Documentation, and Management of Practice Records (KSA)

A social worker charged with giving a case presentation provides background and demographic information on the client, the reason for the presentation, and the interventions delivered. The supervisor would consider this case presentation to be: a. Inappropriate as a case presentation should never contain demographic information b. Comprehensive if the theoretical basis for the intervention modality chosen is included c. Incomplete because it did not include the nature of the problem d. Acceptable as a basis for collaborative discussion because all of the required elements are included

c. Incomplete because it did not include the nature of the problem Explanation Preparing a case presentation can be a daunting task for a social worker. While there is no standard format, there are key sections which should be included. Sections include: Demographics: Age, gender, ethnicity, living situation, social work involvement, and so on Background: Relevant history Presenting Problem/Key Findings: Details of the presenting problem and current situation—signs and symptoms of illness, environmental factors that impinge on the situation, and actual or potential resources Formulation: Understanding of why things are as they are—including one or more theoretical perspectives and any uncertainty or ambivalence about the situation Interventions and Plans: What has been done and what plans exist to address the situation Reason for Presentation: Explanation of why this situation is being discussed—unique challenges? unusual problems? More detailed case presentations may include additional sections including legal/ethical, crisis/safety, diversity, and so on. Test-Taking Strategies Applied The supervisor is used in this question to determine if all the necessary elements of a case presentation were included. The goal of supervision is to ensure that clients receive the most effective and efficient services possible. Thus, the supervisor will appear in many questions throughout the examination to provide quality assurance, ensuring that a social worker is meeting acceptable standards. The case presentation described only contains some of the required elements. Even a brief case presentation must contain information on the presenting problem. The presenting problem was not mentioned, making the case presentation incomplete. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Consultation and Interdisciplinary Collaboration (Competency); The Elements of a Case Presentation (KSA)

Which of the following is TRUE about transference in social work practice? a. It is always sexual in nature. b. It does not have any therapeutic value. c. It is more likely with clients with certain personality features. d. It is a conscious process.

c. It is more likely with clients with certain personality features. Explanation Clients with Borderline Personality Disorder or its associated features are more likely to engage in transference. Transference-focused psychotherapy is, therefore, often used with clients who have Borderline Personality Disorder. Transference is unconscious, can be used therapeutically, and/or does not have to be sexual in nature. Knowledge Area Unit IV - Professional Values and Ethics (Content Area); Professional Development and Use of Self (Competency); The Impact of Transference and Countertransference in the Social Worker-Client/Client System Relationship (KSA)

Performance monitoring in social work agencies does NOT aim to: a. Identify key aspects about how a program is operating b. Determine whether program objectives are being met c. Justify the need for service delivery to meet target problems d. Suggest innovations based on unachieved results

c. Justify the need for service delivery to meet target problems Explanation Performance monitoring is used to provide information on (a) key aspects of how programs are operating; (b) whether, and to what extent, program objectives are being attained (e.g., numbers of clients served compared to target goals, reductions in target behaviors); and (c) identification of failures to produce program outputs, for use in managing or redesigning program operations. Performance indicators can also be developed to (d) monitor service quality by collecting data on the satisfaction of those served and (e) report on program efficiency, effectiveness, and productivity by assessing the relationship between the resources used (program inputs) and the outcome indicators. If conducted frequently enough and in a timely way, performance monitoring can provide social workers with regular feedback that will allow them to identify problems, take timely action, and subsequently assess whether their actions have led to the improvements sought. Performance monitoring involves identification and collection of specific data on program outputs, outcomes, and accomplishments. Although they may measure subjective factors such as client satisfaction, data is often numeric, consisting of frequency counts, statistical averages, ratios, or percentages. Test-Taking Strategies Applied The question contains a qualifying word—NOT—that requires social workers to select the response choice which is not an aim of performance monitoring. When NOT is used as a qualifying word, it is often helpful to remove it from the question and eliminate the three response choices which are aims. This approach will leave the one response choice which is NOT a reason for doing performance monitoring. Justification of the need for a service is not the aim of performance monitoring. Performance monitoring occurs during implementation of services while identification of needs happens before they are designed or planned. Needs assessments are conducted to determine the scope and severity of problems. Performance monitoring should not be approached as a perfunctory task to justify ongoing operations or delivery or it will not lead to quality evaluations of what is working and what is not. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Service Delivery and Management of Cases (Competency); Quality Assurance, Including Program Reviews and Audits by External Sources (KSA)

A social worker is hired by an agency to provide consultation aimed at reducing high client dropout rates. According to the funder, a greater proportion of this agency's clients leave services when compared with clients of similar providers. What is the source of the social worker's authority when making recommendations? a. Agency employment b. Funding mandates c. Professional expertise d. Organizational structure

c. Professional expertise Explanation Social workers often serve as consultants for problems related to clients, services, organizations, and/or policies. Consultation is the utilization of an "expert" in a specific area to assist with developing a solution to the issue. Consultation is usually time limited and the advice of consultants can be used or not used by those who have formal decision-making power. Although consultants do not have formal authority within agencies, they have informal authority as "experts" based upon their expertise and skill. Formal authority comes from one's official position with agencies, with those at the top of organizational structures having more formal authority than those at the bottom. Test-Taking Strategies Applied As the social worker in the case scenario is a consultant, the source of his or her authority comes from professional expertise. This knowledge base evolves from both education and experience in the field. The incorrect answers are not sources of authority based on the social worker's role. The social worker is not an employee of the agency. There is no evidence that the consultation was mandated by the funder, just that funding data was used to illuminate the problem. Lastly, a consultant has no official position within an organizational structure. Thus, consultants usually do not appear on organizational charts or are depicted with dotted lines to show that they are advisory and not within the hierarchical structures. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Consultation and Interdisciplinary Collaboration (Competency); Consultation Approaches (e.g., Referrals to Specialists) (KSA)

Who has the ultimate responsibility for selecting models of social work supervision? a. Administrators b. Supervisees c. Supervisors d. Funders

c. Supervisors Explanation There are many models of supervision described in the literature, ranging from traditional, authoritarian models to more collaborative models. Different models of supervision place emphasis, in varying degrees, on the client, the supervisor, the supervisee, or the context in which the supervision takes place. Ideally, the supervisor and the supervisee use a collaborative process when a supervision model is selected; however, it is ultimately the responsibility of supervisors to select the model that works best for the professional development of supervisees. Supervision encompasses several interrelated functions and responsibilities. Each of these interrelated functions contributes to a larger responsibility or outcome that ensures clients are protected and that clients receive competent and ethical services. As a result, supervision services received by the client are evaluated and adjusted, as needed, to increase benefits. It is supervisors' responsibilities to ensure that supervisees provide competent, appropriate, and ethical services. Test-Taking Strategies Applied Social workers must be knowledgeable about supervision models. This question requires social workers to remember that supervisors are responsible for the quality of services delivered by supervisees and their ultimate benefit to clients. Ruling out administrators and funders leaves supervisees and supervisors as possible correct answers. As the question asks about "ultimate responsibility," supervisors are distinguished from the supervisees as they have authority in supervisory relationships. While administrators and funders have influence on service delivery, they are not direct parties in supervisory relationships and their directives should never be honored over those of supervisors. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Consultation and Interdisciplinary Collaboration (Competency); Models of Supervision and Consultation (e.g., Individual, Peer, Group)

After social workers determine that ethical dilemmas exist, they should NEXT: a. Seek supervision to determine which agency policies impact on the situation b. Prioritize the ethical values which must be used to choose correct courses of action c. Weigh the issues in light of key social work values and principles d. Determine the root causes of the problems so that they can be eradicated

c. Weigh the issues in light of key social work values and principles Explanation An ethical dilemma is a predicament when a social worker must decide between two viable solutions that seem to have similar ethical value. Sometimes two viable ethical solutions can conflict with each other. Social workers should be aware of any conflicts between personal and professional values and deal with them responsibly. In instances where social workers' ethical obligations conflict with agency policies or relevant laws or regulations, they should make a responsible effort to resolve the conflict in a manner that is consistent with the values, principles, and standards expressed in the NASW Code of Ethics (2008). In order to resolve this conflict, ethical problem solving is needed. There are six essential steps in ethical problem solving: 1. Identify ethical standards, as defined by the professional NASW code of ethics, that are being compromised (always go to the NASW code of ethics first—do not rely on a supervisor or coworkers). 2. Determine whether there is an ethical issue or dilemma. 3. Weigh ethical issues in light of key social work values and principles as defined by the NASW Code of Ethics. 4. Suggest modifications in light of the prioritized ethical values and principles that are central to the dilemma. 5. Implement modifications in light of prioritized ethical values and principles. 6. Monitor for new ethical issues or dilemmas. Test-Taking Strategies Applied The question contains a qualifying word—NEXT. Its use indicates that the order in which the response choices should occur is critical. Knowledge of the sequential steps in the ethical problem-solving process is needed. The question states that there is already a realization that an ethical dilemma exists. Once the issue has been identified, social workers must next weigh ethical issues in light of key social work values and principles. Seeking supervision is a practical answer which is incorrect as it does not represent a step in the ethical problem solving model. Social workers often seek supervision when they are not sure of the correct course of action. The examination expects social workers to have knowledge about the proper actions to take based on best practices in the field. Social workers cannot choose a correct course of action based on prioritized ethical values until they have been weighed in light of existing principles. Thus, this action will occur after the one specified in the correct answer. Determining the root cause of problems is critical, but the question is asking for the sequential steps in ethical problem solving. The issues cannot be eradicated until all steps have been taken, making this answer also incorrect. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Values and Ethical Issues (Competency); Techniques to Identify and Resolve Ethical Dilemmas (KSA)

Which of the following is NOT a condition often cited by courts that must be met in order for information to be considered privileged? a. Harm caused by disclosure of confidential information outweighs the benefits. b. Written records are kept documenting confidential material. c. Parties involved in the communication assumed that it was confidential. d. Confidentiality is an important element in the relationship.

c. Written records are kept documenting confidential material. Explanation The right of privileged communication—which assumes that a professional cannot disclose confidential information without the client's consent—originated in British common law. The attorney-client privilege was the first professional relationship to gain the right of privileged communication. Over time, other groups of professionals have sought this right. Social workers should understand the distinction between confidentiality and privileged communication. Confidentiality refers to the professional norm that information offered by or pertaining to clients will not be shared with third parties. Privilege refers to the disclosure of confidential information in court or during other legal proceedings. Courts commonly cite the following four conditions that must be met for information to be considered privileged: 1. The harm caused by disclosure of the confidential information would outweigh the benefits of disclosure during legal proceedings. 2. The parties involved in the conversation assumed that it was confidential. 3. Confidentiality is an important element in the relationship. 4. The broader community recognizes the importance of this relationship. A significant court decision for social workers concerning privileged communications was the landmark case of Jaffe v. Redmond (1996) in which the U.S. Supreme Court ruled that the clients of clinical social workers have the right to privileged communication in federal courts. Many states, though not all, now extend the right of privileged communication to clinical social workers' clients. Test-Taking Strategies Applied The question contains a qualifying word—NOT—that requires social workers to select the condition which does not need to be met in order for information to be considered privileged. When NOT is used as a qualifying word, it is often helpful to remove it from the question and eliminate the three response choices which are legal effects. This approach will leave the one response choice which is NOT a decision-making variable. While documentation is important in the provision of social work services, confidentiality and privilege do not only apply to written materials. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Legal and/or Ethical Issues Regarding Confidentiality, Including Electronic Information Security (KSA)

A person who has an obsessive need for control and order becomes a successful business entrepreneur. This is an example of: a. repression b. denial c. sublimation d. rationalization

c. sublimation

When a social worker experiences a value conflict with a client, the social worker must: a. Refer the client to another social worker b. Seek supervision to identify the reasons for the difference in beliefs c. Respect the client's right to self-determination d. Acknowledge the impact of this conflict on the problem-solving process

d. Acknowledge the impact of this conflict on the problem-solving process Explanation Social workers must be mindful of value differences which often arise with clients. Social workers' own values and beliefs can greatly influence social worker-client relationships. Culture, race, and ethnicity are strongly linked to values. A social worker's self-awareness about his or her own attitudes, values, and beliefs and a willingness to acknowledge value differences are critical factors in working with clients. A social worker is responsible for bringing up and addressing issues of cultural or other differences with clients. Social workers should value and celebrate differences of others rather than ignoring or minimizing them. Social workers must have an awareness of personal values and biases and how they may influence relationships with clients. They must also understand their own personal and professional limitations, as well as acknowledge their own stereotypes and prejudices. Test-Taking Strategies Applied All of the response choices are plausible, but the correct one is most appropriate and relevant in this situation. Even though a qualifying word is not used, it is necessary to select the best action when value conflicts with clients arise. Referring clients to other practitioners implies that such conflicts cannot be successfully managed. It is common for social workers to have different beliefs and attitudes than their clients. Clients should not be penalized by having to reengage with other providers simply because their views differ. It is the responsibility of social workers to acknowledge and manage these conflicts. Seeking supervision can be helpful in practice, but social workers should be able to address this situation independently. Supervision is not required in every instance in which social workers have value conflicts with clients, whereas the correct response choice is always needed. Social workers should always respect clients' rights to self-determination. Self-determination relates to the differences in values between social workers and clients. These differences can impact all steps in the problem-solving process—engagement, assessment, planning, intervention, evaluation, and termination. Self-determination concerns clients' rights to make decisions and take actions in their lives. Role conflicts can also impact social workers' abilities to form therapeutic alliances and gather all relevant information during assessment—problems that will persist unless the impacts of these conflicts are examined. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Professional Development and Use of Self (Competency); The Influence of the Social Worker's Own Values and Beliefs on the Social Worker-Client/Client System Relationship (KSA)

A social worker proposes a pilot program for youth with substance use problems in order to determine whether an intervention which has been highly effective with adults has similar results with children. The social worker wants to examine whether outcomes can be generalized to younger age groups before offering the service to all minors in the agency. The pilot program aims to address concerns about: a. Measurement error b. Internal validity c. Reliability d. External validity

d. External validity Explanation Social workers must have basic research knowledge in order to evaluate the appropriateness of interventions and assist in decision making. The promotion of evidence-based research within social work is widespread. Evidence-based research gathers evidence that may be informative for clinical practice or clinical decision making. It also involves the process of gathering and synthesizing scientific evidence from various sources and translating it to be applied to practice. The use of evidence-based practice places the well-being of clients at the forefront, desiring to discover and use the best practices available. The use of evidence-based practices (EBPs) requires social workers to only use services and techniques that were found effective by rigorous, scientific, empirical studies—that is, outcome research. Social workers must be willing and able to locate and use evidence-based interventions. In areas in which evidence-based interventions are not available, social workers must still use research to guide practice. Applying knowledge gleaned from research findings will assist social workers in providing services informed by scientific investigation and lead to new interventions that can be evaluated as EBPs. When reading and interpreting experimental research findings, social workers must be able to identify independent variables (or those that are believed to be causes) and dependent variables (which are the impacts or results). In many studies, the independent variable is the treatment provided and the dependent variable is the target behavior that is trying to be changed. The reliability and validity of research findings should also be assessed. Reliability is concerned with obtaining the same findings repeatedly when conditions are not altered. Validity focuses on accuracy. There are two types of validity—internal validity and external validity. Internal validity is the confidence that exists that the independent variable is the cause of the dependent variable and not extraneous factors. External validity is the extent to which the same results will be produced if the context or population is altered. It determines to what extent an intervention can be generalized. Measurement error is the difference between what assessments indicate and actual constructs (knowledge and abilities). These errors are often introduced when collecting data. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding key research terms and concepts. Such knowledge is essential to having a sufficient understanding of KSAs related to the use of measurable objectives, subjective and objective data, applying research to practice, and so on. In addition to being able to understand and explain the meaning of important research terminology, social workers must be versed in experimental and single-subject research designs. Knowledge Area Unit II—Assessment, Diagnosis, and Treatment Planning (Content Area); Treatment Planning (Competency); Methods to Assess Reliability and Validity in Social Work Research (KSA)

When social workers engage in peer supervision, the PRIMARY method for learning is: a. Modeling b. Summative evaluation c. Positive reinforcement d. Formative feedback

d. Formative feedback Explanation Peer supervision enables social workers to go beyond individual limitations and to expand on their knowledge, skills, and experiences. It involves groups of social workers with the same knowledge, skill levels, and statuses meeting regularly to discuss challenges in the profession, self-exploration, diversity and culture, new interventions and solutions, and ethical dilemmas or situations in the workplace. Peer supervision groups do not have defined leaders. As a result of peer supervision, social workers may feel validated, discuss difficult situations, self-explore, and learn different interventions and perspectives. Peer supervision counteracts burnout and social isolation as members are supported and feel group cohesion. Members also learn to practice supervisory skills for when they become supervisors in the field. They are able to do this because they practice giving and receiving feedback as well as boundary management. Peer groups serve as trusting environments where social workers talk about their mistakes and feelings in the field. Test-Taking Strategies Applied The question contains a qualifying word—PRIMARY—that requires identification of the main way in which social workers "learn" in peer supervision. Modeling is demonstration of a skill or task which may occur in peer supervision, but is not the primary method for learning. Summative evaluation focuses on assessing outcomes, which is not the aim of peer supervision. Peer supervision is not evaluative in nature. Positive reinforcement is a technique to increase behavior frequency by adding a desirable stimulus. For example, praising actions can be very rewarding, making it likely that social workers will do them again. While peer supervision can be supportive, it is not the "PRIMARY method for learning" within these venues. Feedback, specifically formative feedback, which is characterized as nonevaluative and supportive, is regarded as crucial to improving knowledge and skill acquisition in peer supervision. Formative feedback represents information communicated to social workers by peers that is intended to modify thinking or behavior. Formative indicates that it is occurring while social workers are experiencing difficulties with client situations, not after treatment has ended. It is instructional rather than evaluative. Feedback from others who have had similar experiences is the main method through which social workers gain new knowledge and develop their skills in peer supervision. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); Consultation and Interdisciplinary Collaboration (Competency); Models of Supervision and Consultation (e.g., Individual, Peer, Group)

A social worker is approached by a group therapy client who is concerned about the confidentiality of information that he would like to share during the next session. The social worker should: a. Inform the client that information disclosed during meetings will be kept private unless it involves danger to himself or others b. Ask the client about the nature of the disclosure so that appropriate guidance can be given as to whether it should be shared c. Advise the client not to disclose sensitive information as there may be repercussions associated with sharing it with others d. Inform the client that confidentiality cannot be guaranteed as group members are not legally prohibited from disclosing information that is learned

d. Inform the client that confidentiality cannot be guaranteed as group members are not legally prohibited from disclosing information that is learned Explanation Confidentiality is a cornerstone of healthy therapeutic relationships and effective treatment and is based upon the ethical principles of autonomy and fidelity, and to a lesser degree beneficence and nonmaleficence. Autonomy assumes clients have the right to decide to whom they will reveal information, and confidentiality is based upon respect for clients' ability to choose what they disclose. Fidelity refers to social workers' faithfulness and loyalty to keep promises to clients, including not revealing information clients disclose. Social workers are also honest about limits of confidentiality so clients are able to make informed decisions about self-disclosure. Beneficence and nonmaleficence have an important role in confidentiality. Clients benefit when information is kept confidential and trusting relationships can be achieved. The disclosure of private information without client consent can do harm to therapeutic relationships even when such disclosures are mandated by law. Issues of confidentiality are often complex, especially when group therapy is provided. Group psychotherapy is a powerful and curative method of psychological treatment, but issues of confidentiality are magnified at least as many times as there are group members. Not only is information revealed to social workers, it is also revealed to other group members, and there is no guarantee that other group members will maintain confidentiality. However, group members expect complete confidentiality and do not fully understand how confidentiality in group settings differs from confidentiality in individual therapy. Informed consent is the process whereby clients learn about confidentiality. When group treatment is being provided, education regarding confidentiality should begin prior to entering group. Potential group members should be informed that social workers may have to break confidentiality in certain circumstances, and those circumstances should be fully explained. They should also be informed that social workers can assure confidentiality on their part (within the constraints of the law), but cannot promise that other group members will maintain confidentiality. Another important issue to discuss is the probable lack of privileged communication. In most states, privileged communication does not exist in group settings due to the third-party rule, which states that information revealed in front of a third party was not intended to be private and is not privileged. Therefore, group members may be called to testify against their peers regarding information obtained in group sessions. Confidentiality should be discussed openly, thoroughly, and often among group members. Maintaining confidentiality should be the goal for group members, and consequences for participation for those who breach confidentiality should be openly discussed. A common phrase used in group therapy is, "What is said in group—stays in group." However, absolute confidentiality in groups is difficult and often unrealistic. Test-Taking Strategies Applied This is a recall question which relies on social workers understanding the ethical standards related to the provision of group versus individual therapy. In order for clients to make informed choices about what they disclose, it is critical that they understand confidentiality standards which apply. The social worker cannot assure the client in this case scenario that information disclosed will be kept confidential as there are no legal mandates which prohibit group members from sharing it with others. The client is participating in group therapy, not individual treatment, so it is not appropriate for the social worker to ask about the nature of the information and provide "guidance" to the client. The group is the helping agent and concerns should be shared with all members, not the social worker individually. The client should also not be discouraged from sharing sensitive information with others as doing so is the basis of group therapy. The correct answer provides the client with accurate information about confidentiality in group treatment and lets him make the decision on his own about whether to share it during the next session. Knowledge Area Unit III—Psychotherapy, Clinical Interventions, and Case Management (Content Area); The Intervention Process (Competency); Group Work Techniques and Approaches (e.g., Developing and Managing Group Processes and Cohesion) (KSA)

During a session, a client discloses to a social worker that she was sexually abused by her father when she was an adolescent. The client has never confronted her father and does not want the social worker to disclose the information, as there is no legal duty to report the abuse since the client is no longer a minor. The client reports that she sees the father regularly and he poses no current threat to children given a significant decline in functioning. In order to handle the situation ethically, the social worker should: a. Arrange to meet with the father to formally assess the risk for re-offense b. Seek supervision to determine whether to keep the information confidential c. Report the suspected abuse to the child welfare agency d. Respect the client's wishes by keeping the disclosure confidential

d. Respect the client's wishes by keeping the disclosure confidential Explanation Ethical and legal issues regarding mandatory reporting are very clear when victims are minors. There is both a legal and ethical obligation to report all child abuse to protective services. However, when the victim is a client who is now an adult, the required action becomes less clear. Laws vary by state and it is important for social workers to be aware of their legal duties. Social workers face ethical dilemmas in these situations as they may want perpetrators to be accountable for their actions. However, if clients disclose such abuse in strict confidence and do not want it reported, there is a need to respect their privacy. This abuse does not meet any of the exceptions for disclosure such as due to consent by clients, clear and immediate danger, and other requirements by law (such as duty to warn). In these instances, social workers may provide clients with information and other support so they can consider their options more fully. For instance, they may not be familiar with what happens during abuse investigations, fearing that reports may lead to immediate notoriety and broad publication. Legal and procedural protections afforded to survivors of sex-related crimes may also not be known. However, even with such information and support, adult clients may resist wanting their abuse reported. Thus, social workers must respect their right to self-determination and should avoid imposing their own beliefs on clients. Test-Taking Strategies Applied As the 2008 NASW Code of Ethics does not explicitly address the situation in the case scenario, it is necessary to consider the ethical principles of beneficence (doing good), nonmaleficence (avoiding doing harm), justice, and respect. While reporting the abuse may help protect other minors from being abused, it may be experienced as harm by the client as she is not emotionally ready to confront her father about the abuse. Reporting the abuse also may have a negative impact on the social worker/client relationship as the client may feel betrayed by the disclosure. From a justice perspective, reporting the abuse may be a method of bringing the alleged perpetrator to justice, but justice could entail prioritizing the client's emotional well-being. Finally, respect involves honoring the client's rights to privacy and self-determination. The case scenario stated that the state did not legally require social workers to report past abuse when the survivor is no longer a minor. If it were required, the correct response may have been different. The case scenario also indicates that the father is not a danger to other children given his physical and/or mental status. Meeting with the father is not appropriate as he is not the client and it is not the social worker's role to assess his risk. In addition, while supervision is always useful, the social worker should not be "passing the buck" and relying on the supervisor to make the decision. The social worker must be knowledgeable about the laws and issues regarding mandatory reporting. Knowledge Area Unit IV—Professional Values and Ethics (Content Area); Confidentiality (Competency); Ethical and/or Legal Issues Regarding Mandatory Reporting (e.g., Abuse, Threat of Harm, Impaired Professionals, etc.) (KSA)

A client who thinks that he is doing a good job is having problems at work. He reports being frustrated as his boss keeps telling him that he is not doing what is expected of him. The client is likely experiencing: a. Role ambiguity b. Role reversal c. Role complementarity d. Role discomplementarity

d. Role discomplementarity Explanation Social workers must be aware of role theories and terms. The case scenario states that the client is "not doing what is expected of him." Role discomplementarity is when role expectations of others differ from one's own. The client is not switching roles with another (role reversal) or unclear in his own mind about his role (role ambiguity). Knowledge Area Unit I - Human Development, Diversity, and Behavior in the Environment (Content Area); Human Behavior in the Social Environment (Competency); Role Theories (KSA)

A person who fails to get accepted to their desired university and then says that they didn't want to go there anyway. This is an example of: a. repression b. denial c. sublimation d. rationalization

d. rationalization