Apgar Clinical Questions

A social worker is working with a client who is attending an adult medical day program. Staff report that her hygiene has deteriorated and she is increasingly disoriented. She has a visiting nurse coming to her home to administer her medications on the evenings when her adult son, with whom she lives, works. After a stroke several months ago, she began getting home-delivered meals. The client requires constant supervision while in the day program and the social worker is concerned about her current safety. What collateral source will be MOST helpful in making this assessment? A. The client's adult son B. The client herself C. The agency staff who are providing direct care and ancillary services D. The client's physician who is prescribing her medications

A The client's adult son. A valuable source of data is collateral contacts or informants - relatives, friends, teachers, physicians, and others who possess insight into clients' lives. Collateral sources are particularly important when, because of developmental capacity or functioning, clients' ability to generate information may be limited or distorted. For example, assessments of clients with memory or cognitive limitations will be enhanced with data that collaterals (family members and friends) can provide. Social workers must exercise discretion when deciding that such information is needed and in obtaining it. Clients can assist in this effort by suggesting collateral contacts who may provide useful information. Social workers must weight the validity of information obtained from collateral sources. It is important to consider the nature of their relationships with clients and the ways in which that might influence these contacts' perpectives. Family members may be emotionally involved in client difficulties, skewing their perceptions. Other service providers may have limited contact with clients, with narrow views of their situations. As with other sources of information, input from collateral contacts must be critically viewed and weighted against other information. Test-Taking Strategies Applied: The question contains a qualifying word - MOST. While all of the sources listed may provide some useful information, it is likely that the client's adult son will be able to provide the most detailed and accurate inforamtion as he lives with her. The case scenario states that the client is disoriented. Additionally, clients often overrate their functioning. Therefore, the client herself is not the best person to provide information on herfety. While she is getting visiting nurse services and home delivered meals, agency staff involvement in the home is limited to medication administration and delivery of meals. The social worker's concern about her safety does not focus on her day program as she is constantly supervised there. The client's functioning at the day program may also be different than at home. Staff in the home will not be able to comment on her ability to perform activities of daily living (ADLs) like bathing, toileting, and cooking. Similarly, her physician will only be familiar with her medical status. Collateral contacts who live with clients - in this scenario, her adult son - are usually very good sources of information about clients' functioning as they have the opportunity to observe them for extended periods while performing all tasks which are required for safe, daily living.

To be diagnosed with Cyclothymic Disorder, an adult must experience mood cycling over: A. 2 years B. 6 months C. 90 days D. 12 months

A. 2 years. Cyclothymic Disorder is a rare mood disorder which describes clients who experience mood cycling over a 2-year period, but have no met the diagnostic criteria for Bipolar I, Bipolar II, or Depressive Disorder. There is debate if Cyclothymic Disorder is a disease process, a temperamental variation, or a premorbid syndrome for Bipolar I or II, as many clients with Cyclothymic Disorder will develop one of these conditions. According to the DSM-5, there are six diagnostic criteria, with one specifier: A. For at least a 2-year period, there have been episodes of hypomanic and depressive experiences that do not meet the full DSM-5 diagnostic criteria for Hypomania or Major Depressive Disorder. B. The previous criteria has been present at least half the time during a 2-year period, with not more than 2 months of symptom remission. C. There is no history of diagnoses of manic, hypomanic, or depressive episodes. D. The symptoms in criterion A cannot be accounted for by a Psychotic Disorder such as Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, or Delusional Disorder. E. The symptoms cannot be accounted for by substance use or a medical condition. F. The symptoms cause distress or significant impairment in social or occupational functioning. A specifier is "with anxious distress". The disorder can also be diagnosed in children or adolescents, but the observational period for symptoms is 1 year rather than 2. However, diagnosing in younger children should be considered with clinical skepticism, as they are prone to modiness, emotional dysregulation, and overreacting to minor stressors as they do not yet have adult coping skills. It is a fallacy to project adult behavioral norms onto children and adolescents and pathologize age-appropriate and typical behaviors. Test-Testing Strategies Applied: This question requires recall about the DSM-5 and its disorders, specifically Cyclothymic Disorder. Social workers must be aware of diagnostic critieria, including those for Bipolar and Related Disorders. The mention that the time frame is associated with the observational period for adults provides a clue that it is different for children. It may also be assumed that the observational period for adults would be longer than that required for children. Such an inference may help to eliminate some of the response choices with shorter time frames.

A social worker is working in a cultural community in which bartering is the accepted practice for obtaining goods and services. In order for the social worker to accept goods for clients for the provision of services, all of the following criteria have to be met EXCEPT: A. Clients must demonstrate that these arrangements will not be detrimental. B. Bartering must be essential for the provision of services. C. Coercion must not be used in the negotiation of the arrangement. D. Clients must initiate the request for bartering arrangements.

A. Client must demonstrate that these arrangements will not be detrimental. Bartering arrangemes, particularly involving services, create the potential for conflicts of interst, exploitation, and inappropriate boundaries in social workers' relationship with clients. Social workers should avoid accepting goods or services from clients as payment for professional services. Social workers should explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client's initiative and with the client's informed consent. Social workers who accept goods or services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship. Test-Taking Strategies Applied: While bartering in social work is extremely rare, the 2008 NASW Code of Ethics provides specific guidance about the criteria which must be met in order for it to occur. While these standards are located in provisions about payment for services, they speak to the potential that such financial arrangements have for inappropriate professional boundaries between social workers and clients. The question contains a qualifying word - EXCEPT - that requires social workers to select the response choice which is not specified in the 2008 NASW Code of Ethics with regard to bartering. 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. Social workers - not clients - must demonstrate that bartering relationships are not detrimental.

Grounding techniques used with clients who are experiencing flashbacks of past traumatic events primarily aim to: A. Connect clients with the present so that they do not have additional negative effects associated with reliving their past traumatic experiences B. Helps clients put their past traumatic experiences into perspective by discussing the in the context of all of their significant life events C. Assist clients to understand the triggers for their flashbacks so that they can be reduced or avoided in the future D. Teach clients coping skills to reduce the emotional, physical, social, and other impacts of trauma on personal well-being

A. Connect clients with the present so that they do not have additional negative effects associated with reliving their past traumatic experiences. A flashback is an indicator of trauma that is characterized as reexperiencing a previous traumatic experience as if it were actually happening in that moment. It includes reactions that often resemble the client's reactions during the trauma. Flashback experiences are very brief and typically last only a few seconds, but the emotional aftereffects linger for hours or longer. Flashbacks are commonly initiated by a trigger, but not necessarily. Sometimes, they occur out of the blue. Other times specific physical states increase vulnerability to reexperiencing a trauma (e.g., fatigue, high stress levels). Flashbacks can feel ike a brief movie scene that intrudes on the client. For example, haring a car backfire on a hot, sunny day might be enough to cause a veteran to respond as if he or she were back on military patrol. Other ways people reexperience trauma, besides flashbacks, are via nightmares and intrusive thoughts of the trauma. During flashbacks, clients need to focus on what is happening in the here and now, which is accomplished using grounding techniques. Social workers should be prepared to help the client get regrounded so that he or she can distinguish between what is happening now versus what had happened in the past. There are lots of grounding techniques, but the best are those that use the five senses (sound, touch, smell, taste, and sight) as they bring attention to the present moment; for example, turning on loud music (sound), feeling somethings cold or comforting (touch), sniffing a strong fragrance (smell), and so on. Social workers should also offer education about the experience of triggers and flashbacks, and then normalize these events as common traumatic stress reactions. Afterward, some clients need to discuss the experience and understand why the flashbacks or trigger occurred. It is often helpful for a client to draw a connection between the trigger and the traumatic event(s). This can be a preventive strategy whereby the client can anticipate that a given situation places him or her at higher risk for retraumatization and requires use of coping strategies, including seeking support. Test-Taking Strategies Applied: The question contains a qualifying word - PRIMARILY - even though it is not capitalized. While all of the answers are helpful for survivors of trauma, the aim of grounding techniques is immediate assistance to get clients back to the "here and now". The incorrect answer involve "talk" or psychotherapy by discussing, understanding, and teaching. Several of them also do not address that clients are "experiencing flashbacks of past traumatic events", but instead deal with the impacts of or responses to trauma more broadly. Only the correct response choice deals with orienting the client to the present, which is necessary when flashbacks occur.

A social worker is seeing a client for the first time asks the client how she would like to be addressed. The social worker's actiononstrates: A. Cultural sensitivity B. Professional boundaries C. Practitioner objectivity D. Ethnocentrism

A. Cultural sensitivity. Cultural sensitivity refers to a set of skills used in social work practice that facilitates learning about and understanding clients whose cultural background may not be the same. Social workers must operate with the awareness that cultural differences exist between them and clients without assigning these differences a value. Being culturally sensitive does not mean being an expert in each culture's values. It simply means a willingness to ask honest questions, seek understanding, and demonstrate empathy rather than judging. It also means that, when knowingly entering spaces in which there will be cultural differences at play, social workers should do a bit of homework beforehand and avoid jumping to conclusions. The most important thing when being culturally sensitive is remembering to ground interactions in the understanding that clients' background, expneces, and values naturally vary from those of social workers. These differences should lead to understanding and empathy, rather than judgment. Test-Taking Strategies Applied: This is a recall question which relies on social workers understanding the effect of culture, race, and ethnicity on behaviors, attitudes, and identity. In the case scenario, the social workers is demonstrating respect and not assuming that the client would like to be called by their first nae. Such action is an example of cultural sensitivity. Professional boundaries are the invisible structures which are imposed in therapeutic relationships. The question to the client is not indicative of a limit placed on the interaction between the client and social worker. Objectivity concerns examining issues truthfully and impartially. The social worker is not examining or viewing information - they are simply asking a question. Ethnocentrism is viewing others' cultures solely by the values and standards of one's own culture. The social worker is doing the opposite in the case scenario.

A newly hired social worker in an agency setting learns that he will simultaneously be supervised by more than one person. In order to minimize conflicts in this situation, the social worker should: A. Develop a memorandum of understanding with the supervisors B. Meet with the supervisors simultaneously at all times C. Review the professional code of ethics with the supervisors D. Understand the personal values and beliefs of the supervisors

A. Develop a memorandum of understanding with the supervisors. Social workers employed in agency settings may find that they are required to have multiple supervisors. In circumstances in which a social worker is being supervised simultaneously by more than one person, it is best practice to have a contractual agreement or memorandum of understanding delineating the role of each supervisor, including parameters of the relationships, information sharing, priorities, and how conflicts will be resolved. If not agreement exists, the immediate employment supervisor may have the final sya. If the setting permits, a separate third-party may be brought in to help resolve the conflict. Test-Taking Strategies Applied: Only the correct answer results in a written agreement delineating the role of each supervisor. Written parameters are superior to meeting together, reviewing professional standards, or understanding personal values. When a social worker must answer to more than one supervisor, the likelihood of conflict is enhanced, therefore, guidelines which outline the agreed upon flow of information and how conflicts should be resolved is essential.

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. 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 and homicidal ideation. Thus, the NASW Code of Ethics is giving priority to the principle of protecting life over the principle of respecting self-determiantion. 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 involunarily, 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 cousenling). - 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 emphathizing 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 scenarios, 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 content 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 relationshiop. 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.

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 prefers by funders over braiding due to administrative effeciencies. 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. 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 diffciult. The terms "blending" and "braiding" are used frequently, often togehter, 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, and 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 expenses, 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 that 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 allowed 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 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 exluded. Blending is often not preferred by funders as they receive less detail about how monies are spent, while braided 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.

During an assessment, a client reveals a long history of substance abuse, but states that she has not used drugs in the last 15 years. She reports that she was sexually abused as both an adult and child, engaging in prostitution for many years. The client states that she has a strained relationship with her three children who she did not raise. Recent health problems have resulted in loss of ambulation, requiring her to use a wheelchair when leaving the house. The client reports that she has become isolated and unable to meet her friends due to issues with transportation. Not seeing her friends has resulted in her feeling worthless and not important to anyone. The client feels that have dinner with her friends as she did in the past would help decrease her feelings of insignificance. What will be important in establishing the measurable target for this objective? A. Finding out the frequency of contact in her premorbid functioning B. Identifying available resources for accessible transportation C. Determining the impact of the poor relationship with her children on her current feelings D. Assessing the magnitude of her hopelessness and depression

A. Finding out the frequency of contact in her premorbid functioning. Developing goals, objectives, and intervention is critical to alleviating client problems. The document that contains the problem statement, goals, objectives, and methods is the intervention, treatment, or service place (contract). It is a road map that outlines the journey from problems that are identified through assessment to life when those issues have been successfully addressed. The first step in any helping process is to identify the solvable problem and why a client is seeking help now. Once the problem is identified, goals and objectives can be specified that will help toward a solution. Goals are long-term, general, and often the opposite of the problem. The most basic goal should be for a client to be able to function at the level of functioning before the current problem started. This baseline is referred to as premorbid functioning. The specific steps taken to achieve the goal are called objectives. Objectives are short term and specify who does the action, for how long, and how often to achieve the desired outcome (who will do what by when). Because the goals and objectives derived from the assessment, the frequency of the desired outcome should not be made up out of thin air. Using the frequency before the problem starts and working backwards is helpful. Being realistic and precise in targets will assist in achieving success. Considering premorbid functioning ensures that goals and objectives are not set too high. Strategies are the means by which treatment goals are achieved. Each objective can have more than one intervention. Interventions are typically specific to varying theoretical approaches. Test-Taking Strategies Applied: In the case scenario, since the client is feeling worthless - specifically that she is not important to anyone - the goal or solution is to help her see that she is important to someone. This is obviously not the only problem in her life, but it is the one identified to be worked on. The identified objective was to meet friends, which is not happening now. If she met friends weekly in the past, prior to her feelings of worhtlessness, the objective would be to engage in that behavior again. The objective has a baseline (zero times a week) as well as a target (once a week). It will also need a time frame for achievement. The incorrect response choices do not relate to the stated objective of seeing her friends or are a method needed to achieve the objective (such as identifying accessible transportation) of establishing "the measurable target".

According the the professional code of ethics, social workers who need to report suspected abuse should: A. Inform clients about the need to report and potential actions which may result before any disclosures are made B. Seek supervision to determine that agency policies about informing clients are appropriately followed C. Inform clients about the need to report and potential actions which may result after any disclosures are made D. Refrain from telling clients about the need to and reasons for reporting in order to protect the integrity of abuse investigations

A. Inform clients about the need to report and potential actions which may result before any disclosures are made. Social workers should respect clients' right to privacy and confidentiality. Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client. Social workers should protect the confidentiality of all information obtained in the course of professional serivce, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person such as duty to warn, child abuse, and so on. In these situations, social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made (NASW Code of Ethics, 2008 - 1.07 Privacy and Confidentiality). This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed. Test-Taking Strategies Applied: The 2008 NASW Code of Ethics explicitly acknowledges social workers' ethical obligation to inform clients, to the extent possible, of the n to make mandatory reports due to suspected maltreatment. This obligation should not result in delays in reporting. Additionally, informing clients does not mean that social workers should be deterred in any way from reporting based upon clients' reactions. Social workers must be honest with clients throughout the problem-solving process. Clients should be aware of social workers' obligation for mandatory reporting since it is to be discussed as soon as possible in social worker-client relationships and as needed throughout the course of these relationships.

A client has been approved for six sessions with a social worker by his insurance company. In formulating treatment goals, the client articulates changes which the social worker does not feel are achievable in the time frame approved. The social worker should: A. Inform the client that more feasible goals must be developed B. Advocate for the insurance company to authorize additional sessions C. Respect the client's right to self-determination by working toward the client's desired changes D. Identify other issues which may be of concern to the client

A. Inform the client that more feasible goals must be developed. Contracts in social work specify goals to be accomplished and tasks to be preformed to achieve those aims. They also set time frames for interventions and deadlines for completion of goals. They are agreements between social workers and clients and essential for positive outcomes. It is essential that goals contained in contracts be feasible. Unachievable goals set clients up for failure, which can lead to continued disappointment disillusionment, and defeat. Chosen goals must be able to be accomplished. In instances where clients may have unrealistic expectations, social workers must assist them in realizing what is realistic. Test-Taking Strategies Applied: There are many reasons that desired goals need to be examined and revised in order to be realistically achievable. In the case scenario, the client has a limited number of sessions which will be paid by insurance coverage. It is premature for the social worker to advocate for additional sessions as there is no new information which would cause the insurance company to alter its decision. It is unfair for the client to think that the changes desired will occur in the time frame alloted. The client may become increasingly discouraged when goals are not achieved, jeopardizing motivation to reach desired outcomes. Lastly, making progress toward the target problem should not be abandoned completely as it was identified and prioritized through the assessment process. Instead, the social worker must tactfully work with the client to temper expectations about the amount of change that is possible in the fixed time frame.

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. Privileged communication is a legal right, existing by statue or common law, that protects the client from having their 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 wil 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 the 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 psychotherpist-client privilege is Jaffee vs. 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 privlege. 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 metal health treat 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 blsters 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 Jafee decision as they decide similar matters under their jurisidiction. 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.

A social worker who provides counseling to clients in a job training program is charged with evaluating the program's effectiveness. The social worker finds that 80% of client get jobs and keep them for a year after graduation. The social worker is assessing an: A. Outcome B. Impact C. Output D. Input

A. Outcome. When evaluating agency programs, it is necessary to understand different types of assessment and the terms used to describe them. The resources organizations devote to particular programs are called inputs. Those resources can be financial or the time of staff or volunteers. Expertise, such as consultant or a partner organization, can be considered an input as well. Outputs, outcomes, and impacts are often used interchangeably, but are not the same. Outputs are what are produced by programs. For instance, a training program provides graduates. A homeless shelter creates filled bends. Outputs are usually described with numbers. For instance, "96% of available beds areled" or "the training program graduated 96 individuals". Outputs are measurable and readily determined. It is tempting to stop with outputs because they are easy to produce as the reflect the number of people served or meals distributed. Outcomes are the effects programs produce on the people served or issues addressed. For instance, the result of a training program might be the number of graduates who get a job and keep it for a particular period. An outcome is a change that occurred because of a program. It is measurable and time limited, although it may take a while to determine its full effect. Measuring outcomes requires a bigger commitment of time and resources. Impacts are the long-term or indirect effects of outcomes. Impacts are hard to measure since they may. not happen. They are what is hoped that efforts will accomplish. For instance, graduating from a training program may eventually lead to a better quality of life for the individual. Test-Taking Strategies Applied: This is.a recall question about evaluation methods. Social workers are required to know terms, as well as key concepts, related to each of the KSAs. This case scenario requires the ability to distinguish between an output and outcome, as input and impact are clearly the response choices which are more easily eliminated.

The most effective treatment for Alcohol Withdrawal is: A. Psychopharmacology B. Self-help group participation C. Cognitive behavioral therapy D. Family therapy

A. Psychopharmacology Alcohol Withdrawal is a potentially life-threatening condition that can occur in clients who have been drinking heavily for weeks, or years and then either stop or significantly reduce their alcohol consumption. Alcohol Withdrawal symptoms can begin as early as 2 hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (DTs). DTs are characterized by confusion, rapid hearbeat, and fever. Because Alcohol Withdrawal symptoms can rapidly worsen, it is important for clients to seek medical attention even if symptoms are seemingly mild. Appropriate Alcohol Withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs. Prescription drugs of choice include benzodiazepines, such as diazepan (Valium), chlodiazepoxide (Librium), lorazepam (Ativan), and so on. Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In clients with mild to moderate symptoms, anticonvulsant drugs may be an effective alternative to benzodiazepines, because they are not sedating and have low potential for abuse. Becaussuccessful treatment of Alcohol Withdrawal does not address the underlying disease of addiciton, it should be followed by treatment for alcohol abuse. Relatively brief outpatient interventions can be effective, but more intensive therapy may be required. Services range from 12-step groups - such as AA and NA - to residential treatment that offers a combination of cognitive behavioral and family therapy. Test-Taking Strategies Applied: The question is asking about Alcohol Withdrawal - not the treatment of the underlying disorder. Alcohol Withdrawal focuses on reducing the effects of the symptoms and medically monitoring them for serious health implications. Medications are used to help shakiness, anxiety, and confusion. Thus, psychopharmacolgy is the treatment of choice to address them. The incorrect response choices are effective treatments for the underlying disease and relapse prevention, which occur after withdrawal symptoms have been addressed.

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 interrest, which can adversely impact client care. Social workers must be familiar with ethical standards related to payments for services. There are many practices which are not ethical such as setting unreasonable fees, bartering in most instances, and soliciting extra fees from client 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 spliltting" 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".

A woman comes to see a social worker as she does not want to cause conflict in her marriage, but is very unhappy. She has a preschool child and would like to return to work outside of home. The client reports that she misses working in the company that she left shortly after giving birth. She state that her husband's family comes from a culture which strictly forbids such employment. The social worker should view the problem as a: A. Role conflict B. Family issue C. Cultural bias D. Social injustice

A. Role conflict. From the structural perspective, roles are the culturally defined norms - rights, duties, expectations, and standards for behavior - associated with a given social position. In other words, social position is seen as influencing behaviors. In addition, statuses such as gender, ethnciity, sexual orientation, and social class also shape roles. For example, as a mother, a woman is expected to place the care of her child above all other concerns. However, this normative expectation varies across cultures, with some cultures expecting mothers to be paid workers as well. Many cultures believe that women with preschool-age children should not work outside of the home and that their children will suffer if they do. the actual enactment of role behavior, however, may not correspond to the role expectations. Role competence, or success in carrying out a role, can vary depending on social contexts and resources. In countries with strong normative expectations for women to be full-time mothers, single mothers and low-income mothers often have to violate these role expectations and have been criticized as less competent mothers as a result. Indeed, there is pressure to conform successfully to roles. Sanctions are used as tools of enforcement. Punishment for not following the role of mother can range from informal sanctions, such as rebukes from family members, to formal sanctions, such as divorce. Test-Taking Strategies Applied: Social workers must be aware of social role theory and view problems as emerging from interactions between clients and their environment. Person-in-environment perspectives are sensitive to role conflicts experienced by clients. In the case scenario, the client is facing conflicting demands and expectations - as. a mother, wife, professional, and so on. The client is the same woman and the problem should not be viewed as a family issue. Family problems are best resolved by family therapy in which the interactions of members are the focus of intervention. Cultural bias involves a prejudice or highlighted distinction in viewpoint that suggests a preference of one culture over another. There are cultural differences in views between the client and her husband's family, but the problem does not stem from cultural bias. If cultural bias existed, intervention would focus on education of the client about diverse perspectives. The client recognizes the views of her husband's family and does not appear to see her views as superior. However, she is unhappy due to the conflict that exists between the fulfillment of the various roles. Social injustice is an unfair practice that results in violation of human rights. Her problem is a personal one and not an indicator of social injustice.

A hospital social worker being supervised by a professional in a different discipline finds that she is having difficulty with a social work practice issue. In this situation, the social worker should: A. Seek supervision from another social worker B. Contact the hospital administrator to request a new supervisor C. Consult self-help resources to identify possible solutions D. Determine how the issue would be handled in the supervisor's discipline

A. Seek supervision from another social worker. With the increasing focus on interdisciplinary practice in recent years, social workers may be supervised by a professional of a different discipline. Although this may be appropriate within the team or unit context, social workers should seek supervision or consultation from another social worker with regard to specific social work practices and issues. Similarly, a social worker providing supervision to a member of another discipline should refer that supervisee to a member of their own profession for practice-specific super or consultation. Test-Taking Strategies Applied: While a qualifying word is not used in the case scenario, a social worker should review the response choices and select the one that best assists in resolving a social work practice issue. It in unlikely that another supervisor will be assigned, and requesting one will not necessarily means that a new supervisor will be familiar with social work practice. Self-help resources may be helpful, but should have already been consulted. The social work profession has a unique set of values and practice standards, so it is essential that the social worker seek supervision or consultation from another social worker. The hospital supervisor should be aware that such supervision is being sought and involved clients must be informed of the need for "outside" supervision or consultation if applicable.

Which of the following is NOT considered a deficiency need? A. Self-actualization B. Safety C. Esteem D. Physiological

A. Self-actualization. Maslow's hierarchy of needs is a motivational theory comprising of five-tier model of human needs, often depicted as hierarchical levels within a pyramid. Maslow stated that people are motivated to achieve certain needs and that some needs take precedence over others. The most basic need is for physical survival, which will be the first thing that motivates behavior. This five-tier model can be divided into deficiency needs and growth needs. The first four levels are often referred to as deficiency needs and the top level is known as growth needs. Growth needs can never be satisfied completely. They consist of the need to know and understand. They are linked to self-actualization. Deficiency needs are said to motivate people when they are unmet. Also, the need to fulfill such needs will become stronger the longer the duration they are denied. Lower level deficit needs must be satisfied before progressing on to meet higher level growth needs. When a deficit need has been satisfied it will go away, and our activities become habitually directed toward meeting the next set of needs that we have yet to satisfy. These then become our salient needs. However, growth needs continue to be felt and may even become stronger once they have been engaged. Test-Taking Strategies Applied: Often the names of theorists are not mentioned in questions. However, reasoning using their work is essential to successfully select the correct answers. Maslow's hierarchy of needs can be divided into basic (or deficiency) needs (i.e. physiological, safety, social, and esteem) and growth needs (i.e., self-actualization). "Deficiency needs" arise due to deprivation, according to Maslow. The question contains a qualify word - NOT - that requires social workers to select the response choice which is not a deficiency need. 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 deficiency needs. This approach wil leave the one response choice which is NOT a deficiency need, but instead a growth need.

A former client contacts a social worker and requests a copy of her records. The social worker asks about the reason for the request, but no explanation is provided. While the social worker is not worried about the client seeing the information in the record, the social worker is concerned about the client sharing it with others as it contains sensitive information about the client's history. The social worker should: A. Send a copy of the entire record to the client B. Meet with the client to assess whey she has not explained how the record will be used C. Remove material that may be harmful to the client if shared and send the remaining information D. Ask the client to put her request and the reason for it in writing prior to making a decision

A. Send a copy of the entire record to the client. Social workers should respect clients' right to privacy or confidentiality. In addition, social workers may only disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client. Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. Social workers should also provide clients with reasonable access to records. Social workers who are concerned that clients' access to their records could cause serious misunderstanding or harm to a client should provide assistance in interpreting the records and and consult with a client regarding the records. Social workers should limit clients' access to their records, or portions of their recrods, only in exceptional circumstances when there is compellingevidence that such access would cause serious harm to a client. Both clients' requests and the rationale for withholding some or all of the record should be documented in clients' files. When providing clients with access to their records, social workers should take steps to protect the confidentiality of other individuals identified or discussed in such rrecords. Test-Taking Strategies Applied: The case scenario clearly states that "the social worker is not worried about the client seeing the information in the record". Thus, there is no compelling reason to limit the client's access to her record. The client's lack of explanation about what will be done with the information does not change the social worker's duty to send a copy of the entire record to the client. It is inappropriate for the social worker to meet with the former client to do an assessment. Termination has already occurred and the former client has the right to withhold the reason for the request. The social worker also should not remove information from the record as there is no concern with having the client see it. The client can decide whether she will share all, some, or none of the information with others once she receives and reviews it. It is always good to have requests put in wirting, but the reason for the request is not needed. In addition, this response is incorrect as it is concerned more with administrative procedure than the issues of record access.

The structured inequality of entire categories of people who have different access to social rewards as a result of their status, power, and wealth is known as: A. Social stratification B. Discrimination C. Institutional malfeasance D. Cultural difference

A. Social stratification Social stratification refers to a system by which a society ranks categories of people in a hierarchy. By examining policies, procedures, regulations, and laws - as well as practice - it is perfectly clear that some groups have greater status, power, and wealth than other groups. Social stratification is based on four major principles: 1. Social stratification is a trait of society, not simply a reflection of individual differences. 2. Social stratification persists over generations. 3. Social stratification is universal, but takes different forms across different societies. 4. Social stratification involves both inequality and beliefs, as inequality is rooted in a society's philosophy. Test-Taking Strategies Applied: This question requires social workers to understand the effects that policies, procedures, regulations, and laws have on practice, including perpetuating social stratification. Racial inequality results from institutional discrimination in which policies and procedures do not treat all racial groups equaly. While people of color often do not have the same opportunities, the question is broader, seeking the term which relates to differences in social status. These differences can also result from other attributes, such as gender. Institutional malfeasance refers to wrongdoing by an organization or corporation. Cultural difference involves the integrated and maintained system of socially acquired values, beliefs, and rules of conduct which impact the range of accepted behaviors distinguishable from one societal group to another. Cultural difference is not negative in nature, like social stratification.

A social worker whose client engages in heavy alcohol consumption notices that he has confusion, problems with muscle coordination, drowsiness, and memory loss which persist even when he has not been drinking. These symptoms, which are associated with his alcoholism, are BEST treated with: A. Thiamine injections B. Cognitive rehabilitation C. Physical therapy D. Antipsychotic medications

A. Thiamine injections. Long-term alcohol dependence leads to a variety of moderate to severe heath problems. The longer and heavier the consumption, the worse the physical results become. "Wet brain" is another way of describing a condition called Wernicke-Korsakoff syndrome. It is caused by a deficiency in vitamin B1 (thiamine). If "wet brain" is allowed to progress too far, it will not be possible to recover from it. Wernicke-Korsakoff syndrome is actually a combination of two separate conditions: Wernicke's encephalopahy and Korsakoff psychosis. These two disorders combine to produce a variety of symptoms including confusion, changes in vision, loss of muscle coordiion, difficulty swallowing, and speech problems. Hallucinations, loss of memory, confabulation (occurs as clients make up stories to compensate for their memory loss), inability to form new memories, inability to make sense when talking, and apathy are due Korsakoff psychosis. It is possible for clients who are alcoholic to develop either Korsakoff psychosis or Wernicke's encephalopathy indpendently. It is usual for the effects of Wernicke's encephalopathy to become noticeable first of all. These symptoms tend to come on suddenly. The first sign that something is wrong will be that a client appears confused. This can be hard to diagnose in a client who is habitually intoxication. This confusion differs from drunken confusion because it lasts even when a client has not been drinking. Later the symptoms of Korsakoff psychosis will also become noticeable. In the beginning, only the ability to form new memories will be damaged, so a client can still appear quite lucid. Clients who alcoholic have poor dietary habits; over a long time, this will lead to nutritional deficiences. Lack of thiamine in the diet interferes with glucose metaboslism, which can then lead to atrophy in the brain. Wernicke's encephalopathy occurs due to damage to the thalamus and hypothalamus. Korsakoff psychosis occurs because of damage to those parts of the brain where memories are managed. If wet brain syndrome has been allowed to progress too far, there may be little that can be done to reverse the effects. Thiamine injections can improve things greatly and may restore a client back to full recovery. Those who have developed the chronic form of we brain will be far less likely to recover. In some cases, the best that can be done is prevention of any further deterioration. The only possible cure for wet brain syndrome is complete abstinence from alcohol. Most of those who do find their way into recovery will be able to regain all functioning that was lost due to Wernicke=Korsakoff syndrome. Other clients will have to deal with lingering effects of the damage, but should be able to adapt and find a good life away from alcohol. Test-Taking Strategies Applied: The question contains a qualifying word - BEST - that requires social workers to select the response choice which will optimally treat the root cause of the symptoms listed. While some of the incorrect response choices may be helpful to the client, only the correct answer addresses the reason for the wet brain symptoms. Cognitive rehabilitation and phsycial therapy address the manifestations of the vitamin B1 (thiamine) deficiency, but not the underlying problem. Three is also no justification for antipsychotic medications as delusion or hallucinations by the client were not mentioned in the question.

A client who is planning on ending her marriage comes from a culture in which divorce is strictly prohibited. The client has a poor self-image due to years of feeling a duty to stay married despite being unhappy. In order to be most effective, the social worker should: A. Use universalization when speaking with the client about her situation B. Ensure that the client understands the consequences of her actions C. Help the client identify the steps needed for her to achieve her goal D. Explore why the client wants to end her marriage now

A. Use universalization when speaking with the client about her situation. Cultural identity is often defined as the identity of a group, culutre, or an individual, influenced by one's belonging to a group or culture. Certain ethnic and racial identities may also have privilege. Cultural, racial, and ethnic identities are important, particularly for those who are members of minority groups. They may instill feelings of belonging to a particular group or groups and identification with that group (i.e., shared commitment and values). Cultural, racial, and ethnic identities are passed from one generation to the next through customs, traditions, language, religious practice, and cultural values. Cultural, racial,, and ethnic identities are also influenced by the popular media, literature, and current events. Self-esteem or image can be negatively impacted by cultural issues, especially when practices interfere with childhood development, such as being subject to criticism or abuse; missing out on experiences that would foster a sense of confidence and purpose; and/or receiving little or no positive reinforcement for accomplishments. In adulthood, cultural beliefs may compound life changes by further stigmatizing losing a job or changing jobs, ending an intimate relationship, having legal or financial troubles, struggling with addiction or substance abuse, having chidren with emotional troubles, developing physical health concerns, and so on. People with poor self-image may work with social workers on becoming more assertive, confident, and self-aware. Finding a sense of accomplishment is a huge boost to self-esteem, and therapy can help clients identify specific activities that boost confidence and competence. In addition, many social workers focus on helping people develop self-compassion so that they can develop more realistic, achievable goals for themselves and treat themselves with kindness and encouragement. Universalization is a supportive intervention used by social workers to reassure and encourage clients. Universalization places client experiences in the context of other individuals who are experiencing the same or similar challenges, and seeks to help clients grasp that their feelings and experiences are not uncommon given the circumstances. A social worker using this supportive intervention intends to "normalize" client experiences, emotions, and reactions to presenting challenges. By normalizing client expeirneces, social workers attempt to help avert client natural feelings of shame due to feeling alone or judged. Test-Taking Strategies Applied: The case scenario requires the correct answer to be chosen as it is "most effective". As the poor self-image of the client is presented as a problem, it is necessary to select a response which will help the client see that she is not alone or to blame for her situation. The incorrect answers may be actions that the social worker wil take, but they are not the most critical. The woman has not felt that she has any other choices than to stay married. She may have been skeptical and cautious about seeking help for fear of being mistreated or misunderstood. Thus, trust is an important element in establishing a therapeutic alliance. The client needs to know that the social worker can be trusted and is competent to help her. Only the correct answer helps build trust and rapport by helping her to see that the social worker accepts and understands her situation.

The goal of a client with terminal cancer is to receive hospice services at home. Her health has deteriorated rapidly, but the social worker is having difficulty finding an appropriate provider due to the complexity of the client's medical condition and her current living situation. In order to meet the needs of the client, which social work value is most critical when intervening? A. Dignity and worth of the person B. Competence C. Itegrity D. Social justice

A.. Dignity and worth of the person. The mission of the social work profession is rooted in a set of professional values. These core values - service, social justice, dignity and worth of the person, importance of human relationships, itegrity, and competence - are the foundation of social work's unique purpose and perspective. These core values reflect what is unique to the social work profession. Core values, and the principles that flow from the, must be balanced within the contact and complexity of the human experience. When providing service, social workers' primary goal is to help people in need and to address social problems. Social workers elevate service to others above self-interest. Social workers are encouraged to volunteer some portion of their professional skills with no expectation of significant financial return (pro bono service). Social workers value social justice, challenging social inequalities on behalf of vulnerable and oppressed individuals and groups of people. Social workers' social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. Social workers respect the inherent dignity and worth of the person, treating each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. Social workers promote clients' socially responsible self-determination. Social workers seek to enhance clients' capacity and opportunity to change and to address their own needs. Social workers recognize the central importance of human relationships as relationships between and among people are an important vehicle for change. Social workers engage people as partners in the helping process. Social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuas, families, social groups, orgnaizations, and communities. Integrity means that social workers behave in a trustworthy manner. Social workers act honestly and responsibly and promote ethical practices on the part of the organizations with which they are affiliated. Social workers practice within their areas of competence and develop and enhance their professional expertise. Social workers continually strive to increase their professional knowledge and skills and to apply them in practice. Test-Taking Strategies Applied: Social workers should uphold all social work values. However, this case scenario contains a qualifying word - most - which is not capitalized. The problem of finding an appropriate provider presents a barrier to fulfilling the client's wish to die at home. Thus, the social worker must focus on developing creative solutions to promoting the client's need for self-determination. Competence involves practicing within one's expertise and developing as a professional, which are not prevailing issues in this case scenario. Integrity, being honest or trustworty, is also not directly related to the situation presented. Lastly, pursuing social change or justice for those who are opposed and disenfranchised does not apply as there is no indication that the barrier encountered results from oppression or unequal treatment.

When evaluating the effectiveness of treatment, which technique statistically controls, on a post hoc basis, for differences between nonequivalent groups on outcomes of interest? A. Random sampling B. Case-mix adjustment C. Inter-rater reliability D. Descriptive analyses

B. Case-mix adjustment Social workers must be familiar with various research techniques which are applied to practice. Case-mix adjustment is the process of statistically controlling for group differences when comparing nonequivalent groups on outcomes of interest. It is done on a post hoc basis, after the treatment groups have been formed and the performance measures collected. The groups may be treatment agencies, consumers, providers, programs, regions, or states. Any time these groups are to be compared on performance indicators, case-mix adjustment must be considered. For example, mental health authorities are providers in both the public and private sectors are increasingly interested in measuring outcomes of mental health care. Performance measurement is mandated by some state public mental health systems and managed care organizations. By using comparative performance indicators, mental health systems can track the effects of changes within their systems and the effectiveness of routine care provision across sites. They can identify sites providing the highest quality care and sites that may need to improve the qualify of care they provide. However, the populations of metal health consumers served by different behavioral health care agencies can be vastly different. Agencies serving individuals with severe and comorbid impairment cannot equitably be compared using raw outcomes scores to agencies serving individuals with less challenging mental health concerns. The outcomes that providers or agencies strive for, and for which they are held accountable, are only partly under their control; many individual and environmental variables affect outcomes independently of care. These critical case-mix variables are not evenly distributed across groups. Case-mix adjustment attempts to identify the individual and environmental variables that influence outcomes, measure those variabes, correct for their influence through post hoc statistical methods, and display the case-mix adjusted results in ways that allow for ease of interpretation and use. Case-mix adjustment is a partial correction that cannot create perfectly equivalent groups or duplicate the rigor of experimental assignment. In a true experiment, the researcher assigns people randomly to different treatment groups, controls the administration of the treatment, and measures the outcome of dependent variabe. Statistical laws tell us that, with enough people, the average characteristics will be equal in all groups; the only systematic variation is the treatment. So if the results show that the groups are unequal on the dependent variabe, one concludes that the treatment caused the difference. Case-mix adjustment is a post hoc effort to correct for differences among the groups served by the agencies since random selection does not take place. Case-mix adjustment has an additional function in setting appropriate reimbursement rates in capitation contracts. Adequately and fairly compensating providers on the basis of how much service will be needed, as indicated by case-mix adjustment, removes the incentive for providers to attract only those who are relatively healthy and avoid those with more severe conditions that will require more services. There may be situations where case-mix adjustment in unneccessary. This situation will occur when the case-mix adjusted results lead to the same conclusions as the unadjusted results regarding group level performance. It may also occur when the gain from doing case-mix adjustment is considered to be small relative to the costs, or when the potential case-mix indicators that are available in a limited dataset do not correlate with the outcome. In the latter case, it is important to recognize that any results to be compared among groups are unadjusted and therefore potentially misleading. Random sampling assists with creating equivalent treatment and control groups prior to the delivery of interventions. Inter-rater or interobserver reliability assess the degree to which different raters/observers give consistent estimates of the same phenomenon. Descriptive statistics describes the basic features of data in a study. They provide simple summaries and form the basis of virtually every quantitative analysis of data. Test-Taking Strategies Applied: This is a recall question which relies on social workers being able to apply research principles to practice. Social workers should be able to correctly interpret empirical findings Understanding whether outcomes are related to differences in sample selection or client characteristics rather than interventions is critical as social workers may inappropriately conclude that services are effective or ineffective when they are not.

During an initial session, a client appears reluctant to speak and states, "I am not sure if this is going to work out". In this situation, it is BEST for the social worker to: A. Ignore the comment as the feelings will likely subside over time B. Clarify what can be expected, including the roles of the social worker and client C. Use this comment as an opening to address any hesitancy as a therapeutic issue D. Ask about other situations in which the client has felt this way

B. Clarify what can be expected, including the roles of the social worker and client Engagement within the context of building and maintaining helping relationships is defined as a point at which clients view treatment as a meaningful and important process. It involves developing agreement with social workers on the goals and tasks of treatment. Engagement can also be described as the time when the therapeutic relationship or therapeutic alliance forms between social workers and clients. The engagement process is sometimes described using the words like cooperation, collaboration, participation, or buy in. During the engagement process, clients' worldviews including their values, core beliefs, and ways of life are challenged in order to facilitate substantive change. As clients realize the need to change, resistance can occur. Resistance to change can occur throughout the problem-solving process as it helps clients to protect the status quo. Closely related to resistance is amvivalence, which is a condition of both wanting and not wanting a particular change. Social workers must be alert to the forces of ambivalence and, when necessary, assist clients in working through these blocks to decision making and action. Such work involves various interviewing and therapeutic techniques, but initially it is critical that clients feel that social workers are there to help and will not be judging or giving advice. Test-Taking Strategies Applied: Material in quotation marks deserves particular attention and usually relates to the answer. The clients' comment may result from apprehension about the ability to make change or fear of the therapeutic process. Being reluctant to tell others about problems is typical and should be viewed as a therapeutic issue. The client is in the beginning phase of treatment (engagement) where the goal is to build a strong helping relationship with the social worker. Ignoring the comment may send a message to the client tha the articulated feelings are not important and asking about other situations distracts from the situation at hand. The best way to deal with any resistance or apprehension is by educating the client about what will happen in the future.

A social worker is counseling a client who suffers from depression and has recently been hospitalized for a suicide attempt. During a therapy session, the social worker notices that the client appears significantly more cheerful that she has in past weeks. The client reports that see feels better generally without citing any specific reasons for her improved affect. In this situation, the social worker should FIRST: A. Document the observation in the client's file B. Conduct a suicide risk assessment of the client C. Ask about changes that have taken place in the client's life in the last week D. Praise the client for the progress that she has made since her hospital discharge

B. Conduct a suicide risk assessment of the client. Clients who suffer from severe depression may be at risk of suicide. Although suicide cannot be predicted or prevented with certainty, knowing the warning signs can help recognize when clients are at risk. The most effective way to try to prevent suicide is to recognize the warning signs, respond immediately, and treat underlying causes of suicide such as depression. Some warning signs of suicide include the following behaviors: - Talk about suicide or death - Feeling hopeless, helpless, or worthless and saying things like, "It would be better if I wasn't here" or "I want out" - Exhibiting deep sadness, loss of interest in pleasurable activities, trouble sleeping and eating - Having abrupt change of mood, from extreme sadness to happiness or calm - Engaging in risk-taking behavior such as driving too fast and recklessly - Calling or visiting people to say goodbye - Putting affairs in order such as making changes to a will Along with these behaviors, clients who are depressed have a higher risk of attempting suicide if they have previously made attempts, have chronic or terminal illnesses, are separated or divorced, are underemployed or unemployed, or have family histories of suicide. Test-Taking Strategies Applied: The question contains a qualifying word - FIRST. There may be more than on appropriate response choice, but the order in which they are to occur is critical. In this situation, the social worker must immediately find out more information about the reasons for the change in mood. Improvement in depressive symptoms can be an indication of upcoming suicide attempts. Clients who have put plans in place to end their lives often appear to be calmer or happier. The knowledge that they will be ending their lives soon appears to bring with it peace or happiness for clients plagued by depression. Asking about changes which have recently taken place in the client's life is too vague and does not contain the questions needed to do a proper suicide risk assessment. Documentation and praise will not assist the social worker in understanding the client's current mental status. The need for a suicide risk assessment is most immediate when warning signs are present, such as those described in the case scenario.

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 at 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. Policies, procedures, regulations, and laws can have a profound impact on social work practice. Social workers who treat clients involved in the legal system must be aware of problems that can arise prior, during, 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 can 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 lcinet'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 their 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.

The primary goal of court-ordered competency restoration is for clients to: A. Identify ways to provide restitution for actions which have harmed others B. Develop or regain ability to participate in legal proceedings C. Serve legal sentences which have been imposed, but not served due to mental impairment D. Identify legal standards which may apply to conduct based on mental disorders

B. Develop or regain ability to participate in legal proceedings. Social workers who do forensic work wrestle with professional ethical issues that emerge in determining client mental fitness to face prosecution. The process of evaluating whether a client is competent to stand trial involves two major areas. First, client must understand the legal proceedings against them, what they have been charged with, what the roles of the different court personnel are, the difference between pleading guilty and not guilty, and what accepting a plea bargain means. The second factor is the clients' ability to assist in their own defense or their ability to work with their attorneys and take an active part in their own defense. If a client's mental status is in question, the social worker tells the defense attorney, who then brings the issue to the judge. Alternatley, the state's attorney or the judge could raise the issue. The judge then issues a court order mandating a formal evaluation of client competency to stand trial. A formal evaluation may be done by a psychiatrist working alone or a team of mental health professionals, including a psychiatrist, psychologist, and/or forensic social worker. After the formal evaluation of competence to stand trial, the next phase is often "resotration" in which clients are sent to a particular setting, most often a hospital, where they are "restored to competence". Clients are usually in the hospital for 60 to 90 days for the initial restoration, during which time they not only undergo a full evaluation by psychologists, psychiatrists, and social workers but also attend class to learn about the court process so they face their charges as competent defendants. Competency restoration is a psychoeduational intervention in which clients who have been found incapable of proceeding in legal trials due to any combination of limited understanding, communication deficits, or impaired ability to conform their behaviors to the demands of the courtroom are rendered capable. It is generally a part of a multifaceted treatment strategy that may include anger management skills, relaxation training, and cognitive behavioral therapy (CBT) as adjunct interventions to education regarding general legal processes and specific aspects of the defendant's case. At the conclusion, clients should be able to discuss cases with their attorneys, differentially weigh the risks and possible benefits of the difffernt pleadings, strategize the case in consideration of testimonials and evidence, testify, and conduct themselves in a manner suitable to the courtroom. Clients should understand the roles of the court officers, the responsibilities and limitations of judges and juries, and that their attorneys have their best interest in mind. Test-Taking Strategies Applied: The question contains a qualifying word - PRIMARY - even though it is not capitalized. Competency restoration processes occur before sentencing or restitution decisions. Social workers evaluate and deliver services focused on developing or regaining clients' abilities to participate in legal proceedings. It is not the clients' responsibility to identify legal standards that may apply to their conduct, which eliminates the last response choice.

Which action is BEST supported when Gender Identity Disorder, Gender Incongruence, and Gender Dysphoria are viewed using a medical model? A. Treating these disorders concurrently with medication and therapy B. Eliminating them as mental health diagnoses C. Exploring the mind-body connection associated with gender nonconformance D. Screening for physical conditions that may be comorbid

B. Eliminating them as metal health diagnoses. Many believe that Gender Identity Disorder, Gender Incongruence, and Gender Dysphoria should be viewed and approached from the perspective of a medical model rather than that of a mental health model. Many anatomical inconsistencies can now be corrected surgically or chemically to align with the experienced true sefl. A medical diagnosis for individuals who are transgender, whose self-experienced gender does not match the sex assigned at birth and who require medical services to align the body with the experienced self, is considered more appropriate and consistent with research and best practice. Those with the aforementioned diagnoses already are stigmatized by society due to myths and misunderstandings, and victimized by intolerance and prejudice. The effects of this stigma are profound and long-standing, resulting in increased risk for negative health, mental health, educational, professional, and social outcomes. Continuing to include these diagnoses in the DSM contributes to sustained oppression of those who receive them. Labeling individuals with Gender Identity Disorder, Gender Incongruence and Gender Dysphoria views these conditions as aberrant and is harmful. Considering medical diagnoses instead is more appropriate and addresses intolerance, discrimination, and oppression related to cons these diagnoses as psychological problems needing to be fixed. Test-Taking Strategies Applied: This question requires knowledge about "using a medical model". A medical model is based on the assumption that abnormal behavior is the result of physical problems and should be treated medically. Providing therapy as mentioned in the first response choice implies that a mental health model is being used. Also, treatment may involve corrective surgery - not just medication. Exploring the mind-body connection and screening for physical conditions may help in considering biological or medical issues, but are not directly related to gender identity. The question contains a qualifying word - BEST - that requires selecting a response choice that is essential if these diagnoses are viewed using a medical model or resulting from physical problems - not psychological ones.

"Doorknob disclosures" are MOST commonly caused by: A. Premature closure of inquiry by social workers when doing biopsychosocial assessments B. Fear and embarrassment by clients about information provided C. Lack of empathetic responding by social workers during treatment D. Perceived power imbalance by clients within therapeutic relationships

B. Fear and embarrassment by clients about information provided. A doorknob disclosure is an uncomfortable, painful, or embarrassing revelation offered at the end of a session, usually by a client who is leaving. Social workers often see clients reveal their most painful conflicts during the last 30 seconds of session, just when they are ready to leave. Often they already have their hands on the door knobs. These revelations may be new issues or other aspects of problems already discussed. The two main reasons for doorknob disclosures are (a) the need to gauge reactions because of fear, rejection, or judgment about the disclosed material; and (b) the need to prolong the helping relationship by extending the session or number of sessions due to fear of not being able to cope without support. Doorknob disclosures are often a form of resistance. Bringing up important material or intense emotions at the end of sessions, rather than earlier, ensures that there will not be enough time to deal with it. Social workers must be skilled in the principles of communication - encouraging clients to raise all issues early in the session and therapeutic process. Social workers should also help manage the time in sessions - giving clients ample notice of when sessions are drawing to an end, which is an inappropriate time to bring up new concerns or topics. Immediate responses to doorknob disclosures need to be to reassure clients that they will get to discuss material at the next sessions (once ruling out that there is an immediate safety issue that requires immediate attention). If the disclosure comes from a fear of coping alone or ending the therapeutic relationship, time should be spent discussing this issue - rather than the disclosure itself. Test-Taking Strategies Applied: The question contains a qualifying word - MOST. While clients may use doorknob disclosures for more than one purpose, revealing information in this manner clearly stems from fear. Clients want the safety of gauging social workers' reactions to the material and/or back time to discuss revelations more fully. It can be comforting to clients to bring up painful or sensitive topics in this manner as they have the knowledge that they will not have to explore them in more depth until the next session, giving them time to feel content with even saying the information out loud.

All of the following are appropriate reasons for seeking feedback from a client during the beginning phase of treatment EXCEPT: A. Ensuring an understanding of what going to happen during treatment B. Focusing the treatment on a client's feelings and thoughts C. Emphasizing that treatment is a mutual and reciprocal process D. Conveying an interest in a client's views

B. Focusing the treatment on a client's feelings and thoughts. In using feedback during the beginning phase of treatment, a social worker encourages clients to comment about service purpose, social worker-client roles, ethical factors, or any other aspect of the introductory session. An important part of communicating effectively involves checking whether clients have understood the messages being conveyed. Seeking feedback serves this function. Seeking feedback early in the problem-solving process is part of the informal consent process. Clients are forced to identify areas that are unclear, share thoughts that have occurred to them, or express disagreements. The use of feedback sends the message that treatment is a mutual and reciprocal process and that social workers are interested in what clients have to say. It sets the expectation that clients will continue to be active participants throughout the helping process. Test-Taking Strategies Applied: The question contains a qualifying word - EXCEPT - that requires social workers to select the response choice which is not a reason for seeking feedback. The question specifically asks about "the beginning phase of treatment". During the beginning phase, social workers introduce and identify themselves and seek introductions from clients. Following the exchange of introductions, social workers describe the initial purpose for meetings, identify professional roles that social workers might undertake, orient clients to the process, and identify relevant policy and ethical factors that might apply. Three of the response choices directly relate to this initial orientation and educating clients about the reciprocal nature of the work, as well as engaging them by showing interest. The correct answer is important when actually intervening with clients, but is not appropriate for the beginning phase at the delivery of treatment occurs later in the process.

A social worker is counseling a middle-aged client who regrets spending most of his time during his adult life building a business. He blames this decision for prevention him from getting married and having children. The client would like to spend more time focused on hobbies that he abandoned due to his work schedule, but does not know how to make this change. This client appears to be struggling with which state of psychosocial development? A. Ego identity versus despair B. Generativity versus stagnation C. Industry versus inferiority D. Initiative versus guilt

B. Generativity versus stagnation. Erikson's psychosocial theory of development considers the impact of various "crises" on personality development from childhood to adulthood. According to Erikson's theory, everyone must pass through a series of eight interrelated stages over the entire life cycle. 1. Infancy Basic Trust versus Mistrust During the first or second year of ife, the major emphasis is on nurturing, especially in terms of visual contact and touch. A child will develop optimiism, trust, confidence, and security if properly cared for and handled. If a child does not experience trust, they may develop insecurity, worthlessness, and general mistrust of the world. 2. Toddler/Early Childhood Years Autonomy versus Shame ad Doubt At this point, a child has an opportunity to build self-esteem and autonomy as they learn new skills and right from wrong. The well-cared-for child is sure of themselves, carrying themselves with pride rather than shame. Children tend to be vulnerable during this stage, sometimes feeling shame and low self-esteem during an inability to learn certain skills. 3. Preschooler Initiative versus Guilt During this period, a child experiences a desire to copy adults and take initiative in creating play situations. A child also beings to use that wonderful word for exploring the world - "Why?". If a child is frustrated over natural desires and goals, they easily experience guilt. The most significant relationship is with the basic family. 4. School-Age Child Industry versus Inferiority During this stage, a child is capable of learning, creating, and accomplishing numerous new skills and knowledge, thus developing a sense of industry. This is also a very social stage of development; if there are unresolved feelings of inadequacy and inferiority, there can be serious problems in terms of competence and self-esteem. As the world expands a bit, most significant relationship is with the school and neighborhood. Parents are no longer the complete authorities they once were, although they are still important. 5. Adolescence Identity versus Role Confusion An adolescent must struggle to discover and find their own identity, while negotiating and struggling with social interactions and "fitting in", as well as develop a sense of morality and right from wrong. Some attempts to delay entrance to adulthood and withdraw from responsibilities. Those unsuccessful with this stage tend to experience role confusion and upheavla. Adolescents begin to develop a strong affirmation and devotion to ideals, causes, and friends. 6. Young Adulthood Intimacy versus Isolation At the young adult stage, people tend to seek companionship and love. Young adults seek deep intimacy and satisfying relationshiops, but if unsuccessful, isolation may occur. Significant relationships at this stage are with marital partners and friends. 7. Middle Adulthood Generativity versus Stagnation During this time, adults strive to create or nurture things that will outlast them, often by parenting children or contributing to positive changes that benefit other people. Contributing to society and doing things to benefit future generations are important. Generativity refers to "making a mark" on the world through caring for others, as well as creating and accomplishing things that make the world a better place. Stagnation refers to the failure to find a way to contribute. Those who are successful during this phase will feel that they are contributing to the wold by being active in their homes and communities. Others may feel disconnected or uninvolved. Some characteristics of stagnation include being self-centered, failing to get involved with others, not taking an interest in productivity, exerting no efforts to improve the self, and placing one's concerns over above all else. It is at this point in life that some experience what is often referred to as a "midlife crisis" and feel regret. This might involve regretting missed opportunities such as going to school, pursuing a career, or having children. In some cases, this crisis is an opportunity to make adjustments that will lead to greater fulfillment. 8. Late Adulthood Integrity versus Despair - Wisdom This last stage involves much reflection. Some older adults look back with a feeling of integrity - that is, contentment and fulfillment - having led a meaningful life and valuable contributions to society. Others have a sense of despair during this stage, reflecting upon their experiences and failures. They may fear death as they struggle to find a purpose to their lives, wondering "What was the point of life? Was it worth it?" Test-Taking Strategies Applied: This is a recall question which relies on social workers understanding the stages of psychosocial development. The case scenario provides the age of the client, as well as his struggles - both of which can assist with distinguishing the correct answer from the incorrect ones.

Emotional or psychological trauma is MOST significantly associated with events that: A. Occurred in adulthood B. Happened unexpectedly without warning C. Were anticipated due to existing antecedents D. Could have been prevented

B. Happened unexpectedly without warning. Emotional and psychological trauma result from extraordinary stress events that destroy a sense of secuirity, making a client feel helpless and vulnerable in a dangerous world. Traumatic experiences often involve a threat to life or safety, but any situation that leaves a client feeling overwhelmed and alone can be traumatic, even if it does not involve physical harm. It is not the objective facts that determine whether an event is traumatic, but a subjective emotional experience of the event. A number of risk factors make client susceptible to emotional and psychological trauma. Clients are more likely to be traumatized by a stressful expeirence if they are already under a heavy stress load or have recently suffered a series of losses. Emotional and psychological trauma can be caused by one-time events or ongoing, relentless stress. Not all potentially traumatic events lead to lasting emotional and psychological damage. Some clients rebound quickly from even the most tragic and shocking experiences. Others are devastated by experiences taht, on the surface, appear to be less upsetting. Clients are also more likely to be traumatized by a new situation if they have been traumatized before - especially if the earlier trauma occurred in childhood. Experiencing trauma in childhood can have a severe and long-lasting effect.. Children who have been traumatized see the world as a frightening and dangerous place. When childhood trauma is not resolved, this fundamental sense of fear and helplessness carries over into adulthood, setting the stage for further trauma. An event will most likely lead to emotional or psychological trauma if it happened unexpectedly, there was no preparation for it; there is a feeling of having been powerless to prevent it; it happened repeatedly; someone was intentionally cruel; and/or it happened in childhood. Test-Taking Strategies Applied: The question contains a qualifying word - MOST. Emotional and psychological trauma may occur as a result of events in adulthood or those which were anticipated/preventable. However, events which happen unexpectedly with no preparation or warning are those which are associated with the greatest negative impacts. Clients who feel that there is no way to prevent these traumatic circumstances are likely to feel ongoing danger or that they are vulnerable for repeated incidents in the future.

A social worker employed in an agency setting receives a referral for a former girlfriend who he has not seen in 20 years. The client is Spanish speaking and the social worker is the only staff linguistically competent to provide clinical services in Spanish. In order to act ethically in this situation, the social worker should: A. Speak to his supervisors to disclose the prior relationship before meeting with the client B. Inform agency personnel that he cannot provide services to the client C. Meet with the client to determine the severity of the need in order to weight the ethical options D. Schedule an intake given the time that has passed since the prior relationship

B. Inform agency personnel that he cannot provide services to the client. The 2008 NASW Code of Ethics explicitly acknowledges that social workers should not provide clinical services to individuals with whom they have had a prior sexual relationship. Providing clinical services to a former sexual partner has the potential to be harmful to the individual and is likely to make it difficult for a social worker and individual to maintain appropriate professional boundaries. In addition, social workers should not engage in sexual activities or sexual contact with current or former clients or clients' relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to a client (NASW Code of Ethics, 2008 - 1.09 Sexual Relationships). Test-Taking Strategies Applied: In the case scenario, the social worker is aware that the referral is for a woman with whom he had a prior intimate relationship. According to the 2008 NASW Code of Ethics, it is unethical to provide clinical services to this client. Since there should be no therapeutic relationship between them, meeting with the client to discuss her problem or scheduling an intake are both inappropriate. Informing a supervisor is advisable, but not a sufficient action to properly "act ethically in this situation". The social worker must decline the referral even if he is the only Spanish-speaking clinician. Services may need to located for the client at another agency if there is no one iinguistically competent to counsel her at the existing one.

Which is NOT a goal of treatment when working with clients who have experienced complex trauma in childhood? A. Removal of and protection from other sources of trauma B. Recognition that recovery is possible and can occur quickly C. Separation of residual problems from those that are uncontrollable D. Acknowledgement that the trauma is real and undeserved

B. Recognition that recovery is possible and can occur quickly. When a client has experienced multiple, severe forms of trauma, the psychological results are often multiple and severe as well, this phenomenon is sometimes referred to as complex posttraumatic disturbance. Complex trauma can be defined as a combination of early and late-onset, multiple, and sometimes highly invasive traumatic events, usually of an ongoing, interpersonal nature. In most cases, such trauma includes exposure to repetitive childhood sexual, physical, and/or psychological abuse, often (although not always) in the context of concomitant emotional neglect and harmful social environments. Complex trauma has a dramatic impact on development and resulting emotional dysregulation and the loss of safety, direction, and the ability to detect or respond to danger cues - this often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescence and adulthood. The impact of complex trauma includes anxiety and depression; dissociation; relational, idetity, and affect regulation disturbance; cognitive distoritions; comatization; "externalizing" behaviors such as self-mutilation and violence; sexual disturbance; substance abuse; eating disorders; susceptibility to revictimization; and traumatic bereavement associated with loss of family members and other significant attachment figures. Clients who have experienced complex trauma may be diagnosed with a range of disorders, and consequently treated with multiple medications and therapies that are ultimately ineffective because they fail to address the underlying problem and do not reflect a trauma-informed approach to assessment and treatment. It is essential that social workers perform comprehensive assessments that capture the broad range of reactions. Thorough assessments must also carefully date and track the various traumatic events so they can be linked with developmental derailments. Treatment approaches that are limited to a single modality (e.g., exposure therapy, cognitive therapy, or psychiatric medication) may be less helpful - especially if the intervention is not adapted to the specific psychological and cultural needs of a client. Treatment should focus on: - Removal of and protection from the source of the trauma and/or abuse - Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort - Separation of residual problems into those that clients can resolve (such as personal improvement goals) and those that clients cannot resolve ( such as the behavior of disordered family members) - Acknowledgment of the trauma as real, important, and undeserved - Acknowledgement that the trauma came from something that was stronger than clients and therefore could not be avoided - Acknowledgement of the "complex" nature of trauma (trauma may have led to decisions that brought on additional, undeserved trauma) - Mourning for what has been lost and cannot be recovered - Identification of what has been lost and can be recovered - Placement in a supportive environment where clients can discover they are not alone and can receive validation for their successes and support through their struggles. Test-Taking Strategies Applied: The question contains a qualifying word - NOT - that requires social workers to select the response choice which is not a goal of treatment. 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 goals. This approach will leave the one response choice which is NOT a reason for conducting a needs assessment. While recovery from complex trauma is possible, it will require significant time and effort. Thus, the correct answer is NOT a goal of treatment as it inaccurately indicates that recovery can occur quickly.

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 released. 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 subjected 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 requirements 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 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 is they are 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 a client can be involved in legal disputes or matters. Test-Taking Strategies Applied: Clients who are mandated to receive services may also be referred to an 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 they 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.

Which of the following is NOT an assessment to detect an alcohol or substance use problem? A. AUDIT B. SCOFF C. CAGE D. SDS

B. SCOFF Despite the high prevalence of alcohol and substance use problems, many go without treatment - in part because their disorders go undiagnosed. Regular screenings enable earlier identification. Screenings should be provided to people of all ages, even the youth and the elderly. The Alcohol Use Disorder Identification Test (AUDIT) is a 10-item questionnaire that screens for hazardous or harmful alcohol consumption. Developed by the World Health Organization (WHO), the test correctly classifies 95% of people into either alcoholics or non-alcoholics. The AUDIT is particularly suitable for use in primary care settings and has been used with a variety of populations and cultural groups. It should be administered by a health professional or paraprofessional. The SCOFF Questionnaire is a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. The questions can be delivered either verbally or in written form. The CAGE Tool consists of five commonly used questions to screen for drug and alcohol use. The CAGE is a quick questionnaire to help determine if an alcohol assessment is needed. If a client answers "yes" to two or more questions, a complete assessment is advised. The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. Test-Taking Strategies Applied: The question contains a qualifying word - NOT - that requires social workers to select the response choice which is not a screening tool for an alcohol or substance use problem. 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 such screening tools. This approach will leave the one response choice which is NOT a tool for alcohol or substance use, but may detect the potential presence of other disorders. While most questions on the examination will not be this specific, there are always a few that require very specific knowledge related to a KSA. In these instances, it is helpful to try to eliminate any incorrect answers to increase the chances of selecting the correct ones. It is important not to get nervous when such questions arise as these select few can be missed and still get a passing score.

A client who was recently promoted speaks to a social worker about how he believes that his boss does not like him and is critical of his work despite never verbally stating any dissatisfaction. The client, who has lost a previous job due to company downsizing, is nervous that he might be fired if rumors of financial troubles in the business prove accurate. After accurately reflecting the client's nervousness, the social worker can demonstrate a higher level of validation by: A. Listening as the client describes further feelings about his relationship with his boss B. Suggesting that the client's feelings may result from his prior job loss C. Helping the client examine behavioral cues by his boos that support or dispel his claims D. Explaining that his recent promotion makes it unlikely that he will be fired in the future

B. Suggesting that the client's feelings may result from his prior job loss. There are many methods that social workers use to facilitate communication. For example, within the teaching of dialectical behavior therapy (DBT), conscious validation is often called upon to help clients improve interpersonal effectiveness and mindfulness skills. DBT has six levels of validation, with each "level" offering a different tactic for validating a client. Six Levels of Validation 1. Mindful engagement - listening as a way of showing presence and interest - communicating understanding by way of nodding, making eye contact, and asking appropriate questions. ("I hear you! What'd you do after she told you that?) 2. Accurate reflection - repeating to ensure that the message is being received accurately. ("I just hear you say that your boss really likes you, but you don't think you're doing a good job.") 3. Reading cues - using nonverbal and other cures to determine current feeligns. The social worker may need some guesswork and should seek correction for a client if misunderstood. ("You look unhappy. Is something bothering you?") 4. Historical perspective - drawing on knowledge of a client's prior experiences to lend perspective to current feelings. ("Maybe you don't trust your new girlfriend because your previous girlfriend cheated on you?") 5. Assuring reasonableness - letting a client know that their thoughts, feelings, or behaviors are normal and quite reasonable. This provides reassurance, comfort, and healthy perspective. ("I see you frustration. Most people would be annoyed.") 6. Respectful honesty - providing feedback that lets a client know that you respect them enough to "keep it real". This level of validation is best delivered with an accomplishment of radical acceptance/genuiness, along with a nonjudgmental stance - taking into account that everyone has their strengths and limitations. ("I understand why you said that, but I think you could have had a better result if you used a softer tone.") Test-Taking Strategies Applied: The correct answer is the one that demonstrates "a higher level of validation". In the case scenario, the social worker has already reflected the client's nervousness (Level 2). Suggesting that the client's feelings may result from his prior job loss - information that was deliberately provided in the scenario - draws on knowledge of the client's prior experience to lend perspective to his current feelings (Level 4). Listing to him is the first level of validation - prior to reflection. Helping the client examine behavioral cues may be helpful, but is not a validation tool aimed at acknowledging the accepting his feelings. Similarly, explaining to the client that his firing is unlikely given his recent promotion discounts the client's feeligns, which are real whether supported by external factors or not. While this question does not mention DBT, social workers are often called upon to apply practice modalities and techniques to case scenarios on the examination. Social workers should never answer based on their own opinion of what they think is best. Correct answers are grounded in social work theories, models, and perspectives that were leaned in graduate coursework.

When marital problems are viewed as stemming from different understandings and expectations that spouses have of their marriage, social workers are using: A. Conflict theory B. Symbolic interactionism C. Functionalist perspective D. Psychodynamic models

B. Symbolic interactionism. Symbolic interactionism sees clients as active in shaping their world, rather than as entities who are acted upon by society. With symbolic interactionism, reality is seen as social, developed interaction with others. Symbolic interactionists believe physical reality exists based upon clients' social definitions, and that social definitions develop in part or in relation to something "real". Thus, clients do not respond to this reality directly, but rather to the social understanding of reality; that is, they respond to this reality indirectly through a kind of filter which consists of clients' different perspectives. This perspective is based on three premises: * Clients act toward things on the basis of the meanings they ascribe to those things. * The meaning of such things is derived from, or arises out of, the social interaction that they have with others and society. * These meanings are handled in, and modified through, an interpretative process used by clients in dealing with the things encountered. Essentially, client behave toward objects and others based on the personal meanings that they have already given those items. The second premise explains the meaning of such things is derived from, or arises out of, the social interaction that one has with other humans. Lastly, clients interact with each other by interpreting or defining each other's actions instead of merely reacting to each other's actions. Therefore, responses are not made directly to the actions for one another, but instead are based on the meaning which clients attach to such actions. Thus, the interaction of intimate couples involves shared understandings of their sitautions. Wives and husbands have different styles of communciation, and social class affects the expectations that spouses have of their marriages and of each other. Marital problems stem from different understandings and expectations that spouses have of their marriage. In conflict theory, the family is viewed as contributing to social inequality by reinforcing economic inequality and by reinforcing patriarchy. Family problems stem from economic inequality and from patriarchal ideology. The family can also be a source of conflict, including physical violence and emotional cruelty, for its own mebers. In functionalism, marriage performs several essential functions for society. It socializes children it provokes emotional and practical support for its members, and it help regulate sexual activity and sexual reproduction, and it provides its members with a social identity. Marital problems stem from sudden or far-reaching changes in the structure or processes; these problems threaten the marital stability and weaken society. Psychodynamic models focus on the dynamic relations between the conscious and unconscious mind and explore how these psychological forces might relate to early childhood experiences. Test-Taking Strategies Applied: This is a recall question which requires knowledge of various theories, perspectives, and treatment approaches. When response choices consist of proper names and recall questions, it is often wise to look at the answers first and ruminate about the theories, perspecgives, and treatment approaches before reading the question. Getting the question correct requires some basic knowledge about each of the four answers so they can be appropriately selected or eliminated.

A mother comes with her 4-year-old daughter to a social worker as her husband is receiving hospice and she is worried about the child's reaction to his death in the coming weeks. The mother has many questions about the child's ability to comprehend what will happen. Based on developmental theories, the child is likely to view death as a: A. Comforting experience which should not be feared B. Temporary state which can be reversed at any time C. Permanent condition which is caused by accidents and factors which cannot be controlled D. Final part of the life course which inevitably happens to everyone

B. Temporary stat which can be reversed at any time. Death is just one life event or crisis which impact families. When deaths of family members occur, children go through a series of stages in trying to understand its meaning. For example, preschool children usually see death as reversible, temporary, and impersonal. Watching cartoon characters on TV miraculously rise up whole again after having been crushed or blown apart tends to reinforce this notion. In order to identify when death is truly understood by children, it is necessary to outline the complex concepts associated with death, including: - Irreversibility or finality, the understanding that the dead cannot come back to life - Universality or applicability, the understanding that all living things (an only living things) die - Personal mortality, the understanding that death applies to oneself - Inevitabilit, the understanding that all living things must die eventually - Cessation or nonfunctionality, the understanding that bodily and mental functions cease after death - Causality, the understanding that death is ultimately caused by a breakdown of bodily functions - Unpredictability, the understanding that the timing of (natural) death is not known in advance Piaget's cognitive developmental stages indicate that these death concepts cannot really be understood by someone until age 7 years at the absolute earliest. Using Piaget's model, child understanding emerges as follows: - First stage - Preoperational (2-7 years) - Children think of death as a temporary or reversible state, and tend to characterize death with respect to concrete behaviors such as being still or having closed eyes or departing. - Second stage - Concrete operational (7-11 years) - Children recognize that all living things must die and that death is irreversible; however, they consider death to be caused by concrete elements originating from outside the body and do not recognize death as an intrinsic and natural part of the life cycle. - Final stage - Formal operational (11 years and older) - Children hold an adult view of death as an inevitable, universal final stage in the life cycle of all living things, characterized by the cessation of bodily functions. Thus, children's understanding of death is truly linked to cognitive developmental maturation. Test-Taking Strategies Applied: If the age of a client is mentioned in a case scenario, it is usually relevant in selecting the correct response choice. The age is a useful hint of where a client is in the life course and what might be expected with regard to their cognitive, emotional, and/or social development. This case scenario requires knowledge about the complex concepts associated with death as well as child development. Most questions, like this one, require an integration of several knowledge areas. Memorization is not needed when studying, but instead the ability to apply knowledge learned. All of the response choices listed, except the first one, concern the child's ability to comprehend death. As the child is only 4 years old, each answer must be evaluated based on the theoretical knowledge about cognition at this age. As the beginning of abstract thought does not occur until age 7, the child would see death as a temporary or reversible state, like being asleep. The first answer is incorrect as children find death to be an emotionally charged issue, reacting with sadness, anxiety, and fear over separation.

A couple seeks assistance from a social worker as they are having problems in their marriage. While they have been happily married for about 10. years, the wife complains that issues have arisen in the last year as her husband frequently telephones his mother after the couple argues. The wife states that she feels uncomfortable around her mother-in-law and is worried that her mother-in-law has a negative opinion of her based on her husband's conversations. The husband insists that he has tried to work out issues directly with his wife, but needs his mother's opinion to successfully resolve his feelings. This family dynamic is known as: A. Role reversal B. Triangulation C. Entropy D. Oedipal repression

B. Triangulation. Dysfunctional family dynamics are traits or behaviors that characterize unhealthy interactions between members. In dysfunctional families, members to to communicate poorly and not listen to each other. Triangulation is a family therapy concept discussed most famously by multigenerational family systems theorist Murray Bowen. Bowen described dyads as being inherently unstable under stress, much like a two-legged stool. When in balance, the dyad is capable of functioning well and meeting the needs of both people in it. However, when thrown out of balance by conflict, stress, or transition, the dyad will often pull in a third person, or "leg" of the stool, to help them stabilize the relationship. According to Bowen, some triangulation is normal and even healthy in the course of family interactions. Because dyads are inherently unstable, the involvement of a third party can assist a two-person relationship in overcoming impasses, meeting needs, and coping through stressful times. This kind of triangulation occurs because both people in a dyad are looking for healthy and effective mediation. When the triangulated person give inupt, it is accepted into the dyad and processed together in a way that moves the original dyad forward in their relationship. Healthy triangulation can also occur in the context of parents (or other family caregivers) who come together to meet the needs of a third member, such as a child. Triangulation can become unhealthy in families when it causes undue stress on the third party and/or when it prevents, rather than invites, resolution of the dyad's conflict. In the case scenario, the triangulation is being sought by only one of the spouses. Furthermore, the input provided is not being brought back into the marriage for joint processing by both spouses. It is being withheld by the husband for his own individual purposes. The husband's conversations with his mother are essentially taking the place of the emotional process that needs to be occurring within the marriage itself in order to return the marriage to healthy functioning. Role reversal is a situation in which two people have chosen or been forced to exchange their duties and responsibilities, so that each is now doing what the other used to do. This case scenario is not a role reversal as the mother has taken on being an emotional confidant, a function usually assumed by a spouse. However, the wife has not taken on the mother's duties or responsibilities. Entropy, based in systems theory, is characteristic of randomness and disintegration within the structure. The Oedipal complex, also known as the Oedipus complex, is a term used by Sigmund Freud in his theory of psychosexual stages of development to describe a boy's feelings or desire for his mother and jealousy and anger toward his father. This answer is not correct given the age of the man. It also does not address the "family dynamic", which includes the wife. Test-Taking Strategies Applied: This is a recall question related to family systems. Even when the names of theories are not mentioned, social workers are often asked about their key terms and concepts. When proper names are listed as answers, it is useful to look at them first, before reading the question. Often a response choice will look correct after reading the question simply due to the words used. However, the one that looks the best is often not correct. Defining the terms in your head first helps you remember them without distraction or having the question's wording inappropriately influence your answer.

A school social worker is asked by a family to conduct an evaluation of a youth services program. The evaluation is based on personal interviews with middle school children who are participating in the program. After explaining the nature, extent, duratio, and risks of participation, what documentation will be needed in order for the social worker to ethically conduct the evaluation? A. Written consent from the children's guardians B. Written assent from the children and consent from their guardians C. Written consent of the children D. Written agency permission as the children's guardians already consented to service partipation

B. Written assent from the children and consent from their guardians. Competently conducting evaluations of practice requires skill and knowledge. There are also many ethical considerations. Social workers engaged in evaluation should obtain voluntary and written informed consent from participants, when appropriate, without any implied or actual deprivation or penalty for refusal to participate; without undue inducement to participate; and with due regard for participants' well-being, privacy, and dignity. Informed consent should include information about the nature, extent, and duration of the participation requested and disclosure of the risks and benefits of participation in the research. When evaluation or research participants are incapable of giving informed consent (including due to being below the age of consent), social workers should provide an appropriate explanation to the participants, obtain the participants' assent to the extent they are able, and obtain written consent from those legally authorized to act on their behalf. Test-Taking Strategies Applied: This is a recall question which relies on social workers being fully informed of ethical standards of evaluation and research. The correct answer is that which is required for "the social workers to ethically conduct the evaluation". When questions concern ethical behavior, the NASW Code of Ethics must be remembered. Written consent is necessary, but not sufficient, as the assent of the children is also needed. Assent is a willingness to participate even though a child is not legally able to provide authorization. Children are not able to provide written consent as consent indicates authority to make legal decisions, which those under the age of majority are not able to do unless emancipated. Lastly, separate informed consent procedures are needed for evaluation and research. Those given for service participation cannot be used to indicate that participation in evaluation and research are permissible. Written permission from the agency is not sufficient as it is not legally authorized to act on behalf of the children or their guardians.

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.

B. Written records are kept documenting confidential material. 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 communciation. Over time, other groups of professionals have sought this right. Social workers should understand the distinction between confidential and privileged communicaiton. 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 priviledged: - The harm caused by disclosure of the confidential information would outweigh the benefits of disclosure during legal proceedings. - The parties involved in the conversation assumed that it was confidential. - Confidentiality is an important element in the relationship. - 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.

A social worker is providing counseling to a client who is having trouble in her workplace. The client feels isolated as she does not have any meaningful collegial relationships in her job. The client, who is lesbian, feels that her support system is limited to her partner with whom she has been living for the past 2 years. At the end of a session, the client gives the social worker a hug while thanking her for understanding the situation. The social worker, who has a policy not to have physical contact with her clients, hesitates, which causes the client to accuse her of being homophobic. In this situation, the social worker should: A. Ask the client why the action is being viewed as homophobic B. Explain the reasons for the rule about not touching clients C. Continue to hug the client after apologizing for the hesitation D. Provide assurance that the response was not meant to be homophobic

B.. Explain the reasons for the rule about not touching clients. There are many ethical stadards, including those on touching clients, that speak to professional boundary issues that social workers face in practice. Often the maintenance of appropriate boundaries can be challenging for social workers. Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (such as cradling or caressing clients). Social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact. The 2008 NASW Code of Ethics leaves the door open, but cautions social workers that they bear responsibility for ensuring that no negative consequences ensure. The language leave open the possibility that, when used responsibily, touch might occasionally make clinical sense, perhaps by helping a client stay grounded or feel less isolated or overwhelmed. However, social workers using touch within the context of a therapeutic alliance must always carefully consider clients' factors, such as presenting problems and symptoms, personal touch and sexual hisotry, ability to differentiate types of touch, and clients' ability to assertively identify and protect their boundaries, as well as the gender and cultural influences of both clients and social workers. Social workers should have clear policies about touching, self-disclsure, and other boundary areas which are applied consistently to client situations. One of the most effective ways to establish profesional boundaries is for a social worker's behavior to set the standard for meets with clients. Appropriate dress and behavior should be displayed and talk should not include a social worker discussing their personal life. Test-Taking Strategies Applied: The case scenario describes a client's reaction to a hesitation by a social worker to a hug at the end of a session. There is no indication that physical touch has been discussed between the client and social worker in this or any prior interaction. The client may be accusing the social worker of being homophobic due to an exchange with some else in the past. In the case scenario, it is necessary for the social worker to explain her policy on phsycial touch, as well as other boundary issues. Educating clients about the 2008 NASW Code of Ethics is essential so they can better understand therapeutic or helping alliances and not confuse them with friendships or romantic relationships. None of the incorrect responses include this critical education. It would not be appropriate to explore the client's belief about being rejected based on her sexual orientation when the session is ending. In addition, there is no indication that the client's statement is anything other than a misunderstanding about professional boundaries between the social worker and client. The client may not realize that the social worker has a policy which is applied to all clients. Continuing to hug the client would be contraindicated, especially given the accusaion. It violates the social worker's policy on physical contact and treats this client differently than others. Simply telling the client that the social worker is not homophobic does not provide an explanation for the hesitation. it also misses the opportunity to educate the client about the importance of maintaining professional boundaries and differentiating the therapeutic alliance from other personal relationships.

A client is referred to a social worker as she has been repeatedly hospitalized due to medication noncompliance. During the assessment, the client admits to frequently missing doses of her prescribed medication. This behavior has resulted in numerous inpatient stays, which she complains are both costly and adversely impacting her quality of life. Which is the BEST question for the social worker to ask? A. "Why haven't you been able to take your medication as prescribed?" B. "Can you think of any advantage of having to stay in the hospital?" C. "What are some of the reasons for skipping your medications?" D. "How can I help to ensure that your medications are taken properly?"

C. "What are some of the reasons for skipping your medications?" Interviewing skills are essential to ensuring that clients feel understood, problems are assessed, and effective treatment is delivered. A comprehensive social work interview includes conducting a multiple biopsychosocial-spiritual-cultural assessment in order to better understand the presenting problem. Questions asked and techniques used may promote or inhibit information gathering and other aspects of the problem-solving process. Skills and questioning techniques used include active listening, empathy, rapport building, open- and closed-ended inquiries, silence, and so on. When interviewing clients, social workers should avoid "Why" questions in order to prevent clients from feeling as though they need to defend their choices and actions. Although it may be necessary to learn the reasoning behind clients' choices and actions, the wording used may impact respones. For example, if a social worker need to know why a client is missing doses of medication, instead of asking "Why haven't you been able to take your medication as prescribed?" it is better to ask "What are some of the reasons for skipping your medication?". The difference may be subtle, but it can affect the way a client perceives the question. With the "Why" method, a client may be defensive, whereas the "What" method allows a client to reflect on action without feeling judged. Testing-Taking Strategies Applied: The correct answer is the BEST question for the social worker to ask as part of the assessment. The use of the qualifying word, which is capitalized, indicates that other response choices may be appropriate, but are not as essential to identifying causes for the presenting problem, the primary aim of assessment. In the case scenario the social worker must find out the reasons for the medication noncompliance. There is no indicating that the client is not taking the medication to become hospitalized. It is also premature to see how the social worker can assist as the reasons for missing the doses is not known. The correct "What" question is preferred to the inaccurate "Why" question to avoid having the client feel judged. The "Why" response choice also implies that the client's actions are in direct violation of the doctor's orders as she has not been able to take her medication "as prescribed". Pointing out that she has done something other than what the doctor stated can cause defensiveness or shame.

According the family systems theory, in what types of relationships does blame for the dynamics rest with specific individuals? A. Parent-child B. Polygamous C. Abusive D. Adulterous

C. Abusive. Family systems theory views issues and problems within a circular fasion, using what is described as a systemic perspective; this means that the event and the problem exist within the context of the relationship, where each influences the other. Family systems theory aims to assess these patterns of interactions and look at why things may be happening instead of why they happened. Family systems theory considers the nature of relationships to be bidirectional, and moves away from seeking blame of one person from the dynamic of the relationship. The exception of this theory is within abusive relationships, where the responsibility and blame lay clearly with the perpetrator of the abuse. Within family systems theory, behaviors are believed to arise due to the interrelated nature and connectedness of various family members. For example, to seek understanding of children in distress, their behavior would be viewed through the lens of their family (parent-child_ behaviors and family systems rather than looking at young persons in isolation. Polygamy or the act of having more than one spouse at a time is based on cultural beliefs or traditions. There is no blame associated with polgyamy. Adultery of infideltiy, using a family systems approach, is seen as a "family affair" that must be understood and treated within the marital system rather than from an individual perspective. Social workers use marital therapy to understand the relational dynamics that led to and/or sustain affiras. They shy away from blame and focus on issues of intimacy, communications, expectations, agreements, and conflict management in the marriage. Test-Taking Strategies Applied: This is a recall question about family dynamics and functioning. Social workers must understand family systems theory, as well as the dynamics of abuse. Victims should never be seen as contributing to or responsible for their abuse. As the question asks about "blame for the dynamics" resting with specific individuals as opposed to resulting from the action of all parties, a belief contrary to a family systems approach, the correct answer must involve abuse of one person by another.

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. A social worker's own values and beliefs can greatly influence the social worker-client relationshiop. 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: 1. Move from being culturally unaware to aware of one's own heritage and the heritage of others 2. Value and celebrate differences of others rather than maintaining an ethnocentric stance 3. Have an awareness of personal values and biases and how they may influence relationships with clients 4. Demonstrate comfort with racial and cultural differences between themselves and clients 5. Have an awareness of personal and professional limitations 6. 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 relationships 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.

During the first session, a client blames the recent termination from his job for many of his other problems. He reports that his girlfriend ended their relationship as she was angry that he was fired. He also had to move in with a relative as he could no longer afford his rent. He reports feeling like a failure and does not know "hot things got so bad". The social worker should respond by: A. Assisting him to find another job as his self-worth appears closely tied to his unemployment B. Identifying which problems is the top priority so it can be targeted for immediate assistance C. Assuring him that many people lose their jobs and experience similar feelings D. Exploring the reasons for his termination in order to get at the root cause of the problem

C. Assuring him that many people lose their jobs and experience similar feelings. In order to facilitate change through the problem-solving process, a social worker must use various verbal and nonverbal communication techniques to assist clients to understand their behavior and feelings. In addition, critical to ensuring that clients are honest and forthcoming during this process, social workers must build trusting relationships with clients. These relationships develop through effective verbal and nonverbal communication. Social workers must be adept at using both forms of communication successfully, as well as understanding them, because verbal and nonverbal cues will be used by clients throughout the problem-solving process. Insight into their meaning will produce a higher degree of sensitivity to clients' experiences and a deeper understanding of their problems A social worker should also display genuineness in order to build trust. Genuineness is needed in order to establish a therapeutic relationship. It involves listing to and communicating with clients without distorting their messages, and being clear and concrete in communications. Another method is the use of positive regard, which is the ability to view a client as being worthy of caring about and as someone who has strengths and achievement potential. It is built on respect and is usually communicated nonverbally. Communication is also facilitated by listening, attending, suspending value judgements, and helping clients develop their own resources. A social worker should always be aware of culturally appropriate communication behaviors. It is also essential to be clear to establish boundaries with clients to facilitate a safe environment for change. Test-Taking Strategies Applied: Material in quotation marks deserves particular attention and usually relate to the answer. The client-social worker interaction in the case scenario is occurring in the first session. The first session focuses on engagement or building a therapeutic alliance. The correct response choice is the one which addresses the client's belief that he is a failure and his comment about not understanding "how things got so bad". The incorrect response choices may be actions that will be taken at some time during the problem-solving process, but do not make him feel that the social worker understand his situation. The question asks for a social worker's response to his statements. Central to the formation of a therapeutic alliance is displaying empathy, which the social worker is doing in the correct answer.

Delusions of reference are BEST defined as: A. Insisting assertions are correct despite contradictory evidence B. Becoming disoriented with regard to person, place, and/or time C. Believing neutral stimuli or communications have personal meanings or messages D. Attributing personal failure to external factors that cannot be controlled

C. Believing neutral stimuli or communications have personal meanings or messages. Delusions are false beliefs which clients hold with a strong amount of convictions. These beliefs are not typical of their culture or religion, and clients adhere to the erroneous beliefs despite evidence and proof which totally contradict the. Delusions of reference are perceptions that stimuli in the environment are directed toward clients themselves and referencing them specifically even though they are not. It is the belief that simple coincidences are relevant and specific to clients even though they are not connected to them in any way; for example, clients thinking people they do not know are talking about them or thinking that newscasters are speaking directly to them. Clients with delusions of reference may think that things written in newspapers or stated in newscasts, passages found in a book, or the words in a song are about them directly. Thus, neutral events are believed to have special and personal meaning; for example, clients might believe billboards or celebrities are sending messages meant specifically for them. These ideas and connections are delusions as they are though to be true, though they are not. This can be a sign of mental illness such as Schizophrenia and other Psychotic Disorders. Test-Taking Strategies Applied: The question requires knowledge about basic terminology associated with psychopathology or the study of mental illness or the manifestation of behaviors that may be indicative of mental illness or psychological impairment. There are also common delusions such as delusions of gradeur, control, guilt, persecution, jealousy, or paranoia. Social workers must be aware of the presence of delusional thoughts by clients and the diagnostic methods/tools that can be used to identify them. The first response choice provides an accurate statement about delusions generally; for example, they are false, fixed beliefs despite evidence to the contrary, but it is incorrect as it does not provide information specifically about delusions of reference. The qualifying word - BEST - indicates that more than one listed answer may apply, but the most suitable definition is the one that illustrates the key attributes to this delusional type. Thus, the correct response choice is the one which indicates that neutral events are believed to have special and personal meaning.

What is the main difference between Bipolar I and Bipolar II Disorder? A. Bipolar I is rapid cycling while Bipolar II can have periods of sustained mania and depression. B. Depression is more severe in Bipolar I as compared with Bipolar II. C. Bipolar I must include at least one manic episode while Bipolar II includes only hypomania. D. Bipolar II never includes psychosis, which is always present in Bipolar I.

C. Bipolar I must include at least one manic episode while Bipolar II includes only hypomania. There are two major forms of Bipolar Disorder - Bipolar I and Bipolar II (also known as Bipolar 1 and 2) - which are separate diagnoses with significant differences between them. To be diagnosed with Bipolar I, a client must have had a least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in life and may require hospitalization or trigger a break from reality (psychosis). To be diagnosed with Bipolar II Disorder, a client must have had at least one major depressive episode lasting at least 2 weeks and at least one hypomanic episode lasting at least 4 days, but never had a manic episode. Major depressive episodes or the unpredictable changes in the mood and behavior can cause distress or difficulty in areas of your life. The most important distinction between Bipolar I and II is that a client with Bipolar I has manic episodes while a client with Bipolar II has hypomanic episodes. The main difference between mania and hypomania is a matter of severity. In the hypomania of Bipolar II, a client has a sustained mood that is elevated (heightened), expansive (grand, superior), or irritable. This mood has to be noticeably different from their normal mood when not depressed. In mania, that mood is extremely abnoral, and is also combined with increased activity or energy that is also abnormal. Examples of hypomania may include being exceptionally cheerful, needing only 3 hours of sleep instead of the usual 7, spending more money than can be affored, and/or speaking far more rapidly than usual. Hypomanic behavior is noticeably differefrom a client's own mood, but not outside the range of possible behavior in general. Manic episodes may include being out-of-control happy even during serious events, which is atypical behavior for anyone. Someone with Bipolar I Disorder may also have hypomanic episodes, but someone with Bipolar II cannot ever have had a manic episode. If a manic episode occurs in someone with Bipolar II, the diagnosis will be changed. However, the depressive episodes of Bipolar II Disorder are often longer-lasting and may be even more severe in Bipolar I Disorder. Therefore, Bipolar II Disorder is not simply a "milder" overall form of Bipolar I Disorder. At least one of the following conditions has to exist in mania, but can't be present in hypomania: - Mania may include psychotic symptoms - delusions or hallucinations. Hypomania does not have psychotic symptoms. (However, a client with bipolar II may experience hallucinations or delusions during depressive episodes without the diagnosis changing to Bipolar I). - While hypomania may interfere to a degree with daily functioning, in mania day-to-day life is significantly impaired. - The manic person was hospitalized because of the severe symptoms. Test-Taking Strategies Applied: The question contains a qualifying word - MAIN - even though it is not capialized. "Main" refers to the need to select an answer that is the primary distinction between Bipolar I and II. In this question, only one answer is an accurate statement and it is the primary difference between the disroders. Rapid cycling is a pattern of frequent, distinct episodes in Bipolar Disorder. In rapid cycling, a client with Bipolar Disorder moves between mania/hypomania and depression frequently. It can occur at any point in the course of Bipolar Disorder, and can come and go, so it is not necessarily a "permanent" or indefinite pattern. It is not unique to Bipolar I as it can occur in Bipolar II. Bipolar II also does not include manic episodes, making the first response choice incorrect. Depressive episodes of Bipolar II Disorder are often longer-lasting and may be even more severe in Bipolar I Disorder, making the second answer inaccurate. A client with Bipolar II may experience hallucinations or delusions during depressive episodes without a diagnosis changing to Bipolar I. Thus, the last response choice is not correct.

When an agency receives a single disbursement for services provided by two or more providers during a single episode of care over a specific period of time, the payment methodology is known as: A. Capitation B. Free-for-service C. Bundled payment D. Shared savings

C. Bundled payment. Reimbursement methodologies can have a dramatic impact on the delivery of services. Social workers must be aware of different payment policies and the implications of each. Capitation is based on a payment per person, rather than a payment per service provided. There are several different types of capitation, ranging from relatively modest per person per month case management payments to assist with care coordination to per person per moth payments covering all professional services (professional, facility, pharmaceutical, clinical laboratory, durable medical equipment, etc.). There may also be particular services that are "carved out" of such payments. These may be handled on either a fee-for-service basis or by delegation to a separate benefit management company. Capitation is often used as a means of controlling growth in the cost of of care. Fee-for-service is a payment model where services are unbundled and paid for separately. It given an incentive to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when clients are shielded from paying (cost-sharing) by health insurance coverage, they are incentivized to welcome any medical service that might do some good. Fee-for-service is the dominant physician payment method in the United States. In a bundled payment methodology, a single, "bundled" payment covers services delivered by two or more providers during a single episode of care or over a specific period of time. For example,, if a client has cardiac bypass surgery, rather than making one payment to the hospital, a second payment to the surgeon, and a third payment to the anesthesiologist, the payer would combine these payments for the specific episode of care (i.e., the bundled payment and subsequently apportion the payment among participating providers. In other cases, the payer may pay participating providers independently, but adjust each payment occurring to negotiated, predefined rules in order to ensure that the total payments to all of the providers for all of the defined services do not exceed the total bundled payment amount. This latter type of payment methodology is frequently referred to as "virtual" budling. Bundled payment arrangements are a type of risk-contracting. If the cost of services is less than the bundled payment, participating providers retain the difference. But if the costs exceed the bundled payment, provider are not compensated for the difference. Shared savings models can be roughly divided into two categories. In the first category, if the actual total costs of all care received by clients is lower than budgeted costs, the entities responsible for their care receive a percentage of the difference between the actual and budgeted costs (i.e., a "share of the savings"). However, if actual total costs exceeds the budgeted costs, the entities are not on the hook for any portion of the difference. Because the entities are only at risk for additional revenue, shared savings arrangements are sometimes said to involve only "upside" risk. Test-Taking Strategies Applied: This is a recall question which relies on social workers understanding the effects that policies, procedures, regulations, and laws have on practice. Reimbursement methodologies can dramatically impact the ways in which services are coordinated and delivered. The question focuses on a single payment for multiple services. Fee-for-service would be excluded as it represents a separate reimbursement for each service provided. There is no mention of savings in the question, eliminating the last response choice. Capitation should not be confused with bundled payments. Capitation is an actuarially determined payment per client who may or may not use services. The distinction between capitation and bundled payment is that capitation pays the same amount regardless of what clients need clinically or receive. calculation of the capitation amount derives from actuarial principles of insurance. The big risk in capitation is incidence risk. The question asks about "services provided", making bundled payment the correct answer over capitation.

A social worker is seeing an elderly woman who has recently experienced declining health due to aging and loss due to the death of several close friends. She has missed several appointments due to illness and states that she is not participating in many of her prior community activities as she is too tired to do so. In order to determine if the client is in crisis, the social worker should: A. Review her most recent physical evaluation to determine the severity of her health problems B. Refer her for neuropsychiatric testing to identify mental disorders which may be present C. Conduct an interview with her to gather subjective data on recent life events and changes D. Obtain information from collaterals to get a more comprehensive understanding of her current functioning

C. Conduct an interview with her to gather subjective data on recent life events and changes. Crises are defined as an acute disruption of psychological homeostasis in which a client's usual coping mechanisms fail and there exists evidence of distress and functional impairment. The subjective reaction of life experiences dictates clients' abilities to cope or function. The main cause of a crisis is a stressful, traumatic, or hazardous event, but two other conditions must be present - (a) a client's perception of the event causes considerable upset or disruption and (b) a client is unable to resolve the disruption by previously used coping skills. Thus, it is a client's subjective experience that signals whether a crisis exists as it is the way that these experiences are perceived by a client that cause a crisis. Clients can encounter life stressors (deaths, health issues, etc.), but it is only if these events are perceived as threats or beyond coping abilities that crises occur. Test-Taking Strategies Applied: The question requires knowledge about the difference between subjective and objective data in assessment and treatment planning. While all of the response choices may be helpful in gathering information relevant to a client's state, a crisis is a subjective experience. Many clients experience adversity and cope. Only the correct response choice involves speaking with the client directly to understand her feelings about recent events. Two incorrect answers involve reviewing or obtaining objective, not subjective, information related to her phsycial/neurological condition. The remaining incorrect response choice relies on speaking to collaterals whose views about the current happenings may be different, and are less relevant, than the client's.

In an initial meeting with a man who has been mandated to receive counseling due to severely beating his young son, a social worker explains the terms outlined in the court order and what can be expected in treatment. The social worker ends by asking the client, "What do you think about what we have talked about so far?". The purpose of this question is to: A. Determine the level of resistance that can be expected from the client B. Identify whether the client is aware of the legal mandates placed upon him C. Convey to the client that treatment is a mutual and reciprocal process D. Assess the presence of denial with regard to the incident in question

C. Convey to the client that treatment is a mutual and reciprocal process. Feedback during engagement in the problem-solving process encourages clients to comment about treatment purpose, social worker/client roles, policy or ethical factors, and so on. An important part of communicating effectively involves checking to see whether clients have understood social workers' messages. Seeking feedback serves this function.. In addition, seeking feedback is essential for informed consent by inviting clients to identify areas that are unclear, share thoughts that have occurred to them, introduce new topics, or express disagreement. By seeking feedback, social workers effectively send messages that treatment is a mutual and reciprocal process. Social workers convey that they are genuinely interested in what clients have to say and there is a desire to have them actively participate in the process. Social workers routinely seek feedback throughout the problem-solving process by asking, "How does that sound to you?". Other feedback can be elicited by inquiring, "What do you think about what we have talked about so far?". It is also good to find out about client questions or comments. Test-Taking Strategies Applied: When provided with a case scenario, it is necessary to determine when it is taking place within the problem-solving process. In this question, the social worker is "in an initial meeting with a man", indicating that engagement is occurring. During engagement, a social worker must begin to form a working alliance with a client. A client must feel respected and understood that a social worker can be a valuable resource toward making change, but cannot solve a client's problems and is not there to tell them what to do. In this case scenario, the social worker's question demonstrates to the client that his opinions about treatment matter despite the involuntary nature of the service. It aims to get the client talking about his feelings, which is the first step in forming a therapeutic relationship. While the client may reveal some resistance when answering, the question is not aimed to do so. It also does not seek to determine if denial is present or identify whether the client is aware of his legal mandates. All of these are assessment tasks which will occur later. Assessment follows engagement in the problem-solving process. In addition, a social worker should not make assumptions about the presence of resistance or denial just because a client is managed into services. Universal among involuntary clients is that other entities have the power to influence terms of their treatment, which may make them feel that they have less control in the process. Social workers can address this issue by eliciting their feedback, sending the message that their input is essential.

A school social worker who is facilitating a group of adolescents notices that one member who recently immigrated with her family from Japan interacts very little during most of the sessions. In order to meet the client's needs, the social worker should: A. Suggest that meeting individually may be more appropriate to facilitate expression of feelings B. Determine class participation to see if this behavior occurs in other settings C. Create ongoing varied opportunities for interaction by all group members D. Ask for input in establishing rules which govern group participation

C. Create ongoing varied opportunities for interaction by all group members. The function of silence, like its meaning, it culturally defined. There are vast differences in culture, race, and/or ethnicity with regard to its use. It has a "linkage" function in that it can bind people together as well as isoate. Being silent with others can indicate rapport,, respect, and comfort as it acknowledges solidarity or that no conversation is needed. Silence can also have an "affecting" function, meaning that it has a power to affect others for both good and ill. Silence can be interpreted as indifference, causing negative feelings by others who observe it. Conversely, it can be seen as a sign of respect, viewed positively. Assumptions should not be made that those who are silent are not benefiting from others' participation or not actively engaged. For some, silence is seen as an opportunity given to others to speak or express their ideas. This dialogue by others mutually benefits those who do not verbalize. Silence also can indicate assent - there may be no need to verbally affirm what is said as remaining quiet is seen as having the same effect. Silence may be viewed as a way to retain harmony among the group. Silence can be seen as a way to agree with others without vocalizing. This indirect form of communication is more common among some cultures, including those who are Asian. In addition, some cultures are more collectivist, placing the views of larger groups as more important than those of individual members. Thus, remaining silent is seen as a sign of respect even when having an opposing view. Dissenting opinions are viewed as having possible negative repercussions for the work of the overall group, which is prioritized. Test-Taking Strategies Applied: In the case scenario, there is no indication of the race, culture, and/or ethnicity of other group members. However, the recent immigration of the youth may have been mentioned as an indication that her participation may be influenced by different cultural, racial, and/or ethnic norms. Some races, cultures, and/or ethnicities are more dominant and pervasive than others. This influences how people in both dominant and minority cultures interaact; this, in turn, can impact on a group's interactions. It is the social worker's job as facilitator to encourage participation and challenge behavior which inhibits it. The facilitator is not responsible for what a member chooses to say or withhold in a group - clients should not be forced to participate. What a social worker can and must do is create an environment in the group where clients can choose to contribute and where it is safe for them to do so. Thus, a social worker must challenge and dilute any negative impacts of prejudice which may arise in the group due to differences in communication styles. Ensuring that any negative effects of social prejudice are not tolerated will create a "safe space" where group members can choose to express their opinions if they wish.

Conversion is BEST defined as: A. Therapeutic process aimed at turning negative thoughts directed at others into positive ones B. Reaction to trauma which limits emotional growth and development throughout the life course C. Defense mechanism in which a repressed urge is expressed by disturbance of a body function D. Strategy used in family therapy to get consensus among those with divergent viewpoints

C. Defense mechanism in which a repressed urge is expressed by disturbance of a body function Defense mechanisms are psychological mechanisms aimed at reducing anxiety. They were first discussed by Sigmund Freud as part of his psychoanalytic theory and further developed by his daughter, Anna Freud. Often unconscious, defense mechanisms are used to protect clients from psychological pain or anxiety. While such mechanisms may be helpful in the short term, alleviating suffering that might otherwise incapacitate, they can easily become a substitute for addressing the underlying cause and so lead to additional problems. The solution, therefore, is to address the underlying causes of the pain these mechanisms are used to defray. Conversion is a defense mechanism which occurs when cognitive tensions manifest themselves in physical symptoms. The symptom may be symbolic and dramatic and often acts a a communication about the situation. Extreme symptoms may include paralysis, blindness, deafness, becoming mute, or having a seizure. Lesser symptoms include tiredness, headaches, and twitches. For example, a client's arm becomes suddenly paralyzed after they ave been threatening to hit someone else. Conversion is different from psychosomatic disorders where real health changes are seen (such as the appearance of ulcers). It also is more than malingering, where conscious exaggeration of reported symptoms is used to gain attention. With time, symptoms will go away, especially if clients' stress is reduced, such as by taking them away from the initial, anxiety-provoking situations. Test-Taking Strategies Applied: This is a recall question on the defense mechanisms. It is not necessary to memorize the definitions of the defense mechanisms, but their names should be familiar. The correct answer could have been obtained simply by recognizing that conversion was a defense mechanism Often questions on defense mechanisms include case scenarios which describes clients' behaviors. Thus, social workers must be able to distinguish between the defense mechanisms based on client verbalization and actions using the situational contexts as clues

A purpose of 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 and trauma histories when making sentencing recommendations for juvenile offenders C. Determine the occurrence of abuse and 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 and trauma based on information that can be sued for prosecution of perpetrators. A forensic interview of a child is a developmentally sensitive and legally sound method of gathering factual information regarding allegations of abuse and 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 investigation, one in which a professional interviews a child to find out if they have been maltreated. In addition to yielding the information needed to make a determination about whether abuse or neglect has accurred, this approach produces evidence that will stand up in court if the investigation lead 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.

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 experience a: A. Paradoxical directive B. Negative feedback loop C. Double bind D. Metacommunication

C. Double bind. 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 the 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 want 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, ect.). In prescribing the symptom, a social worker helps a client understand this need and determine how much control (if any) they have over the symptoms. By choosing to manifest the symptom, a client may recognize that they can create it, and therefore has the power to stop or change it. A negative feedback loop is information the 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.

The goal of attending behavior by social workers is to: A. Determine the scope and severity of client problems B. Assist clients to identify alternatives which result in change C. Encourage clients to speak openly about their concerns D. Explore barriers which have impeded client progress

C. Encourage clients to speak openly about their concerns. Attending is a term frequently used to describe the process of nonverbally communicating to clients that social workers are open, nonjudgmental, accepting of them as people, and interested in what they say. The purpose of attending is to encourage clients to express themselves as fully and freely as possible. During the beginning of the problem-solving process, especially, nonverbal presentation is equally important to verbal communication as clients are usually doing most of the talking. Many of the guidelines available may be useful, but they tend to reflect nonverbal characteristics of majoriyt-member, middle- and upper-class adults. Good attending behavior is usually described as follows: * Eye Contact: Looking at clients is one way of showing interest. However, social workers can make clients feel uncomfortable if they stare at them too intensely. The best way of showing that social workers are listening is by looking at clients naturally. * Posture: This a natural response of itnerest. It is best to lean slightly toward clients in a relaxed manner. Relaxation is important, since social workers want to shift focus from themselves so they are better able to listen to client. * Gesture: Social workers communicate a great deal with body movements. If hands are flailed, arms are crossed, or chest/shoulders are hunched, then messages, whether intentional or unintentional, will be communicated. * Facial Expressions: Facial expressions, such as smiling, eyebrow raising, and frowning, indicate responsiveness. Test-Taking Strategies Applied: Social workers must be aware of verbal and nonverbal communication tehcniques. This question requires recall of the name of a nonverbal technique. Determining the scope and severity of client problems, as well as the barriers which impede progress, are assessing tasks. Identifying alternatives which will result in change is a planning or intervening action. Attending behavior is heavily used in engaging, though it continues throughout the problem-solving process. The correct answer is much broader than the other response choices and is the aim of attending behavior.

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. 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 interacti, 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 of all discussions and interactions - Persons/services involved in the provision of support including referral inforamtion, telephone contacts, and emal/written correspondence - Attendance/nonattendance at scheduled sessions - Discussions of legal and ethical responsibilities (client rights, responsiblities, and complaints process; 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 of 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 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.

A social worker is assisting a client to cope with depression after a stroke. The client reports having difficulty meeting his basic needs and suggests having his daughter come to the next session to discuss his current problems as she lives nearby and is supportive. In this situation, the social worker should: A. Determine whether other family members or friends should be included in the meeting B. Explain that including her in session is not allowed due to confidentiality standards and their limits C. Ensure there is an agreement about the meeting purpose and what information will be shared D. Identify what specific activities of daily living the client is having problems completing

C. Ensure there is an agreement about the meeting purpose and what information will be shared. There is tremendous importance placed on social relationships, which consist of interactions between clients and their family and friends. Thus, social workers often rely on the use of collaterals to obtain relevant information to assist clients. Unfortunately, while the 2008 NASW Code of Ethics advises social workers of their ethical obligations to clients, it is silent on what obligations, if any, social workers owe to clients' family members, friends, and other collaterals who may be brought into the helping process. Thus, social workers must adhere to broad professional values when interacting with collaterals regardless of whether a particular situation is explicitly covered by the code of ethics. In the absence of ethical standards, it is helpful for social workers to have agency policies and contracts that fill these gaps. For instance, before meeting with collaterals, there should be an agreement regarding the meeting's purpose, what information will be shared, and how that information may be used. Although contracts have traditionally been used with clients, they can also be used with collaterals to clarify expectations, to prevent conflicts, and to provide clients, collaterals, and social workers with legal safetguards. Service contracts with collaterals could include, but not be limited to, explaining the roles of social workers, their primary commitments to clients, any commitments to collaterals, the roles of collaterals, the nature of collateral involvement, benefits and risks of collaterls, and/or confidentiality issues. Test-Taking Strategies Applied: The case scenario relates to the client's request to have his daughter come to the next session. Using other family members or friends as collaterals may be helpful, but does not address the suggestion at hand. Confidentiality is a client right, so a social worker can share information with others when requested by the client. It is allowed and appropriate to discuss client information with collaterials as long as the social worker ensures that the sharing is done at the client's wishes and there is a clear understanding about what will be discussed. Including his daughter in discussions about the extent of the client's current problems was suggested by the client. Thus, it is not appropriate for the social worker to identify them without addressing the desire to use her a a collateral informant to obtain relevant information. The correct response choice ensures that there is a mutual understanding about key ethical issues which may arise when using the daughter as a collateral informant.

Which is the sole condition listed in a new category on behavioral addictions in the DSM-5? A. Sexual Addiction B. Compulsive Shopping C. Gambling Disorder D. Internet Gaming Disorder

C. Gambling Disorder. In the DSM-5, the chapter on Substance-Related and Addictive Disorders also includes Gambling Disorder as the sole condition in a new category on behavioral addictions. DSM-IV listed Pathological Gambling, but in a different chapter. This new term and its location in the new manual reflect research findings that Gambling Disorder is sim to Substance-Related Disorders in clinical expression, brain origin, comorbidity, physiology, and treatment. Recognition of these commonalities will help people with Gambling Disorder get the treatment and services theeed, and others may better understand the challenges that individuals face in overcoming this disorder. While Gambling Disorder is the only addictive disorder included in DSM-5 as a diagnosable condition, Internet Gaming Disorder is included in Section III of the DSM-5. Disorders listed there require further research before their consideration as formal disorders. This condition is included to reflect the scientific literature that persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. Other repetitive behavior, such as that related to exercise, sex, or shopping, are not included because there is insufficient peer-reviewed evidence to establish the diagnostic criteria to identify these behaviors as metal disorders at this time. Test-Taking Strategies Applied: This is a recall question which relies on social workers understanding that empirical evidence supports treating other addictions, such as gambling, like Substance-Related Disorders since gambling behaviors activate reward systems similar to those activated when abusing drugs. In addition, Gambling Disorder produces behavioral symptoms that are comparable to those produced by Substance Use Disorders. Knowing which other addictions are included in the DSM-5 is essential when social workers are working with clients who are experiencing impairment due to excessive or repetitive behaviors.

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 should consider this 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. 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.

A family seeks counseling as their adolescent daughter recently ran away from home. During the first session, the daughter states her parents do not care about her well-being and are overly concerned with meeting their job demands. She feels that all interactions with them are contentious and end in arguments. The mother admits to feeling overwhelmed by daily life and disconnected from both her husband and her daughter at times. The father feels that the root of the problem is that the daughter has been given too much control in the household. Using the structural family therapy approach, the social worker should: A. Gather information on how the childhoods of both parents influenced their parenting styles B. Assess whether the current state of the mother requires immediate attention due to a risk of self-harm C. Instruct the daughter to discuss with her parents a current concern that she has that she feels they are not addressing D. Determine when each family member's concerns began in an attempt to determine the etiology of the problem

C. Instruct the daughter to discuss with her parents a current concern that she has that she feels they are not addressing. Structural family therapy (SFT is similar to other types of family therapies that view the family unit as a system that lives an operates within larger systems, such as a culture, the community, and organizations. This system - ideally - grows and changes over time. But sometimes a family gets "stuck", often resulting from behavioral or mental health issues of one of its family members. Rather than focus on the individual's pathology, however, SFT considers problems in the family's structure - a dysfunction in the way the family interacts or operates. SFT does not maintain that the family's interactions, or "transactions", cause the pathology, but rather that the family's transactions support or encourage the symptoms. Transactions are simply patterns of how family members routinely interact with each other. Through its transactions, a family establishes a set of rules for its daily functioning, and these rules form its "strucutre". A social worker employing SFT must first assess a family's interactions, figuring out a family's hierarchy and alliances within a family. The social worker composes a map or flow chart describing the process that a family unconsciously follows. Ultimately, the social worker's goal is to change or modify the family map or structure - to get it "unstuck" from its harmful transactions that are supporting and amplifying certain issues or problems. They delineate proper "boudaries" between family members and their transactions or interactions. When boundaries are crossed, ignored, or distorted, the family's structure becomes dysfunctional. Social workers using SFT identify a wide range of dysfunctional communication and interaction patterns. Unlike more traditional approaches that prescribe a supportive, empathetic-listening approach to therapy, social workers using SFT get involved with a family's transactions. In this unique role, and in the context of the therapeutic setting, a social worker will provoke the family members to interact and speak about the problem of issue. The therapist asks questions, points out harmful transactions, and uncovers not only dysfunctional patterns, but positive behaviors or personal qualities that are ignored or overlooked by a family. During interactions that take place in therapy, hidden conflicts become apparent, inappropriate or counterproductive transactional patterns are observed, and finally, ways to help a family change or restructure interactions are made. To assist with understanding the family system, social workers will ask for "live" displays of concerns called enactments. The family will be encouraged to engage in a difficult communication so that social workers can best identify the current problematic patterns and dynamics. SFT focuses on family interaction in the "here and now". It is less concerned with how their interactional styles evolved. Test-Taking Strategies Applied: While several response choices may appear appropraite, the correct one is most closely associated with SFT. This approach focuses on the boundaries, communication patterns, and interactions between family members. Obtaining information about childhood events or past feelings is not viewed as being as helpful as "enactements" or observing current relational communication between members. Using this technique, a social worker takes a very active role to provoke conflicts and point out maladatptive behavior. While the mother's current mental status may be a concern and requires assessment, it is not the correct answer as it does not most directly relate to a SFT approach.

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. 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 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 soughts. 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 choiwhich is not an aim to 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 service is not the aim of performance monitoring. Performance monitoring occurs during implementation of services while identification of needs happen 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.

When clients have co-occurring mental health and Substance Use Disorders, which statements best describes the appropriateness of taking psychotropic medications? A. Psychotropic medications should never be taken for co-occurring disorders as they are contraindicated. B. Psychotropic medications can only be prescribed if clients understand the side effects. C. Psychotropic medications are part of accepting treatment protocols for co-occurring disorders. D. Psychotropic medications have not been adequately studied in clients with co-occurring disorders, making their appropriateness questionable.

C. Psychotropic medications are part of accepting treatment protocols for co-occurring disorders. Clients with mental health disorders are more likely than clients without mental health disorders to experience an alcohol or substance use disorder. Co-occurring disorder can be difficult to diagnose due to the complexity of symptoms, so both may vary in severity. In many cases, clients may receive treatment for one disorder while the other disorder remains untreated. This may occur because both mental and Substance Use Disorders can have biological, psychological, and social components. Other reasons may be inadequate training or screening by service providers, an overlap of symptoms, or that other health issues need to be addressed first. In any case, the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death. Clients with co-occurring disorders are best served through integrated treatment. With integrated treatment, social workers can address mental and Substance Use Disorders at the same time, often lowering costs and creating better outcomes. Increasing awareness and building capacity in service systems are important in helping identify and treat co-occurring disorders. Early detection and treatment can improve treatment outcomes and the quality of life for those who need these services. Prescribed medications play a key role in the treatment of co-occurring disorders. They can reduce symptoms and prevent relapses of a psychiatric disorder. Medications can also help clients minimize cravings and maintain abstinence from addictive substances. In order to get the most out of medications, client must make an informed choice about taking medications, and understand the potential benefits and costs associated with medication use. In addition, they must take the medication as prescribed. Taking medication is not substance abuse. Clients in recovery for a Substance Use Disorder may think it is wrong to take any medications. However, a medication that manages clients' moods is very different from a drug that alters clients' moods. Test-Taking Strategies Applied: As co-occurring disorders are so prevalent, social workers must be versed in their treatment. While not all clients with psychiatric comorbidities need or receive psychotropic medications, the treatment of mental health symptoms with medications can be effective in reducing the severity of the symptomatology. Much research has been done in this area. Further, it might reduce the elevated risk of suicide attributed to each of the comorbid disroders and to their combined effect. Reducing risk of suicide is an important aim of treatment. Psychotropic medications should only be prescribed after clients understand their side effects, but informed consent is not unique to only those with co-occurring mental health and Substance Use Disorders - which makes it an incorrect answer.

A social worker has additional information on a client situation that he would like to add to the record. It helps clarify discussions that took place with the client during the last session. In order to handle this situation properly, the social worker should: A. Ask his supervisor about agency protocol related to management of client records B. Add the material to the previous case note as it clarifies material presented in the last session C. Record the information as a new, separate entry in the record with a reason for its addition D. Refrain from documenting it in the record as it was not collected during a session with the client

C. Record the information as a new, separate entry in the record with a reason for its addition. Case notes may be subject to a range of legislative processes and requirements during and following the conclusion of professional relationships. The nature of these requirements may differ greatly according to the state or nature/context of practice. Social workers should use care to make sure that case notes are imparitial, accurate, and complete. Information may need to be added to client records to ensure that they are not misleading and are comprehensive. Care should be taken at all times to avoid errors or omissions. If a change must be made to correct an error or omission, the change must be recorded as a new and separate case note. In addition to outlining the error or omission as part of new case notes, it is advisable to provide explanations for earlier absences or inaccuracies. An existing case note should never be amended or changed in light of additional information obtained at a later date. This should always constitute a new case note. Test-Taking. Strategies Applied: This case scenario requires knowledge about documentation and the management of practice records. Careful and diligent documentation enhances the quality of services provided to clients. Social workers should take responsible steps to ensure that documentation in records is accurate and reflects the services provided. In addition, social workers should include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to clients in the future. Comprehensive records are necessary to assess clients' circumstances, as well as plan and deliver services. Social workers should know the professional protocol for adding or making changes to client records, so asking for supervisory input is not needed, making the first answer incorrect. Material should never ben added to existing case notes as they need to accurately reflect documentation of "the facts" that were known at the time of these entries. Thus, the second answer is not correct. Lastly, client records should be complete, so not recording information in client files is also unethical, eliminating the last response choice listed.

Which of the following actions by a social worker is considered unethical according to the professional code of ethics? A. Charging rates which are significantly higher than those of other colleagues for the same services based on professional experience and training B. Bartering in limited circumstances when it is an accepted cultural practice and not detrimental to clients or professional relationships C. Soliciting private fees for providing services which are available through the social worker's employer or agency D. Terminating services to clients who are not paying overdue balance after financial contractual arrangements have been made clear

C. Soliciting private fees for providing services which are available through the social worker's employer or agency. Social workers' ethical responsibilities include those related to payment for services. When setting fees, social workers should ensure that the fees are fair, reasonable, and commensurate with the services performed. Consideration should be given to clients' ability to pay. Social workers should avoid accepting goods or services from clients as payment for professional services. Bartering arrangements, particularly involving services, create the potential for conflicts of interest, exploitation, and inappropriate boundaries in social workers' relationships with clients. Social workers should explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client's initiative and with the client's informed consent. Social workers who accept goods for services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship. Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contracted arrangement have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client. Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client. Social workers should not solicit a private fee or er remuneration for providing services to clients who are entitled to such available services through the social workers' employer or agency. Test-Taking Strategies Applied: This is a recall question which requires social workers to select the unethical action "according to the professional code of ethics". While the examinination will never refer directly to the 2008 NASW Code of Ethics as there are other professional organizations with ethical mandates, it is helpful to read the 2008 NASW Code of Ethics and remember its standards when choosing between answers. Most questions on the examination will focus on the first section, which addresses social workers' ethical responsibilities to clients. The correct answer is always the one which most closely mirrors the standard which is explicitly stated in the 2008 NASW Code of. Ethics.

A young man who has a criminal history for violent acts later becomes an acclaimed boxer - which of the following defense mechanisms is the young man MOST likely using? A. Introjection B. Incorporation C. Sublimation D. Undoing

C. Sublimation. Defense mechanisms are psychological mechanisms aimed at reducing anxiety. They were first discussed by Sigmund Freud as part of his psychoanalytic theory and further developed by his daughter, Anna Freud. Often unconscious, defense mechanisms are used to protect clients from psychological pain or anxiety. While such mechanisms may be helpful in the short term, alleviating suffering that might otherwise incapacitate, they can easily become a substitute for addressing the underlying cause and so lead to additional problems. The solution, therefore, is to address the underlying causes of the pain these mechanisms are used to defray. Sublimation is a mature type of defense mechanism where socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or behaviors. It causes "id" impulses to be channeled into refined and civilized behavior. Alfred Adler called sublimation "the healthy defense mechanism" because it produced socially beneficial outcomes for humanity. Test-Testing Strategies Applied: This is a recall question on the defense mechanisms. It is not necessary to memorize the definitions of the defense mechanisms, but their meanings should be familiar. Often questions on defense mechanisms include case scenarios which describe clients' behavior. Thus, social workers, must be able to distinguish between the defense mechanisms based on client verbalizations and actions using the situational contexts as clues.

A social worker employed at a nursing home notices that a client with Alzheimer's disease experiences heightened delirium during the evening hours and improvement during the day. This phenomenon is referred to as: A. Folie a deux B. Dementia C. Sundowning D. Neruodegeneration

C. Sundowning. Older adulthood is a time of continued growth. Clients in the later stages of life contribute significantly to their families, communities, and society. At the same time, clients face multiple biopsychosocial-spiritual-cultural challenges as they age; changes in health and physical abilities; difficulty in accessing comprehensive, afforable, and high-quality health and behavioral health care; decreased economic security; increased vulnerability to abuse and exploitation; and loss of meaningful social roles and opportunities to remain engaged in society. Social workers must understand the needs of older adults and issues that may be facing them. Sundowning is a term used to refer to behavioral changes that often occur in the late afternoon or evening in people with Alzheimer's disease and similar conditions. The behavioral changes may take the form of aggression, agitation, delusions, hallucinations, paranoia, increased disorientation, or wandering and pacing about. Sundowning is not a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia. The exact cause of this behavior is unknown. Factors that may aggravate late-day confusion include fatigue, low lighting, increased shadows, disruption of body's "internal clock", and/or difficulty separating reality from dreams. Reducing sundowning can be assisted by maintaining a predictable routine for bedtime, waking, meals and activities, and limiting daytime napping. When sundowning occurs in a nursing home, it may be related to the flurry of activity during staff shift changes or the lack of structured activities in the late afternoon and evening. Staff arriving and leaving may cue clients with Alzheimer's to want to go home or to check on their children - or other behaviors that were appropriate in the late afternoon in their past. It may help to occupy their time with another activity during that period. Folie a deux, a shared psychosis, is when symptoms of a delusional belief and hallucinations are transmitted from one individual to another. While not listed in the DSM-5, recent psychiatric classifications refer to the syndrome as shared psychotic disorder. Dementia is a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning. Neurodegeneration is an umbrella term for the progressive loss of structure or function of neurons. Many neurodegenerative diseases including amyotrophic lateral sclerosis, Parkinson's, Alzheimer's, and Huntington's occur as a result of neurodenerative processes. Such diseases are incurable. Test-Taking Strategies Applied: This is a recall question which relies on social workers being able to recognize and understand terms associated with neurogenerative diseases, such as Alzheimer's. Such diseases cause change in client behavior. One of the response choices, folie a deux, is used to describe shared psychosis, which is not associated with neurogenerative disease. Social workers must be well-versed in actions associated with typical human development, as well as those which indicate the presence of disease or disturbance.

Who has the ultimate responsibility for selecting models of social work supervision? A. Administrators B. Supervisees C. Supervisors D. Funders

C. Supervisors. 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 take 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 supervsees. 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, appropraite, 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 responsiblity", supervisors are distinguished from the supervisees as they have authority in supervisory relationshiops. 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.

A client tells a social worker that she has been communicating with her recently deceased son. The client states that she has an altar in her home at which she leaves daily food offerings. She is hopeful that he son will return to the home sometime in the future to visit her. In this situation, it is MOST important for the social worker to: A. Determine if the client is at risk for self-harm B. Assess the client for psychiatric symptoms C. Understand the mourning rituals of the client's culture D. Identify coping strategies which can assist the client in dealing with her loss

C. Understand the mourning rituals of the client's culture. Each culture has its own traditions, rituals, and ways of expressing grief and mourning. The effects of culture, race, and ethnicity on behaviors, attitudes, and identity must be considered. Almost every religion or culture has its own traditions involving mourning. Grief is the thoughts and feelings associated with loss, while mourning is the outward behaviors the represent a person's grief. Every culture has its own traditions regarding mourning, and it is important for people to realize that everyone mourns differently and that there is no right way to mourn. While social workers cannot be expected to know the mourning ceremonies and traditions of each client's culture, understanding some basics about how different cultures may prepare for and respond to death is important. Though difficult to ask, there are crucial questions that need to be part of conversations between social workers and clients. For example: - What are the cultural rituals for coping with dying, the deceased person's body, the final arrangements for the body, and honoring the death? - What are the family's beliefs about what happens after death? - What does the client consider to be the roles of each family member in handling the death? - Are certain types of death less acceptable (e.g., suicide) or are certain types of death especially hard to handle for that culture (e.g., the death of a child - in countries with high infant mortality, there may be different attitudes about the loss of children)? Clients should be viewed as a source of knowledge about their special/cultural needs and norms - but social workers sometimes are at a loss about what to ask under such trying circumstances. While there are many similarities across cultures, such as wearing black as a sign of mourning, there are always exceptions. The mix of cultural/religious attitudes and behaviors surrounding death and dying can become very complex indeed. And when a death actually occurs, some clients break with tradition entirely, often creating chaos within families. Test-Taking Strategies Applied: The question contains a qualifying word - MOST. The client's behavior may be psychotic, placing her at risk for self-harm. It also may be typical given the client's cultural practices and religious beliefs. In order to best understand these actions, the social worker must ask the client about her mourning rituals. It will be important for the client to employ coping strategies to deal with her loss, but there is no indication that they are not already being utilized and such identification is not directly related to the behaviors described in the case scenario.

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 on 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. 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 2008 NASW Code of Ethics. In order to resolve this conflict, ethical problem solving is needed. There are six essential steps in ethical problem solvling: 1. Identify ethical standards, as defined by the professional code of ethics, that are being compromised (always go to the 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 code of ethics. 4. Suggest modification 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 the problems is critial, but the question is asking for the sequential steps in ethical problem solving. The issue cannot be eradicated until all steps have been taken, making this answer also incorrect.

For which diagnosis is brief cognitive behavioral therapy MOST appropriate? A. Substance Use Disorders B. Personality Disorders C. Dissociate Disorders D. Adjustment Disorders

D. Adjustment Disorders. Cognitive behavioral therapy (CBT) combines cognitive and behavioral therapies. The basic premise of CBT is that emotions are difficult to change directly, so CBT targets emotions by changing thoughts and behaviors that are contributing to the distressing emotions. CBT builds a set of skills that enables an individual to be aware of thoughts and emotions; identify how situations, thoughts, and behaviors influence emotions; and improve feelings by changing dysfunctional thoughts and behaviors. The process of CBT skill acquisition is collaborative. Skill acquisition and homework assignments are what set CBT apart from "talk therapies". Brief CBT is the compression of CBT material and the reduction of the average 12 to 20 sessions into four to eight sessions. In brief CBT, the concentration is on specific treatments for a limited number of client problems. Specificity of the treatment is required because of the limited number of session and because a client is required to be diligent in using extra reading materials and homework to assist in their therapeutic growth. Brief CBT can range in duration from client to client and provider to provider. Certain problems are more appropriate for brief therapy than others. Problems amenable to brief CBT include, but are not limited to, Adjustment, Anxiety, and Depressive Disorders. Therapy also may be useful for problems that target specific symptoms (e.g., depressive thinking) or lifestyle changes (e.g., problem solving, relaxation), whether or not these issues are part of a formal psychiatric diagnosis.. Brief CBT is particularly useful in a primary care setting for clients with anxiety and depression associated with a medical condition. Because these clients often face acute rather than chronic mental health issues and have many coping strategies already in place, brief CBT can be used to enhance adjustment. Issues that may be addressed in primary care include, but are not limited to, diet, exercise, medicationmpliance, mental health issues associated with a medical condition, and coping with a chronic illness or new diagnosis. Other problems may not be suitable for the use of, or may complicate, a straightforward application of brief CBT. Borderline Personality Disorder or Antisocial Personality Disorder typically are not appropriate for a shortened therapeutic experience because of the pervasive social, psychological, and relational problems individuals with these disorders experience. Long-standing interpersonal issues often require longer treatment durations. Clients exhibiting comorbid conditions or problems also may not be appropriate because the presence of a second issue may impede progress in therapy. For example, a client with a Substance Use Disorder comorbid with Major Depressive Disorder may not be appropriate because the substance use requires a higher level of care and more comprehensive treatment than is available in a brief format. However, brief CBT could be used with Personality Disorders and comorbid clients in dealing with specific negative behaviors or in conjuction with more intensive treatment. Lastly, conditions such as serious mental illness require focused and more intensive interventions. Test-Taking Strategies Applied: Central to selecting the correct response choice is recognizing that the intervention modality mentioned in the question is brief therapy. Brief therapy is a systematic, focused process that relies on assessmet, client engagement, and rapid implementation of change strategies. Brief therapy providers can effect important changes in client behavior within a relatively short period. Substance Use Disorders are chronic, requiring long-term support. Brief therapy for substance abuse treatment can be a valuable, but limited, approach and it should not be considered a standard of care. Personality Disorders form a class of mental disorders that are characterized by long-lasting, rigid patterns of thought and behavior. Personality Disorders are seen as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it. These patterns are inflexible and pervasive across many situations. Thus, they are not optimally treated by brief therapy. Dissociative Identity Disorder (DID), formerly called Multiple Personality Disorder, is a condition that is characterized by the presence of at least two clear personality states, called alters, which may have different reactions, emotions, and body functioning. While there's no "cure" for DID, long-term treatment is very successful. Effective treatment includes talk therapy or psychotherapy, medications, hypnotherapy, and adjunctive therapies to help clients with DID improve their relationships with others, prevent crises, and experience uncomfortable feelings. Because oftentimes the symptoms of Dissociative Disorders occur with other disorders, such as anxiety and depression, Dissociative Disorders may be treated using the same drugs prescribed for those disorders.

In an initial meeting with a man who is seeking assistance after several arrests, a social worker determines that his reasoning is significantly impaired as he admits to using drugs before the meeting. The social worker wants to obtain the man's consent to find out more about his arrests and begin providing services aimed at assisting him to meet his basic needs. However, the social worker questions his ability to understand what she is asking and understand the information provided on the agency's consent form. The social worker should: A. Waive the informed consent procedures since the man is in need of services now B. Ask the man to sign the consent form, which will be reviewed with him at a later time C. Use verbal informed consent procedures in lieu of written forms given his impairment D. Arrange to meet the man at a later time when informed consent can be obtained

D. Arrange to meet the man at a later time when informed consent can be obtained. Social workers' commitment to informed consent is based on clients' right to self-determination. The informed consent process is one of the clearest expressions of social workers' respect for clients' dignity and worth as individuals to make choices which are best suited to meet their needs. A client must have the right to refuse or withdraw consent. Social workers should be prepared for the possibility that clients will exercise these rights. Social workers should inform clients of their rights and help clients make thoughtful and informed decisions based on all available facts and information about potential benefits and risks. Social workers must be familiar with informed consent requirements concerning clients' right to consent, especially when working with those who are incarcerated, children, individuals with cognitive impairments, and so on. While state and federal laws and regulations vary on interpretations and applications of informed consent standards, there are essential standards in all processes which are needed for their validity. First, coercion and undue influence must not have played a role in clients' decisions. As social workers often maintain control over approving benefits, admission into programs, and the termination of services, they must ensure that clients do not feel pressured to grant consent based upon this control. Second, social workers must not prevent clients with general, broad-worded consent forms that may violate clients' right to be informed and may be considered invalid if challenged in a court of law. The use of broad or blank consent forms cannot possibly constitute informed consent. Social workers should include details that refer to specific activities, information to be released, or interventions. Typical elements include details of the nature and purpose of a service or disclosure of information; advantages and disadvantages of an intervention; substantial or possible risks to clients, if any; potential effects on clients' families, jobs, social activities, and other important aspects of their lives; alternatives to the proposed intervention or disclosure; and anticipated costs for clients. This information should be presented to clients in clear, understandable langauge. Consent forms should be dated and include a reasonable expiration date. Third, clients must be mentally capable of providing legal consent. Clearly, clients with significant permanent cognitive deficits may be unable to comprehend the consent procedure. Social workers should assess clients' ability to reason and make informed choices, comprehend relevant facts and retain this information, appreciate current circumstnaces, and communicate wishes. Some clients may be only temporarily unable to consent, such as individuals who are under the influence of alcohol or other drugs or are experiencing transient cognitive symptoms at the time consent is sought. Clients who are unable to consent at a given moment may be able to consent in the future if the incapacity is temporary. Test-Taking Strategies Applied: The case scenario described a man who is using drugs which interfered with his ability to give informed consent. It is not appropriate to waive consent procedures or have the man sign a form which he does not understand. Verbal consent procedures are also problematic as "the social worker questions his ability to understand what she is asking". Thus, he cannot give consent if he is unable to understand parameters of the information to be gathered or the services to be delivered (the nature and purpose of the service; the advantages and disadvantages of an intervention; substantial or possible risks; anticipated costs; and so on). His impairment may be temporary as he admits to using drugs which interfered with his reasoning prior to the meeting. Arranging to meet him at a later time may result in him being in a mental state in which he can make informed choices and comprehend relevant facts, which are necessary elements for informed consent.

A client who was briefly admitted to the hospital after a panic attack is being discharged with a prescription for a benzodizepine. Which of the following medications has been recommended? A. Prolixin B. Lithium C. Prozac D. Ativan

D. Ativan Benzodiazepnies are psychotropic medications that help relieve nervousness, tension, and other symptoms by slowing the central nervous system. Benzodiazipnes are a type of antianxiety drug. While anxiety is a normal response to stressful situations, some clients have unusually high levels of anxiety that can interfere with everyday life. For them, benzodizepines can help bring their feelings under control. The medicine can also relieve troubling symptoms of anxiety, such as pounding heartbeat, breathing problems, irritability, nausea, and faintness. They are also sometimes prescribed for other conditions, such as muscle spasms, epilepsy and other seizure disorder, phobias, Panic Disorder, withdrawal from alcohol, and sleeping problems. The family of antianxiety drugs known as benzodizepines includes alprozolam (Xanax), chloradizepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). These medicines take effect fairly quickly, stating to work within an hour after they are taken. Benzodiazepines are available only with a prescription and are available in tablet, capsule, liquid, or injectable forms. Prolixim is an antipsychotic medication used to treat hallucinations and delusions. Lithium is a mood stabilizer used for the treatment of Bipolar Disorder. Prozac is an antidepressant medication used to treat depression. Test-Taking Strategies Applied: This is a recall question about benzodiazepines (commonly called "tranquilizers"), which are useful for treating anxiety. They are highly addictive, and their use is normally limited to a short-term, as-needed basis. They need to be carefully controlled by prescribing phsycians. The examination requires social workers to be aware of the four major types of psychotropic medications - antispychotics, antidepressants, mood stabilizers, and antianxiety drugs - and be able to identify some common medications in each of these types. While it is possible to have no medication questions on the examination as other KSAs under assessment, diagnosis, and treatment planning are tested instead, it is important to have some knowledge about psychotropic drugs. For example, knowing which types of medications are commonly prescribed for various diagnoses can be helpful.

A client tells a social worker that she is having difficulty with her teenage daughter's behavior. The daughter has begun to violate strict rules set in the home. The clinet, who is frustrated with this disobedience, states that she often does not speak to her child for days as punishment. The client does not understand why the girl questions the rules and does not behave as expected. Based on the description, which style of parenting is the client likely using? A. Permissive B. Authoritative C. Uninvolved D. Authoritarian

D. Authoritarian. There are four major parenting styles which reflect the skills and capabilities of clients. Permissive parenting, sometimes referred to as indulgent parenting, has very few demands placed on children. Permissive parents rarely discipline their children because they have relatively low expectations of maturity and self-control. They are often nontraditional and lenient, not requiring mature behavior, allowing considerable self-regulation, and avoiding confrontation. Permissive parents are generally nurturing and communicative with their children, often taking on the status of a friend more than that of a parent. Auhothoriative parenting establishes rules and guidelines that children are expected to follow. However, this parenting style is demoncrative. Authoritative parents are responsive to their children and willing to listen to questions When children fail to meet the expectations, these parents are nurturing and forgiving rather than punishing. These parents monitor and impart clear standards for their children's conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods and supportive, rather than punitive. They want their children to be assertive as well as socially reponsibe, and self-regulated as well as cooperative. In authoritarian parenting, children are expected to follow the strict rules established by the parents. Failure to follow such rules usually results in punishment. Authoritarian parents do not explain the reasoning behind these rules. If asked to explain, the parent might simply reply, "Because I said so." These parents have high demands but are not responsive to their children. These parents are obedience- and status-oriented, and expect their orders to be obeyed without explanation. An uninvolved parenting style is characterized by few demands, low responsiveness, and little communciation. While these parents fulfill the child's basic needs, they are generally detached from their child's life. In extreme cases, these parents may even reject or neglect the needs of their children. Test-Taking Strategies Applied: This is a recall question on parenting sytles. Social workers should be knowledgeable about the impact that parenting styles have on child development outcomes. Authoritarian parenting styles generally lead to children who are obedient and proficient, but they rank lower in happiness, social competence, and slef-esteem. Authoritative parenting styles tend to result in children who are happy, capable, and successful. Permissive parenting often results in children who rank low in happiness and self-regulation. These children are more likely to experience problems with authority and tend to perform poorly in school. Uninvolved parenting styles rank lowest across all life domans. These children tend to lack self-control, have low self-esteem, and are less competent than their peers.

A social worker at an impatient psychiatric unit is reviewing an intake assessment completed on a 21-year-old college student who was admitted the previous day due to bizarre behaviors. He was brought to the emergency department by the police who responded to student concerns about him yelling in an agitated voice, even though there was no one nearby. When asked about his actions, the client stated that he was being monitored by a deadly chip implanted in his brain by evil aliens. When contacted, his parents reported that they began to worry about him 8 months ago due to the presence of some unusual behaviors, but their concerns grew in the last 2 months when he stopped attending classes altogether. The social worker sees that the client was examined by the psychiatrist upon intake and medication was prescribed. Due to these symptoms, the client was MOST likely prescribed: A. Paxil B. Lithium C. Prozac D. Clozaril

D. Clozaril. According the the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), to meet the criteria for diagnosis of Schizophrenia, a client must have experience at least two of the following symptoms: - Delusions - Hallucinations - Disorganized speech - Disorganized or catatonic behavior - Negative symptoms At least one of the symptoms must be the presence of delusions, hallucinations, or disorganized speech. Continuous signs of the disturbance must persist for at least 6 monts, during which the client must experience at least 1 month of active symptoms (or less if successfully treated), with social or occupational deterioration problems occurring over a significant amount of time. These problems must not be attributable to another condition. The American Psychiatric Association (APA) removed Schizophrenia subtypes from the DSM-5 because they did not appear to be helpful for providing better-targeted treatment or predicting treatment response. Treatments for Schizophrenia are aimed at reducing or eliminating symptoms of Schizophrenia, including hallucinations, delusions, and jumbled speech. There is, however, no cure for Schizophrenia. Most clients will require both medication and psychotherapy. Antispyshotics are a class of psychiatric medication primarily used to manage psychosis (including delusions, hallucinations, paranoia, or disordered thought), principally in Schizophrenia. However, their long-term use is associated with significant side effects such as involuntary movement disorders and metabolic syndrome. Test-Taking Strategies Applied: This question requires determining the correct diagnosis for the client in the case scenario. Based on the information provided, it appears that the client has Schizophrenia. This diagnosis is listed in the DSM-5 with Schizophrenia Spectrum and Other Disorders, such as Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorrder, Schizoaffective Disorder, and so on. These disorders are generally treated with antipsychotic medications. Thus, the response choices must be reviewed and the drugs must next be classified into one of four major types - antispychotics, mood stabilizers, antidepressants, or antianxiety medications. Cloazril is the only antipsychotic drug listed, making it the correct response choice. Paxil and Prozac are antidepressant medications while Lithium is a mood stabilizer used for the treatment of Bipolar Disorder.

Due to an agency closure, a social worker has referred.a client to a new provider. With the client's consent, all relevant treatment information has been transferred. The social worker and client have also had several joint meetings with the new provider to discuss ongoing client needs. Several weeks later, the social worker learns that the client has had not contact with the new provider despite numerous outreach attempts. The social worker feels strongly that ongoing treatment is needed. The social worker should: A. Seek consultation to determine if steps in the referral process inhibited continuity of treatment B. Send a termination letter with the discharge plan and contact information of the new provider C. Meet with the client to determine whether new issues have emerged that have prevented follow through D. Contact the client about the risks involved with not following through with the referral

D. Contact the client about the risks involved with not following through with the referral. Social workers must handle issues surrounding the discharge and termination of services very carefully. Clients whose services are discharged or terminated unethically may not receive needed support. Once services are provided, social workers have legal and ethical responsibilities to continue these services or properly refer clients to alternative providers. While social workers do not have to work with all those in need or requesting services, services cannot terminate abruptly once therapeutic relationships have been established. Social workers must take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary. When it is necessary to terminate services, social workers should provide clients with n ames, addresses, and telephone numbers of at least three appropriate referrals. When feasible, they should follow up with clients who have been terminated. If clients do not visit the referrals, clients should be contacted about the risks involved with the lack of follow. Clients who will be terminated should be given as much advance notice as possible. When clients announce their decision to terminate prematurely, social workers must explain the risks involved and provide suggestions for alternative care. All decisions and actions related to termination of services should be documented in letters and clients should be provided with clear written instructions to follow and telephone numbers to use in the event of an emergency. Clients should be asked to sign a copy of the documents, affirming that they received the instructions and that the instructions were explained to them. In instances involving court-ordered clients, social workers should seek legal consultation and court approval before terminating services. Test-Taking Strategies. Applied: The correct answer involves direct action by the social worker to assist with the referral and discharge process. Seeking consultation to review what has already occurred may be helpful for professional development after the situation has been resolved, but it will not directly help reenage the client. Additionally, sending a letter is very passive and there is no reason to believe that the client is not aware of the discharge plan and contact information of the new provider. This action should have been taken earlier in the referral process and will not be helpful now. Lastly, meeting with the client to discuss "new issues" is contraindicated as the social worker needs to discharge the client. The client should be discussing new problems with a provider who will be able to assist with assessing and treating them. Contacting the client about not following through is an active response to address the situation in the case scenario. Central to this contact can be an assessment of why the benefits of continuing treatment have not compelled the client to make contact.

In client-centered therapy, which is NOT a core condition that must exist in order to have a climate conducive to growth and therapeutic change? A. Congruence B. Positive unconditional regard C. Empathic understanding D. Cultural competence

D. Cultural comptence. Cient-centered therapy, also known as person-centered therapy, is a nondirective form of talk therapy that was developed by humanist psychologist Carl Rogers during the 1940s and 1950s. Client-centered therapy operates according to three basic principles that reflect the attitude of the therapist to the client: 1. The social worker is congruent with the client. 2. The social worker provides the client with unconditional positive regard. 3. The social worker shows empathetic understanding to the client. Congruence is also called genuineness. Congruence is the most important attribute in counseling, according to Rogers. This means that, unlike the psychodynamic practitioner who generally maintains a "blank screen" and reveals little of their own personality in therapy, the Rogerian is keen to allow the client to experience the social worker as they really are. A social worker does not have a facade (like a psychoanalysis); that is, a social worker's internal and external experiences are one in the same. In short, a social worker is authentic. The next Rogerian core condition is unconditional positive regard. Rogers believed that it is important that clients are valued as themselves so they can grow and fulfill their potential. A social worker must have a deep and genuine caring for a client. A social worker may not approve of some of a client's actions, but a social worker does approve of a client. In short, a social worker needs an attitude of "I'll accept you as you are". The person-centered social worker is thus careful to always maintain a positive attitude to a client, even when disgusted by a client's actions. Empathy is the ability to understand what a client is feeling by having the ability to understand sensitively and accurately a client's experience and feelings in the here-and-now. Test-Taking Strategies Applied: The question contains a qualifying word - NOT - that requires social workers to select the response choice which is not a core condition "in client-centered therapy". When NOT is used as a qualifying word, it is often helpful to remove it from the question and eliminate the three response choices that are core conditions. This approach will leave the one response choice which is NOT an important social work quality according to Rogers. While cultural competence is essential for working with diverse client groups, it is not specifically related to client-centered therapy, which is the focus of the question.

What is the PRIMARY distinction between defense and coping mechanisms? A. Defense mechanisms are discrete reactions to traumatic stressors while coping mechanisms are continuous unconscious actions taken to deal with everyday life events. B. Defense mechanisms fluctuate depending upon situational and personality factors while coping mechanisms are stable and rigid over time. C. Defense mechanisms are maladaptive methods of addressing threatening events while coping mechanisms are based on healthy decisions aimed toward self-preservation. D. Defense mechanisms are unconscious while coping mechanisms involve deliberate cognitive and emotional modifications.

D. Defense mechanisms are unconscious while coping mechanisms involve deliberate cognitive and emotional modifications. Defense mechanisms are unconscious mechanisms which are activated in times of anxiety, stress, and distress without any choice or conscious intentionality. They are a necessary tool of protection and in moderate use contribute to successful adaptation. Defense mechanisms are a part of normal functioning, but they can be considered as pathological in some instances. Coping, on the other hand, includes conscious strategies that enable clients to attain realistic goals by using available resources and past experiences while acting within society's rules of conduct. While defense mechanisms are unconscious processes whereas coping methods are conscious, in reality, sometimes clients exhibit rational coping simultaneously with unconscious defenses. Coping mechan[isms are often confused and interchanged with defense mechanisms due to their simlarities. Both processes are activated in times of adversity. Defense mechanisms and coping strategies reduce arousal and negative emotions. Furthermore, both processes aim at achieving adaptation; only the means to the end differ. Defenses help the individual by distorting reality and coping strategies attempt to solve the problem, thus changing the reality. Coping behaviors involve conscious modification of cognitive and emotional appraislals, which eventually modify the reactions to the stressful even rather than distort the perception of the event. Clients have full control of coping strategies used. They can choose to stop certain coping styles and choose others. Defense mechanisms, on the other hand, operate outside consciousness and awareness. Clients cannot intentionally choose to use other defense mechanisms. Coping involves flexibility, and defenses are more rigid. The choice of coping mechanisms is perceived more as dependent on timing, situation, and personality factors. Deifferent situations lead to different coping strategies. Defense mechanisms are more stable and habitual. The idea regarding whether defense mechanisms produce adaptive and functional behaviors is still controversial In the long term, defense mechanisms do contribute to the development of serve pathology, yet the fact that they seem to help individuals to cope with the short term should not be ignored or dismised. Defenses are efficient mechanisms that help deal with threatening and, at times, traumatic stressors. Pathology probably does not originate from the actual use of defense mechanisms; it is caused by a continuous reliance on defenses, instead of actually attempting to solve the core problems that cause their necessity in the first place. Test-Taking Strategies Applied: The question contains a qualifying word - PRIMARY - that indicates that there may be more than one distinction between defense and coping mechanisms. However, the correct response choice is the one which contains the most fundamental or important difference. Defense mechanisms and coping strategies describe distinct psychological proceses, namely those which are unconscious and unintentional versus those which are not. In addition, the first response choices are not accurate statements. Coping mechanisms are not unconscious actions as stated in the first answer. Additionally, defense mechanisms are rigid and do not fluctuate like coping skills, contrary to what is stated in the second response choice. Lastly, defense mechanisms can be adaptive and functional ways to deal with stress, making the third answer incorrect as well.

During an assessment, a social worker learns that a couple spends little time apart despite having problems which have caused them to seek treatment. The wife feels lonely when her husband travels for work as she has few friends outside the marriage. The husband states that he is "smothered", but gets jealous easily, causing him to contact his wife frequently throughout the day. The husband reports that he is often unhappy as his wife seem miserable, while the wife states that she is frustrated as she is just trying to find ways to make her husband more content. In order to address the problem, treatment should focus on: A. Assisting the wife to develop a stronger sense of self-worth in the marriage B. Finding out more about past intimate relationships of both the husband and wife C. Helping the husband and wife to better understand each other's feelings D. Differentiating roles and boundaries for the husband and wife in the relationship

D. Differentiating roles and boundaries for the husband and wife in the relationship. Clients engaged in enmeshed interpersonal relationships are nearly always that last to know. Often social workers work with adult children who are recovering from the pain and confusion caused by enmeshed relationships with parents. There are may signs of enmeshed relationships including: - Neglecting other relationships because of an obsession or concern about one relationship - Happiness contingent upon a relationship - Self-esteem contingent upon a relationship - Excessive anxiety, fear, or a compulsion to fix the problem whenever there is a disagreement in a relationship - Feeling of loneliness that overwhelms when not with the other person - often creating irrational desires to reconnect - Symbiotic emotional connections which results in an individual becoming angry, upset, or depressed when another person is angry, upset, or depressed - Strong desire to fix another person's situation and change their state of mind When relationships are enmeshed, they are no longer able to grow. Social workers must work to establish healthy boundaries and respect for autonomous choices. This process can be painful for clients. Test-Taking Strategies Applied: In order to select the correct answer, social workers must first diagnose the problem. The feelings and behaviors of the couple are indicative of enmeshment. Once the cause of the problem is known, the question can be simplified to picking out the treatment focus when working with enmeshed relationships. The wife is not the client as the couple sought treatment, so focusing on the wife's self-worth will not address the problem. Find out more about past intimate relationships is an assessment - not a treatment - task. Understanding each other's feelings will not help each person develop boundaries and differentiate from one another, which is the root of the issue.

A social worker recently terminated with a client who made substantial progress in managing her anxiety. The former client has been asked by her church to facilitate a peer support group for others who have experienced similar problems. The former client is nervous about this request and asks the social worker to be a co-facilitator. The social worker feels that the former client would benefit from this peer interaction. In this situation the social worker should: A. Assist with helping prepare for, but not co-facilitate, the group B. Help co-facilitate for several sessions until the former client feels more comfortable C. Agree to co-facilitate as the experience will be beneficial to the former client D. Encourage participation while declining the request to co-facilitate.

D. Encourage participation while declining the request to co-facilitate. Social workers must ensure that they do not engage in dual or multiple relationships that may impact on the treatment of clients. Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consectutively. Social workers should be alert to, and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgement. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes clients' interests primary and protects clients' interests to the greatest extent possible. In some cases, protecting clients' interests may require termination of the professional relationship with proper referral of clients. Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests. Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to a client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropraite, and culturally sensitive boundaries. Test-Taking Strategies Applied: The case scenario suggests that a former client would like to enter into a new relationship with a social worker. While this new relationship is professional in nature, it still reflects the existence of a dual relationship. While perhaps not readily apparent, the former client may be harmed by this relationship with the social worker. For example, the client may need treatment again in the future. Being a co-facilitator with the social worker would preclude them from providing services, thereby eliminating the availability of a clinical support for the former client if neeed. In addition, the client may personalize or feel that examples provided by the social worker during group sessions relate to their own service provision. While the former client is not currently receiving services from the social worker, dual or multiple relationships can occur consecutively such as described in the case scenario. Co-facilitating, even for a short time, would be inappropriate. In addition, assisting the former client in preparing for the group is also prolematic. The former client may experience anxiety during this process and confuse the social worker's support with a therapeutic alliance. It is best for the social worker to keep involvement, even encouragement, to a minimum.

What is considered best practice in treating pregnant women who are addicted to heroin? A. Continued use of heroin under medical supervision B. Discontinuation of all opioids immediately C. Participation in intensive therapy and social support D. Enrollment in a methadone maintenance program

D. Enrollment in a methadone maintenance program. When addiction and substance abuse occur during pregnancy, it can have effects not only on the pregnant mother, but also in the unborn child. Opioid use in pregnancy is associated with an increased risk of adverse outcomes. The current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone. Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant women can result in preterm labor, fetal distress, or fetal demise. After birth, special considerations are needed for women who are opioid-dependent to ensure appropriate pain management, to prevent postpartum relapse and a risk of overdose, and to ensure adequate contraception to prevent unintended pregnancies. Stabilization with opioid-assisted therapy is compatible with breastfeeding. Neonatal abstinence syndrome is an expected and treatable condition that follows prenatal exposure to opioid agonists. The rationale for opioid-assisted therapy during pregnancy is to prevent complications of illicit opioid use and narcotic withdrawal, encourage prenatal care and drug treatment, reduce criminal activity, and avoid risks to a client of associating with a drug culture. Methadone maintenance, as prescribed and dispensed on a daily basis by a registered substance abuse treatment program, is part of a comprehensive package of prenatal care, chemical dependency counseling, family therapy, nutritional education, and other medical and psychosocial services as indicated for pregnant women with opioid dependence. Test-Taking Strategies Applied: This is a recall question which assesses social workers' awareness of the effects of addiction and appropriate treatment protocols. Medically supervised withdrawal from opioids in opioid-dependent women is not recommended during pregnancy because the withdrawal is associated with high relapse rates. During pregnancy, chronic untreated heroin use is associated with an increased risk of fetal growth restriction, fetal death, preterm labor, and other adverse outcomes. Additionally, the lifestyle issues associated with illicit drug use put the pregnant woman at risk of engaging in activities, such as prostitution, theft, and violence, to support herself or her addiction. Methadone is an opioid used to treat pain and as maintenance therapy or to help with tapering in clients with opioid dependence. Thus, discontinuation of all opioids is an incorrect answer. Intensive therapy and social support are benefitical, but not sufficient for treating heroin. Best practice includes medication-assisted treatment for all clients, including pregnant women.

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 generated 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. Social workers must have a 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 sufficient understanding of KSAs related to the use of measurable objectives, subjective and objective data, applying research to prctice, and so on. In addition to being able to understand and explain the meaning of important research terminolgoy, social workers must be viewed in experimental and single-subject research designs.

When social workers engage in peer supervision, the PRIMARY method of learning is: A. Modeling B. Summative evaluation C. Positive reinforcement D. Formative feedback

D. Formative feedback. 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 professional, 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-esplore, 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 feeling sin 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 of 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 stiatuions, 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.

A client who has recently married undergoes genetic testing to learn if she is a carrier of a specific disease given her family history. Upon learning that she is a carrier, the client becomes very upset that the news will impact a future decision to have children. The client is nervous about telling her husband as he is not aware of the testing. In this situation, the social worker should: A. Arrange a joint session with the husband to support the client when she tells him B. Refer the client to a physician to address any medical issues associated with being a carrier C. Work with the client to minimize the anxiety and depression that she is experiencing D. Help the client understand the likelihood of her children having the disease

D. Help the client understand the likelihood of her children having the disease. Human genetics is the study of inheritance as it occurs in humans. Genetic testing can confirm or rule out suspected genetic conditions or help determine clients' chances of developing or passing on genetic disorders. This process can be very stressful for clients and it is important that social workers have knowledge about the benefits, as well as the limitations and risks, of genetic testing. Social workers can help clients weigh the pros and cons of the test and discuss the social and emotional aspects of testing. Every person carries two copies of most genes (one copy from the mother and one from the father). A carrier is a person who has a change in one copy of a gene. The carrier does not have a genetic disease related to the abnormal gene. A carrier can pass this abnormal gene to a child. Carrier identification is a type of genetic testing that can determine whether clients who have a family history of a specific disease, or who are in a group that has a greater chance of having a disease, are likely to pass that disease to their children. Information from this type of testing can guide a couple's decision about having children. For many genetic disorders, carrier testing can help determine how likely it is that a child will have the disease: - If both parents carry the abnormal gene, there is a one-in-four (25%) chance that their child will have the disease and two-in-four (50%) chance that their child will be a carrier of the disease (but will not have it). There is also a one-in-four (25%) chance that the child will not get the abnormal gene and so will not have the disease nor be a carrier. - If only one parent carries the abnormal gene, the child has a one-in-two (50%) chance of being a carrier but almost no chance that they will have the disease. Test-Taking Strategies Applied: The question asks about an appropriate role for a social worker when a client has learned information through genetic testing. The client is a woman who was recently married. It would not be appropriate to meet with the husband as there is no indication, in the case scenario, that the client wants a joint session to occur and the couple is not the client. Additionally, no medical issues have been raised by the client, making a referral to a physician unwanted. While the client is anxious and upset, her feelings may result from not understanding that her children not automatically contract the disease. The client needs information about the potential likelihood that her children would be carriers or have the disease. This information may alleviate some of her fears. Knowing whether the husband is also a carrier is critical information which may not yet be known and/or is not provided in the case scenario. Anxiety and depression are the symptoms, not the root of the problem, which is a lack of understanding. Providing education is a critical social work task when clients are deciding to have genetic testing and interpreting its results.

A mother and her adult son with developmental disabilities meet with a social worker for assistance in helping the young man move into his own apartment. While both the mother and son would like this move to occur, they have concerns as he will need support to meet his daily living needs, as well as attend to ongoing medical issues. The social worker recommends a multidisciplinary team approach to service planning. The FIRST step in this process would be to: A. Complete a biopsychosocial history so that team members have adequate background information for planning B. Determine whether there are professionals known to the family who would be good team members C. Develop a timeline for the problem-solving process to help structure the team's decision making D. Identify areas of anticipated support to ensure that individuals with needed skills and perspectives are identified for the team

D. Identify areas of anticipated support to ensure that individuals with needed skills and perspectives are identified for the team. A multidisciplinary team is a group of individuals from different disciplines, each with unique skills and perspectives, who work together toward a common purpose or goal. The benefits of this approach are well documented. Multidisciplinary teams are often seen as advantageous to clients because they do not have the burden of navigating multiple service systems and communicating to multiple providers who are involved in their care. Test-Taking Strategies Applied: The question contains a qualifying word - FIRST. While more than one response choice may be helpful throughout the process, the order in which they are to occur is critical. The first answer is incorrect as the team should be involved in determining what assessment information is needed and helping to gather it. Additionally, a biopsychosocial history may not be needed or appropriate as the goal is to determine the current and future needs of the young man. The second response choice is also incorrect. While it may be useful to have professionals who have treated the client in the past on the team, identifying actual individuals comes after the unique skills and perspectives needed have been articulated. It is also premature to outline the timeline for moving as the specific goals and objectives which need to be accomplished before the move have not been set. Thus, the third response choice is incorrect. The initial action must be to identify the requisite skills needed. Without knowing what other disciplines need to be represented, a social worker will be unable to understand their role, as well as those of others, on interdisciplinary teams. Central to effective multidisciplinary team approaches is the seeking to establish common ground with other professionals, including commonalities in goals. Professionals should also acknowledge the differences within the field and across other disciplines.

Using a public health model, what would NOT be the resulting action from screening for substance disorders of those in emergency rooms, trauma centers, child protection settings, or other medical or behavior environments? A. No intervention B. Referral to treatment C. Short-term intervention D. Long-term intervention

D. Long-term intervention. Social workers must be well versed in techniques and instruments used to assess client problems. There is evidence that early identification of problematic alcohol or drug use can save lives and reduce costs related to health care and behavioral health care, crime and incarceration, and overall loss of productivity. Thus, Screening, Brief Intervention, and Referral for Treatment (SBIRT) is reimbursable services by the Centers for Medicare and Medicaid Services. SBIRT has been identified as an evidence-based practice by the Substance Abuse and Mental Health Services Administration )SAMHSA) as it matches clients with the appropriate type and amount of services the require, avoiding under- or overtreatment. Screening is the first step in the SBIRT process. Screening is a universal process, meaning that an entire population group is screened for an illness or disease. Screening is different from assessment. Screening is brief, time limited, and intended to simply identify clients with problem alcohol or drug use. In constrast, assessment is a deeper, more thorough process that may take several sessions. Assessment interviews are conducted by substance abuse specialists who consider multiple domains of a client's alcohol or drug use, including risk for withdrawal, medical complications, emotional/behavioral complications, stage of change, relapse potential, recovery environment, legal complications, family systems, and employment history. The result of the screening dictates one of the three clinical responses: no intervention, brief intervention, or referral to treatment. * No Intervention: A screening interview with negative results requires no further action specific to substance abuse intervention or treatment. * Brief Intervetnion: A screening interview that indicates moderate risk requires a brief intervention, or a discussion aimed at raising an individual's awareness of their risky behavior and motivating the individual to change their behavior. Brief interventions are conducted in the community sector, often at the same time and by the same clinician who conducted the screening interview. A key component of brief interventions is to educate clients on safe drinking behavior, as well as the phsycial, social, and familial consequences of alcohol and drug use. * Referral to Treatment: A screening interview that indicates severe risk of dependence requires a referral to a specialized alcohol and drug treatment program for comprehensive assessment and treatment. It is insufficient to simply give a client the name and number of an alcohol and drug treatment program. Instead, it is best for social workers to make an appointment with the client and follow up to be sure the client follows through. Recommendations from a substance abuse assessment may include one or more of the following interventions: detoxification, short-term residential treamtnet, long-term residential treatment (such as a half way house or therapeutic community), outpatient treamtnet, day or evening treatment, medications, and/or group treatment. Test-Taking Strategies Applied: The question contains a qualifying word - NOT - the requires social workers to select the response choice, which is not "the resulting action taken from screening". When NOT is used as qualifying word, it is often helpful to remove it from the question and eliminate the three response choices which are resulting actions. This approach will leave the one response choice which would NOT result from screening. Social workers need to be aware of screening models used in public health which identify people in large populations who need further assessment. It would be unlikely that clients would receive long-term treatment directly after being screened. Further information about the scope and severity of the problem would be needed if issues were detected. Short-term intervention and referrals to treatment would yield data to justify long-term treatment if needed. Social workers seek to serve clients in the least restrictive and intensive environments possible.

A client reports that she is very upset by her 17-year-old daughter's behavior. She has not been completing her homework and is showing up late for her classes. The client reports that she recently took away her daughter's cell phone until her behavior changes. Which of the following behavioral techniques is the mother using? A. Positive reinforcement B. Negative reinforcement C. Positive punishment D. Negative punishment

D. Negative punishment. Operant conditioning attempts to understand complex human behavior without studying the internal mental thoughts and motivations. B.F. Skinner based his theory of conditioning on the preexistent theory called "Law of Effect", or the belief that responses that produce satisfying effects become more likely to occur again and responses that produce discomforting effects become less likely to occur again. Punishment has as its objective to decrease the rate of certain undesired behavior from occurring again. Punishment can be further classified into two major pats - positive and negative. Positive punishment focuses on decreasing the undesired behavior by presenting negative consequences once undesired behavior has been exhibited. When subjected to negative consequences, individuals are less likely to repeat the same behavior in the future. Negative punishment focuses on undesired behavior by removing favorite or desired items. When desired stimuli are removed, there is less chance of the behavior occurring again in the future. Reinforcement aims to strengthen or increase behavior frequency. Positive reinforcement increases the iikelihood that behavior will occur again in the future by pairing it with desirable stimuli (reinforcers). Negative reinforcement increases the probability that behavior will occur again in the future by removing negative stimuli. Test-Taking Strategies Applied: This is a recall question which relies on social workers understanding various operant conditioning techniques. Negative punishment is when a desirable stimulus is removed following an undesirable behavior for the purpose of decreasing or eliminating the behavior. In the case scenario, the client takes away her daughter's cell phone (a desirable stimulus) with the desire to decrease her homework incompletion and tardiness (targeted behaviors).

When is family therapy best introduced in the treatment of clients with Substance Use Disorders? A. Concurrently with clients' acknowledgements that substance use problems exist B. When there is a recognition by clients that there is family dysfunction C. Immediately after clients complete detoxification D. Once clients are stable in their new pattern of behavior

D. Once clients are stable in their new pattern of behavior. Family therapy is based on the idea that a family is a system of different parts. A change in any part of the system will trigger changes in all the other parts, so when one member of the family is affected by a Substance. Use Disorder, everyone is affected. As a result, family dynamics can change in unhealthy ways. Some family members may take on too much responsibility, other family members may act out, and some may just shut down. Often a family remains stuck in unhealthy patterns even after the family member with the behavioral health disorder moves into recovery. Even in the best circumstnaces, families can find it hard to adjust to the person in their midst who is recovering, who is behaving differently than before, and who needs support. Family therapy can help the family as a whole recover and heal. Family therapy is typically introduced after the individual in treatment for addiction has made progress in recovery. This could be a few months after treatment starts, or a year or more later. Timing is important because people new to recovery have a lot to do. They are working to remain stable in their new patterns of behavior and ways of thinking. They are just beginning to face the many changes they must make to stay mentally healthy, as well as remain clean or sober. They are learning such things as how to deal with urges to fall into old patterns, how to resist triggers and cravings, and how to avoid temptations to rationalize and make excuses. For them to explore family issues at the same time can be too much. It can potentially contribute to relapse. Family therapy tends to be most helpful once the person in treatment is fully committed to the recovery process and is ready to make more changes. Test-Taking Strategies Applied: Social workers must understand family roles in addiction and codependency. Addiction is a "family affair"; therapy with the entire family involves understanding the roles that members assume which are dysfunctional and support the addictive behavior. However, it is important that clients have made progress in their recovery before taking on additional stress, which comes with understanding family roles in families impacted by addiction. Cients, acknowledgement of their addictions and family dysfunction, as well as detoxification - if needed - would come prior to the onset of family therapy. Clients may not yet be stable in their new patterns of behavior. This question contains a qualifying word - best - even though it is not capitalized. There may be reasons for engaging in family therapy earlier or later in the recovery process, but it is most beneficial after individual progress has been made by clients. Only the correct answer describes this progress.

When making a determination of the needed level of care for an older adult client who will be moving from home into a residential setting, it is MOST helpful to assess the ability to: A. Adapt to life changes B. Manage medical problems C. Complete cognitive tasks D. Perform activities of daily living

D. Perform activities of daily living. Many programs use the ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as eligibility criteria to determine eligibility and/or level of care. Whether or not clients are capable of performing these activities on their own or if they rely on family caregivers to perform the ADLs can serve as a comparative measure of their independence. Assessments can help with determining assistance needed. Measuring a client's ability to perform the ADLs and IADLs is important not just in determining the level of assistance required, but as a metric for a variety of services and programs related to caring for older adults and for those with disabilities. Many state-funded, non-Medicaid programs use an inability to perform two or three ADLs as one of the eligibility criteria for participation in their assistance programs. Medicaid often requires older adults to be qualified for nursing home care, and nursing home care qualification can be determined by how much assistance one requires for ADLs. Long-term care insurance often uses an inability to perform the ADLs as a trigger for paying out on a policy. Social Security Disability Insurance (SSDI) also considers ADLs as a qualification factor. ADLs are activities in which clients engage on a day-to-day basis. These are everyday personal care activities that are fundamental to caring for oneself and maintaining independence. There are many variations of the definition of the ADLs but most organizations agree there are five basic categories: - Personal hygiene - bathing, grooming, and oral care - Dressing - the ability to make appropriate clothing decisions and physically dress oneself - Eating - the ability to feed oneself though not necessarily to prepare food - Maintaining continence - both the mental and physical ability to use a restroom - Transferring - moving oneself from seated to standing and getting in and out of bed IADLs are activities related to independent living. The instrumental activities are more subtle than ADLs. They can help determine with greater detail the level of assistance required. The IADLs include: - Basic communication skills - such as using a regular phone, mobile phone, email, and the Internet - Transportation - either by driving oneself, arranging rides, or the ability to use public transportation - Meal preparation - meal planning, preparation, storage, and the ability to safely use kitchen equipment - Shopping - the ability to make appropriate food and clothing purchase decisions - Housework - doing laundry, cleaning dishes, and maintaining a hygienic place of residence - Managing medications - taking accurate dosages at the appropriate times, managing refills, and avoiding conflicts - Managing personal finances - operating within a budget, writing checks, paying bills, and avoiding scams Test-Taking Strategies Applied: The question contains a qualifying word - MOST. While it may be useful to assess all areas listed, level of care is primarily determined by the amount of help that the client needs to complete necessary personal assistance and independent living tasks. Adapting to life changes may be important to the client's ability to adjust to their new home, but will not directly relate to "making a determination of the needed level of care". Managing medical problems may also need to be addressed. However, such assistance can be done by care management in the setting. Lastly, while cognition is related to self-care abilities, performing the tasks is also based on mobility or the ability to move upper or lower extremities in order to complete them. Thus, assessing cognitive tasks will not give a complete picture of assistance needed.

What is the MOST critical factor in the selection of an appropriate intervention? A. Available resources B. Past service history C. Agency setting D. Presenting problem

D. Presenting Problem. Effective interventions depend on using the most appropriate theory and practice strategies for a given problem or situation. Different theories/interventions are best suited for different problems. Evidence-based practices (EBPs) are treatments that have been proven effective (to some degree) through outcome evaluations. EBPs are interventions that have strong scientific proof that they produce positive outcomes for certain types of disorders. Clearly defining problems will help rationalize the implementation of EBPs and help inform the selection process. Other interventions - sometimes labeled promising practices - may also produce good outcomes, but research has not been conducted at a level to say that there is strong evidence for those practices. As such, EBPs are treatments that are likely to be effective in changing target behaviors if implemented with integrity. The selection of an EBP depends on client problems, the outcomes desired, and treatment preferences. For example, both antidepressant medications and psychotherapy interventions are effective in the treatment of depression in older adults. The choice of one of these interventions over the other may vary with respect to the nature and severity of depression, the presence of other health conditions or medicatolerability of side effects or required effort, and the preferences and personal values of older adults regarding these treatment characteristics. Test-Taking Strategies Applied: The question contains a qualifying word - MOST - that indicates that all response choices may be considered, but the correct answer is the factor which must drive this decision. Treatment modalities differ depending upon presenting problems. Social workers should not limit available options to clients based on available resources, past history, and/or setting. EBPs which have demonstrated that they are effective for problems at hand must be used. Social workers can advocate for additional resources or refer clients to settings which provide the appropriate treatment if it is not available in the current setting. In addition, treatment decisions should not be based predominantly on what has been done in the past. Interventions can be very effective to address some problems and useless in helping others. Thus, matching EBPs/interventions to presenting problems is vital to ensuring that change will occur.

A social worker at an outpatient program observes a court-mandated client who is being treated for Alcohol Use Disorder become outraged during a group session when leniency for those arrested for addiction-related offenses is discussed. The client states that severe punishment, as opposed to treatment options, must be required. This behavior surprises the social worker as the client has repeatedly expressed his appreciation for being offered treatment in lieu of impresonment. Based on this behavior, the social worker feels that the client is MOST likely using which of the following defense mechanisms? A. Denial B. Projection C. Displacement D. Reaction formation

D. Reaction formation. Defense mechanisms are unconscious process that protect clients from unacceptable or painful ideas or impulses. Denial involves blocking external events from awareness. If some situation is just too much to handle, a client may refuse to experience it. It is a primitive defense, operating by itself or, more commonly, in combination with other, more subtle mechanisms that support it. Projection involves clients attributing their own thoughts, feelings, and motives to others. Thoughts most commonly projected onto another are the ones that would cause guilt. For instance, a client might hate someone, but his or her superego tells him or her that such hatred is unacceptable. Thus, the client solves the problem by believing that the other person hates him or her. Displacement is the redirection of an impulse (usually aggression) onto a powerless substitute target. The target can be a person or an object that can serve as a symbolic substitute. A client who is frustrated by their superiors on the job may go home and kick the dog or yell at a family member. Reaction formation is actually a mental process, transforming anxiety-producing thoughts into their opposites in consciousness. A client goes beyond denial and behaves in the opposite way to which they think or feel. By using reaction formation, the id is satisfied while keeping the ego in ingornatce of the true motives. In short, reaction formation means expressing the opposite of inner feelings in outward behavior. Test-Taking Strategies Applied: The question contains a qualifying word - MOST. While the client may be using more than one of the defense mechanisms listed, it is likely the behavior constitutes reaction formation. There is no evidence that the client denies having an Alcohol Use Disorder or fails to recognize the implications of this disorder, which are both indications of denia. The client's actions go beyond denial as the client is engaging in actions, outrage, and advocacy, which are counter to his inner beliefs of appreciation for his own mandated services.

A social worker meeting with a 10-year-old boy and his mother notices what appear to be burns on the boy's legs. After the social work asks about the markings, the mother provides an explanation that does not seem plausible. The social worker suspects that the burns resulted from physical abuse in the home. In this situation, the social worker should: A. Contact authorities without disclosing the suspicions to the mother or child B. Question the child alone to determine who is the perpetrator of the abuse C. Ask the mother for evidence to support her explanation D. Report the suspicions to the authorities with the mother and child present

D. Report the suspicions to the authorities with the mother and child present. The 2008 NASW Code of Ethics provides standards with regard to confidentiality, including the process for disclosing information as a result of mandatory reporting. Social workers should respect clients' right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply. Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client. Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the amount of confidential ifnoramtion necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed. Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent. Test-Taking Strategies Applied: The case scenario calls for reporting the suspicions to the child protection agency (referred to as the authorities in the question). The social worker does not need to prove that the abuse is occurring or identify the perpetrator. The child protection agency is responsible for doing the investigation. While two answers include reporting the suspicions, only the correct one involves informing the clients about the disclosure and the information which needs to be legally released without the clients' consent. Informing clients - or even involving them in the process - is required, when feasible, according to the 2008 NASW Code of Ethics.

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 to keep the disclosure confidential

D. Respect the client's wishes to keep the disclosure confidential. 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 protection afforded to survivors of sex-related crimes may also not be known. However, even with much 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 doe snot 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 may also have a negative impact on the social worker/client relationship as the client may feel betrayed by the disclosure. From a justice perpsecitve, 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 not longer a minor. If it were reuiqred, 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.

Which of the following disorders is listed as an Anxiety Disorder in the DSM-5? A. Obsessive-Compulsive Disorder B. Acute Stress Disorder C. Posttraumatic Stress Disorder D. Separation Anxiety Disorder

D. Separation Anxiety Disorder. Anxiety Disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Fear is more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety is more often associated with muscle tension and vigilance in preparation for future dan and cautious or avoidant behviors. Panic attacks are a type of fear resposne. Panic attacks are not limited to Anxiety Disorders, but rather can be seen in other mental disorders as well. In the DSM-5, changes were made to the chapter on Anxiety Disorder, representing both additions and deletions. Obsessive Compulsive Disorder (OCD), which was listed as an Anxiety Disorder in the DSM-IV, was moved into its own chapter with Hoarding Disorder (a new disorder), Trichotillomania (hair-pulling), and so on. Acute Stress Disorw was also moved - into a chapter with Trauma- and Stressor-Related Disorders, which includes Posttraumatic Stress Disorder. Such removals resulted from a scientific review that concluded that these disorders were not characterized by the presence of anxiety. In the DSM-IV, Separation Anxiety Disorder was included in a chapter with other disorders that are first diagnosed in infancy, childhood, or adolescence. However, its listing as an Anxiety Disorder is the DSM-5 is based on scientific evidence that links it with other disorders, such as Selective Mutism, Specific Phobia, Social Anxiety Disorder, Agoraphobia, and so on. Test-Taking Strategies Applied: This is a recall question which relies on social workers knowing the DSM-5 and its diagnoses. Social workers should expect to get as many as eight or so such questions. When studying for the examination, social workers do not need to memorize all of the diagnostic criteria, but should know the defining or distinguishing feeilngs, thoughths, and behaviors associated with each disorder. Also, questions may ask about groupings of disorders - such as those which are Neurodevelopmental, Psychotic, Depressive, and so on. Thus, being able to recall in which chapter particular disorders are listed can be helpful, such as is the case in this question.

A social worker, who is counseling a couple, learns that the husband has been recently diagnosed with a rare medical condition that is being treated with medication. The wife reports that this medication causes dramatic mood changes, which she has witnessed. Due to the lack of knowledge about this medical condition and the medication prescribed, the social worker contacts a physician for consultation. The social worker's action is based on which of the following concepts? A Interdisciplinary collaboration B. Coordinated service delivery C. Team building D. Standard of care

D. Standard of care. Relying on the expertise of other professions when needed can reduce major liability risks for social workers. For example, in situations which require medical or other expertise, social workers should look to obtain appropriate guidance from others or else clients may be harmed. If such consultation does not occur, social workers breach standards of care through acts of omission (not acting when they should have done so). Under the common law doctrine of standard of care, courts usually seek to determine what a typical, reasonable, and prudent (careful) social worker with the same or similar education and training would have done under the same or similar conditions. In many instances, establishing the standard of care is easy. But in other instances, it is not easy to establish what constitutes ordinary, reasonable, and prudent practice. Well-educated, skilled, thoughtful, and careful social workers may disagree with colleagues about the best course of action in complex circumstances, perhaps because of their different schools of though, training, and experience. Test-Taking Strategies Applied: In the case scenario, the social worker has "a lack of knowledge about this medical condition and the medication prescribed", which is causing dramatic mood changes in the client. Thus, the social worker has an ethical responsibility to learn more through consultation with an appropriate medical professional. Failure to seek consultation may adversely affect the client. The reason for the contact is for the social worker to learn more a the medical condition and medication. The social worker is not collaborating, which is defined as working with another to produce or create something. Joint work both the social worker and physician is not occurring. There is also no indication that the physician is the treating medical professional of the husband, so the social worker's action is not an effort to enhance coordination of services. Similarly, the social worker and physician are not part of a team so the action is not aimed at team building

Which of the following documentation practices of supervisory sessions is MOST appropriate in social work? A. Supervisory records should solely be maintained by supervisors as they are legally responsible for the delivery of services by supervisees. B. No records should be kept by either supervisess or supervisors in order to maintain client confidentiality. C. Supervisees must maintain records of supervision sessions for licensing and other regulatory bodies. D. Supervisess and supervisors should maintain separate records of each session with both parties being able to access the other's notes as needed.

D. Supervisees and supervisors should maintain separate records of each session with both parties being able to access the other's notes as needed. Supervision is an essential and integral part of training and continuing education required for the skillful development of professional social workers. The knowledge base of the social work profession has expanded and the population it serves has become more complex. Supervision protects clients, supports practitioners, and ensures that professional standards and quality services are delivered by competent social workers. It is important to the profession to have assurance that all social workers are equipped with the necessary skills to deliver competent and ethical social work services. Equally important to the profession is the responsibility to protect clients. Documentation is an important legal tool that verifies that services, including supervisio, occurred. Supervisors should assist supervisees in learning how to properly document client services performed, regularly review their documentation, and hold them to high standards. When appropriate, supervisors should train the supervisees to document for reimbursement and claim submissions. Each supervisory session should be documented separately by supervisors and supervisees. Documentation for supervised sessions should be available to both parties and provided to superviees within a reasonable time after each session. Social work regulatory boards may request some form of supervision documentation when supervisees apply for licensure. Records should be safeguarded and kept confidential. Test-Taking Strategies Applied: The question contains a qualifying word - MOST. Supervisors are responsible for the actions of supervisees, but records should not only be kept by them. Failure to keep any documentation of supervision sessions is ill advised as information used to make critical treatment decisions will not be recorded. It is true that licensing entities may require supervision notes, but the correct answer describes the "MOST appropriate" documentation practice, namely that both supervisees and supervisors should maintain separate records.

A social worker is reviewing referral information for a new client which identifies him as zenophobic. In order to address this fear, services should focus on: A. Exploring the benefits of his interaction with those who are younger B. Educating him about the importance of injecrtions, especially for required vaccinations C. Managing the anxiety which results from his physical contact with others D. Understanding his aversion to those from other countries and their cultures

D. Understanding his aversion to those from other countries and their cultures. Xenophobia is a severe aversion to foreigners, strangers, their politics, and their cultures. Often, the term "xenophobia" is used interchangeably with racism, yet the two are actually different. While racism defines prejudice based solely on ethnicity, ancestry, or race, xenophobia covers any kind of fear related to differences in culture, race, and/or ethnicity, as well as other ways of being different. Those with xenophobia do not understand or accept that their condition is based on fear, yet is is the perceived threat of losing one's own identity, culture, and imagined superiority or purity that is the cause. If left untreated, xenophobia can have seriously detrimental effects. An individual who is xenophobic is liable to pass along their highly generalized and ungrounded perceptions to children and family members.. Some symptoms of a xenophobic person include: - Feelings of fear or dread when exposed to people or cultural items perceived to be different - Apparent hostility toward people or cultures perceived to be different - Distrust aimed specifically toward cultures perceived to be different - Rash generalizations and stereotypes aimed at a set of people based on superficial qualities Like all phobias, there is no universally specific cause that leads to the development of xenophobia. It can be caused by unique experiences or can simply be the result of alienation from people and cultures different than one's own. Like many phobias, treatment focuses on first targeting the initial inciting factor that caused the irrational and extreme fear. Therapy includes talking about why the fear was unfounded and addressing any traumatic experiences that caused the phobia, as well as identifying ways to deal with symptoms. Sometimes behavioral techniques are used to systematically and gradually confront the source of fear and learning to control the physical and mental reactions to it. By facing the phobia directly, it is possible to realize that fears are not grounded in real or imminent danger. Test-Taking Strategies Applied: This is a recall question which relies on social workers understanding terminology related to cultural competence and its barriers. Social workers should promote conditions that encourage respect for cultural, racial, and/or ethnic diversity and promote policies and practices that demonstrate respect for differences; support the expansion of relevant knowledge and resources; advocate for programs and institutions that demonstrate cultural, racia, and/or ethnic competence; and promote policies that safeguard the rights of all people. If the definition of xenophobia is not known, it may be possible to narrow the choices through eliminating other answers. Ephebiphobia, also known as hebephobia, is the fear of young people or teenagers. Trypanophobia is the fear of needles which can lead to potential health issues, especially when important vaccines and medications that require injections are refused. Mysophobia, also known as germophobia,, is a common fear of general contamination which can lead to extreme anxiety of contact with others.

When social workers contract with supervisors who are not employed in their agencies, all of the following documents are necessary EXCEPT: A. Contractual agreements between social workers, supervisor, and agencies B. Authorization by agency decision makers allowing supervisors to provide clinical supervision C. Monthly progress reports prepared by supervisors D. Verification from regulatory bodies that disciplinary action has not been taken against supervisors

D. Verification from regulatory bodies that disciplinary action has not been taken against supervisors. Social workers must be aware of the models of supervision and consultation, including that provided via contract. In situations in which an agency may not have a clinical supervisor who meet the qualifications of a supervisor, a social work supervisee may contract for supervision services outside the agency. Supervisee should contact the regulatory board in their jurisdictions in advance of contracting to confirm if such as practice is permitted and conform the documentation required from the supervisor. The time frame required for the supervision period should also be verfiied. Contracting for "outside supervision" can be problematic and place a supervisor at risk. If the supervisee is paying for the services, they can dismiss the supervisor, especially if disagreements or conflicts arise. In addition, the supervisor may encounter conflicts between the supervisee and the agency. Development of a contractual agreement among the social worker, the supervisor, and the employing agency is essential in preventing problems in the supervisory relationship. The agreement should clearly delineate the agency's authority and grant permission for the supervisor to provide clinical supervision. Evaluation responsibilities, periodic written reports, and issues of confidentiality should also be included in the agreement. Supervisors and supervisees should also sign a written contract that outlines the parameters of the supervisory relationshiop. Monthly written progress reports prepared by the supervisor should be required and, if appropriate, meet the standards established by the state licensing board for supervision related to licensing. Test-Taking Strategies Applied: The question contains a qualifying word - EXCEPT - that requires social workers to select the response choice which is not a requirement when supervision is contractual. While it is always good to understand the practice histories of supervisees, including actions taken by licensing boards against them, before hiring and entering into contractual relationships, it is not necessary. Social workers may still choose to be supervised by supervisors who have had licensing infractions. The other three response choices directly relate to the parameters of the contracted relationships and/or monitoring the actions of social workers through progress reporting in order to ensure that client services are not compromised by these arrangments.