SOCIAL WORK MSW EXAM FLASH CARDS

Dialetical Behavioral Therapy

DBT is a treatment approach developed by Marsha Linehan and is used primarily with clients with Borderline Personality Disorder. DBT is a combination of CBT and behavioral therapy and incorporates mindfulness as a critical component of treatment. Two required parts of DBT are individual therapy with a focus on skill building and weekly group therapy. The four modules of DBT are: 1) Mindfulness, 2) Interpersonal effectiveness 3) Distress Tolerance and 4) Emotion regulation.

Sexual Dysfunctions--Delayed Ejaculation

Delayed Ejaculation is characterized by a marked delay in ejaculation or marked infrequency or difficulty in maintaining an erection until completion of sexual activity or a marked decrease in erectile rigidity. Delayed Ejaculation can interfere with fertility and affect self-esteem and results in significant distress or interpersonal conflict.

Neurocognitive Disorders--Delirium

Delirium disorders are characterized by significant decline in cognition caused by either the direct effects of a substance or toxin or a medical condition, or both. the substance or medical condition is provided as part of the diagnosis. Delirium is a disturbance in the level of consciousness with concomitant changes in cognition. The onset is over a brief time period and often clears when the condition relents with particular impairment in attention. 1) Delirium due to a general medical condition; 2) substance-induced delirium; Delirium due to Multiple Etiologies; and, 4) Delirium NOS. Treatment for Delirium involves determining and treating the underlying cause.

Personality Disorders--Dependent Personality Order

Dependent Personality Disorder is characterized by an extreme need to be take care of which leads to submissive behavior and clinginess as well as fear of separation. It is more common in females. Common symptoms of Dependent Personality Disorder include: 1) an excessive need for advice and reassurance when faced with decisions; 2) the needs for others to take responsibility for much of the individual's life; 3) a tendency to express agreement with others even when in disagreement because of the fear of losing approval and support; 4) trouble taking on projects, especially independent projects because of low self-confidence; 5) volunteering for unpleasant tasks frequently to gain nurturance and support of others; 6) discomfort with being alone because of fear of not being able to take care of oneself; 7) seeking to fill a gap created by a long lost relationship by urgently seeking a replacement relationship; and, 8) preoccupation with situations that require independent care for self. Medications should only be prescribed for other disorders and with caution. Sedative drug abuse and overdose are common with individuals with Dependent Personalty Disorders. The most effective therapeutic treatment focuses on solutions and specify life problems of the individual. Termination issues will be of extreme importance. The focus of treatment should be the following: ambivalence, catastrophic thinking, lack of initiation, passive control of others, placing too much emphasis on others' opinions.

Dissociative Disorders--Depersonalization/Derealization Disorder

Depersonalization/Derealization Disorder is characterized by episodes of depersonalization (ie a sense of being detached from one's body or. mental processes) and/or derealization (feelings of unreality or of being detached from the environment) while reality testing remains intact. SSRIs have shown some effectiveness in treating Depersonalization/Derealization Disorder. Psychotherapy is not effective in treating Depersonalization/Derealization Disorder. The most viable options are stress management strategies, distraction techniques, reduction of sensory stimulation, relaxation training and physical exercise in some patients.

Trauma and Stressor Related Disorders--Disinhibited Social Engagement Disorder

Disinhibited Social Engagement Disorder is characterized as a disruption in a child's normal attachment behavior. It is the result of grossly negligent parenting and maltreatment. The child engages in an inappropriate behavior pattern where he/she actively approaches and interacts with unfamiliar adults, violating cultural boundaries. The child doesn't check back with adult caregivers and will go off with an unfamiliar adult with no hesitation. Must be diagnosed at at least 9 months of age. Medications not recommended unless depression, anxiety or ADHD are also present. Treatment includes parenting skills (attachment and behavioral catch-up), family therapy, individual counseling, psycho-education, special ed services and residential or inpatient treatment for children with more serious issues or who put themselves at risk for harm.

Depressive Disorders--Disruptive Mood Deregulation Disorder

Disruptive Mood Deregulation Disorder is characterized by chronic, severe, persistent irritability. The diagnosis cannot be made before the age of 6 and after the age of 18. The typical age for onset is age 10. Children with Disruptive Mood Deregulation Disorder have frequent outbursts that are grossly out of proportion in intensity or duration for the situation and are not consistent with the child's developmental level. Outbursts occur regularly and the child is consistently irritable. Symptoms must persist for at least 12 months and be present in at least two settings. CBT and Behavior Therapy are essential components of psychosocial intervention and SSRIs may be used if depression and anxiety are present. If symptoms are more similar to bipolar disorder, then atypical antipsychotic agents and mood stabilizers might be considered first. Disruptive Mood Deregulation Disorder is a relatively new diagnosis so treatment and medication options are still under investigation.

Dissociative Disorders: Dissociative Amnesia

Dissociative Amnesia is characterized by an inability to remember information of a personal nature (typically associated with a traumatic or stressful event) on one or more occasions. Symptoms cause clinically significant impairment or distress. When there is purposeful travel or bewildered wandering that is associated with amnesia or other important personal information, then the specifier "with dissociative fugue" is used. There are no specific medications to treat Dissociative Amnesia. Individuals with Dissociative Amnesia frequently have comorbid disorders of mood and anxiety and can be treated with medications associated with these symptoms. Many cases of Dissociative Amnesia resolve spontaneously when the individual is removed from the stressful situation. The treatment of choice for Dissociative Amnesia is Cognitive Therapy with augmentation by hypnosis or drug-facilitated interview. Group psychotherapy has also been shown to be beneficial. Hypnosis is helpful but not necessary for recovery of historical material or for dealing with material that has been recovered.

Dissociative Disorders

Dissociative Disorders are characterized by a disruption in one or more of the following: consciousness, memory, identity or perception. The disruption can be gradual or sudden, transient or chronic. Symptoms of Dissociative Disorders are frequently caused by trauma. The disruption is not caused by a medical condition or substance.

Dissociative Disorders--Dissociative Identify Disorder

Dissociative Identity Disorder is characterized by the presence of two distinct identities that alternately take control of an individual's behavior accompanied by extensive forgetting of personal information. Dissociative Identity Disorder is generally a result of a traumatic experience(s) in which dissociation is a defense mechanism. The symptoms are not the result of a medical condition or substance. Antidepressants are effective in managing depression, mood stabilization and PTSD symptoms. Some antipsychotic medications have been effective in managing overwhelming anxiety and intrusive PTSD symptoms. Psychotherapy is norally used for Dissociative Identity Disorder. Type of psychotherapy varies with the goal of moving the individual to toward better integrated functioning through safety stabilization and symptoms reduction; working in depth and directly with trauma memories and integration and rehabilitation. Some treatments used for DID are controversial, such as hypnosis.

Range and Expertise of Professions Other than Social Work

Educational System--guidance counselor, school teacher, special education teacher; Medical and Health Professionals--nurse, occupational therapist, physical therapist; Social and Community Services--CPS worker, Case worker, Child Welfare/Placement Caseworker, Family Caseworker, Social Services Aid. (some social workers do case work but not all case workers are social workers). (child welfare placement caseworkers are also not all social workers) Psychiatric, Behavioral, Health and Development--psychiatrist, child psychologist, counseling psychologist, educational psychologist, school psychologist, substance abuse counselor, licensed professional counselor (LPC) Justice System/Corrections--Correctional treatment specialist (provides casework services to those who are incarcerated), corrections officer, police officer, probation/parole officer--probation officers are also called community supervision officers supervise people who have been put on probation; parole officers supervise offenders who are on parole; probation officers who work with youth exclusively are also called after care officers Vocational/Employment--employment counselor vocational guidance counselor, Human Resources advisor, vocational rehabilitation counselor, vocational training teacher the most common manner in which behavioral health professionals coordinate care is through professional communication. Face to face case consultation meetings between professionals in most circumstances--teleconference meetings, phone calls, and emails are often used to supplement coordination process -remember to be mindful of privacy laws and considerations

Couples' Theory and Therapy--Ego Analytic Couples' Therapy (Fenchiel, Gray, Apfelbaum, Wile)

Ego Analytic Couples' Therapy fosters the ability of the couple to communicate important feelings. The model proposes that dysfunction originates from the individual's incapacity to recognize and validate sensitivities and problems in the relationship. According to the Ego Analytic Couples' Therapy model, there are two major categories of problems in couple relationships: 1) dysfunction brought into the relationship from early childhood trauma and experiences; and, 2) the individual's reaction to difficulties and sense that he or she is un-deserving because of shame and guilt.

Ego Psychology

Ego Psychology is a school of psychodynamic thought that emphasizes the skills and adaptive capacities of the ego. Ego Psychology theorists identified defense mechanisms (such as repression, regression, projection, reaction formation, displacement, sublimation, denial, introjection, rationalization, and undoing). Ego Psychologists believed that when a conflict arises between the id and superego, the individual experiences anxiety. This anxiety is a signal to the individual (to the ego) to do something to alleviate the anxiety such as to utilize a defense mechanism. As a result, the anxiety is alleviated and the disturbing impulse is kept at bay. Ego-oriented approaches to therapy place greater emphasis on the present than no the past and attempt to increase awareness of and conscious control over behavior. Assessment is holistic, focusing on environmental stressors, accessibility to needed resources, trauma, developmental difficulties and deficits in ego functioning. Two categories of intervention in Ego Psychology include the following: Ego-supportive--interventions that restore, maintain and enhance adaptive functioning (ego mastery or the ability to mediate between basic primary needs of an individual and the higher moral standard). Psychologically-based interventions are helpful and environmentally-based interventions can be useful as the client works to change his environment to change his behavior (ie don't buy cookies for home so don't eat). Treatment focuses on conscious thoughts and feelings. Interventions are more directive and structured and treatment can be either short-term or long-term. Ego supportive interventions are used with clients who have deficits in ego strength, low tolerance for anxiety and poor impulse control. Ego-modifyiing--these interventions involve modification of basic personality patterns . These interventions are psychologically based and are longer term. Treatment focuses on the past and the present, as well as the conscious, preconscious and unconscious. Social workers use positive and negative transference as a tool in therapy. The therapeutic interventions are non directive and use interpretation. Ego-modifying interventions are typically used with those having good ego strength to address maladaptive patterns. The intervention may also be use with individuals with ego deficits and several dysfunctional patterns. Ego psychology is probably the most significant model for social work and clinical expertise in that it deals with mastering stages of development, emphasizes the development of coping behaviors and integrates psychological and social realms.

Couples' Theory and Therapy--Emotionally Focused Therapy--L. Greenberg and S.M. Johnson

Emotionally Focused Couples' Therapy or EFT is well- researched and widely accepted as effective at changing distressed marital relationships. Emotionally Focused Couples' Therapy views emotions and cognition (thinking) as interdependent and that emotion drives interpersonal expression. Emotionally Focused Therapy has origins in Emotions Theory and Attachment Theory. Relationship Distress is believed to be a result of unexpressed and unacknowledged emotional needs. The basic principles of Emotionally Focused Therapy are: --relationships are attachment bonds --partners are seen as coping well given their circumstances --rigid interaction patterns create and reflect absorbing emotional states --emotions are the target and agent of change Change involves a new experience of the old self The social worker employing Emotionally Focused Couples' Therapy helps couples acknowledge, assess and express emotions related to the distress in the relationship and then helps the couple find the underlying emotions that are keeping them stuck in rigid positions and negative interactions. Emotionally-Focused Couples' Therapy is considered to be short-term (8-20 years).

Elimination Disorders--Encopresis

Encopresis is characterized by a pattern of expelling feces voluntarily or involuntarily into places deemed inappropriate (clothing, floor, etc) by an individual who is at least 4 years old. There must be a minimum of one of these episodes each month for at least three months and it can't be due to a medical condition or medication. Specifiers include with constipation, with overflow incontinence and without constipation and without overflow incontinence. It is more common in males. Medication treatment includes daily use of laxatives if constipation is an issue. Otherwise medication is not indicated. CBT can be useful to help child deal with shame/guilt or loss of self esteem. The treatment goal is to. prevent constipation and encourage good bowel habits. Treatment also includes education for child and family about Encopresis and discussion of how tension can be reduced and establishing a non-punitive atmosphere.

Elimination Disorders: Enuresis

Enuresis is characterized by a pattern of urinating in bed or clothing by an individual who is at least 5 years old. Urination must occur at least twice a week over three consecutive months or cause significant distress or impairment. Urination may be voluntary or involuntary. There are three subtypes: nocturnal, diurnal or nocturnal and diurinal. A behavioral approach is commonly used with Enurinesis (reinforcement charts or restricting water before bedtime). Alarm therapy is also helpful. When medication is indicated, desmopressin acetate (DDAVP) is currently the preferred medication.

Couples' Theory and Therapy--Integrative Behavioral Therapy (Neil Jacobson and Andrew Christensen)

(IBCT) or Integrative Behavioral Therapy for couples focuses on the functioning of the couple. The couple's negative interactions are believed to be repetitious, which causes the problems in the relationship. Integrative Behavioral Social Workers help couples improve behavior exchanges, communication and problem-solving skills. Therapy is individualized, flexible and based on specific problems in the relationship. The basic assumptions of Integrative Behavioral Therapy for Couples are: --talking about how a partner feels and thinks about problems is sometimes necessary before the partner can accept them. --most partners can learn ways to alter the negative emotional response they have to problems as well as their partner --most partners can learn new ways to resolve problems and the emotions that come with them-- --couples who learn new skills can be happy and content Integrative Behavioral Couples' Therapy is an empirically validated approach that integrates the twin goals of acceptance and change as positive outcomes for couples in therapy. Integrative Behavioral Couples' Therapy--evocative rather than prescriptive interventions are used; focus is on emotional acceptance as a basis for concrete change; and, it is driven by case formulation which is based on thematic analysis.

Effects of Addiction on the Family System and Other Relationships

1) Family Rules-rules change as family members initially deny or minimize addiction and then spend more time and energy around the addicted person and then avoid confrontation; 2) Emotional Effects: the emotional effects of addiction include stress, anger, guilt, denial and shame. Children may stay away from home because of addicts behavior and may feel deprived of emotional and physical support and may develop an inability to trust others.

Anxiety Disorders--Panic Attack Specifier/Panic Disorder

A panic attack is characterized by a set period of intense fear or discomfort that peaks within ten minutes. At least four of the following symptoms must be present: palpations/pounding/rapid heat beat; sweating; trembling/shaking; shortness of breath or sense of smothering; sense that one is choking; discomfort or pain in the chest area; dizziness/lightheadedness, feeling faint; nausea or abdominal discomfort; fear of dying; depersonalization; derealization (sense of unreality); chills or hot flashes; fear that one is going to lose control or go crazy. Panic Disorder is characterized by a pattern of recurrent panic attacks accompanied by persistent worry or behavioral change. Anxiety symptoms and functional impairment are independent of actual panic attack. Panic attacks are spontaneous/uncued. At least one of the attacks has been followed by one month or more of the following--persistent concern about having additional attacks; worry about the implications of the attack or its consequences, a significant change in behavior related to attacks.

critical incident stress management (CISM)

A process that confronts the responses to critical incidents and defuses them, directing the emergency services personnel toward physical and emotional equilibrium. CISM was developed by Jeffrey T. Mitchell, PhD, in response to traumatic events and the psychological effects on first responders. This model has been adapted for use with the general population. The premise of CISM is that most stress-related symptoms are transitory with no long-term detrimental effects. The model has both counseling and educational components. CISM starts with on-scene management (defusing) where observers watch for stress and take action to mitigate stress. Critical Incident Stress Debriefing (CISD) is a specific, 7-phase, small group intervention process that is conducted 24-72 hours after the incident in which participants talk about their experience and the positive and negative emotions associated with it. The group leader normalizes reactions and teaches stress response strategies. If individuals need additional help, they are referred to mental health service providers. Further research is needed on the effectiveness of CISD.

Confidentiality and Privileged Communication Legal and Professional Considerations--Subpoenas

A subpoena is a lawfully issued mandate that compels the social worker to appear in court as a witness or to release specific documents to the court. A subpoena is used by prosecuting and defense attorneys to gather information that has a bearing on an individual's legal case. Social workers must respond to subpoenas--either by complying or objecting--even though subpoenas are not court orders, they are commands and must be responded to. Social worker should read subpoena, contact client and review with client and ask client to sign a release of information. If client refuses, social worker may not release. Social workers should always take into consideration the best interests of the client when responding to a subpoena. Social workers do not need to release any information that is not directly related to the case or that could cause the client harm. Social workers should always refer to the NASW Code of Ethics and to the HIPPA Privacy Act when considering the release of confidential information. It may be prudent to seek legal counsel. A court order, rather than a subpoena, must be followed by the social worker--otherwise, there may be legal consequences.

Cognitive Behavioral Therapies--Cognitive Therapy Aaron Beck

Aaron Beck, who was trained in psychoanalysis, believed that depression was a bias of negative thought and that most mental illnesses were baed on pervasive negative thoughts. For example, depression is a negative view of oneself; anxiety disorder is a sense of psychological or physical danger, etc. Beck identified common thinking disorders: 1) All or nothing or dichotomous or black and white thinking; 2) emotional reasoning--ie an individual believes something is true because of strong feelings and ignores evidence to the contrary; 3) Overgeneralization--individual arrives at broad principles based on minimal information; 4) Magnification/Minimization--magnify the negative and minimize the positive in evaluations of self and others; 5) Personalization--person A erroneously believes that the negative behavior of person B is the result of something person A has done; 6) Catastrophizing--believing that the worst will happen; 7) Mind reading--individual assumes he/she knows another person's thoughts on an issue. In Aaron Beck's Cognitive Therapy, the patient's problems are continually defined in cognitive terms. Therapy requires the formation and maintenance of a good therapeutic alliance, where therapy is collaborative effort between the social worker and client. Therapy is goal-oriented and problem-focused. The focus is primarily on the present and has a large educational component. Cognitive Therapy is time-limited, adheres to a relatively strict structure and emphasizes relapse prevention. The client is taught how to identify, evaluate and change dysfunctional thoughts and beliefs. Cognitive Therapy uses techniques from a number of therapeutic techniques, including Behavior Therapy, Gestalt, etc. Cognitive Methods include: 1)Collaborative Empiricism--client and social worker work in tandem to test the validity of the client's beliefs; 2)Socratic Dialogue--use of questions to lead the individual to discover a reality 3)Guided Discovery--interventions are structured, including the use of a progression of questions, to enable clients to discover inaccuracies in their thinking; 4)Decatastrophizing--help clients see that events are really not the end of the world, even if they are relatively difficult 5)Reattribution Training--identification of cognitive errors and distortions in thinking followed by the consideration of alternative beliefs 6) Decentering--helping the client break patterns of self as the reference point for all life events

Types of Research

Action Research--research designed to find solutions or to develop new approaches to solving problems, typically in an agency or other practice setting. Case (Field) Study--involves and in-depth study or a particular case or unit Correlational Research--research that seeks to identify the extent to which changes in one variable are associated with changes in another variable/variables using correlation coefficients Descriptive (Survey) Research--research designed to provide a description of an area of concern or interest and may lead to the formulation of research questions that can be addressed in future studies. Evaluative Research--research that attempts to determine the extent to which an intervention or program that has been successful in achieving its goals and objectives and/or is cost effective. Experimental Research--research that involves the exposure of one or more experimental groups to one or more treatment interventions and the compares on results to those obtained from one or more control groups in an effort to identify possible cause and effect relationships. Experimental Research is a type of Explanatory Research Design. Explanatory (Causal Comparative) Research involves searching through data in an attempt to find possible causal factors of observed consequences. Historical Research--research that attempts to develop an accurate reconstruction of the past. A historical perspective is used to interpret and organize data obtained in the course of research. Pre-test/Post-test Research--involves testing participants prior to an intervention and following the intervention Qualitative Research--research from a non-statistical perspective, designed to understand the phenomenon under investigation from the perspective of the respondent. Examples of qualitative research include: Ethnography (research that seeks to understand an individual in their own social or cultural context. The researcher is a participant-observer in this research. A blend of two research perspectives are used in this approach, including an emic perspective (or a perspective of a member of the group) and an epic perspective (perspective of an outsider of the group being studied); Oral Histories--interview study participants who can relay firsthand the phenomenon under study. Quantitative Research--research that can be summarized using numbers and statistics--including: Quasi-Experimental Research (researcher attempts to approximate the conditions of experimental research in a setting in which the researcher is unable to control and/or manipulate all relevant variables; Single Subject Research--evaluation measurement done on a single case to determine the effectiveness of an intervention. AB Design--baseline--A-- and intervention--B--phase; ABAB Design--involves the initial baseline-A- and intervention phases-B- followed by the withdrawal of the intervention for a time (second baseline) and the reintroduction of the same intervention; ABAC Design--a baseline phase--A-the introduction of an intervention-B--and then introduction of a second intervention. Multiple Baselines--collecting data on a minimum of three target behaviors: 1) applying an intervention to a single target behavior; 2) applying an intervention to a different target behavior after change has been effected in the first target behavior; 3) applying an intervention to a different target behavior after change has been effected int he second target behavior. This design is seeks to test causality by demonstrating that a given target behavior only undergoes changes when an intervention is introduced.

Trauma and Stressor Related Disorders--Acute Stress Disorder

Acute Stress Disorder consists of PTSD-like symptoms that occur for over three days and up to one month after trauma exposure. SSRIs and other antidepressants can provide relief to symptoms. CBT may speed recovery and prevent PTSD when therapy begins 2-3 weeks after trauma exposure. Case management services, early supportive interventions, psycho-education (relying on personal strengths, using existing support networks/resources), and EMDR (Eye Movement Desensitization and Reprocessing) are effective with ASD. Single intervention techniques or psychological debriefings are not recommended because they may increase symptoms.

Trauma and Stressor Related Disorders--Adjustment Disorder

Adjustment Disorder is characterized by the development of emotional or behavioral symptoms, within three months of a stressor or stressors, that result in distress and/or impaired functioning. Adjustment Disorders identified in the DSM-5 are: Adjustment Disorder with Depressed Mood, Adjustment Disorder with Anxiety, Adjustment Disorder with Mixed Anxiety and Depressed Mood, Adjustment Disorder with Disturbance of Conduct (violation of others' rights or of important social norms and rules ), Adjustment Disorder with Mixed Disturbance of Emotions and Conduct and Adjustment Disorder Unspecified.

Management, Administration and Policy--Advocacy

Advocacy refers to representing the interests of and defending individuals and communities. Advocacy can occur through direct intervention on the client-system's behalf or though empowerment of the client system. Social workers are ethically responsible to be engaged in advocacy work. The administration, board, supervisors, front line workers, support staff and clients have advocacy responsibilities within an organization. NASW states that all social workers carry a philosophical charge to protect and empower the vulnerable and disadvantaged. There are a variety of means in which social workers conduct advocacy, including writing op-ed pieces, lobbying, organizing local protests, harnessing the power of the internet, sit-ins, and helping to change laws that adversely affect vulnerable and disadvantaged members of society. Social workers function as client-advocates via media involvement (public education, education), community organizing (activities that empower citizens to improve social services, address social problems, and enhance social well-being), and demonstrations (vehicle for empowering citizens to solve local problems)

Anxiety Disorders--Agoraphobia

Agoraphobia is characterized by fear and anxiety in two or more of the following situations--using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd or being outside of the home alone. The individual with Agoraphobia fears or avoids these situations because of thoughts that escape might be difficult or help might not be available. Many people with Panic Disorder and Agoraphobia can be treated without the use of medication. If medication is needed, SSRIs and benzodiazepines are the medications of choice. Individualized psychotherapy is the preferred type of treatment. Relaxation and imagery techniques are proven to be effective. A cognitive or rational-emotive approach for irrational thoughts during a Panic Attack is helpful as is a behavioral approach emphasizing graduated exposure to panic-inducing situations. Education around fight or flight response and the development of better coping sills are primary focuses of treatment.

Social Learning Theory by Albert Bandura

Albert Bandura proposed Social Learning Theory and believed that self-determination is an important part of learning and emphasized observational learning, imitation and modeling. Bandura stressed that learning depends on environment, cognition and behavior, rather than learning only from one's own actions. Bandura conducted the "Bobo" doll experiment in 1961 where children observed an adult abusing a Bobo doll and then did this themselves.Bandura described observational learning as attention, retention, reciprocation and motivation. Bandura stressed self-efficacy and self-determination. Social Learning Theory has been described as a bridge between Behaviorism and Cognitivism.

Cognitive Behavioral Therapy-Allbert Ellis' Rational Emotive Behavior Therapy (REBT)

Albert Ellis was initially trained in psychoanalysis but came to believe that irrational beliefs, not unconscious conflicts from early child behavior, were at the root of neurotic behavior. In therapy, Ellis directly attacked the client's belief system and encouraged the client to challenge his/her own beliefs (different approach than Beck--more confrontational). Albert Ellis' Explanation of Personality: Ellis believed that an Activating Event (A) does not cause a person to feel a certain way but that the person's feelings are a result of the consequences of the individual's beliefs about the event. Beliefs can be rational or irrational and irrational beliefs can lead to unnecessary painful emotions and maladaptive behavior. Emotional health results from the rational or logical processing of activating events. A=Activating events B=Belief system of individual C=Consequent emotion of A& B D=Disputing irrational thoughts and beliefs E=Emotional and cognitive effects of revised beliefs Rational Emotive Behavioral Therapy identifies common irrational beliefs which are a serious of demands and absolutes--examples of common irrational beliefs are: sexual and other basic human desires are needs not desires, we can't stand basic events that we can actually handle; our worth is based on material things or skills or achievements; life should treat us fairly; people we judge to be bad should be punished; its awful when things don't work out as we wish; harmful behaviors such as substances use disorders are justified because we are in pain; life circumstances determine a person's happiness. In Rational-Emotive Behavioral Therapy the social worker educates the client on the principles of Rational Emotive Behavioral Therapy and challenges the rationality of the client's beliefs and assists the client in learning how to challenge his/her own beliefs. The social worker and the client work together to dispute the irrational beliefs that restful in distressing negative consequences. The client's homework includes reading relevant books and critiquing tapes of his/her therapy sessions in an effort to increase awareness of irrational beliefs.

Applied Behavioral Analysis

Also called behavior modification/engineering, the use of operant conditioning principles to change human behavior. Based on principles of respondent and operant conditioning to change behavior of social significance. Used most frequently with Autism Spectrum. Also used in classroom support, pediatric feeding therapy, rehabilitation of brain injury, dementia, fitness training and counseling, substance use disorders, phobias, tics and organizational behavior management

The Top 11 Curative Factors in Group Therapy by Irvin Yalom

Altruism--helping others lifts self-esteem Catharsis--experiencing relief from emotional distress through free and uninhibited expression of emotion Existential Factors--learning one has to take responsibility for one's life Cohesiveness--members feel like they belong, feel validated and feel accepted Imparting Information (Guidance)--learning factual information from other members of the group Imitative Behavior (Identification)--group members develop social skills through modeling process, observation and imitation Instillation of Hope--group members encouraged by others who have survived experience Interpersonal Learning (AKA Interpersonal Input)--group members achieve a greater level of self-awareness Development of Socialization Techniques (Interpersonal Output)--group members are able to take risks by extending their repertoire of interpersonal behavior and improving their social skills Corrective Recapitulation of the primary family experience--transference enables social worker and group members to point out the impact of childhood experiences on personality and how to avoid repetition of maladaptive behaviors Universality--understanding that you are not alone and that problems are widespread The group social worker's role is to create and maintain the group, illuminate the here and now (group process) and create a group culture and sense of safety. Other issues related to groups include: co-leadership which can be effective in groups as long as leaders are not competitive. It's critical that leaders prepare ahead of time and after to debrief. Co-leadership can be particularly effective when a group member has a crisis--one leader can deal with individual while other continues the group. concurrent group and individual therapy--Irwin Yalom does not believe that concurrent group and individual therapy is necessary or beneficial. He believes individual therapy can drain off effect from the group. Some social workers believe it is effective if there is ongoing communication between the group social worker and individual social workers. Predictors of group member early termination include: high use of denial, low motivation, low IQ, low self-esteem, unrealistic expectations, and major differences between that group member and others. Transference that can occur in group settings: transference to social worker (parental figure) transference to other group members (siblings) transference to group itself (mother-womb symbol) Johari Window is a graphic model of interpersonal behavior that can be applied to many different theories of group interaction and is useful in evaluating interpersonal interaction and group effectiveness. This model is more likely to be successful if individual group members have been prepared for the group experience. Developed by Joseph Luft and Harry Ingham in 1955-the Johari Window model is used the enhance the individual's perceptions of others. The model is based on two ideas--that trust can be acquired by revealing information about yourself to others and learning about yourself from others' feedback. Groups high on cohesiveness are associated with better outcomes.

The Intervention--Skills Social Workers Teach Their Clients

Anger management (anger can be a secondary emotion really rooted in fear, anxiety or frustration) Stress management Mindfulness--here and now/present Assertiveness Training--express views clearly without being aggressive and enable others to do so Cognitive Reframing--restructure how clients view feelings in more positive and helpful format How to Monitor Feelings and Behaviors (baseline and tracking) Role Playing and Modeling are useful tools for social worker to use Modelin

Feeding and Eating Disorders--Anorexia Nervosa

Anorexia Nervosa is characterized by either explicit refusal to maintain an appropriate body weight or failure to gain the amount of weight appropriate to a given growth period (85% of appropriate body weight or less). It also involves a distorted image of one's body (weight or shape), intense fear of becoming fat, negative self-evaluation based on this image, or refusal to acknowledge that the low body weight is a problem that has significant medical consequences. Subtypes of Anorexia Nervosa include Restricting Type (no binging or purging on a regular basis) and Binge-Eating/Purging Type. CBT, Group and Family Therapy are standard treatments. Anti-depressants (such as amitriptyline, a tricyclic antidepressant) may be helpful. Chlorpromazine (Thorazine) may be helpful for individuals experiencing severe obsessions and increased anxiety and agitation. Inpatient treatment may be necessary for severe cases.

1936 Anna Freud: Ego Defense Mechanisms

Anna Freud worked with children and believed observations by the psychoanalyst and information obtained from a child's significant others could substitute for hypnosis, or free association that Sigmund Freud proposed as basis for adult psychoanalysis. She developed the following ego defense mechanisms or unconscious strategies used by the Ego to minimize distress caused by conflicting demands of Id and Superego: Compensation: seeking success in one area of life to replace failure or lack of success in another; ie video games for lack of success in sports. Conversion: Transformation of anxiety into a physical dysfunction such as blindness--which does not have a physiological basis. Symptoms may be symbolic and dramatic. Denial: refusal to acknowledge an aspect of reality due to overwhelming anxiety. Displacement: shifting of negative feelings about one person or one situation to another person or another situation. For example, upset about boss at work and take this out on partner. Identification: identifying with the source of one's anxiety--ie victim identifying with a kidnapper like Patty Hearst in 1974. Isolation of Affect: painful feelings are separated from the incident that triggered them--ie describing a rape in nonemotional terms. Remove emotions from a stressful event. Intellectualization: reasoning is used to block difficult feelings--ie mom describing grandma's death in medical terms. Projection: projecting one's own negative characteristics onto another person to relieve anxiety. Rationalization: substitution of a more socially acceptable, logical reason for an action rather than identifying the real motivation for the action--ie saying you can't attend an event because you have to work versus admitting you just don't want to go. Reaction Formation: adopting a behavior that is the opposite of the instinctual urge (ie sympathizing with an oppressed group when you are actually prejudiced toward this group). Regression: reverting to behaviors from earlier periods of development to avoid dealing with anxiety of reality. Repression: unconscious pushing of anxiety-producing thoughts and issues out of the conscious and into the unconscious. For example, an individual who doesn't remember being abused as a child. This ego defense mechanism is actually from Sigmund Freud. Sublimation: mechanism where intolerable drives or desires are diverted into activities that are acceptable--ie have an urge to fight/toward violence and become a professional boxer or police officer. Substitution: mechanism where person substitutes an acceptable goal for an unacceptable goal--ie don't become a flight attendant and work in advertising to please parents. Undoing: mechanism where individual engages in repetitious ritual to try to reverse an unacceptable action taken previously--ie wash hands over and over again to wash off what on hands during fight.

Personality Disorders--Anti Social Personality Disorder

Anti Social Personality Disorder is characterized by a pattern of disregard for or violation of others' rights evident since at least age 15 and the individual has to be at least 18 years old to be diagnosed with Anti Social Personality Disorder. (Conduct Disorder is diagnosed in individuals younger than 18). This disorder is more common in males and includes the following symptoms: 1) frequent violations of the law; 2) deceitfulness for personal gain for gain or pleasure; 3) impulsive behavior or lack of planning; 4) irritability or aggressiveness; 5) disregard for one's safety or the safety of others; 6) consistency irresponsibility; 7) absence of remorse. Mediation is not indicated for Anti-Social Personality Disorder and individuals with this disorder rarely seek treatment. If treatment is sought, the focus should be on denial of consequences, impulsivity and lack of thinking through actions, duplicity and lying, practical consequences of behavior, suggestions or behaviors that will improve consequences, blaming of others and self-control. Individuals are sometimes mandated by court order to seek treatment, but threats are never an appropriate motivating factor for any type of treatment, especially with this disorder.

Anti-Anxiety or Anxiolytic Medications-Antihistamines

Antihistamines (Benadryl and Vistaril) are used less frequently in the treatment of anxiety. They are rapidly absorbed and have a sedative effect.

Antipsychotics

Antipsychotics are also called major tranquilizers or neuroleptics. Thorazine (chlorpromazine) Mellaril (thioridazine) Stelazine (trifluoperazine) Haldol (haloperidol) Prolix (fluphenazine) Trillion (perphanazine) Orap (pimozide) Used for Tourette's Disorder Phenothiazines is the largest of the five main classes of neuroleptic antipsychotic drugs. Common side effects include: Dystonia (severely disordered tissue tone characterized by mini-seizures and facial, tongue, neck and back spasms), Anticholinergic effects (weight gain, sexual dysfunction, blurred vision, confusion, constipation), Akathisia (restlessness accompanied by anxiety or agitation), Parkinsonian symptoms (hand and finger tremors, mask-like facial expression, physical rigidity, slowed speech). Less common but severe side effects include Tardive Dyskinesia (involuntary movements of face, torso or limbs), Neuromalignant Syndrome (NMS) (categorized by catatonic stupor, fever and unstable vital signs). Drugs used to address side effects from antipsychotic medications are: Cogent (benztropine) Benadryl (diphenhydramine) Artane (trihexyphenidyl)

Atypical Antipsychotics

Antipsychotics that do not have significant side effects common to older antipsychotics. Examples are: Clozaril (clozapine) Risperdal (risperidone) Zyprexa (olanzapine) Abilify (aripiprazole) Seroquel (quetiapine) Fanapt, Fanapta (ilperidone) Loxitane (loxapine) Invega (paliperidone) Latuda (lurasidone HCL)

Behavioral Therapy--Assertiveness Training

Assertiveness Training involves training and individual to communicate his/her feelings in an honest and direct fashion. Behavioral rehearsal is an important component of assertiveness training,

Antidepressants--Atypical Antidepressants

Atypical Antidepressants (SSNRIs) include: Effexor (venlafaxine) Wellbutrin (bupropion) Desyrel (trazodone) Cymbalta (duloxetine) Serzone (nefazodone) Asendin (amoxapine) Pristiq (desvenlafaxine) Common side effects are similar to SSRIs.

1939 Kurt Lewin, Ronald Lippit and Ralph White: Leadership Climates

Authoritarian, Democratic and Laissez Faire

Personality Disorders--Avoidant Personality Disorder

Avoidant Personality Disorder is characterized by social inhibition, low self-esteem, and excessive sensitivity to criticism. Other common symptoms include the following: 1) avoidance of interpersonal relationships because of oversensitivity to rejection, disapproval or criticism; 2) guardedness in intimate relationships because of fear of being shamed or ridiculed; 3) perception of inferiority to others; 4) avoidance of new activities or taking risks because of fear of embarrassment. Medications should only be prescribed for other disorders. Individual therapy is the preferred modality but group therapy can also be effective if the person agrees to attend enough sessions. Self-esteem issues will be raised during treatment; negative self-valuation is a lifelong pervasive thought that necessitates a solid therapeutic relationship. Target issues for therapy includes fear, anger, passive-aggression, shame and catastrophic thinking style.

Feeding and Eating Disorders--Avoidant/Restrictive Food Intake Disorder

Avoidant/Restrictive Food Intake Disorder is characterized by a lack of interest in food or avoidance based on the sensory features of the food or perceived consequences of eating. It is a persistent failure to meet nutritional or energy needs as evidenced by one or more of the following: significant weight loss or achieved expected weight; nutritional deficiency; dependence on nutritional supplements, or marked interference with psychosocial functioning . The individual may outright refuse food, be selective about what food to eat, eat too little, avoid food or delay eating. Medication is not a standard treatment for Avoidant/Restrictive Food Intake, and treatment is based on optimizing the interaction between the caregiver and the child during feedings and identifying any factors that can be changed to promote increased food intake (ie decrease distractions during eating, praise good eating).

General Guidelines for Direct Social Work Practice

Begin where the client is; goals have to have the potential to benefit the client; be honest and direct when difficult situations arise in practice; acknowledge cultural differences and provide a culturally competent assessment of the client's situation, as well as culturally competent interventions.; assess communication skills of client and speak same language or get an interpreter; don't try to reality test a delusional client--deal with client's anxiety and thoughts in a calm, empathetic manner and arrange for the client to get a psychiatric evaluation asap; always be aware of transference and countertransference; conduct Evidenced Based Practice and ensure it is adaptable and appropriate for clients.

Couples' Theory and Therapy-Behavioral Marital Therapy (Stuart)

Behavioral Marital Therapy seeks to improve relationships between couples by increasing the frequency of positive exchanges and decreasing the frequency of negative and punishing exchanges. The Behavioral Martial Therapy model includes the influence of the environment on the relationship and well as the histories of the partners. In Behavioral Martial Therapy, the social worker assesses both the strengths and weaknesses of the relationship. The belief is that when certain behaviors are reinforced (positively or negatively) they will be linked to the individual's sense of relationship satisfaction. Skills that are taught in Behavioral Marital Therapy are: --expression in clear behavioral terms --improved communication skills --establishing a means to share power and decision making --improved problem-solving skills

Statistical Terms

Bell Shaped or Normal Curve--involves a symmetrical distribution consisting of a higher point in the middle of the distribution and equal tails on the sides. Approximately 68% of the scores in the distribution lie within one standard deviation of the mean. Much in nature is distributed in this fashion. Skewed Distribution--occurs when the distribution of some variable fit asymmetrical Statistic--a number computed from the data to describe samples and to test hypotheses Descriptive Statistics-statistics that seek to simply summarize a set of observations; Correlation Coefficient (r) is a statistic that reflects the degree to which two variables are associated or co-vary (ranges from +1 to -1); A positive sign in front of a number indicates a positive correlation and negative sign in front of a number is associated with a negative correlation (change in one variable is associated with a change of another variable in the opposite direction). The closer the r value is to 1 (negative or positive, the stronger the correlation) A positive or negative in front of the number does not impact the strength of the correlation; a correlation less than .5 is considered a weak correlation. Mode is the number that occurs most often in a series of numbers Median is the number that has the same number of scores above and below it Mean is the arithmetic average Range is the difference between the highest and the lowest scores in a distribution Standard Deviation is the spread of a set of data around the mean of the data. In a normal distribution, approximately 68% of scores will fall within plus or minus one standard deviation of the mean and 95% fall within plus or minus two standard deviations from the mean. Standard deviation is the most common measure of statistical dispersion. Variance is the standard deviation squared Statistical Significance is the probability that a difference in scores could have resulted from sampling variance alone ANOVA is a statistical test designed to identify whether there are real differences in the mean scores of more than two groups

Anti-Anxiety or Anxiolytic Medications-Beta Blockers

Beta Blockers (Lopressor and Inderal) reduce the physiological symptoms of anxiety (ie racing heart) which makes them particularly effective with anticipatory anxiety. Common side effects include: sedation, hypotension, and decreased heart rate.

Feeding and Eating Disorders--Binge-Eating Disorder

Binge Eating Disorder is characterized by recurrent binge eating over a short period of time. Binges consist of eating more rapidly than normal to the point of being uncomfortably full, eating large amounts of food, even when not hungry, eating alone and feeling guilty or upset about the episode. The behavior must occur at least once a week for 3 months. There is no compensatory behavior utilized after binges. The behavior occurs in private and with foods. that have dense caloric content. Individuals feel they cannot control their eating. CBT is the most effective treatment for Binge Eating Disorder . Self-help groups like Overeaters Anonymous and Weight Watchers can be helpful. SSRIs and tricyclic antidepressants have helped improve mood and binge eating episodes.

Bipolar and Related Disorders--Bipolar I Disorder

Bipolar 1 Disorder involves a minimum of one manic episode and major depressive episodes (although mania may be the first manifestation of the disorder). In coding Bipolar 1 Disorder, indicate the type of episode the person is currently experiencing or last experienced.

Bipolar and Related Disorders--Bipolar II Disorder

Bipolar II Disorder involves a minimum of one hypomanic episode and major depressive episodes.

Obsessive Compulsive Disorders--Body Dysmorphic Disorder

Body Dysmorphic Disorder is characterized by a preoccupation with a slight or perceived physical defect judged by the individual to negatively affect his/her appearance. SSRIs are most common medications used for Body Dysmorphic Disorder. CBT or behavior modification therapies are highly recommended in addition to medications. Body Dysmorphic Disorder is considered a chronic condition and requires maintenance therapy and regulation of SSRIs.

Personality Disorders--Borderline Personality Disorder

Borderline Personality Disorder is characterized by instability in relationships, self-image and affect, as well as impulsive behavior. It is more common in females. Common symptoms include: 1) frantic efforts to avoid abandonment; unstable and intense relationships, disturbance in identity, impulsive behavior that has a potential for self-harm; repeated suicidal threats, gestures, behavior or, alternatively, self-mutilation; unstable affect caused by reactivity of mood; persistent feelings of emptiness; chronic anger that the individual has difficulty controlling; brief episodes of paranoid ideation or severe dissociative symptoms in response to stress. Antipsychotic medications may be helpful during brief brief, psychotic symptoms. Anti-depressants and anti-anxiety medications may be appropriate for anxiety and depressive symptoms. Dialectial Behavior Therapy is a common therapy used for persons with Borderline Personality Disorder. Therapy focuses on treatment for dichotomous thinking, impulse control, behavioral excess, lack of self-regulation, self-damaging behaviors.

1969 John Bowlby and Mary Ainsworth: Attachment Theory

Bowlby and Ainsworth built on the work in human development done previously by Rene Spitz and Erik Erikson. Bowlby is considered the first attachment theorist but Ainsworth was conducting her research at the same time. Bowlby believed relationship with caregiver is blueprint for future relationships. Separation Anxiety--6-8 months of age--baby distressed when separated from mother; Stranger Anxiety--8 months of age baby is distressed when sees a stranger's face versus a familiar face; (Phases baby goes through when separated from mother for a prolonged period of time--Protest Phase, Despair/Depression Phase, Detachment Phase, Anaclitic phase). Characteristics of Attachment: Proximity Maintenance--desire to be near people to whom baby is attached; Safe Haven--returning to attachment figure for comfort and safety in the face of fear or threat. Secure Base--point of security (normally the mother) from which the child can explore the environment without fear of abandonment. Separation Distress--anxiety that occurs in the absence of attachment figure. Mary Ainsworth expanded on John Bowlby's work and identified three styles of attachment: Secure Attachment, Ambivalent-Insecure Attachment (children become unusually distressed when parent/caregiver leaves) and Avoidant Attachment (prefer strangers same as caregivers) A fourth style of attachment was later added by Main and Solomon--disorganized/insecure attachment or a mix of behavior --child learns parent may be a source of fear at times and a source of comfort at other times.

Breathing-Related Sleep Disorders

Breathing-Related Sleep Disorders share respiratory control instability as a common risk factor but have different physiological and anatomical causes. All of these disorders are diagnosed with a sleep study or polysomnography. 1) Obstructive Sleep Apnea Hypopnea--the most common type of breathing-related sleep disorder and is characterized by a total absence in breathing (apnea) or a decrease in airflow (hypopnea). Snoring is the central focus of this sleep disorder. Treatments include weight loss,, surgical intervention, positive airway pressure (CPAP, BPAP), and oral appliances. 2) Central Sleep Apnea--this occurs when breathing completely stops and starts during sleep. The brain neglects to send signals to muscles that regulate breathing, 3) Sleep-Related Hypoventilation--elevated carbon dioxide levels that decrease respirations. There are frequent episodes of shallow breathing that last 10 or more seconds. 4) Circadian Sleep-Wake Disorders are characterized by a persistent or recurrent pattern of sleep caused by incongruity between sleep-wake requirements imposed by the person's environment and actual sleep-wake patterns. It leads to excessive sleepiness, insomnia or both. Types of Circadian Sleep-Wake Disorders include Delayed Sleep Phase Type or a pattern of late onset sleep and late awakening despite efforts to change and Advanced Sleep Phase Type or an inability to remain awake or asleep until the desired or conventionally acceptable later sleep or wake times or Unspecified Type. Treatment includes chronotherapy (to rest the biological clock to gradually adjust sleep wakes times to those desired) and photo or light therapy to expose individual to bright light and alter the endogenous biological rhythm.

Feeding and Eating Disorders--Bulimia Nervosa

Bulimia Nervosa disorder is characterized by eating large amounts of food for a brief period of time and a subsequent feeling of having lost control of eating during a binge episode. The individual engages in recurrent efforts to compensate (self-induced vomiting, laxative abuse, diuretics and strenuous exercise) for binging to avoid weight gain. The binging and punching occur an average of one (mild) to 14+ (extreme) or more times a week over a three month period. Anti-depressants such as tricyclic antidepressants (imipramine, desipramine or phenelzine), Nardil (MAO inhibitor) and SSRIs can be helpful in treating individuals with Bulimia Nervosa. Phenytoin (Dilantin) and carbamazepine (Tegretol) may help reduce the frequency of binging behavior. Monitoring is particularly imprint. CBT is considered the benchmark for the treatment of Bulimia Nervosa. Group Therapy is powerful and cost saving. Family Therapy focuses on the individual's compliance with treatment recommendations.

Self Care in the The Professional Therapeutic Relationship

Burnout, compassion fatigue, secondary trauma are important issues in social work Burnout-physical and emotional exhaustion that is involved in negative job attitudes and a loss of concern for the client; burnout happens slowly over time Compassion Fatigue--occurs as an overexposure to the suffering of the client--clinician absorbs the client's pain and that leads to impacts professionally and personally--it is cumulative over time--symptoms include lower self-esteem, apathy poor concentration, perfectionism,/rigidity, negativity, irritability, lapses in empathy and feelings of anxiety, guilt, anger or sadness Secondary trauma--pervasive cognitive and emotional changes in meaning and sense of self to the therapist--increased arousal, avoidance symptoms, intrusive thoughts, dreams, distress with reminders or cues, anhedonia (reduced ability or motivation to experience pleasure), negative thoughts, irritability, anger, hyper vigilance, concentration and sleep issues (consistent with PTSD symptoms) stemming from exposure to traumatic material--symptoms frequently have slow onset and begin with Compassion Fatigue or can have a distinct onset due to working with a particular client Social workers need to practice self-care--take vacations, sustain relationships, set boundaries, exercise, healthy eating, sleep well, protect time off, engage with social support, peer support, and supervision, share stress with other, practice mindfulness, spirituality, gaining pleasure from doing a job well, accept occasional failures in treatment finding meaning in what you do

Anti-Anxiety or Anxiolytic Medications-Buspar

Buspar (buspirone) does not have a sedative effect and is not addictive. It is an effective treatment for Generalized Anxiety Disorder and when and anxiety and depressive symptoms occur together. It takes at least two weeks for Buspar (buspirone) to become effective, so it should not be used during crisis intervention or with panic disorder. It should not be taken with Haldol (an antipsychotic), MAO inhibitors (a category of antidepressants) or Antabuse (used in treatment of alcohol dependence). Common side effects of Buspar (buspirone) are nausea, headache, and dizziness.

Jungian Psychotherapy

Carl Jung developed this form of therapy which defines libido as a general psychic energy and it is believed that behavior is determined by past events as well as future goals and aspirations. Jungian Personality Theory states that personality is the consequence of both conscious and unconscious factors. The conscious personality is oriented toward the external world. The unconscious personality consists of two parts--personal unconscious and collective unconscious. The personal unconscious contains experiences that were once conscious but are now repressed or forgotten or unconsciously perceived. The collective unconscious is the repository of of latent memory traces and primordial images that causes people to understand phenomena in the same way (archetypes). Archetype of particular importance to personality development are: 1) the self--which represents a striving for a unity of the different parts of the personality; 2) the persona or public mask; 3)the shadow or dark side of personality; 4)the anima or feminine archetype; and the 5)animus or masculine archetype. Jung also considered the psychotherapeutic use of abreaction, a type of catharsis. Abreaction refers to the process of ridding oneself of intense feelings associated with a previous painful or traumatic experience. Jung later decided that the release of such pent-up feelings was not as important as the client-social worker relationship.

Humanistic-Existential Models/Theory--Person-Centered Therapy--Carl Rogers

Carl Rogers' Person-Centered Theory includes the belief that human beings have an inherent tendency toward self-actualization (ie achievement of their full potential). People will naturally grow and self-actualize in warm, caring, authentic, nonjudgemental, empathetic and understanding environments. Maladaptive behaviors result when a person experiences conditions of worth (ie love and support are contingent upon conformity to standards). The child then internalizes some of these conditions and comes to define an experience as positive or negative based on the internalized conditions of worth rather than the capacity of the experience to enhance the person. There is a belief that the individual's defenses block awareness of the organismic processes that would naturally propel them in a direction of growth. In Person-Centered Therapy, the critical component is he experiential relationship between the client and social worker--ie the therapeutic alliance. The social worker is non-directive (ie respectful to the self-directing capacity of the client). The social worker's attitudes, rather than technical skills or specific knowledge base, are critical ingredients of effective therapy (genuineness, empathy, understanding). In such an environment, the client is free to experience all elements of self and reclaim parts of self previously disowned because of conditions of worth.

Case Managment

Case management is a social work practice that is defined in The Social Work Dictionary as " a procedure to plan, seek and monitor services from different social agencies and staff on behalf of a client." (Barker, 2003) The professional social worker performs the following tasks in case management: 1) gather information and make assessment about the need of the client 2) arrange multiple services to meet the complex needs of the client 3) coordinate services 4) monitor the quality of services 5) evaluate the effectiveness of the services provided 6) advocate for the client in the community As the primary provider of social work case management, professional social workers address individual client's bio psychosocial status and also the environmental system in which the client lives. Social work case management occurs on both micro and macro levels. The NASW has set standard for social work case management--these are: Standard 1) The social work case manager shall have a BS or graduate degree from a social work program accredited by the Council on Social Work Education and shall possess the knowledge, skills, and experience necessary to competently perform case management activities. Standard 2) The social work case manager shall use his/her professional skills and competence to serve the client whose interests are of primary concern Standard 3) The social work case manager shall ensure that clients are involved in all phases of case management practice to the greatest extent possible Standard 4) The social work case manager shall ensure the client's right to privacy and ensure appropriate confidentiality when information about the client is released to others Standard 5) The social work case manager shall intervene at the client level to provide and/or coordinate the delivery of direct services to clients and their families Standard 6) The social work case manager shall intervene at the service systems level to support existing case management services and to expand the supply of and improve access to needed services. Standard 7) The social work case manager shall be knowledgeable about resource availability service costs, and budgetary parameters and be fiscally responsible in carrying out all case management functions and activities. Standard 8) The social work case manager shall participate in evaluative and quality assurance activities designed to monitor the appropriateness and effectiveness of both the service system in which case management operates as well as the case manager's own case management services and to otherwise ensure full professional accountability. Standard 9) The social work case manager shall carry a reasonable caseload that allows the case manager to effectively plan, provide and evaluate case management tasks related to client and system intervention. Standard 10) The social work case manager should treat colleagues with courtesy and respect and strive to enhance the inter-professional, intra-professional, and interagency cooperation on behalf of the client.

General Systems Theory Terminology

Circularity--behavior systems, such as the family, that cannot be adequately explained using a simple, bi-directional, linear model; behavior can only be understood in the context of the complex interaction patterns of the family. Open System--a system that accepts information from systems outside itself Closed System--a system that does not accept information from systems outside itself Homeostasis--the tendency of a system to maintain internal stability Identified Patient--the symptomatic family member or individual the family identifies as having a problem Negative feedback loop -also called Attenuating means input that maintains the status quo of a system Positive feedback loop (also called amplifying)--means input that forces a system to change Multi-finality--(equipotentiality) the same beginning point can lead to multiple results Equafinality--same end can come from multiple beginnings

Behavioral Therapy-Classical Conditioning

Classical Conditioning involves helping the client unlearn maladaptive responses to environmental stimuli (ie fear of riding in a car following an accident). Involuntary responses. Classical Conditioning that incorporates counter conditioning by Joseph Wolpe (South African/American 1915-1997), focuses on reciprocal inhibition--where an individual is conditioned to associated pleasant feelings with a stimulus that had been anxiety-producing.

Client Referral and Termination

Client referral is the process of directing a client to another agency, community resource or another mental health professional or other professionals who can provide the client with needed services. The social worker must assess the client's needs, be familiar with community resources, facilitate the client's connection with needed services and follow up to be sure service transfer takes place. Termination of client service depends on a number of factors (insurance, client progress, agency requirements). But the first consideration for termination is that the client has completed the treatment plan and is able to function independently. The NASW Code of Ethics, Standard 1.16, states the following guidelines regarding Termination of Service: social workers should terminate services with clients when services are no longer needed or no longer serve the client's' best interests --social workers should take steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services early only under unusual circumstances and while 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. --social workers in fee for service settings may terminate services to clients who are not paying an overdue balance if the financial contractural arrangements have been made clear to the client, if the client doesn't pose any imminent danger to self or others and if the clinical and other consequences of 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 who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral or continuation of services in relation to the client's needs and preferences. --social worker who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.

Cluster A versus B versus C Personality Disorders

Cluster A Personality Disorders are those characterized by odd, eccentric thinking or behavior. Cluster A Personality Disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster B Personality Disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. These include anti-social personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Cluster C Personality Disorders are characterized by anxious, fearful thinking. or behavior. They include avoidant personality disorder, dependent personality disorder, and obsessive-personality disorder.

Couples' Theory and Therapy--Cognitive Behavioral Marital Therapy

Cognitive Behavioral Marital Therapy is focused on the need to understand the couple's emotional and behavioral dysfunction and how these relate to inappropriate information processing. The Cognitive Behavioral Marital Therapy model proposes that emotional states have an innate adaptive potential and therapy seeks to discover the types of negative thinking that drive the negative behavior that causes difficulties in relationships. The social worker who uses Cognitive Behavioral Marital Therapy educates and increases awareness about perceptions, assumptions, and standards of interactions between the couple. Common cognitive distortions in couples are: --arbitrary inference--conclusions made in the absence of substantiating evidence --overgeneralization --magnification and minimization --dichotomous thinking --labeling and mislabeling --tunnel vision --biased explanation--suspicious thinking--spouse holds a negative alternative motive behind his/her intent --mind reading --selective abstraction--information is taken out of context and specific details are highlighted while others are ignored --personalization--external events are attributed to oneself when insufficient evidence exists to render a conclusion

Communication within the Professional/Therapeutic Relationship

Communication in social work refers to the interchange of thoughts, feelings, ideas, and facts between people in the context of the human experience. In the therapeutic relationship, the social worker attempts to help the client make sense of his/her information, feelings, responses and memories and to develop a plan to deal with the problems that have been created--the social worker uses and teaches communication techniques with clients It is the social worker's responsibility to direct the therapeutic interview--communication includes listening, observing, interviewing, verbal statements and nonverbal behavior Guidelines for self-disclosure--choose to disclose when there is an established trusting relationship, when the disclosure will enhance the treatment or learning process for the client, the client may feel less alienated if knows social worker has similar experience; choose not to disclose when the purpose of disclosure is ego-enhancing or gaining admiration of the client or the disclosure is something you don't want the client to share or the disclosure would jeopardize the safety of the client or future treatment

Disruptive, Impulse-Control and Conduct Disorders--Conduct Disorder

Conduct Disorder involves a pattern of repetitive and persistent behaviors in which the basic rights of others are violated. The behaviors can be aggressive, causing or threatening harm to others or animals, or nonaggressive behavior that results in property damage, deceitfulness or theft or more serious violation of rules. There is evidence of 3 or more behaviors in the past 12 months and and the pattern of behavior is persistent and repetitive. Child Onset Type if onset is before age 10 and if age 10 or after, Adult or Adolescent Onset. Type. This disorder is more common in males and specifiers are with limited prosocial emotions (ie lack of remorse or guilt, callous lack of empathy, unconcerned about performance, shallow or deficient affect).About 40% of those diagnosed with Conduct Disorder are diagnosed with Antisocial Personality Disorder later in life. Antipsychotic medication has been effective in managing aggressive behaviors. SSRIs have been used to target impulsivity, irritability and mood labelitity. Medication is only indicated if the individual has another disorder (depression, ADHD). Behavior and psychotherapy are usually necessary to help the individual express and control anger appropriately. Treatment is long term and challenging. because the individual is fearful and distrustful of adults and is often uncooperative. The earlier the treatment starts, the better. Parents often need expert assistance in designing special educational and mangemenet programs for home and school.

Consultation

Consultation in social work is a problem-solving, contractural relationship between a knowledgeable expert and a less knowledgeable expert. Consultation may consist of sharing of professional expertise as it relates to programs, personnel, budgets and research findings. The consultation process is dynamic and composed of a number of distinct stages which may or may not occur in sequence, may occur at the same time or may be returned to before advancing to later stages. Parsons and Meyers's (1984) have identified the following six stages of consultation: Stage 1: The Entry Stage--become accepted in agency, determine and reduce sources of resistance. Stage 2: The Goal Identification Stage--gather data about concerns and areas for improvement Stage 3: The Goal Definition Stage-SMART goals Stage 4: The Intervention Stage--development of intervention strategies and implementation of these strategies with client. (brainstorming and Delphi or a method that seeks participation from all involved in the process are two helpful techniques in the intervention stage. Stage 5: The Assessment Stage--assess the impact of the intervention on the agency Stage 6: The Concluding the Relationship Stage-foster independence in the client Consultation in social worker can be a problem-solving, contractural relationship between a knowledgeable expert and a less knowledgeable expert AND it can be when a social worker discusses a client with another social worker--this second type of consultation is used in case conferences Supervision is different than consultation in that consultation doesn't include a treatment relationship. Peer support provides experience, emotional, social and practical help to each other. Peers don't have authority supervisors do.

Neo-Freudians--Erich Fromm

Erich Fromm was considered to be a Humanistic psychoanalyst. He blended Marx's Social Determinism (the individual is determined by the economic system) and Freud's biological determinism. Fromm went beyond Freud and Marx in that he believed that the individual can transcend biological and societal factors. Fromm saw freedom as the core feature of human nature and believed that humans can find principles of action and decision- making which replace the principles of instincts. He believed that human beings are individuals with their own thoughts, feelings and a sense of what is right and wrong and that they are ultimately responsible for their behavior. He further believed that human beings have characteristic ways of trying to escape their individual identity (ie their freedom) which result in self-alienation. Fromm stated that an important determinant of which escape mechanism we choose is the nature of our family of origin and identified two types of "unproductive " families: 1. The Symbiotic Family--members are meshed and devoid of individual personalities. 2. The Withdrawing Family--family members express indifference to each other. Punishment may be ritualistic, without feeling, or involve guilt-loading and withdrawal of affection. An alternative form is the permissive approach that leaves children without adult guidance and children derive their values from the media and their peer group. Erich Fromm identified five personality types of orientations--all described in economic terms and only one is healthy/adaptive: 1.) Receptive Orientation--constant need of support from others but don't reciprocate the support--individuals who grew up in overbearing and controlling households often have this orientation 2) Exploitative Orientation--this orientation is willing to lie, cheat, and manipulate others in order to get what they need.--seek out people with low self-esteem to be be able to fulfill their need to belong 3) Hoarding Orientation--these orientation types cope with insecurity by never parting with anything 4) Marketing Orientation--look at relationships in terms of what they can gain from the exchange--focus on money and social status and tend to have shallow and anxious personalities 5) Productive Orientation--healthy--this orientation takes their negative feelings and channels the energy into productive work. The focus on building loving, nurturing and meaningful relationships with other people-often described as a good spouse, parent, friend, co-worker and employee. Channel their anxiety in healthy ways. Healthy families have parents who appropriately assume their responsibility of teaching their children rationality and providing a loving environment. Children are treated as individuals and are not expected to simply conform to the wishes of their parents. Reason is valued above rules.

Mood Stabilizers

Examples of Mood Stabilizing Drugs are: Eskalith, Lithobid (lithium, lithium citrate). (common side effects include weight gain, fatigue, nausea and vomiting, confusion, increase in urination, diarrhea, muscle weakness and hand tremors). A patient's blood level must be monitored. Depakote (divalproex sodium) an anti-convulsant Common side effects include: sedation, dizziness, hair loss and weight gain. A patient's blood must be monitored. Lamictal (lamotrigine--an anti-convulsant) Common side effects include: headache, dizziness, insomnia, and skin disorders that can be life threatening) Neurontin (gabapentin)--common side effects include: migraines, dizziness, pain, drowsiness, peripheral edema Topamax (topiramate--an anti-convulsant) Common side effects include: constipation, decreased sweating, dizziness, drowsiness, decreased appetite, nausea, nervousness, difficulty sleeping and weight loss) Tegretol (carbamazepine-an anti-convulsant) and Tripletal (oxcrbazepine--an anti-convulsant). Common side effects include: clumsiness, unsteadiness, dizziness, drowsiness, lightheadedness, nausea or vomiting. Zyprexa (olanzepine) Common side effects include: constipation, dizziness, drowsiness, dry mouth, headache, runny nose, vision problems, weakness and weight gain. Geodon (ziprasidone). Common side effects include: drowsiness, dizziness, restlessness, uncontrollable muscle movements, constipation, diarrhea, nausea, vomiting, rash or hives, runny nose, sneezing, cough Symbyax (combination of zyprexa and prozac) used to treat the depressive episode of Bipolar disorder as well as Schizophrenia and Schizoaffective Disorder. Common side effects include: weight gain, sleepiness, diarrhea, dry mouth, increased appetite, weakness, swelling of hands and feet, tremors, sore throat, and difficulty concentrating.

Obsessive Compulsive Disorders-Excoriation

Excoriation is characterized by the recurrent, compulsive picking of the skin, leading to skin lesions. There are repeated attempts to stop the behavior. The disorder causes clinically significant distress or impairment. The most common areas for skin picking are hands, fingers, torso, arms and legs. There may be multiple areas and use of multiple instruments (fingers, fingernails, knives, tweezers, pins). There is little data on effective treatment for Excoriation Disorder. There is some support that SSRIs are helpful. Naltrexone (an opioid antagonist) reduces the urge to skin pick. Lamictal has shown some efficacy. Brief CBT and habit reversal have been used to treat the disorder.

Somatic Symptom and Related Disorders--Factitious Disorder

Factitious Disorder is characterized by the repeated feigning, inducing, or aggravating physical and psychological symptoms motivated by a desire to receive medical care and be involved in the medical system, in the absence of financial or other external incentives. Sometimes referred to as Münchausen Syndrome, individuals embellish their personal history, chronically fabricate symptoms to gain hospital admission and move from hospital to hospital. Onset of Factitious Disorder is normally in one's 20s or 30s and Factitious Disorder is more common in women than men. Factitious Disorder Imposed on Another or Factitious Disorder by Proxy is most commonly prepetrated by mothers on infants or young children. Individuals with Factitious Disorder elude therapy by abruptly leaving the hospital or failing to keep follow up appointments. Treatment focuses on management rather than a cure. The goals of treatment are to reduce the risk of serious illness or death, address underlying emotional needs or underlying psychiatric diagnosis, be mindful of ethical and legal issues. A primary care provider should be appointed as a gatekeeper for all medical and psychiatric treatment. Treatment for Factitious Disorder Imposed on Another focuses on ensuring the safety and protection of any real or potential victims.

Sexual Dysfunctions--Female Orgasmic Disorders

Female Orgasmic Disorders are marked by infrequency of orgasms and reduced intensity of orgasmic sensations. There is significant distress or interpersonal conflict.

Sexual Dysfunctions-Female Sexual Interest/Arousal Disorder

Female Sexual Interest/Arousal Disorder is characterized by a lack of, or significantly reduced, sexual interest/arousal in sexual activity. Dysfunction can be experienced across the entire range of sexual response/pleasure (decrease or absence of erotic feelings, thoughts, fantasies, decreased impulse to initiate sex, decreased or absent receptivity to partner overtures or inability to respond to partner stimulation).

Anxiety Disorders--Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder involves excessive anxiety and worry about a number of things that persists for a minimum of six months. The behavior is not due to a medical condition or stimulus. Medications should be prescribed if symptoms are interfering with normal functioning. Most commonly prescribed medications are benzodiazepines (Ativan, Xanax, Valium, Librium, Klonipin). Antidepressants and Buspirone are alternatives to benzodiazepines. Individual theory is recommended and needs to focus on the low level, ever present anxiety.

Sexual Dysfunction Disorders--Genito-Pelvic Pain/Penetration Disorder

Genito-Pelvic Pain/Penetration Disorder is characterized by pain or discomfort, muscular tightening or fear or anxiety about pain when having sexual intercourse.

Group Work Techniques and Approaches

Group Composition--there is significant controversy about ideal composition of groups but generally agreed that members should have about the same level of intelligence and that groups should be homogenous in developmental level of members (chronological age and developmental age need to be considered in adolescents and children) Inclusion of both genders in children is not recommended in general. Mixed gender groups generally have the most lasting effects for adults. Rudolf Dreikurs believed that members should be matched by age, particularly in children's groups and that there should be no more than two years' age difference between the oldest and the youngest. Irvin Yalom believes that there should be heterogeneous conflict areas and homogeneous ego strength. Glaver and Gavin maintain that if a group is too homogeneous in deviant behavior, that it will lead to reinforcement of those traits. Garvin, Reid and Epstein believe that similarities among members in task oriented groups are important as these groups are more effective when the members share common goals Homogeneous groups tend to gel faster, become more cohesive, offer more immediate support to group members, have better attendance and less conflict and provide more symptomatic relief. Homgogeneous groups can remain superficial and are ineffective for altering character structure. Closed groups don't allow new members after a certain cut off period and are most effective for short-term, task-oriented therapy. Open groups (new members may be added at any time) offer members fresh input and allow them to benefit from the success of graduates; however, open groups can often impede the development of trust, acceptance and cohesiveness. Group size influences the effectiveness of treatment. Treatment groups are most effective when they include between seven and ten members. Assimilation of new members is another concern of group work. A new person's assimilation into a group depends on 1) the size of the group-easier with larger groups; 2) the age of the group--if a group is relatively new, it typically accepts new members with ease. Group therapy is not recommended for children less than eight years old.

Confidential and Privileged Communications Legal and Professional Considerations--Client Records

HIPPA has provisions for two sets of client records to be kept by social workers. The primary record or medical record as it is often called, contains information pertinent to the client's treatment. The information in the primary/medical record includes assessment, diagnosis, treatment plan, medical information, clinical tests, treatment modalities, progress notes, collateral information, dates and times of sessions, billing records, etc. The primary or medical record can be subpoenaed. and the information released if required by law or approved by the client. The second set of records can be private psychotherapy notes and do not need to be a subsection of the primary file. Private psychotherapy notes are recognized, but not mandated, by the HIPPA Privacy Rule. A separate written authorization form must be signed by the client in order for psychotherapy notes to be released. A subpoena that asks for the "complete medical record" does not include private psychotherapy notes. However, under unique circumstances, the court may require the release of these notes and social workers need to be aware of this. The length of time that agencies/practitioners. keep client records vary by state and can be anywhere from 3-10 years. Social workers should follow local laws and consider the statue of limitations in the state of employment as a guide. Social workers should also be knowledgeable about best practices in their geographic location for when they retire, move or close their practice and social workers should consult with peers, local laws, associations and liability insurer.

General Research Terms

Halo Effect--when someone is evaluated too positively or too negatively because of the presence of one or more characteristics Hawthorne effect-the term used to describe subjects who behave differently than they normally do because they know they are being observed for research purposes Levels or Scales of Measurement--refers to the precision with which a variable is measured and is dependent on the nature of the variable and on the method of measurement; Nominal refers to a level of measurement that involves categories that are distinguished by name; Ordinal refers to a level of measurement that reflects each person's position or rank with respect to a characteristic--absolute differences between levels cannot be calculated (ie 1=very stafisied, 2=satisfied, 3=dissatisfied) Interval is a level of measurement that involves rankings. The intervals between the adjacent rankings are equal (ie thermometer using Fahrenheit temperate scale) Ratio--refers to an interval scale with a true zero point (ie age, height, weight) Placebo Effect--refers to changes in a dependent variable that result from a subject's belief that he/she is being treated Null Hypothesis--a statement predicting that there will be no relationship between two or more variables Research Hypothesis is a statement that predicts a relationship between two or more variables Reliability--is the consistency in measurement of a variable --or the extent to which repeated administrations of an instrument with the same sample will yield the same results Sample is the subset of a population or a universe of of individuals or objects selected to represent a population from which they are drawn to be the subject of the research study Representative Sample is the term used to refer to the extent to which a sample is important in ways similar to the population in which it was drawn (ie race, age distribution, income, etc). The more similar the sample is to the population, the more confidence the researcher can have that a study of the entire sample would lead to similar results Sampling Bias is a systematic distortion of a sample, whether intentional or unintentional. Sampling Bias affects the extent to which a sample is representative of the population from which it is drawn Sampling Error--refers to the normal differences that exist between a population and a sample (normally a sample is unlikely to be perfectly representative of the population from which it is drawn) Random Sampling or Randomization--is a method for assigning subjects to an experimental and a control group where every individual has an equal chance of being assigned to the other group. Validity--measures the extent to which an instrument measures what it is intended to measure; External Validity refers to the amount of confidence we can have that findings from the study are applicable to the larger population from which the sample was drawn; Internal Validity refers to the amount of confidence we can have that variations in the dependent variable can be explained by variations in the independent variable. There may be factors that pose a threat to internal validity. Independent Variable-is the item that is thought to cause or influence a behavior or outcome. In mental health, the independent variable is frequently the intervention. Dependent Variable-is the outcome or behavior thought to be caused or influenced by the Independent Variable Intervening and Extraneous Variables are factors other than the IV and DV that may exert influence on an outcome Self-Anchored Rating Scales are scales created by the client and social worker to measure progress in achieving treatment objectives

Harm Reduction

Harm reduction is a concept that was introduced in the 1980s as a way to address the HIV epidemic. Harm reduction is defined as reducing harm of a risky behavior. Risky behaviors are often coping mechanisms to other stressors. Risky behaviors allow individual to avoid identifying underling stressors. Person must want to change to reduce the harm of a risky behavior. Harm reduction is most often paired with motivational interviewing. Motivational Interviewing is made up of four states of change: pre-contemplation, contemplation, action and maintenance. Harm reduction is introduced in the the pre-contemplation first stage. Pre-contemplation refers to acknowledgment that a problem behavior exists but no interventions or decision are made yet. At this stage, the social worker asks the client to reduce risky behavior. Harm reduction does not have an established model of practice or set procedures. harm reduction is often identified as a collection of interventions that have as their objective the reduction of damage. Brocato and Wagner (2003) identify three general interventions that are considered harm reduction approaches pertaining to substance abuse: 1) change in the route of administration of a substance 2) providing a safer substance of drug to replace the more harmful substance 3) reducing the frequency or intensity of the target behavior According to Brocato, there are five principles associated with harm reduction: 1) pragmatism--reasonable not idealistic or theoretical 2) adoption of humanistic values accorded to clients--clients follow their values not those of another person or treatment modality 3) prioritizing the amelioration of harm--based on individual client's priorities 4) conceptualizing treatment as collaborative 5) prioritizing immediate and feasible goals Social workers do not provide treatment that a client does not want--forcing treatment hinders the therapeutic alliance. (Micro level) Social workers are well-equipped to identify problems within a culture or group that have led to oppression and vulnerability. (Mezzo level) Social workers collaborate with policy makers and lobbyists to identify problems and develop solutions. (Macro level)

Neo-Freudians-Harry Stack Sullivan

Harry Stack Sullivan placed an emphasis on the importance of relationships over the lifespan. He believed that personality consists of the relationships that contributed to its formation along with the dynamisms or reciprocal patterns that resulted from these relationships. Harry Stack Sullivan recognized the role of cognitive factors in personality development and proposed three modes of cognitive experience: 1.) Protaxic mode--in which Sullivan believed that the first few months of life are related to a discreet series of momentary states; 2) Parataxic Mode--entails seeing causal connections between events that occur at about the same time but that are actually unrelated. Sullivan believed that maladaptive behavior is attributable to parataxic distortions (misperceptions that involve responding to a person as though he/she is a significant person from the past) which are due to arrest in the Parataxic Mode. 3) Syntactic Mode--occurs at the end the first year of life and is characterized by logical, sequential, internally-consistent and modifiable thinking. Harry Stack Sullivan was the founder of the Interpersonal School of Psychotherapy. He viewed the social worker as both a participant or observer ad expert in interpersonal relationships.

1875 WILLIAM JAMES FUNCTIONALISM

Harvard University. Believed function of consciousness is more important than its structure. Believed experience happens first and then emotional reaction to it. Human mental states or thoughts and behaviors arise because of their functional role in adaptation to the environment. Considered the American founder of Experimental Psychology.

Psychoanalytic Psychotherapy/Psychodynamic/Ego Psychology--Heinz Hartmann

Heinz Hartmann, an Ego Psychologist, disagreed with Freud's contention that the ego develops out of the id and that the capacities of the ego are dependent upon instinctual drives. Hartmann maintained that the capacity for ego and id is present at birth, having evolved in the human species as part of the process of adaptation. He saw the ego as having its own independent source of energy and as developing independently of instinctual drives and internal conflicts. Hartmann saw the ego as having purposes beyond intrapersonal conflict. Hartmann believed the ego strives for adaptation, competence, and mastery. Some ego functions that Hartmann identified as conflict-free and autonomous from instinctual drives include: perception, memory, intelligence, thought processes, motor activity and reality testing. He believed human beings experience pleasure when they exercise these ego functions. Heinz Hartmann developed Autonomous Ego Functions.

Problem-Solving Therapy Model

Helen Perlman first conceptualized a basic problem-solving model for individuals in the 1950s. In the 1970's, Compton and Galaway elaborated on Perlman's model and expanded the problem-solving process to include more emphasis on groups, communities, and organizations. Compton and Galaway based their assumptions on human development social interaction theories, which include systems theory, role theory, communications theory, ego psychology, and human diversity. Compton and Galaway proposed that if problems are to be considered an inevitable part of life, then people have the capacity to solve those problems. The problem-solving process may be blocked because the clients do not have the requisite knowledge, adequate resources, or the emotional responsiveness needed to solve their problems on their own. Social workers need to create a collaborative relationship in Problem-Solving Therapy where clients are motivated to think and feel through the situations they face. The Problem-Solving Model is circular and flexible and contains the following phases: 1) Contact Phase: Identification of the problem (client, social worker, input from others), identification of the goals (short and long term), contract (initial contract that clarifies the agency's role in providing resources and committing to further study of the problem), exploration (assessment of the motivation of the client and the capacities and opportunities available). 2) Contract Phase--assessment and evaluation, plan of action, prognosis 3) Action Phase--intervention and assignments timeline, identification of services and resources 4) Termination--evaluation of accomplishments, considerations of reasons for possible lack of success, maintenance strategies, planning for termination, identification of client support system 5) Evaluation--listing of accomplishments, evaluation of appropriateness of treatment methods, listing of client's new learned problem-solving skills, social worker's generalization of problem-solving successes to other clients.

Personality Disorders--Histrionic Personality Disorder

Histrionic Personality Disorder is characterized by high emotionality and attention-seeking behavior. IT is more common in females. Common symptoms include the following: 1) discomfort when he/she is not the focus of attention; 2) inappropriate seductiveness or provocative behavior; 3) rapid shifts in emotion and emotional shallowness; 4) use of physical appearance to attract others' attention; 5) speech that is impressionistic or devoid of detail; 6) dramatic behavior and expression of emotion; 7) suggestibility; 8) perception that relationships are closer than they are in reality. Medications are not recommended unless there are comorbid disorder. These can be misused for self-destructive/harmful behaviors. Individuals with Histrionic Personality Disorder present for treatment only when stress or some other situational factor has overwhelmed their ability to function and cope effectively. They may seek treatment under these circumstances and exaggerate symptoms and be emotionally needy and not want to terminate therapy. Therapeutic treatment should focus on impulsive reactions, provocativeness, seductiveness, need for attention, and catastrophic thinking.

Obsessive Compulsive Disorders--Hoarding Disorder

Hoarding Disorder is characterized by a persistent difficulty discarding or parting with possessions. The accumulation of possessions interferes with living areas of the home. The hoarding causes clinically significant distress and impairment. SSRIs have been used to treat Hoarding Disorder with mixed results. Hoarding Disorder is difficult to treat. CBT is most effective psychotherapy modality.Training in decision-making, categorizing, exposure and habituation to discarding and cognivitte restructuring are recommended.

Sleep-Wake Disorders--Hypersomnolence Disorder

Hypersomnolence Disorder is characterized by excessive sleepiness that persists for a minimum of three times per week for at least three months. The person either experiences recurrent sleep or lapses into sleep within the same day. Also characteristic of Hypersomnolence Disorder is prolonged main sleep episodes of more than 9 hours a day that is non-restorative and results in the person having difficulty being fully awake after abrupt awakening. It results in significant distress or impairment in functioning and is not a byproduct of insomnia or another sleep disorder. Symptoms can be managed with wake-promoting medications such as Provide or traditional psychostimulants. Behavioral therapy and sleep hygiene techniques are the preferred treatments.

Somatic Symptom and Related Disorders--Illness Anxiety Disorder

Illness Anxiety Disorder is characterized by a preoccupation with being sick or developing a disease. There are few or no somatic symptoms present but the individual is primarily concerned concerned with the idea that he/she is ill. An Illness Anxiety Disorder diagnosis can also be used with individuals who do have a medical condition but for whom the anxiety is out of proportion to the illness and who assume the worst possible outcome. The anxiety is incapacitating and causes emotional distress or impairs the individual's ability to function. Some individuals with Illness Anxiety Disorder may seek help (care-seeking type) and some may not (care-avoidant type). Anti-anxiety medications may be helpful in alleviating the anxiety associated with the individual'a fear about the illness. The medication typically cannot provide lasting relief.

Sleep-Wake Disorders--Insomnia Disorder

Insomnia Disorder is characterized by dissatisfaction in the quantity and quality of sleep through difficulty falling asleep or staying asleep or non-restorative sleep that persists for at least three times per week for three months despite adequate opportunities for sleep. Insomnia Disorder results in marked distress or impairment in functioning and is not due to Narcolepsy, Breathing-Related Sleep Disorders, Circadian Rhythm Sleep Disorder or Parasomnia. Medication includes use of benzodiazepines, Lunesta Sonata or other hypnotics. These mediations should be used in the short term and should be targeted to the specific time that the person has trouble with sleep. Over-the-counter medications like Melatonin are believed to alleviate sleeplessness but are not rigorously tested. CBT is recommended to treat disruptive thoughts about sleep; behavioral techniques address improving sleep hygiene patterns, relaxation techniques and biofeedback.

Disruptive, Impulse-Control and Conduct Disorders--Intermittent Explosive Disorder

Intermittent Explosive Disorder is characterized by aggressive outbursts that are rapid onset and short duration. This aggressiveness is clearly out of proportion to the precipitating factors. Episodes include verbal assault, destructive/non-destructive property assault, and injurious/non-injurious physical assault.. Damage to personal property or physical assault must occur at least three times during a 12 month period. This disorder may appear as early as six years of age but the typical age of onset is between 13 and 21 years old. Anticonvulstants have been used in treating explosive clients but with mixed results. Moods stabilizers have also been helpful. SSRIs have even useful in treating impulsiveness and aggression. Group therapy or family therapy are useful if the individual is an adolescent or young adult. The goal of therapy is to help the individual express thoughts or feelings that precede an explosive outburst.

Asset Building Approaches to Organizational Development

It is important to evaluate existing and potential assets when working to meet organizational goals and asset identification is also needed when working with clients. Asset identification is also needed with individuals and communities--social workers may help clients identify existing and new assets. Funding sources to develop assets--public funders, foundations, corporations, private foundations and trusts, corporate foundations, events Fundraising plans should include the following: assessment, cultivation, solicitation, stewardship,

Family Systems Theory and Therapy--Strategic Family Therapy--Jay Haley

Jay Haley's Strategic Family Therapy emphasizes change techniques over theory. Strategic Family Therapy is consistent with the influence of Milton Erickson's work. Strategic Family Therapy social workers believe in the possibility of rapid change and use resistance of family members in the service of change. Communication is seen as defining relationships. Every relationship involves a struggle for power or a struggle for who defines the relationship. Symptoms are tactics to control--they define the relationship. The social worker is very directive in Strategic Family Therapy and relieves symptoms by helping patients find alternative ways of defining relationships. Strategic Family Therapy is especially useful with change-resistant families. The basic techniques of Strategic Family Therapy are: 1) Take charge role--the social worker plays a very active, directive role. He or she is responsible for changing maladaptive family organization and for solving the family's problems. The social worker must maintain his/her control in therapy. 2) Directives--the tasks that the social worker tells family members he/she wants them to perform 3) Paradoxical Directives--"prescribing the symptom"----tasks assigned by the social worker he/she wants to the family members to resist. (ie--social worker tells parents to let adolescent youth in home determine the atmosphere of the home--parents rebel against the directive and enforce limits instead) 4) Ordeals--making the client's symptoms too much trouble for the client to continue to have--(ie assign the client to exercise for three or four hours in the middle of the night when he/she has been symptomatic that day) 5) Restraining--meeting the family's resistance to change with warnings of the dangers implicit in change and the need to change slowly 6) Out-positioning--a form of paradox that involves having a family member act in an exaggerated way, consistent with another family member's perception of them. 7) Reframing--providing an alternative, more positive explanation of behavior to the family so it will be more amenable to change.

Neo-Freudians--Karen Horney

Karen Horney agreed with Freud that the basis of neurosis is anxiety but differed in that she did not believe that conflicts between instinctual drives and moral platitudes of the superego were at the root of anxiety. She believed that certain parental behaviors such as indifference, overprotectiveness or rejection can include anxiety in a child. Horney believed that the child may seek to alleviate anxiety in one of three ways: 1) by becoming compliant and moving toward people; 2) by becoming detached and moving away from people; and 3) by becoming aggressive and moving against people. She identified that children have two basic needs: 1) to be protected from pain, danger and fear and 2) to have their biological needs met.

1969 Elizabeth Kubler-Ross: Death and Dying

Kubler was a Swiss American who identified stages people go through when dying (not always in order): Denial, Anger, Bargaining, Depression, Acceptance

Anti-Anxiety or Anxiolytic Medications (often referred to as benzodiazepines)

Librium (chlordiazepoxide) Xanax (alprazolam) Valium (diazepam) Klonipin (clonazepam) Restoril (temazepam) Dalmane (flurazepam) Tranxene (clorazepate) Sera (oxazepam) Common side effects of anti-anxiety or anxiolytic medications include fatigue, dizziness, confusion, drowsiness, impaired motor coordination, headache, memory impairment , irritability and restlessness.

Antidepressants--MAO Inhibitors

MAO Inhibitors include: Nardil (phenelzine) Parnate (tranylcypromiine) Marplan (isocarboxazid) Emma (selegiline) Common side effects include: dry mouth, dizziness, insomnia, weakness, hypotension, sexual dysfunction and weight gain. When taking MAO Inhibitors it is necessary to avoid foods that have a high content of the amino acid tyramine (cheeses, chocolate, yogurt) because MAO Inhibitors combined with tyramine may result in extreme hypertension and even death.

Neurocognitive Disorders--Major and Mild Neurocognitive Disorders

Major and Mild Neurocognitive Disorders are described by progressive impairments in cognitive functioning that do not affect the level of consciousness. These result in impairment in social and occupational functioning over time. The individual's memory is compromised with an inability to learn new information and recall previously learned information. Disturbance is shown in executive functioning and there may be associated symptoms with mood behavior, judgement and personality. Mild Neurocognitive Disorder is characterized by a modest cognitive decline from a previous level of performance in one or more cognitive areas (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition). Minor Neurocognitive Disorder is distinguished from normal age related changes. This disorder does not interfere with independence in every day activities but the individual may need to exert greater effort or use compensatory strategies. Major Neurocognitive Disorder (formerly known as dementia) is defined as progressive impairment in one or more cognitive areas, with at least two being impaired. Substantial impairment to the degree that it interferes with independence in every day living. The possible causes of the disorder is required in either minor or major neurocognitive disorder, including: Alzheimer's disease, Frontotemporal Lobar Degeneration, Lewy body Disease, Vascular Disease, Traumatic Brain Injury, Substance/Medication Use, HIV Infection, Prion Disease, Parkinson's disease, Huntington's Disease, another medical condition, multiple etiologies or unspecified. First step in treatment is to determine the cause of the symptoms. Neurocognitive Disorders cannot be cured but medications may improve mental function, mood and behavior. For m ild and moderate memory impairment, medications such as Aricept, Reminyl, Exelon and Namenda are helpful. Antidepressants help with depression symptoms. Anxiety, agitation, and hallucinations may be treated with antipsychotic medications. Goal of treatment is to keep individual safe. Calendars and lists and structure and home accommodations are helpful. Maintaining good nutrition and sleep are key. Nursing home treatment may be needed as disease progresses.

Depressive Disorders--Major Depressive Disorder

Major depressive disorder involves a minimum of one major depressive episode and causes clinically significant distress or impairment. Specifiers include one episode or recurrent episode. Antidepressants such as SSRIs, tricyclics, MAO inhibitors and atypical antidepressants (Trazodone, Wellbutrin). Electronic shock therapy is a treatment of last resort for chronic and severe depressive symptoms. Cognitive Behavioral Therapy is the most popular and typically the most effective therapeutic treatment for MDD. Interpersonal therapy can also be used to focus on the individual's social relationships, more effective communication appropriate expression of emotions and appropriate assertiveness in social and occupational situations. Rational Emotive Therapy and Behavioral Therapy can also be used and no matter what the approach, the emphasis of therapy should be on individual taking a proactive approach to treatment.

Sexual Dysfunction Disorders--Male Hypoactive Sexual Desire Disorder

Male Hypoactive Sexual Desire Disorder is characterized by diminished desire for sexual activity and few if any sexual thoughts or fantasies.

Management, Administration and Policy

Management has been defined as "certain functions performed by social workers at all administrative levels with human services organizations which are designed to facilitate the accomplishment of organizational goals." (Weinbach, 2003). Managers are accountable to the public, to owners and to lenders to demonstrate that they are achieving goals. Management is an art and a science. Most knowledge about management is descriptive with increasing amounts of predictive knowledge and very little prescriptive knowledge The functions of management: 1) planning-taking action to influence future events-9 planning tools: Mission Statement, Goals, Objectives, Strategies, Policies, Rules, Procedures, Programs, Budgets. Widely used types of planning include: budgets, strategic planning, contingency planning. 2) organizing--staff activities must be organized and integrated to maximize the likelihood of the achievement of organizational goals. This process includes the identification of the roles of different staff members and that the nature of their interactions will be and the institution and maintenance of a plan that will facilitate the meshing of individual and group roles towards the attainment of organizational goals. 3) Staffing--recruiting and hiring and evaluation and discipline types of organizational staff--professionals, pre-professionals, para-professionals (paid staff that are trained to assist professional staff members), volunteers, indigenous nonprofessionals, and support staff (individuals who perform semi-skilled or unskilled work) 4) leading--refers to the manager's efforts to influence organizational staff to willingly work toward achievement of the goals of the organization--a key piece of leadership is the development and maintenance of the kind of organizational atmosphere that facilitates goal achievement. The elements of this kind of leadership include teamwork, mutual respect, mutual confidence, a clear understanding of one's own role as well as roles of others, advocacy for subordinates, clear communication of information pertinent to the mission of the organization, a high level of staff autonomy and the opportunity for staff to evaluate managers Leadership Styles--authoritarian, democratic (participative) and laissez-faire. 5) control--any mechanism designed to ensure that organizational plans are carried out as designed. Mechanisms of control include: plans, training staff evaluations, information, advice, directives, negative sanctions, loyalties, staff idealism, professional values and ethics, natural consequences and the manager as a role model and budgets to limit activities of an organization Types of budgeting: line-item budgeting (most common form); zero-based budgeting (every dollar requested must be justified--zero budget at start of fiscal year)

Psychoanalytic Psychotherapy/Psychodynamic/Ego Psychology

Modifications were made to classic psychoanalysis by individuals whose innovations were rejected by classical analysts. These individuals subsequently developed their own systems of therapy. Many objected to the impracticalities of classic psychoanalysis. For example, some clients lacked sufficient ego strength or finances to engage in classical psychoanalysis. These theorists made modifications based on meeting the client's specific needs. These theorists also believed in relatively high therapeutic neutrality though to a lesser degree than traditional psychoanalysis. Leading psychoanalytic psychotherapy/psychodynamic/ego psychologists include: Anna Freud, Heinz Hartman, Ernest Kris, David Rapport and Erik Erikson. Psychoanalytic psychotherapist/psychodynamic/ego psychologists believed that the social worker does not simply allow the therapy to be free-flowing, as is the case with classical analysis. Psychoanalytic Psychotherapy is more brief, so the social worker is more active and more directive and psychoanalytic psychotherapy is more individualized and different than classical psychoanalysis is that it is: 1) brief (weekly rather than daily meetings) 2) direct (less free association and more face to face discussion) 3) reliant on positive transference to facilitate progres 4) focused on the present Providing the patient with a corrective emotional experience is more important than consciousness raising in psychoanalytic psychotherapy versus classic psychoanalysis. Leading classic psychoanalysis theorists are Sigmund Freud, Alfred Adler, Lawrence Kohlberg and Melanie Klein (object relations)

The Intervention--Monitoring

Monitoring the treatment plan is a vital step in the intervention process. The client's progress needs to be evaluated regularly and adjustments made as needed. Client empowerment is recommended as focus of intervention--when clients have the opportunity to have some control over their lives, they typically feel and function better. Giving tasks to clients and asking them to accomplish the tasks helps clients gain self-confidence, improved self-image and a sense of empowerment. Client empowerment is a process and an outcome.

Bipolar and Related Disorders--Cyclothymic Disorder

Mood shifts between hypomanic and depressive symptoms that do not meet criteria for either episode. The symptoms have been present for at least half the time. Symptoms can cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms must persist for a minimum of two years in adults and one year in children and adolescents. Medication is not normally the first line of treatment. Cyclothymic Disorder is a chronic condition so therapy should include psychoeducation and skills management for predicting and managing mood swings. Lithium carbonate can be tried to manage mood swings that are similar to those found in Bipolar disorder.

Safety Considerations for Social Workers

NASW has developed policy recommendations and resources to reduce risk to clients, direct service staff, management and administration. General recommendation are in the following areas: --develop professional skills related to risk assessment and safety promotion--obtain education and training in risk reduction (risk-assessment involves a review of client's potential for violence. Safety planning involves review of procedures and activities that need to be followed in client care and transportation of clients. Verbal de-escalation techniques correspond to the ways in which one may diffuse a potentially explosive situation with client interventions. Finally, non-violent self-defense includes special training for mental health professionals.) --develop safety policies in agencies (have policies and procedures that address the security of clients, direct service staff, management and administration. Policies and procedures include training of service staff, protocols for preventing, assessing and responding to risk, how to respond to situations, incidents and aftermath and guidelines for administration and oversight --develop safety policies in schools of social work (for students in field placement and communicate these to students and apply in classroom where applicable) --advocate for legislation and state guidelines (schools of social work and social work students, in harmony with aspects of the NASW code of ethics) According to Crisis Prevention International (CPI) there are seven principles for effective verbal intervention as a means of de-escalation: 1) remain calm 2) isolate the individual 3) watch your body language (keep a distance, watch eye rolling or finger pointing) 4) keep your messaging simple 5) use reflective questioning 6) use silence 7) watch the paraverbals (tone, volume, cadence (rate and rhythm of speech)

Personality Disorders--Narcissistic Personality Disorder

Narcissistic Personality Disorder is characterized by grandiosity, a need to be admired by others, and absence of empathy. It is more common in males. Common symptoms of Narcissistic Personality Disorder include: 1) and exaggerated sense of importance; 2) fantasies of unlimited success, power, brilliance, etc; 3) perception of being special and a belief that he/she can only be understood by specific, high-status individuals; 4) sense of entitlement; 5) using others to achieve personal goals; 6) envy of other or perception that others envy him/her; and, 7) arrogance or haughtiness. Medications are not recommended for Narcissistic Personality Disorder unless there is another disorder. Therapy should focus on manipulative behaviors that demean and devalue others, lack of empathy and self-centeredness. Grandiosity and devaluing others should be interpreted as defensive strategies.

Sleep Wake Disorders--Narcolepsy

Narcolepsy Disorder is characterized by sudden, recurrent periods of an irrepressible need to sleep, lapses into sleeping napping that occur three times a week for a minimum of three. months. The individual experiences extreme drowsiness every 3-4 hours, sleep paralysis, loss of muscle tone (cataplexy) and sleep attacks. Interruptions of REM sleep exist as the individual moves from sleep to wakefulness. Medications that include psychostimulants that induce wakefulness (Modafinial/Provigil, Methylphenidate/Ritalin, Sodium oxybate/Xyreme, controls cataplexy and improves nighttime sleepiness. Lifestyle modifications such as sticking to a schedule, taking short naps throughout the day, avoiding nicotine and alcohol and engaging in moderate exercise at least 4-5 hours before bedtime are helpful.

Neo-Freudians

Neo-Freudians are followers of Freud who developed their own competing psychodynamic theories. Neo-Freudians typically downplay the importance of instinctual forces in personality and emphasize interpersonal and social influences. Leading Neo-Freudians are Karen Horney, Harry Stack Sullivan, and Erich Fromm.

Neurocognitive Disorders (NCDs)

Neurocognitive Disorders are characterized by abnormalities of the following mental processes: 1) memory deficits; 2) language disturbance; 3) perceptual disturbance; 4) impairment in planning and ongoing activities; 5) failure to recognize or identify certain objects. Conditions may be temporary or permanent.

Obsessive-Compulsive and Related Disorders--Obsessive Compulsive Disorder --OCD

OCD is characterized by anxiety-producing obsessions and compulsions that an individual feels to think or do repeatedly. These obsessions and compulsions are all time-consuming or cause clinically significant distress/impairment in social, occupational or other important areas of functioning. Antidepressants are first prescribed including Prozac, Luvox, Paxil, Zoloft and Anafranil. CBT has been shown to be the most effective form of therapy for OCD in children and adults. One CBT format--exposure or response prevention--involves gradually exposing the person to the feared object or obsession ad teaching the individual appropriate coping skills.

Couples' Theory and Therapy--Object Relations Couples' Therapy (Ronald Fairborn, Heinz Kohut and Carol Gilligan)

Object Relations Couples' Therapy is based on the premise that marriage becomes a closed system that inhibits growth through mutual unconscious interactions between the partners. The social worker creates a neutral and impartial environment to understand the distortions and internalized conflicts that each partner brings to the relationship that is dysfunctional. The Object Relations Model proposes that there is a complementary personality fit between couples that is unconscious and fulfills certain needs. The "mothering figure" is the central motivation for selection and attachment of a mate. The supposition is that a partner finds lost parts of him/herself in the other. Object Relations Couples' Therapy values affect, silence, body language, fantasy, dreams and transference as necessary for reaching the unconscious in order to develop insight. The social worker is the agent of change by modeling.

Object Relations Models of Psychoanalytic Psychotherapy/Psychodynamic/Ego Psychology

Objects Relations Models came from classic psychoanalytic theory and Ego Psychology.Since Freud's theory of human development had its basis almost exclusively in his work with adult patients, some psychoanalytic thinkers such as Melanie Klein, Ronald Fairborn, Margaret Mahler (the British School of Object Relations Theory), Otto Kernberg, Heinz Kohl and James Masterson questioned its validity. Object Relations Therapy is a psychodynamic approach to therapy. The focus of Object Relations Therapy is on early childhood experiences and relationships with significant others in childhood, in particular, the mother, as well as the resulting personality structure. The therapeutic process also looks at unconscious fantasies and impulses. Therapy is focused on childhood relationships and experiences that influenced personality development. Intervention strategies include encouraging the client to talk about childhood experiences, interpretation of the impact of childhood experiences on present functioning and relationships, dream analysis, analysis of transference or resistance and provision of a therapeutic environment that supports adjustments in the individual's sense of self, in his or her psychological functioning and in the nature or his/her relationships. Brief forms of psychodynamic therapy have been developed in recent years that appear to hold promise for working with individuals with substance abuse problems and depression. Melanie Klein, a psychoanalytic writer who based her theorizing about human development specifically on her work with children, saw the internal world of children focused more on relationships with others than on instincts and drives. Other Object Relations theorists have further developed her ideas and refined psychodynamic theory and practice. According to Object Relations theorists, infants are innately relationship (object) seeking. The. infant's relationship with the mother provides the basis for the development of the infant's sense of self and pattern for all subsequent relationships. The infant internalizes (interjects) qualities of the mother and then split these introjects into positive and negative aspects. The infant initially experiences the mother as good or bad, depending upon whether the mother is fulfilling or frustrating his/her needs in the moment. Over time, the child typically becomes aware that the same person can have positive and negative qualities. Melanie Klein viewed this process as "splitting" and saw it as an important step in the developmental tasks of childhood. Splitting can also be seen as a defense mechanism in older individuals. In order to relate to significant others, an individual. may split the significant other into two parts--the good and bad parts, in order to cope with the painful feelings associated with the person. For example, a child who has an abusive parent may use splitting as a defense mechanism, thus separating the "good parent" from the "bad parent". The child may form either a secure or insecure attachment with the mother. A secure attachment happens when the mother-child relationship has been predominantly positive and an insecure attachment forms when the relationship has been predominantly negative

Personality Disorders--Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder is characterized by perfectionism, preoccupation with orderliness, and considerable effort to control self and others, resulting in reduced flexibility, reduced openness and reduced efficiency. Common symptoms include the following: preoccupation with rules, details, lists, etc.; perfectionism that makes completion of tasks difficult or impossible; rigidity around morals, ethics, etc; inability to let go of worthless or worn out items; reluctance to delegate or work with others; miserliness; rigidity and stubbornness; excessive deviation to work at the expense of other activities/relationships. Medications are not indicated unless there are co-occuring disorders. Individuals with Obsessive-Compulsive Personality Disorder will seek treatment when life overwhelms their existing coping skills. Short term therapy is likely to be beneficial with the person's current support system and when coping skills are not functioning. Individuals with Obsessive -Compulsive Personality Disorder are more in touch with their thoughts than their feelings. Therapy should focus on: affect, guilt, anger and fear of retribution; rigidity, self-protectiveness.

Programs

On of the most important roles a social worker plays in working with individuals, groups and communities is that of an information broker. Social workers need to keep up-to-date on resources and programs and should be able to help clients navigate the process of accessing services. Here are some of the important programs that are designed to help or intervene on behalf of clients in distress: Abused Women's Shelters--protection, temporary housing, counseling and support services Adult Protective Services--vulnerable adults Child Protective Services--a function of the Division of Child and Family Services--provides legal protection, and a variety of support services for abused and neglected children--investigation, shelter care, foster care, family counseling, therapy, juvenile court involvement, health services Criminal Courts--issues orders of protection and adjudicates guild or innocence of accused abusers Division of Child and Family Services--legally-mandated service agency designed to provide assistance to families in crisis.--services include child protective services, family intervention, therapy, referrals for education and employment training Financial Program such as TANF, SSI, Social Security Survivors' Benefits, Disability Insurance, SNAP Worker's Comp Hospice Services--continuum of services for elderly and terminally ill Juvenile Court--legal venue for investigating, charging and adjudicating child abuse and neglect cases as well as youth offender cases Hospital Emergency Services--referrals for suicidal individuals, persons experiencing drug and alcohol overdoes and acute mental illness episodes. Mental Health Centers--provides inpatient and outpatient services for adults and children--both for-profit and non-profit Living (housing) options--nursing homes, assisted living facilities, care centers

Individual Theories and Types of Psychotherapy

Once a diagnosis has been made and a treatment plan is established, social workers use these treatment strategies to help their clients meet their desired goals.

Confidentiality and Privileged Communication--Legal and Professional Considerations--Confidentiality

One of first responsibilities of a social worker is to explain confidentiality of treatment to client and execute a written informed consent agreement. Confidentiality is absolutely essential for professional therapy and casework services.Disclosure of confidential information is subject to ethical and legal action. Confidentiality--the laws or professional ethics that regulate the disclosure of information obtained in psychotherapy,. Privileged Communication--legal concept that refers to the admission of evidence into court. Some states grant privilege to information from social work therapy/casework and some do not. Exceptions in states where social work-client info is privileged include if the client or client's attorney waives the privilege or if the court determines that the benefits outweigh the injury that might result from the release of information or the client makes information public (Ie shares with others like friends or family--besides the social worker and the client sues the social worker and the social worker needs the information for his/her defense. Tarasoff v the Regents of the University of California (1976)--mental health social workers who worked with a client who said he/she wanted to kill someone were found negligent because they did not warn the intended victim.

Behavioral Therapy-Operant Conditioning

Operant Conditioning focuses on behaviors that operate or act on the environment (operants) with the goal of obtaining some response (ie reinforcing behavior so it will be repeated and withholding reinforcement so a behavior will not be repeated). Reinforcer--a consequence that increases the likelihood that a preceding behavior will be repeated. The reinforcer needs to immediately follow the behavior. Primary Reinforcer--stimuli that sustain life such as water and food and sleep or to satisfy physiological needs. Primary reformers are naturally reninforcing. Secondary Reinforcer--a stimulus the recipient learns to value Positive Reinforcer--repetition of a behavior because the behavior is followed by a positive stimulus Negative Reinforcer--repetition of a behavior because of the behavior's power to turn off negative stimuli (ie rat pushes lever to stop pinching) (person takes a Tylenol to get rid of a headache) Premak Principle--using high probability behavior to reinforce a low probability behavior in order to increase the frequency of the low probability behavior--ie rewarding homework with video game time) Differential Reinforcement for Alternative Behaviors (DRA)--alternative behaviors are reinforced while the target behaviors are not Shaping--the technique of reinforcing successive approximations to the desired behavior Schedules of Reinforcement: Continuous reinforcement--useful early in the learning process--reinforce every occurrence Intermittent reinforcement--reinforce only some of the incidents of the behavior--useful in maintaining the behavior Fixed Interval/Variable Interval Reinforcement--getting a paycheck every two weeks vs checking email randomly so emails are sent randomly Fixed Ration/Variable Ratio--reinforcement given after a specific number of responses vs after a random or varied number of responses Punishment--following the behavior with an aversive stimulus (eg spanking a child for misbehaving). The use of punishment does not teach appropriate behavior and often makes the subject resent the punisher. Extinction--refers to failing to reinforce the target behavior, which results in disappearance of the behavhior Response Cost--withdrawing a specific positive reinforcer each time an undesirable behavior is performed (ie a child loses a token earned previously for appropriate behavior) Verbal Clarification and Prompts are helpful aids in the development of new behavior Modifying Behavior with Contingency Contracts and Token Economies--contingency contract is a treatment contract that makes a specific consequence, positive or negative, contingent upon a specific behavior; token economies are widely used (often in classrooms) that involves rewarding desired behaviors with tokens that can be redeemed for reinforcers

Disruptive, Impulse-Control and Conduct Disorders-Oppositional Defiant Disorder

Oppositional Defiance Disorder is represented by an angry/irritable mood, argumentative/defiant behaviors and vindictiveness that is not typical of the child's developmental level. In children younger than age 5, the behaviors must be present on most days for six months. In children older than 5, it must occur at least once per week for at least six months. Medication is not currently recommended and there is little research on the effectiveness of medications for the treatment of Oppositional Defiance Disorder. Current focus in therapy for Oppositional Defiance Disorder is behavior modification via parent training and family therapy that gradually shapes the child's behavior. The goal of intervention is to reinforce more prosocial behaviors and diminish undesired behaviors at the same time. Parent support groups are also helpful.

Trauma and Stressor Related Disorders--Post Traumatic Stress Disorder

PTSD is defined as exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways: directly experiencing a traumatic event, witnessing the event that occurred to others, learning that the traumatic event occurred to a close relative or friend, and/or experiencing repeated or extreme exposure to aversive details of traumatic events. Symptoms need to occur for at least one month. The individual has increased arousal and avoids internal or external stimuli that are reminiscent of the trauma. There are specific criteria for children 6 and under.SSRIs and other antidepressants can provide relief to symptoms.

Personality Disorders--Paranoid Personality Disorder

Paranoid Personality Disorder is characterized by general distrust/suspiciousness of others and is more common in males. Individuals must exhibit a minimum of four of the following symptoms to be diagnosed with Paranoid Personality Disorder: 1) believing that others are exploiting or harming them in the absence of convincing evidence; 2) consistently and without justification questioning the loyalty and trustworthiness of others; 3) avoiding confiding in others because of unjustified beliefs that they will use information against him/her; 4) perceiving benign remarks or events as demeaning and threatening; 5) bearing grudges; 6) interpreting innocuous remarks as personal attacks; 7) having unwarranted doubts about spouse or partner's fidelity. Medications are not indicated for Paranoid Personality Disorder because medication can cause unnecessary suspicion that usually results in noncompliance and premature treatment termination. If individual with Paranoid Personality Disorder suffers from severe anxiety or agitation, an anti-anxiety medication may be prescribed. Individuals with Paranoid Personality Disorder rarely present for therapy. When an individual with Paranoid Personality Disorder does present for therapy, a client-centered, supportive approach is most effective. Primary focus of treatment should be on the here and now feelings of the individual, their discounting of disconfirming data, the accuracy of the individual's observations contrasting with the rigidity of his/her paranoid interpretation and the consistency of the individual's mistrust of the social worker with his/her typical suspicious thought patterns.

Paraphilic Disorders

Paraphilic Disorders are sexual disorders and deviations in which sexual arousal occurs almost exclusively in the context of inappropriate objects or individuals. Examples are: 1) Exhibitionistic Disorder; 2) Fetishistic Disorder; 3) Frotteuristic Disorder; 4) Pedophile Disorder; 5) Sexual Masochism; 6) Sexual Sadism; 7) Transvestite Disorder; and, 8) Voyeuristic Disorder. SSRIs have shown promise in treating individuals with paraphilic disorders, as well depression and and other mood disorders. Treatment options vary and include individual psychotherapy, group therapy marital therapy and family therapy. CBT can be used with the following steps: aversive conditioning, confrontation of cognitive distortions, victim empathy, assertiveness training, relapse prevention, surveillance systems, lifelong maintenance. Group therapy is useful in helping individuals overcome the denial that is frequently associated with Paraphilic Disorders and as a form of relapse prevention.

Parasomnias

Parasomnias are sleep disorders that involve abnormal behavior, experiential or physiological events/sleep, specific sleep stages or sleep-wake transitions. These include: 1) Non-Rapid Eye Movement Sleep Arousal Disorders are non-REM sleep arousal disorders the represent variation of both wakefulness and non-REM sleep. These result in a combination of complex motor behaviors without conscious awareness. There are recurrent episodes of incomplete awakening from sleep, accompanied by either sleepwalking or sleep terrors. The individual does not remember any dream imagery and amnesia for the episodes is present; 2) Nightmare Disorder which is characterized by recurrent dreams that are threatening, frightening or cause dysphoria. The individual is fully oriented when awakened and can usually remember dream content. Treatment includes lucid dream therapy, universal sleep hygiene and cognitive therapy; 3) Rapid Eye Movement Sleep Behavioral Disorder--is characterized by repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors during REM sleep. The behaviors reflect action-filled or violent dreams and can result in significant injury to the person and/or bed partner. Person can usually recall the dream content upon wakening and is fully alert. 4) Restless Leg Syndrome--sensorimotor, neurological seep disorder characterized by a desire to move the legs or arms associated with uncomfortable sensations (ie creeping, crawling, itching, tingling, burning). The frequent movements are in response to the uncomfortable sensations. Symptoms must occur at least three times a week for at least three months. Restless Leg Syndrome is more common in women than men. Medication treatments include Mirapex, Requip, benzodiazepines, Gabapentin and opiates.

Depressive Disorders--Persistent Depressive Disorder-Dysthymia

Persistent Depressive Disorder is characterized by depressive symptoms that do not meet the criteria for a Major Depressive Episode. Symptoms have been present a minimum of two years for adults and one year in children and adolescents in combination with other depressive symptoms. It is common for individuals with Persistent Depressive Disorder to develop Major Depressive Episodes but once major episode clears, individual returns to the chronic state of dysthymia. Individual must have two or more of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, feelings of hopelessness. Antidepressants are helpful in keeping person's energy level up and preventing depressed moods. SSRIs are the most commonly prescribed medication for Persistent Depressive Disorder/Dysthymia. Best form of treatment is a combination of medication and psychotherapy. CBT, Interpersonal Therapy, Solution-Focused Therapy and social skills training are all effective.

Personality Disorders

Personality Disorders are defined in the DSM-5 as "enduring patterns of inner experience and behavior that deviate markedly from the exceptions of the individual's' culture are pervasive and inflexible, have an onset in adolescence or early adulthood, are stable over time and lead to distress or impairment".

Four phase Model of the Cycle of Abuse

Phase I--Tension building; Phase Two--incident; Phase Three--reconciliation; Phase IV--Calm.

Adult Development and Learning Process

Physical development complete. Social development focuses on dating, career choice, mating and forming a new home and family. Learning process continues in formal education or work training. David Kolb developed a model where he identified an experiential learning style that he labeled as: Doing--active experimentation; Watching--reflective observations; Feeling--concrete experience; and Thinking--abstract conceptualization. In its most simplistic form, people learn visually, auditorily and/or experimentally.

Feeding and Eating Disorders--Pica

Pica is typified by age-inappropriate, persistent eating of at least one nonfood item (dirt, hair, insects, paints) for at least a one month period. The individual diagnosed with Pica does not display an evident aversion to food. Pica must be severe enough to require medical assistance and may occur with another mental disorder.

Play Therapy

Play therapy is a technique whereby the child's natural means of expression, namely play, is used as a therapeutic method to assist him/her in coping with emotional stress or trauma. Used for broad range of problems: Anxiety, OCD, ADHD, etc. The basic premise of play therapy is that children's emotional conflicts are manifested in their play (assessment) and that reenactment in play therapy of their experiences and situations that underlie emotional conflict can facilitate the healing process (intervention). Play therapy also lessens children's self-consciousness talking about difficult subjects and facilitates communication.

Power Structures/Governance

Power can be established a number of ways and there is formal and informal power. Formal power is typically given in accordance with a person's position within a company and the corresponding authority typically assigned that role. Informal power stems from the relationships an individual develops and the respect earned within those relationships. Organizational structure determines formal power while personal relationships determine informal power. Legitimate Power--also called positional power--to be recognized, person in position needs to be seen as having earned it legitimately. Expert Power--based on significant knowledge of a specific subject. These individuals tend to have more influence on the decision making process and is typically weighted more heavily when there is a pool of candidates for a position of legitimate power. Referent Power--stems from the interpersonal relationships the person cultivates within the origination. Referent power is tied to likeability and is often associated with individuals with charisma. Coercive Power--is derived from a person's ability to influence others via threats or punishments such as termination Reward Power--refers to the ability of a person to influence incentives in an organization including salaries, bonuses, awards, promotions, etc. Reward power if used correctly greatly motivates employees--if it is applied via favoritism, it can demoralize employees and worsen performance

Sexual Dysfunction Disorders--Premature (Early) Ejaculation

Premature Ejaculation is ejaculation that persistently occurs within one minute following vaginal penetration and before the individual wishes it to occur. These occurrences of Premature Ejaculation cause significant distress or interpersonal conflict. This is the most common sexual dysfunction in novel sexual situations or in men who have had a substantial interval since their last orgasm.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder is a condition associated with severe emotional and physical problems that are closely linked to the menstrual cycle.Symptoms begin a week before onset of period and become minimal or absent in the week after completing period. One or more of the first three symptoms and up to five additional symptoms must be present: 1) significant affective lability; 2) significant irritability or anger or increased interpersonal conflict; 3) Marked anxiety, tension and/or feelings of being keyed up or one edge. 4) Dereased interest in usual activities; 5) Subjective difficulty in concentrating; 6) Lethargy, easily fatigued or lack of energy; 7) Significant change in appetite, overeating or specific food cravings; 8) Hypersomnia or insomnia; 9) Physical symptoms such as breast tenderness/swelling/joint/muscle pain, sensation of bloating or weight gain; 10) Sense of being overwhelmed or out of control. These symptoms must cause a clinically significant amount of stress. SSRIs and Xanax have been reported to be effective in treating but no studies have supported. CBT, light therapy, exercise, relaxation strategies and nutrition therapy are appropriate but untested interventions.

Program Evaluation

Program evaluation is a form of applied research that includes a number of research activities designed to evaluate programs from planning to completion. Types of Evaluation: Summative Evaluation--(outcome analysis)--evaluates the extent to which goals and objectives have been achieved and the extent to which identified. effects of the program an be generalized to other populations and settings Formative Program Evaluation (process analysis)--evaluates a program from the planning stage through the implementation stage Cost-Benefit Analysis--compares the cost of the program to the identified benefits--ratio of costs to benefits Cost Effectiveness--compares the cost of the program to the program output (cost per unit) Peer Review--formal process in which previously defined, specific professional standards of intervention are used by the social worker's colleagues as a basis for monitoring and evaluating his/her own professional practice.

Psychostimulants

Psychostimulants reduce impulsive behavior by increasing the level of neurotransmitters. Psychostimulants are used to treat ADHD and can also be used for Narcolepsy and obesity. In most individuals, these drugs create wakefulness, improved mood and an increase in alertness. In those with ADHD, Psychostimulants have a paradoxical response including improved concentration and increased ability to exercise self-control. Examples of Psychostimulants are: Ritalin, Daytrana, Metadate and Methylin (methylphenidate) Dexedrine, Dextrostat (dexotroamphetamineP Adderall (amphetamine and dextroamphetamine) Concerta (methylphenidate) Vyvanse (lisdexafaetamine dimesylate) Dexozym (methamphetamine) Focalin (dexmethyophenidate) Commons side effects include: insomnia, anxiety, loss of appetite, gastrointestinal pain and cardiac arrhythmia. Strattera (amoxetine-non-stimulant; a norepinephrine) reuptake inhibitor to treat ADHD. Common side effects include: nausea, fatigue (in children and adolescents) and difficulty sleeping (in adults) Catapress (clonidine) Tenex (guanfacine) and Intiniv (guanfacine). These psychostimulants are prescribed for tics, impulsivity and aggressive behaviors. Common side effects include: marked increased or decreased heart rate, shortness of breath, rapid weight gain and swelling, confusion and hallucinations, fever, pale skin, decreased urination, dizziness, dry mouth, blurred vision, headache, joint pain, nausea, vomiting, loss of appetite, insomnia, frequent nighttime urination, skin rash, decreased sex drive or impotence.

Disruptive, Impulse-Control and Conduct Disorders--Pyromania

Pyromania is the deliberate setting of fires on more than one occasion. The individual experiences pleasure or relief while setting the fires, or in the aftermath of the first setting. Behavior involves a fascination with or attraction to fire. Pyromaniacs spend significant time planning, staging and watching fires. The person fails to resist an impulse to set fires. Individuals may be indifferent to the effects of fire on life and property. There is no single treatment that has proven effective with Pyromania.

Trauma and Stressor Related Disorders--Reactive Attachment Disorder

Reactive Attachment Disorder is characterized as a disruption in a child's normal attachment behavior. It is the result of grossly negligent parenting and maltreatment. Reactive Attachment Disorder affected individuals show minimal social and emotional responsiveness to others, episodes of unexplained irritability, and sadness and fearfulness with adult caregivers. Onset is diagnosed between 9months and 5 years old. Medications not recommended unless depression, anxiety or ADHD are also present. Treatment includes parenting skills (attachment and behavioral catch-up), family therapy, individual counseling, psycho0education, special ed services and residential or inpatient treatment for children with more serious issues or who put themselves at risk for harm.

Other Conditions that. may be the Focus of Clinical Attention

Relational Problems--parent/child, sibling, upbringing away from parents, spouse/partner, high expressed emotional level within a family, uncomplicated bereavement Abuse/Neglect Related Problems--child physical abuse, child sexual abuse, child neglect, child psychological abuse, spouse or partner violence--sexual, physical, spouse or partner neglect, spouse or partner abuse-psychological, adult abuse by a non-spouse or partner Educational/Occupational Problems--problem related to current military employment, academics/educational or employment Housing and Economic Problems--homelessness, inadequate housing, discord with neighbor or landlord, or lodger, problem related to living in a residential institution, lack of adequate food or water, extreme poverty, low income, insufficient social service support, unspecified housing or economic problem Other problems related to social environment--phase of life problems, problem related to living alone, social exclusion or rejection, target or perceived target of discrimination or persecution Problems Related to Crime or Involvement with the System-- Other Health Service Encounters for Counseling or Medical Advice-- Problems Relating to Other Psychosocial, Personal and Environmental Circumstances-- Other Circumstances of Personal History-- Adult Antisocial Behavior-- Child or Adolescent Antisocial Behavior-- Problems Related to Access to Medical or Other. Health Care-- Non-adherence to medical treatment-- Overweight or Obesity-- Malingering--a behavior which produces or exaggerates psychological or physical symptoms to avoid something unpleasant or to obtain something desirable Wandering Associated with a Medical Disorder Borderline Intellectual Functioning[[

1945 Rene Spitz: Attachment/Anaclitic Depression

Rene Spitz was associated with the psychoanalytic movement in America with an interest in the ego development of the child and the relationship between mother and child. Spitz observed children in hospital settings and orphanages and noted emotional deficiencies that significant effects on children's psycho-emotional development-Spitz called this "hospitalism" or "Anaclitic depression". Spitz also identified three significant principles in the psychological development of children--the smiling response, stranger anxiety and semantic communication (where child learns now to be obstinate)

Ethical Issues in Research

Research ethics are designed to protect research subjects. --Minimize the risk of harm --Obtain informed consent --Protect anonymity and confidentiality --Avoid deceptive practices --Provide the right to withdraw from the research

Working with Involuntary Clients

Resistant clients (incarcerated and mandated or just those who believe they cannot be helped or don't need help. Reluctant clients often use coping mechanisms that have worked in the past, including: withdrawal (refusal to talk, avoid the expression of deep feelings, minimize problems), diversion (change the subject, blame someone else for the problem, guide the conversation in another direction, shift the focus to the social worker rather than the client); aggression--passive-agression, hostility or verbal and physical abuse.

Risk Management

Risk Management includes all efforts designed to preserve assets and earning power associated with a business. Risk management involves proactive measures that identify potential risk factors and then prevent, reduce or eliminate those factors, AND, reactive measures that address risk incidents that have occurred. The NASW estimates that nearly half of all lawsuits they investigate are ethics-related and this means that social workers need to be especially aware of risk management issues. Agency Risk Management: Participative Management Theory is effective in creating risk management policies and procedures through employee collaboration and decision-making. Direct service providers and management can work together to create a comprehensive risk management plan. Steps tor Development of a Risk Management Plan: 1) Establish the purpose of the process and identify external and internal drivers of the need for a risk management plan/risk to provide context, structure and accountability. 2) Identify Risk to provide baseline for risk assessment and treatment.--define the nature of the risks and the extent to which they occur, the circumstances under which the risks arise and the causes of the identified risks and potential factors that contribute to their occurrence. Both clinical and managerial risks need to be assessed and managed in agency settings. Internal and External Sources for Proactive and Reactive Risk Management--incident reports, internal reactive information such as accident report, complaints, etc, external reactive information from audits, inspections, hazard warnings, injury reports, consumer reports, internal proactive information. including advance directives, general risk assessments, internal audits and inspections, consumer consultation, self-assessments and specialist risk assessments, external proactive information from external evaluations and inspections, accreditation processes, external patient surveys, legal and professional standards, independent reviews and external stakeholder consultations. 3) Assess the risk to analyze the impact of the risk and evaluate the necessary next steps to be taken to reduce or eliminate risk. 4) Develop solutions to treat the risk--action plan with responsible parties and a timeline 5) Monitor and review the risk Staff training for Risk Management should be done at the earliest opportunity and on a regular basis. A safety response should be developed in relation to the following scenarios--physical aggression and violence, non-physical aggression and violence, behaviors that are the result of a medical condition such as cognitive impairment, substance use or withdrawal and systemic illness, working alone, training procedures that teach physical interventions, use of physical interventions in clinical practice, and psychological impact of violence or aggression. Staff training programs should provide information to employees regarding the risks that clients with mental health issues may face--including: self-harm, mental instability, vulnerability, risk to others Ethics in Risk Management--Moral aspects of social problems and behavior, ethical decisions and dilemmas, and now ethics risk management which pertains to to the dilemma of how to handle the different ethical cases that arise, not simply what is right and wrong. Having a sexual relationship with a client, engaging in fraudulent billing practices, misrepresentation, social work impairment due to substance abuse, practicing outside one's scope of practice and illegal actions are clearly in violation of the NASW Code of Ethics However, there is another category of ethics; behavior that may be interpreted in various ways by different social workers. Typically, the "standard of care" is used to make ethical decisions--standard of care refers to the concept of what would an ordinary, reasonable and prudent professional person wit the same or similar training have done under the same or similar circumstances? Social workers should seek guidance from experts in particular areas when ethical issues arise that are unclear in how to resolve.. Some agencies have ethics committees to handle ethical issues, These committees provide consultation in how to handle ethics concerns/violations, training for staff, and policy change recommendations and additions. Documentation is a critical ethical issue--the general rule is that "if it isn't written down, it didn't happen. Don't write thoughts or what individuals know--use facts about clients and workers in reporting--observable terms, not what can be interpreted or summarized.

Exploitation and Trafficking Risk Factors

Risk factors are runaway and homeless youth, foreign nationals, children used in pornography, children and adults forced into sexual or labor services, individuals living in poverty, individuals who have previously been sexually abused by parents, step-parents, boyfriends or older siblings, victims of trauma, sexual assault, domestic violence, social discrimination and war.

The Intervention Process--Social Worker and Client Roles

Roles social workers play in regards to linking clients with needed resources include: 1) broker--help locate community resources/make referrals; 2) case manager--assess client needs and ensure client obtains needed resources; 3) mediator--identify barriers to client receipt of needed resources and assist client and service provider in finding satisfactory strategy for removing barriers; 4) client advocate--works with or on behalf of client to access services unable to otherwise access

Feeding and Eating Disorders--Rumination Disorder

Rumination Disorder is characterized by receptive instances of regurgitation, re-swallowing or spitting out food. The onset must have been preceded by a period of normal functioning and the behavior should not be the result of a medical condition. The symptoms need to persist for at least one month. In infants, the disorder may be associated with inadequate emotional interaction and the infant may learn to self-soothe with rumination. There is no standard medication for Rumination Disorder. Rumination Disorder Treatment is based on the cause of the behavior (mother-child relationship deficits). Behavior modification techniques (such as habit-reversal) may help the individual extinguish the behavior.

Family Systems Theory and Therapy--Structural Family Therapy-Salvador Minuchin

Salvadore Minuchin's Structural Family Therapy is based on the premise that all families have an underlying organization which is either adaptive or maladaptive. Maladaptive patterns of interaction underlie symptoms observed in individual family members. Through observation of family interactions, Structural Family Therapy identifies the maladaptive structural elements that underlie maladaptive family interactions, as well as relationships between the family and non family entities. Structural Family Therapy, after identifying the maladaptive structural elements seeks to make change in these structural elements. Important concepts in Structural Family Theory include: 1) Alignments--coalitions between subsystems in the family that serve a specific purpose 2) Power hierarchies--a term that refers to the distribution of power in the family 3) Subsystems--parts of the family 4) Interpersonal Boundaries--rules that control the amount of involvement family members have with each other and with others who are not part of the family 5) Disengagement--occurs when family members and subsystems of the family are isolated from each other emotionally and in terms of their interaction 6) Enmeshment--occurs when family members are subsystems of the family are overly involved and concerned with each other resulting in minimal autonomy in functioning. 7) Inflexible family structures--rigid structures that do not lend themselves to being changed in the face of changing family circumstances Techniques of Structural Family Therapy include: Joining--social worker's entering into family system by forming a strong bond with members, acknowledging the various perspectives of the members and accommodating the family's organization and patterns. Joining is more central to Minuchin's approach. Evaluating Family Structure--mapping of underlying structures of the family (structural diagnosis or the identification of the problem and its structural dynamics) Restructuring the Family--changing the family structure via enactment, spontaneous behavior sequences and reframing (for example, increasing the involvement of an uninvolved father and decreasing the involvement of an over-involved mother) Enactment--social worker has the family or subsystem of the family act out, in session, how they typically deal with a specific type of problem. The components are defined and directed by the social worker. When the enactment creates a problem, the social worker may push family members to continue in the vein they are going or alternatively, he or she will comment on the problem. Spontaneous behavior sequences--these occur when the social worker highlights an interaction that is naturally occurring in the moment and assists the family in modifying problem sequences. Reframing--means redefining the family's perspective on problems (ie that they are the problems of a specific family member or caused by the environment) as problems with the structure of the family.

Personality Disorders--Schizoid Personality Disorder

Schizoid Personality Disorder is characterized by a restricted range of emotions and a pattern of detachment from others. Common symptoms of Schizoid Personality Disorder are: 1) a lack of interest in close relationships; 2) a preference for solitary activities; 3) a minimal interest in sexual activity; 4) minimal or no pleasure in activities; 5) absence of friends of confidents with the exception of close kin; 6) indifference to praise or criticism; 7) emotional detachment, coldness or flat affect. Medications are not indicated for Schizoid Personality Disorder and individuals with this disorder are not likely to seek treatment. Stability and support and keys to effective treatment for those who do seek therapy. Focus of treatment should be on anything that creates affect in the present, reflections on detachment, prevalence of silence, minimal expression of empathy, and the "in-session experience.

Personality Disorders--Schizotypal Personality Disorder

Schizotypal Personality Disorder is characterized by a pattern of deficits in interpersonal skills and a decreased capacity for close relationships. Cognitive and perceptual distortions and eccentric behavior are also common. Common symptoms include the following: 1) ideas of reference (belief that casual events have specific meaning to the individual; 2) odd beliefs or magical thinking that impacts behavior; 3) unusual perceptual experiences; 4) oddities in thought or speech; 5) suspiciousness or paranoid beliefs; 6) affect that is either inappropriate or constricted; 7) odd or eccentric behavior or appearance; 8) absence of friends or confidents with the exception of close kin; 9) social anxiety frequently associated with paranoid fears. Individuals with Schizotypal Personality Disorder usually distort reality more than Schizoid Personality Disorder. Psychotherapy is the best form of treatment and should focus on illogical thinking and odd emotional reactions, the reaction of others to their strange behavior and confrontation of tangential or suspicious thinking. Medication is not warranted unless used with individual with extreme stress who may develop psychotic symptoms--then anti-psychotic medications may be warranted.

Anxiety Disorders--Selective Mutism

Selective Mutism is characterized by a persistent failure to speak in certain situations with demonstrated ability to talk as evidenced by doing so in other situations. Selective Mutism lasts a minimum of one month and cannot be evident only in the first month of school. Prozac can be helpful in treating Selective Mutism and is more successful in treatment with younger kids. It has been found to reduce symptoms of Selective Mutism in about 75% of cases in children. Behavior. modification with positive rewards for speech is effective as is Stimulus Fading (finding a motivating stimulus for a child to speak in mute situations) combined with positive reinforcement techniques. Punishment is not recommenced.

Antidepressants--Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective Serotonin Reuptake Inhibitors (SSRIs) include: Prozac (fluoxetine) Paxil (paroxetine) Zoloft (sertaline) Celexa (citalopram) Lexapro (escitalopram) Luvox (fluvoxamine) extra (paroxetine-mesylate) Sarafem (fluoxetine-hydrochloride) prospecrebed of Premenstrual Dysphoric Disorder Common side effects include: headache, nausea, anxiety, constipation, dry mouth, sexual dysfunction and sedation.

Behavioral Therapy--Sensate Focus and Non-demand Pleasuring (in Sex Therapy)

Sensate Focus and Non-demand pleasuring was developed by Masters and Johnson to treat performance anxiety or spectator role. The involves the couple pleasuring each other in nonsexual ways to gradually rebuild the couple's sexual repertoire.

Anxiety Disorders--Separation Anxiety Disorder

Separation Anxiety Disorder is characterized by developmentally inappropriate excessive anxiety around separation from significant others (parent or spouse). Features include clinically significant symptoms of anxiety, unrealistic worries about the safety of loved ones, reluctance to fall asleep without being near primary attachment figure, excessive distress such as tantrums when separation is imminent; nightmares with separation related themes; homesicknesses; dizziness, lightheadedness, headaches, nausea, stomachache, cramps, vomiting, muscle aches, or palpitations. Symptoms must be present for at least four months in children and adolescents and at least six months in adults. Prozac (fluoxetine) is the only SSRI approved by the FDA for those younger than 18 and is typically prescribed. Prozac should be used when functional impairment is moderate to severe. Therapy focuses on teaching children skills and developing a plan to manage situations. Play therapy is beneficial in younger children.Modeling, role-playing, relaxation training and reinforced practice are also useful.Teach children to. implement their coping skills while gradually exposing them to anxiety producing situations and offering praise and encouragement.

Sexual Dysfunctions

Sexual dysfunction involves either a disturbance in the sexual response cycle or pain/physical discomfort associated with sexual intercourse. Sexual dysfunction disorders are generally treated by assessing the physical problems that may be contributing to the sexual dysfunction. Once the cause has been determined, then the medical treatment can be instituted. Medications may include hormones and medications that address the specific dysfunction. Behavioral therapy can help the person address feelings of anxiety, fear, or guilt that may have an impact on sexual function. Education about sex and sexual behaviors and responses is helpful in overcoming feelings associated with dysfunction.

Intellectual Disabilities

Significant limitations both in intellectual functioning and adaptive behavior, including the social and practical skills of daily living. The level of severity is defined by adaptive functioning, not IQ as was previously done in earlier versions of the DSM. IQ measures are less valid in the lower end of the IQ range.

Anxiety Disorders--Social Anxiety Disorder/Social Phobia

Social Anxiety Disorder is characterized by a fear of embarrassing oneself in social situations or feeling foolish. Avoidance behavior is often evident and the condition is not due to a medical condition or substance. Social Anxiety Disorder typically lasts for 6+ months. Imipramine has been effective in blocking some panic attacks and MAO inhibitors have also been helpful with some individuals. Some benzodiazepines (Librium, valium) are effective in phobic situations if they are taken in sufficient doses to produce relaxation. Psychotherapy and behavioral treatments (systematic desensitization with increasingly anxiety-producing objects and situations and in vivo exposure) are common interventions that are preferable to medication.

Service Delivery

Social service delivery has evolved from the family to society to governmental and private business systems. Lack of knowledge about available resources is the most common reason why individuals have trouble accessing resources. Other reasons include not knowing how to effectively access the resources, duplication and gaps in services, lack of personal strengths or mental or emotional capability. If is the professional responsibility of social workers to help clients navigate service delivery systems and get the help they need.

Direct Practice

Social work activity that involves primarily one-on-one interactions with clients, many times individuals and families. Also called Clinical Practice or Micro Practice. In Direct Practice, social workers provide professional therapeutic services including psychotherapy, education, advocacy, referral, mediation and social action.

Social Workers as Administrators

Social work administrators should continually evaluate agency/organizational policies to be sure these are not creating adverse effects for clients. If this is the case, it is the social worker administrator's ethical duty to eliminate conditions in their origination that violate, interfere with or discourage compliance with the NASW Code of Ethics. Procedures for Social Work Administrators to Make Change: 1) Define the area of needed change 2) Assess the organizational power structure 3) Suggest possible solutions 4) Select the strategy to be used 5) Prepare the organization for change--increase awareness of staff on need for change, inspire hope, allow stress to be felt/expressed. 6) Strategically position oneself with individuals and the organization. (align with leadership, form coalitions with peer leaders, demonstrate knowledge and join committees doing work on change issues) 7) Initiate the Strategy 8) Institutionalize the Change--monitor process, evaluate effectiveness and revise as necessary--nuture and support staff, address new opposition

Social Work Network Service and Social Work Networking

Social work network service normally means social work services that are provided by social workers or therapists via electronic means (ie zoom) and can include email, video conferencing, chat rooms, live video streaming, discussion forums and use of mobile phones. Networking is social workers meeting with each other in face to face professional settings to make connections and to exchange ideas and resources. More recently, social networking refers to the ability of individuals to access internet sites that provide the sharing of ideas, interests and knowledge. Social networking sits provide the following advantages: --access to information about activities and events --the ability to create common interest groups --the opportunity to gather information about mental and physical problems --a low cost preferred way of interacting with others --provides small organizations, fragmented industries, and isolated agencies the opportunity to reach a broader audience of users with similar interests and needs Concerns about social networking and social work network service are: --privacy--not all sites are secure or used ethically --informed consent, when information is solicited from individuals --control of data, as data may not be screened for accurate content and may be altered by others

Social Work Service Delivery

Social workers deliver services to people in their social environments in the micro, meso and macro level of practice. Service in social work has shifted in recent years from service provided by a single profession to integrated networks and inter-professional practice. Case management, school systems, and health care delivery are examples of this trend. Professionals from each discipline need to h van a clear understanding of the roles of each, open communication, shared goals and decision making and accountability. Advantages of this approach is that clients may be able to access a wider variety of resources but disadvantages include lowering professional competency requirements, downsizing, and possible ethical conflicts.

Practice Evaluation and the Utilization of Research

Social workers engage in research to evaluate their own practice and to add to the body of knowledge in the field. Knowledge gained from research provides the basis for making micro, meso, and macro-level practice decisions. Treatment decisions based on clinical and research findings is called "evidence based practice."

Standardized Testing

Social workers need to be trained and licensed in order to administer and interpret certain standardized tests related to client functioning. Social workers are generally not licensed to administer the following types of tests: Psychiatric evaluations, IQ tests, learning disabilities tests, communication disorders tests, adult and children's ADHD tests, personality tests such as the MMPI (Minnesota Multiphase PersonalityInventory--administered by psychologists). Social workers need to be trained to understand the results of these types of tests and may seek information like this from other professionals in order to make an accurate diagnosis. Social workers may, with specific training, administer tests such as depression inventories, behavioral checklists, personality inventories, alcohol use inventories, and others. Internet tests are available for clients to self-diagnose--be cautious about using results from such tests.

Interdisciplinary Collaboration

Social workers often play the role of case manager on interdisciplinary teams. This means that the social worker is responsible for developing a relationship with the client, making an assessment of the needs of the client, identifying appropriate resources, linking the client with these resources, monitoring the progress of the client and adjusting the plans as needed. Social worker needs to have a good working relationship with other members of the team, understand each member's specific expertise and contribute to the therapeutic process. Social workers on interdisciplinary teams are often asked to make case presentations to other members of the team. The elements of a case presentation include the following: 1. Social history information 2. Individual--issues, strengths and resiliency, education, legal issues, substance abuse, and neglect 3) Family--history and dynamics 4) Community--social support, agency involvement 5) Diversity issues 6) Possible ethical issues--client self-determination 7) Recommendations for intervention, including resources (test question--with clients with medical and mental health issues--first thing a social worker should do is look at social work related factors (mental health) and gather more information--then refer to medical doctor unless medical issue is urgent and the current session with the client cannot be safely completed

Parenting Skills and Capabilities

Social workers should look out for the capacity of parents to prevent children from harm; the parents' knowledge of appropriate development levels of children and their ability to meet milestones; parents' ability to provide consistent physical care of the child; and the parents' ability to be sensitive to the child's needs and emotionally available.

Clients' Rights and Responsibilities--HIPPA Rights and Responsibilities

Social workers should provide their clients with an open disclosure document at the initiation of treatment that outlines clients' rights at all stages of treatment, including the Notice of Privacy Practices document. The clients' rights of due process and the grievance procedures of the social worker or agency should also be given to the client in writing and be thoroughly explained to the client. HIPPA Rights and Responsibilities: --clients have a right to receive easily understood information and help in making informed decisions about their health plans, health care professionals, and medical facilities if needed. --clients have a choice of healthcare providers that is sufficient to ensure access to appropriate high quality healthcare --clients have the right to access emergency health care services as needed --clients have the right to fully participate in all decisions related to their medical care, including the right to refuse services or have representation if unable to fully participate in treatment decisons --clients have the right to considerate, respectful care from all members of the healthcare system at all times and under all circumstances --clients have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable health information protected --clients have the right to review and copy one's own medical records and request amendments. --clients have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers and institutions that serve them, including a rigorous system of internal review and an independent system of external review. --clients also have the responsibility to develop healthy habits, become involved in medical care deacons, work collaboratively with healthcare providers in developing and carrying out agree upon treatment plans, disclose relevant information and clearly communicate wants and needs, and use the health plan's internal complaint and appeal process to address concerns that arise.

Indirect Practice

Soical work activities undertaken to provide services more effectively and efficienctly and to bring about changes in policies, programs, or budget. Activities do not involve personal contact with clients and usually are undertaken with a committee, coalition, or other group. Also called Macro Practice and includes program planning and development, policy analysis, administration and program evaluation.

Solution Focused Therapy

Solution Focused Therapy is a therapeutic approach developed in part from behavioral and cognitive therapy. The Solution Focused Therapy approach is short-term, focused, strengths-based and emphasizes an empowerment strategy to allow the client to take action him/herself. Components of Solution Focused Therapy include: 1) describing the problem; 2) developing well-formulated goals; 3) working cooperatively to identify solutions to problems; 4) end of session feedback; and, 5) evaluation of client progress. Techniques of Solution Focused Therapy include: 1) the Miracle Question; 2) Exception-Finding Questions; 3) Presuppositional Questions; 4) Compliments; 5) Listening Skills; 6) Empathy; and 7) Scaling Questions.

Somatic Symptom and Related Disorders--Somatic Symptom Disorder

Somatic Symptom Disorder is characterized by six+ months of a general preoccupation with fear of having a serious disease that has not been detected based on the individual's misrepresentation of bodily symptoms. Somatic Symptom Disorder was previously known as hypochondriasis. The conviction of having a serious disease persists in the individual with Somatic Symptom Disorder despite evidence to the contrary. This disorder causes significant distress and impairment. Specify if there is predominant pain. Antidepressant or anti anxiety medications alleviate some of the somatic symptoms if there are anxiety or depressive symptoms present. The goal of treatment is to help individuals with Somatic Symptom Disorder learn to control their symptoms thought stress reduction and coping strategies. Other types of psychotheapry (insight oriented, behavior therapy, cognitive therapy and hypnosis) may be helpful . Having a supportive relationship with a sympathetic healthcare provider is the most important part of treatment.

Somatic Symptom and Related Disorders

Somatic Symptom and related disorders are a cluster of disorders characterized by multiple, recurring physical complaints that lead to the individual seeking medical treatment or evaluations. The result of evaluation and treatment is reinforcement of the individual's belief in some non-existent medical illness. At some point, doctors realize there are strong emotional underpinnings and refer the patient to mental health care providers.

Anxiety Disorders--Specific Phobia

Specific Phobia is diagnosed when a specific object or situation causes excessive or unreasonable anxiety. Avoidance behavior is often evident. Types of phobia include animal, natural environment, blood injection types and other. Fear of harm from object, fear of embarrassment or fear of consequences related to exposure to object/situation are concerns. Medications are not normally prescribed for Specific Phobia, although individuals who experience anticipatory anxiety may benefit from benzodiazepines (like Xanax) and individuals whose phobia interferes with daily functioning may benefit from an SSRI like Paxil. Desensitization is an effective technique and can be practiced outside the therapy session. Emotive imagery helps to decrease the anxiety when the individual faces the real-life situation. Relaxation techniques can be used to mange anxiety symptoms.

Gerontology

Specific field of practice that addresses the needs of older people. Gerontological social work addresses factors that may be barriers to the physical and mental well-being of older adults.Social work with older individual requires a multi-modal approach that addresses physical, psychological and social needs. Therapy includes processing grief, finding meaning in life, setting realistic expectations preserving autonomy. A structured, gentle approach with the social worker taking an active role is ideal.Reminiscence therapy can be helpful and crisis intervention and refereal for adult protective services may be required.

Indicators of gambling addiction

Spending increased time and money around gambling, claiming the ability to stop any time but unable to do so; restless and irritable when not engaged in gambling; salaries and savings disappear and money is often borrowed; missing social obligations and other responsibilities; key relationships start to suffer; continuing to gamble despite negative consequences; attempting to gamble him/herself out of financial difficulties; persistent lying about gambling despite feeling helpless against gambling.

The Helping Process Stages

Stage 1--Relationship-Building, Exploration, Assessment and Planning (development of rapport, completion of a multi-dimensional assessment, the identification of mutually-agreed-upon treatment goals, the formulation of the treatment contract and referral to other entities when client has needs social worker cannot meet; Stage 2-- Implementation and Goal Attainment (action-oriented phase) (priorities are established, Partializing techniques may be used to temporarily treat client's interconnected problems separately; Stage 3--Termination, Planning Maintenance Strategies and Evaluation

Couples' Theory and Therapy--Structural-Strategic Marital Therapy (Haley and Madanes--Washington School of Strategic Therapy)

Structural-Strategic Marital Therapy views a couple's relationship difficulties as an inability to cope with environmental or personal life changes. The goal of Structural-Strategic Marital Therapy is to facilitate a solution to the presenting problem in the most efficient and ethical manner. Despite relationship dissatisfaction, the couple will resist change to maintaining the status quo. Focusing on the strengths rather than the weaknesses is the key to success. Pathologizing is is considered counter-productive. Important concepts in Structural-Strategic Couples' Therapy are: moving from who is to blame to what is to be done; relationship maintenance, and encouraging conversations outside of therapy that are not happening.

Substance-Related and Addictive Disorders--Substance-Related Disorders

Substance-Related Disorders include reversible, substance-specific mental disorders caused by substance intoxication and those caused by substance withdrawal. Common behavioral and psychological changes associated with intoxication include belligerence, heightened emotions, impairment in cognitive abilities and social and occupational functioning. Withdrawal is typically associated with substance dependence and involves a craving for more of the substance as a means of alleviating the symptoms. Substance intoxication can occur with any class of substances except for tobacco. Substance withdrawal occurs with alcohol, amphetamines, cocaine, nicotine, opioids, sedatives, hypnotics and anxiolytics (anti-anxiety/anti-panic drugs). Substance Related Disorders involve substance use that is problematic and there is a repetition or pattern of behavior that causes clinically significant distress or impairment. Substance Related Disorders are evidenced by at least two of the following occurring within a 12 month period: tolerance, withdrawal, more use than intended, craving for the substance, unsuccessful efforts to cut back, spending excessive time in acquisition of the substance, cessation of activities because of substance use, continue to use despite negative effects, failure to fulfill major role obligations. Substance Use Disorders by classification: 1) Alcohol (central nervous system depressant); 2) Caffeine (central nervous system stimulant); 3) Cannibas (perception distorting); 4) Hallucinogens (including PCP) (perception distorting); 5) Inhalants (perception distorting); 6) Opioids (narcotics); 7) Sedatives, hypnotics, or anxiolytics (central nervous system depressants); 8) Stimulants (including Cocaine) (central nervous system stimulant); 9) Tobacco (nicotine); and, 10) other

Substance-Related and Addictive Disorders

Substance-Related and Addictive Disorders are brought on by the ingestion of an illegal drug or medication or by exposure to a toxin (ie specific rat poisons, specific pesticides, nerve gases, carbon monoxide). The criteria include "craving" as a symptom whereas legal involvement was deleted from the previous criteria in the DSM-IV-TR.

Supervision (Clinical and Administrative)

Supervision is an important process in agency settings that involves assisting social workers in the development of their skills while providing quality assurance for clients. The primary objective of supervision is to make sure the client's needs are met in accordance with the goals and objectives of the agency. The primary task of a supervisor is to make sure the work is completed. Methods and Techniques of Supervision: Focus on areas of strength and be responsible for providing adequate support for the employee to complete his/her responsibilities. Identifying learning and development needs includes assessment of employee and understanding of current or anticipated gaps in knowledge or skills. Use positive feedback and positive reinforcement. Build on existing skills to address deficit areas. Have a good training structure with specific training objectives and corresponding timelines. The specific functions of supervision are: educational functions--training staff about resources, policy, assist staff in developing work skills needed and gaining greater self-awareness. administrative functions--Human Resources, strategic planning, budgeting, organizational operations, evaluating practice. The supervisor is responsible to the agency, employees and clients. The NASW Guidelines for Clinical Social Work Supervision state that the contract governing the supervisory relationship includes the following: --goals, objectives and methods of supervision --prioritized learning goals --format and schedule of supervision meetings --availability of supervisor between sessions --respective roles of supervisor and employees --procedure to be followed in notifying clients of supervision so that clients provide informed consent for the sharing of information between employee and supervisor. Group Supervision--can be a valuable, complimentary experience to individual supervision. In group supervision, supervisor and employees share supervisory responsibilities. Time saver and enables peer learning--works better for educational meetings than administrative meetings. Effective supervision reflects the following qualities: --case-oriented --structured--employees are informed of structure --regular --consistent --evaluated--supervisor should seek feedback Social work supervisors and administrators should take reasonable steps, per the NASW Code of Ethics, to arrange for continuing education and staff development for all staff for which they are responsible.

Ethical Issues in Supervision in Social Work

Supervisory work in social work is both cognitive and emotional. Supervision is an excellent venue to learn about boundaries in social work. Becoming romantically involved with a supervised is an ethical violation. Supervisors shall be discreet in sharing information and not allow it to be the focus of supervisor. When information is disclosed, it should be brief and relevant to the goals of supervision.Supervisors need to train supervisees in workplace conflict, responding to threats or harassment, protecting property, and dealing with assault and the emotional aftermath. Supervisees also should be trained in conflict resolution and non-violent responses and appropriate ways to respond to crisis situations.

Behavioral Therapy-Systematic Desensitization

Systematic Desensitization is a counter-conditioning intervention frequently used in treating phobias that utilizes relaxation training, construction of the anxiety hierarchy, and desensitization in imagination (pairing of relaxation and mental images of items from the least to the most anxiety-producing image until the person can visualize all images without being anxious).

Systems Theory

Systems Theory is a theory stating that an organization is a managed system that changes inputs into outputs. Systems Theory refers to the relationship of the parts of the system to one another and the effects of these relationships on the system. In Direct Practice, social workers use systems theory to view families in terms of roles, relationships and family dynamics to determine the effect these factors have on individual family members. In macro or indirect social work practice, social workers use systems theory to understand the interrelated social structures of communities and then use policy and advocacy to improve the welfare of society and communities.

Task-Centered Treatment

Task-Centered Treatment is a short-term approach to treatment based on learning and cognitive theories. Task-Centered Treatment can use interventions and strategies from many models of therapy in the task-centered framework to achieve concrete goals. Stages of Task-Centered Treatment are: 1) Engagement 2) Problem-centered assessment 3) development of problem solving tasks or planning implementation 4) performing problem-solving tasks 5) reviewing progress is achieving tasks at the beginning of each session 6) plan new task or deal with obstacles to task completion 7)evaluation 8) termination

Antidepressants--Tetracyclic Antidepressants

Tetracyclic Antidepressants are a class of medications that affect serotonin and norepinephrine: Ludiomil (maprotiline) Remeron (mirtazapine) Common side effects include: drowsiness gastrointestinal upset, nightmares, tiredness and slight sun sensitivity.

Humanistic-Existential Models and Theories

The Humanistic-Existential Model of abnormality consists of humanistic and existential theories/theorists together because of their common focus on broader dimensions of human existence such as self-awareness, strong values, sense of meaning in life, and freedom of choice. Characteristics of Humanistic models include an emphasis on the uniqueness and wholeness of the individual, a belief in the individual's inherent striving for self-determination and self-actualization, and a focus on current behavior. Humanistic-Existential models also have a view of therapy as involving an authentic, collaborative and egalitarian relationship between social worker and client. There is a belief that to understand a person, one must understand his/her subjective experience. The Humanistic-Existential Model rejects traditional assessment techniques and diagnostic labels. The leading theorists of the Humanistic-Existential Movement are Carl Rogers, Fritz Perls and Eric Berne.

Cognitive Behavioral Therapies

The basic premise of Cognitive Behavioral Therapies is that our thoughts and beliefs control how we feel and behave. There is strong evidence that CBT is the treatment of choice for depression (combined with medicine). Cognitive Behavioral Therapy is an integration of three schools of thought: 1) Behavior Therapy; 2) Cognitive Therapy; and, 3) Cognitive and Social Psychology. There are three basic cognitive-behavioral perspectives: 1) Cognitive Therapy-Aaron Beck 2) Rational Emotive Behavior Therapy--REBT-Albert Eliis 3) Self-Management/Self-Instruction--Donald Meichenbaum

Professional Development and Use of Self

The emotional bond that develops between a social worker and a client may be a motivating force in influencing a client to modify his/her feelings, attitudes and behaviors. The therapeutic relationship has four components: empathy--accurately reflect the surface feelings of the client--high-level empathy involves reflecting the surface and underlying feelings of the client and involves interpretation--simply stated, empathy is the ability of the social worker to accurately perceive the client's feelings and then the ability of the social worker to communicate understanding of the client's feelings through accurate reflection--empathy helps the social worker develop and strengthen the therapeutic relationship warmth--pleasantness with a genuine show of interest in and care for the client authenticity/genuineness--verbalizations of social worker are spontaneous and congruent (consistent with social worker's feelings and thoughts) the social worker makes appropriate self-disclosures trust--a social worker establishes an atmosphere of safety and predictability for the client and maintains confidentiality unless client is a danger to self or others Principles of casework: view client as a unique individual--each client is different so help each needs is different in some way--provide thoughtfulness, privacy, remember details and be flexible demonstrate that the client is being treated as an individual allow client to express feelings in a purposeful way--direct interview in a way that allows relevant feelings to be expressed--social workers need to be wary of clients putting their entire emotional burden on the social worker, if an agency does short term work, then client should not be encouraged to express intense feelings related to deeply disturbing emotional problems--the uncontrolled expression of hostility toward the social worker or agency needs to be understood but not encouraged or reinforced interact with the client in a professional emotional manner--sensitive, understanding--response is achieved after sensitivity and understanding are achieved--responses are client focused but encourage self help and demonstrate acceptance of the client--doesn't mean social worker agrees with or approves client's behavior that is illegal or deviates from societal norms--loss of respect for a client or over-identification with a client are problematic for acceptance, be self-aware and culturally competent non-judgmental attitude of social workers--social worker is not in a position to evaluate the guilt or innocence of the client--do not judge the responsibility the client had in creating his/her problem client self-determination--clients want to be helped, not told what to do or controlled or intimidated--the principal of self-determination means that social worker recognizes that clients have a right to make their own decisions as they participate in the therapeutic process --help client use his/her own strengths to solve problems the influence of the social worker's own values and beliefs on the client/client system relationship-imposing one's own values/beliefs on a client is considered a boundary violation--this generally occurs when a social worker is unaware of his/her own beliefs, attitudes and feelings or if the social worker holds bias against a specific group of individuals--social workers need to be aware of power differential in social worker-client relationship--roles and responsibilities of social worker and client need to be clarified --use a neutral position and unbiased language if values conflicts arise Ethical Issues within the Therapeutic Relationship--social worker's primary goal is to help people in need and address social problems, social workers respect the inherent dignity and worth of the person, social workers recognize the central importance of human relationships, social workers behave in trustworthy manner, social workers respect a client's right to privacy, social workers do not use derogatory language in their written or verbal communication to or about clients, social workers should to the greatest extent, understand culture and its function in human behavior and society and recognize the strengths that occur in all cultures--seek consultation and supervision when ethical issues arise in social work--explore self-awareness, transference, and counter-transference, value differences, expectations, agency policies, ethics violations, etc.

Cognitive Behavioral Therapy-Donald Michenbaum's Self-Instruction Training

The focus of Self-Instruction Training is on the client's self-statements. Maladaptive self-statements often underline problems. Training is given in Self-Instruction Training in the source of problems, modeling and practicing behavioral and cognitive skills. There are three phases in Self-Instrucition Training--1) the social worker and client make an assessment of the client's self-statements and a conceptualization of the problem; 2) the client is instructed to imagine a difficult situation and to identify to the social worker the concomitant self-statements The client and social worker discuss the self-statements in terms of their impact on the client's behavior. The client is instructed to self-monitor or listen to self-talk; 3) the client and social worker work in tandem to develop self-statements that result in greater enjoyment of life.

Permanency Planning

The goal of permanency planning is to provide a child with a safe, long-term, stable home environment, while in the care of a nurturing caregiver who is committed to a lifelong relationship with the child. A sense of anxiety exists for a child who is not in a permanent home. Permanency planning is designed to eliminate residence and caregiver fluctuations and will reduce and ideally eliminate the child's anxiety. Guidelines for Choosing a Permanency Plan: There are five permissible Adoption and Safe Families Act (1997) permanency plans: 1) return to parent; 2) adoption upon the filing of a petition to terminate parental rights; 3) referral for legal guardianship; 4) permanent placement with a fit and willing relative; and, 5) another permanent living arrangement but only if there is a compelling reason why none of the other plans are in the child's best interest. (These permanency plans are listed in order of preference.) Permanency planning starts at first contact, continues though the lifetime of the child's case, secures a safe and stable and permanent home for the child asap, protects the child developmentally, protects primary attachments, creates new attachments, preserves cultural and family connections.

Humanistic-Existential Models and Theories--Gestalt--Fritz Perls

The major concepts of Gestalt Therapy include the belief that human beings are constantly discovering and reconstructing who they are.. A person's behavior represents a whole, not differing pieces. Behavior can be fully understood only in the context of the present. An increased awareness of here and now experience allows the individual to choose and to make greater sense of his/her existence. Gestalt Therapy is based on the theory that personality consists of the self and the self-image. The self is the creative aspect of the personality that promotes the individual's inherent tendency for self-actualization. Self-image is seen as the darker side of the personality that can hinder growth and self-actualization by imposing external standards. The child's early interactions with the environment often determine which aspect dominates. Neurotic behavior is considered a developmental disorder resulting from early experience. that involves abandonment of the self in favor of the self-image and results in an inability to see oneself as a whole person. Neurotic behavior stems from a disturbance in the boundary between the self and the external environment. There are four major boundary disturbances identified by Gestalt Therapy: 1) Introspection occurs when person believes the external perception of the whole. The person has difficulty distinguishing between me and not me and may be overly compliant. 2) Projection refers to disowning aspects of the self by assigning them to other people. For example, if you dislike an individual, a form of projection would be for you to portray the scenario that he or she dislikes you instead. Paranoia is an extreme form of projection. 3) Retroflection is described as doing to oneself what one wants to do to others. Retroflection involves redirecting anger one has for another person inward. This can be exhibited in extremem self-blame in response to appropriate feedback given to a person. Rather than expressing anger with the person, that anger is expressed is expressed inward and becomes self-blame. 4) Confluence is the absence of a boundary between the self and the environment. This causes intolerance of any differences between oneself and others and often underlies feelings of guilt and resentment. Gestalt therapy focuses on increasing awareness and clarity of the experience of the moment for both the client and the social worker. Interpretations are seen as less valuable or reliable than the individual's' perceptions and feelings. Via dialogue and structured experiences or experiments, discrepancies between the social worker's and client's experiences are explored in an effort to increase the client's awareness of what he/she is doing and how he/she is doing it. The client is also assisted in learning to accept him/herself fully. The goal of therapy is to hep the client achieve integration of the various aspects of the self in order to become a unified whole. The social worker avoids the use of diagnostic labels and the client's history is seen as relevant only as it impinges on the here and now. The social worker-client relationship is referred to as an "I Thou" dialogue relationship reflecting caring, warmth, acceptance and authenticity. Gestalt therapy uses the following techniques: 1) Directed Awareness--a technique where the social worker helps the client become aware of his or her immediate experience. 2)No Questions--technique that places the focus on increasing own's own awareness of his/her experience in the here and now. 3) I Language--a technique that involves the social worker's use of I statements rather than making interpersonal interpretations. The social worker will often share his/her experience of the here and now (ie what the social worker hears and sees) 4) Enactment--a technique that involves asking the client to act out feelings or thoughts t increase awareness (eg empty chair, role-playing, psychodrama, exaggerating a feeling, thought or motion) 5) Guided fantasy visualization is a technique that involves having the client create a mental image of an experience 6) Loosening/integrating-techniques that involve encouraging the client to think in a new way (eg asking the client to. imagine believing the opposite of what he/she believes about something; having the client locate where on his/her body a specific emotion is located) 7) Body techniques-are techniques used for increasing the client's awareness of their bodies and helping them to learn new ways of using their bodies to create additional self-awareness and to emerge in meaningful contact with others. 8) Dreamwork--technique that focuses on recurring dreams 9) Say with it/Feel it out--a technique that involves encouraging the client to allow him/herself to continue to feel the emotion of the moment. This technique increases the client's capacity to experience his/her feelings fully. Gestalt is a German word that literally means form or shape. Gestalt therapy in psychology means an organized whole is more than the sum of its parts.

Organizational Development Theories

The predominate theories of organizational development are as follows: 1) Scientific Management Approach--based on planning to achieve efficiency, standardization, specialization, and simplification. This approach increases productivity via mutual trust between management and workers. The Scientific Management Approach to Organizational Development is based on four principles: 1) scientific selection of the worker; 2) using science, not rule of thumb; 3) management/labor cooperation; and, 4) scientific training of workers. 2) Bureaucratic Approach to Organizational Development--considers how the organization first into the broader society. The Bureaucratic Approach to Organizational Development is based on the following concepts: 1) structure; 2) specialization; 3) predictability and stability; 4) rationality; and, 5) democracy. This approach is considered to be rigid, impersonal and self-perpetuating. 3) Administrative Theory Approach to Organizational Development: This approach emphasizes the role of the individual or group in determining productivity. The Administrative Theory Approach to Organizational Development emphasizes: 1) division of labor and retention of personnel; 2) authority and responsibility, including unity of command and direction; 3) discipline and training; 4) subordination of individual interest; and, 5) centralization 4) Lewin's Change Management Model of Organizational Development: Lewin's Framework for Organizational Development includes three concepts: 1) Un--freeze--reduces forces and changes existing attitudes which maintain behavior in present form/recognizing the need for change; 2) Change--development of new attitudes/behavior and implementing change; 3) Re-freeze--consolidating the change at a new level and reinforcement through supporting mechanisms/policies/structure/organizational norms. 5) Systems Approach to Organizational Development--this approach views the organization as being composed of inter-related and mutually dependent sub-systems. Included are the individual, formal and informal organization, patterns of behavior, role perception and the physical environment. The goals of the organization are based on growth, stability and interaction. 6) Socio-Technical Approach to Organizational Development--this approach characterizes the organization by a balance of a social system, a technical system and its environment and how they interact for effective functioning of the organization 7) Contingency or Situational Approach to Organizational Development--this approach to organizational development recognizes that organizational systems are inter-related with their environment and that different environments require different organizational relationships in order to be effective. 8) Complexity Theory of Organizational Development--this theory of organizational development sees an organization as a non-linear system that is surrounded by dynamic forms of change. The unpredictability of change means that organization leadership cannot manage change but instead support the organization through its change journey. The organization needs to flex, adapt and change.

Professional Values and Ethical Issues--NASW Code of Ethics

The primary mission of NASW is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed and living in poverty." The focus of the profession of social work is first, the well-being of the individual in the context of the environment and second, the well-being of society in general. Values--define a belief system Ethics--define a standard of conduct based on that belief system The foundation of the NASW Code of Ethics are the profession's core values: Service Social justice Dignity and worth of the person Importance of human relationships Integrity Competence The NASW Code of Ethics outlines the basic values, principles and ethical standards of the social work profession. The NASW Code of Ethics applies to all social worker and social work students, regardless of whether they are members. Latest Code of Ethnics was published in 2017 (primarily to deal with technology and social work practice) Social workers need to have a policy in relation to technology and share this with clients. Social Workers Ethical Responsibilities to Clients--commitment to clients, self-determination (only exception is if client is imminent danger to self or others), informed consent (in writing for all services and practices and for any sharing of info), competence, cultural competence and social diversity, conflicts of interest (avoid dual relationships), privacy and confidentiality (legal responsibility to warn potential victims clients may intend to harm--Tarasoff vs Board of Regents for UC), access to record (assist client in understanding file--may withhold parts of file if potentially harmful to client--need to document--within legal requirements only), sexual relationships (Never--former clients, current clients, close personal relatives or friends of clients), physical contact, sexual harassment, derogatory language, payment for services (no bartering) clients who lack decision making ability, referral for services, termination of services. Social workers ethical responsibilities to colleagues--respect, confidentiality, interdisciplinary collaboration, disputes involving colleagues, consultation, referral for services, sexual relationships, sexual harassment, impairment of colleagues, incompetence of colleagues, unethical conduct of colleagues Social workers ethical responsibilities in practice settings--education and training, supervision and consultation, performance evaluation (clearly defined criteria), client records, billing, client transfer, administration, continuing education and staff development, commitments to employers, labor-management dispute Social workers ethical responsibilities as professionals--competence, discrimination, private conduct, dishonesty, fraud, deception, impairment, misrepresentation, solicitations, acknowledging credit Social workers ethical responsibilities to the social work profession--integrity of the profession, evaluation and research Social workers ethical responsibilities to the broader society--social welfare, public participation, public emergencies, social and political action

Conflict resolution

The process of ending a conflict through cooperation and problem solving. The principles of conflict resolution are: active listening, thinking before reacting, attacking the problem, not the person, accepting responsibility, using direct communication (I not you messages) looking for common interests, focusing on the future.

The Intervention

The process of intervention revolves around the treatment plan that has been developed by the social worker and the client. The treatment plan should include the following elements: 1) client's responsibility in carrying out the plan needs to be clearly understood and agreed upon; 2) goals of the treatment plan should be stated in measurable terms as much as possible; 3) use a strength-based treatment approach with goals framed in positive language

Medication-Induced Movement Disorders and Other Adverse Effects of Medications

The term medication-induced does not necessarily mean caused--it means there is a relationship between the medication and subsequent symptoms. Examples: Narcoleptic-Induced Parkinsons Disease--tremor, muscular rigidity, kinesis Neuroleptic Malignant Syndrome-severe muscle rigidity, temperature Neuroleptic-Induced Acute Dystonia--unusual positioning or spasms Neuroleptic-Induced Acute Akathisia--restlessness, pacing Tardive Dyskinesia--involuntary choreiform--jerky involuntary movements as with chorea; athetoid--slow, involuntary, worm-like movements of the fingers, toes, hands and feet or rhythmic movements of tongue, jaw or extremities Tardive Dystonia or Tardive Akathisia--movement problems that occur late after treatment and [ersist Medication-Induced Postural Tremor--fine tremor accompany efforts to maintain a posture Antidepressant Discontinuation Syndrome--involves abrupt cessation or marked dose reduction of an antidepressant that causes nausea, hyper-responsivity to sounds or lights Other Adverse Effects of Medication

Leon Chestang

Theorist who postulated that we were part of two systems: the nurturing system and the sustaining system -Chestang describes a dual perspective, wherein an individual must shift between the safe culture of loved ones and dominant culture of the larger society

Confidentiality and Privileged Communication-Legal and Professional Considerations--Accreditation and Licensing

There are approximately 172 social work licenses in the US according to the testing company, ASWB. There is a large-scale effort to standardize acronyms and requirements for each designation. Licensing Exam Levels Associate Bachelors Masters--no clinical post-degree supervision Advanced Generalist--advanced macro work Clinical--advanced clinical work

Group Work Techniques and Approaches--Stages of Group Development

There is variation in the number and naming of stages of group development put forth by various theorists of group development but there are commonalities. A general description of a five state sequence that refers to the models of Tuckman (1965), Garland et al (1973) and Wheelan et call (2003 is as follows: Forming-Tuckman (pre-affiliation--Garland) focus on issues of dependency and inclusion (Wheelan); members experience anxiety, seek help from group leader on appropriate behaviors and engage in tentative self-disclosures and sharing. Storming-Tuckman (counter dependency and flight-Wheelman)--struggle around issues of power and control (Garland)--competition and conflict among members, anxiety about the safety of the group, and the authority of the leader are common concerns at this stage. Many group theorists believe these struggles and conflicts are a necessary step to building cohesion and openness. Norming (Tuckman). Intimacy (Garland) trust and structure (Wheelan)--cohesion and openness Performing (Tuckman) work (Wheelan) or differentiation (Garland)--mature and productive group process and expression of individual differences. group has the capacity to focus on the work and members engage in open exchange of feedback Adjourning (Tuckman) Separation (Garland)emergence of painful effects and oscillations between conflict and defensiveness and mature work--members' appreciation for each other and the group experience and effort to prepare group members to be more independent in the future are goals of this stage

Personality Disorders--Other Specified Personality Disorder or Unspecified Personality Disorder

These are diagnosed when dysfunction in personality function is evident and when the symptoms do not meet the criteria for a specific personality disorder.

Forms of Bicultural Identity (Robbins, Chatterjee and Canada 1998

Traditional Adaptation--behaviors, values and beliefs of individuals of a diverse group that are distinct from a those of the majority group. Members of a traditional minority group exhibit strong ethnic identity. Marginal Adaptation--individuals do not adhere closely to the values and behaviors of their ethnic group or the larger society, often resulting in cultural conflicts; Assimilation--individuals learn to value the norms of the Sustaining system but devalue the norms of their ethnic group; Bicultural Adaptation--individuals integrate the values, norms and beliefs of their ethnic group and the larger society.

Humanistic and Existential Theories and Models--Transactional Analysis--Eric Berne

Transactional Analysis was developed by Eric Berne and incorporates elements of psychoanalysis, Gestalt psychology, Rational Emotive Behavioral Therapy, psychodrama and behavior therapy. Transactional Analysis is often used in group settings and teaches individuals to trust one another. The psychological theory of Transactional Analysis incudes the following concepts Ego states are specific patterns of thoughts, feelings and behaviors; . The Adult is the rational part of the personality; The Parent is the critical or nurturing part of the personality; The Child is the creative, intuitive, and emotional part of the personality, rebellious or conforming (free child or adapted child); Life Position refers to four possible life positions--I'm Ok, You're Ok, I'm not OK, You're Not Ok. I'm not Ok you're ok and I'm ok, you're not ok; Lifescript is the plan a person creates during childhood which forms the core of the person's identity and destiny. This theory is based on beliefs about self and others; Environmental Conditions--especially parenting, affect all individuals; Recognition is viewed as an existing innate need to individuals; Transactional Analysis therapy consists of the following components: the role of the social worker is to be a facilitator of change and growth; the social worker completes a structural analysis of the individual's ego states (Critical Parent or Nurturing Parent, Free Child or Adapted Child) using an Ecogram (a graph of the relative energy of the different ego states). The social worker may assist the client in changing the energy balance of these states. Certain structures are associated with personality pathology (eg ego staets with overlapping boundaries) Transactional analysis involves an examination of the interactions between the ego states of two individuals--transaction types include social interactions or observable transactions and psychological interactions that are covert but often discernible through examination of body langauge The social worker does an analysis of the stereotyped games (ie dishonest interpersonal interactions) people play in their relationships. These games reinforce the individual's belief system. Individuals vary in terms of the games they participate in with others (ie when the social worker and the client alternate between playing the role of victim, rescuer and persecutor). Understanding the self-perpetuating role one plays in the relationship will enlighten clients an bring a clearer picture of their relationship games. The social worker creates a script analysis of crucial transactions between parents and the child in early years. The script analysis reveals why the individual chooses to play the specific games that he/she plays. This provides important information in coming to an understanding of the individual's personality development.

Trauma informed care

Trauma informed care is an approach to treatment that acknowledges the role that trauma can have on the mental health of individuals. There is an interrelation between trauma and symptoms of substance abuse, eating disorders, depression and anxiety. It is important for social workers to work in a collaborative manner with survivors, family and friends, and other human service agencies. The social worker's interaction should empower the survivor. Trauma survivors need to respected, informed, connected and hopeful regarding their recovery.

Selection of Treatment Approaches

Treatment planning is normally based on a number of factors, including: the type of agency, the nature of the client's problem, the philosophy of the agency, the individual client's needs, the social worker's knowledge and skill level, legal, ethical or insurance restrictions or considerations and the level of care needed.(psychodynamic therapy is somewhat the same as psychoanalytic therapy but is short term focused)

Treatment Planning

Treatment plans should be developed with clients and be individualized for each client. The plan should involve the client's family or support system and should contain short-term and long-term measurable goals and objectives. The treatment plan should clarify the client's responsibility in carrying out the goals and the social worker's responsibility. The treatment plan should be continually evaluated and updated as necessary. The social worker refers to the client's social history and intake interview to determine strengths and problem areas and to make an assessment of problem areas and level of care. Social worker and client determine focus of treatment and create list of problems, in order of importance.

Obsessive Compulsive Disorders--Trichotillomania (Hair-Pulling Disorder)

Trichotillomania involves compulsive hair pulling that leads to significant hair loss. The condition is more common in women and the average age of onset is 13. There are repeated attempts to stop the behavior. Treatment includes a joint approach between mental health prescribers and dermatologists and insight oriented therapy, behavioral treatment and hypnotherapy are effective treatments for Trichotillomania.

Antidepressants--Tricyclic Antidepressants

Tricyclic Antidepressants (class of medications that inhibits the reuptake of norepinephrine and serotonin): Elavil (amitriptyline) Sinequan (dose-in) Pamela (nortripyline) Anafranil (clomipramine) Vivatyl (protipyline) Tofranil (imipramine) Surmontil (trimipramine) Aventyl (amoxapine) Common side effects include: sedation, anticholinergic effects (dry mouth, constipation, urinary hesitancy, blurred vision, sexual dysfunction).

(1927) Ivan Pavlov: Classical or Respondent Conditioning

Unconditioned stimulus, unconditioned response, conditioned stimulus and conditioned response. Example, meat powder given to dog causes drooling. Ring bell when meat powder is given and then eventually, drooling happens when only bell is rung and there is no meat powder.

Communication Skills for Social Workers

Verbal/Focusing Skills Furthering Responses Paraphrasing Seeking Concreteness Summarizing Empathetic Responding Questioning--close ended/open ended questions (don't use stacked questions (asked in quick succession) or leading questions) Other Communication Skills Active (Reflective) Listening--not judging or advising or criticizing but rephrasing for clarity and then advise and be aware of client's feelings Confrontation--helping client become more self-aware of components of thoughts, behaviors and feelings for which client may be unaware; identify incongruities between client's beliefs and behavior, identify problems in communication address self-defeating patterns of behavior and identify client strengths; effective confrontation supports the goals of therapy and meets the client's needs; is appropriately timed, is specific in nature and is client-based. Transference--the emotional reaction that an individual has toward another person based on the individual's previous experiences with a different person. Counter-transference--the range of reactions and responses that the social worker has toward clients, including client's transference reactions based on the social worker's own background

Behavioral Therapy--Reality Therapy

William Glasses developed Reality Therapy and was influenced by Control Theory in doing so. Control Theory asserts that all human behavior is purposeful and originates from within the person and that the individual is responsible for his/her behavior. Reality Personality Therapy states that individuals have a number of innate needs, including four psychological needs (ie belonging, power, freedom and fun). The brain is a control system and a control system acts on the external world to fulfill the inherent needs or purposes of the system/person. Psychological disorders represent failures to act upon the world in a manner that brings about responsible satisfaction of needs. Responsible behavior is moral according to this theory. The goal of Reality Therapy is to enable the client to better take control of his/her life. Reality Therapy rejects the medical model and the concept of mental illness. It focuses on current behavior and beliefs rather than past behaviors, feelings, attitudes and experiences. Transference is viewed as detrimental to the therapy process. Reality Therapy stresses conscious rather than unconscious processes and helps clients understand that our choice of behaviors reflects our efforts to fill our basic needs. Reality Therapy teaches clients to evaluate their behavior in terms of whether the behavior is enabling them to satisfy needs without interfering with the satisfaction of the needs of others (responsible behavior).

Normal Life Crises

marriage, birth of a child, divorce, death of a loved one retirement, job change, moving, etc.

Ethical Decision Making

social workers should consider the "standard of care"--a one-hundred year old concept that asks the question--"What would an ordinary, reasonable and prudent professional person with the same or similar training have done under the same or similar circumstances?" In cases where there occurs disagreement among reasonable professional people, the following steps should be considered: --consulting colleagues and supervisors --reviewing relevant ethical standards (most current NASW Code of Ethics) --reviewing relevant laws, policies and regulations --reviewing relevant literature --obtaining legal consultation when needed --consulting ethics committees, if available --docmenting decision-making steps Gifts and social contact--let clients know right away that no gifts accepted--never a gift that has great value--either sentimental or monetary--accept if small gift, of little value and if client would be offended if not accepted--document gifts; generally speaking it is poor practice to attend an event with a client of accept a gift--explore the meaning of the gift or social invite with the client FIRST

Psychopharmacology

the use of drugs to control or relieve the symptoms of psychological disorders. Social workers are not medical experts and should refer to a medical doctor when appropriate.

Disruptive, Impuls-Control and Conduct Disorders--Kleptomania

Kleptomania disorder is a repeated failure to resist the impulse to steal items without reason. The theft is not a way of expressing anger or getting vengeance and is not related to a delusion or a hallucination. There is increased tension prior to the event and a sense of pleasure or relief in the satisfaction of the impulse. Most individuals with Kleptomania are women. SSRIs have been effective in treating some individuals with Kleptomania. Behavior Therapy, including systemic desensitization and aversive conditioning has been reported as being helpful.

Substance-Related and Addictive Disorders--Non-Substance Related Disorders-Gambling Disorder

Non-Substance Related Disorders

Social Institutions

Norms, values, codes of conduct, traditions, informal and formal laws and cultural practices that have existed for years and form the framework for society. (Family, Religion, School, Social Youth Organizations, Healthcare system, Justice System, etc) Social institutions are established to support society and maintain stability but sometimes these structures are harmful to those who live outside the norms of society.

Couples Theory and Therapy--Psychoanalytic Couples Therapy--Ronald Fairbairn, Heinz Kohut and Carol Gilligan)

Psychoanalytic therapy attempts to uncover the unresolved childhood conflicts with parental figures and early development and their impact on current interpersonal relationships. Psychoanalytic Couples' Therapy analyzes couple relations and mate selection as originating from the parent-child relationship during child development states. A critical part of this model is Introjection--which is how the infant processes versions of the love object (mother, primary caregiver). A core part of this model deals with the process of becoming a separate distinct person from caregiver-child interactions during childhood.

Electronic Information Security and Standards for Technology in Social Work

The NASW, ASWB, CSWE and CSWA have developed standards for the use of technology in social work practice. These standards are divided into four sections--provision of information to the public, designing and delivering services, gathering, managing, storing and accessing information about clients and educating and supervising social workers. Provision of Information to the Public--content needs to reflect the values, ethics and mission of the profession. NASW Code of Ethics can be used as guidance. Social workers need to take reasonable steps to ensure the accuracy and validity of information they share with others, especially clients. It is important to access several sources for accuracy prior to sharing information. Designing and Delivering Services--services requiring licensure or other forms of accreditation, laws that govern provisions of social work services, informed consent, assessing clients' relationship with technology, competence: knowledge and skills required when using technology to provide services, confidentiality and the use of technology, electronic payment and claims, maintaining professional boundaries Assessing clients' relationship with technology--consider clients' views and use of technology when conducting psychosocial assessments with clients--social workers have historically considered clients' well-being in the context of their environment, including relationships with family members, peers, neighbors and coworkers. Technology and clients' relationship with it should also now be considered; competence--knowledge and skills required when using technology to provide services, maintain confidentiality with policies based on local laws, rules and ethical standards, use proper encryption and follow confidentiality standards and rules when billing via technology, social workers should not post personal information on professional sites, blogs, or other forms of digital media to avoid boundary confusion and dual relationships--always make distinctions between personal and professional communications when using technology, have a technology policy and share upfront with clients, have a plan for continued services if technology disruption happens, have a policy for emergency situations based on jurisdiction where the client is located, do not solicit online or electronic testimonials, be honest, respectful and accurate in advocacy communications, and in fundraising communications, and follow local laws related to soliciting funds, needs of clients are primary, avoid posting political or personal opinions which may be seen by those whom they work with, consider unique needs of clients when using technology, consider access to technology, social workers shall remain current in knowledge of technology and update their skills and knowledge, correct mis-use of messages when the information comes to their attention, include use of technology to facilitate efficiency within the organization in budgets, have a social media policy to guide employees and volunteers within an agency, always get informed consent, including how info will be used and how it may be used legally, separate professional and personal information in client files, explain to client which personnel are able to access clients' files, develop policies for breach of confidentiality, take reasonable steps to verify accuracy and reliability of data gathered electronically, protect confidentiality of clients' information at all times, particularly when sharing information, ensure transfer of client information is done with utmost care toward protecting confidentiality and in the interest of the client, social workers should not use search engines to locate information about clients without the client's consent--gathering this type of data should only be done when there are compelling reasons, always make sure digital content is respectful, accurate and complete, policies should be developed for accessing client records remotely, protect client confidentiality when disposing of outdated technology, when training using technology be sure competent and train students about ethical use of technology, engage in continuing education about technology, teach social media policies, social work educators need to verify that assignments and tests are submitted by students themselves when completed electronically, use of personal devices, unsecured WI-FI networks, shared use of devices, confidentiality risks and other boundary issues shall be addressed in social work education, social workers shall have policies for termination for students and workers who leave an agency, social workers who provide remote supervision should comply with the NASW Code of Ethics, licensing laws, technology standards and organization policies and procedures.

Couples Theory and Therapy

The purpose of couples' therapy is to resolve relationship distress and restore overall functioning: There are multiple couples' therapy models: Psychoanalytic Couples' Therapy Object Relations Couples' Therapy Ego Analytic Couples' Therapy Behavioral Marital Therapy Integrative Behavioral Therapy Cognitive Behavior Martial Therapy Emotionally Focused Therapy Structured Strategic Marital Therapy

Legal and Ethical Issues Related to Death and Dying

The purpose of palliative care is to improve the quilt of life for patients and their families. Palliative care provides relief from pain and other distressing symptoms, affirms life and dying as a normal process, doesn't hasten or postpone death, integrates psychological and spiritual care, offers a support system, and uses a team approach to address the needs of patient and their families. Social workers need to be educated about right to refuse treatment, proxy-decision making, withdrawal or withhold treatment, physicians aid in dying, etc. Social workers should include ongoing documentation, serve as part of the interdisciplinary team, be culturally competent, seek continuing education, and supervisors should provide education, leadership and training when expertise is available in palliative care.

Behavioral Therapy-In Vivo Desensitization

In Vivo desensitization involves the pairing of relaxation and real-life experience with an anxiety-producing stimulus until the person no longer responds to the experience with anxiety.

Gender Dysphoria

Gender Dysphoria refers to emotional distress based on a mismatch between one's assigned gender and how the individual perceives his/her gender. There are different behaviors that express this distress based on the individual's age: 1) Gender Dysphoria in Children--This disorder is expressed by a strong desire to be the other gender or insistence that one is the other gender. Boys want to wear female clothing and girls want to wear male clothing and not wear traditionally female clothing. There is also a strong preference to play with children of the other gender and with toys/activities traditionally associated with the other gender. This disorder causes significant distress and impairment. 2) Gender Dysphoria in Adolescents and Adults--This is a marked incongruence between one's experienced/expressed gender and assigned gender. There is a strong desire to get rid of one's primary and/or secondary sex characteristics. There is a strong desire to be the other gender and be treated as the other gender. The symptoms need to be present for at least 6 months and cause significant distress and impairment. Individual treatment focuses on understanding and dealing with gender issues and group, marital and family therapy can provide a helpful and supportive environment. Hormone therapy and transgender surgery may be the interventions of choice in adults. Pharmacology may be necessary for individuals with comorbid diagnoses (ie anxiety, depression--antidepressants, anxiolytics, and antipychotics).

Community Organization

Community Organizing is a method of social work practice that involves the development of community resources to meet human needs. Community Organization is work with larger entities, such as citizen groups and directors of organizations, for the following purposes: 1) to find solutions to social problems; 2) to develop specific qualities in community members--including proactive behavior, self-directedness, and cooperativeness; and, 3) to bring about needed changes in the quality of community relationships. Community Organization involves planning (identifying problem areas, diagnosing causes, formulating solutions); organizing (developing the constituencies and devising the strategies necessary to bring about change); and, action (implementation of the selected strategies). The basic tenants of Community Organizing are: 1) the community is the client 2) communities may need assistance in learning how to best meet their needs 3) in democracies, people need skills in working collaboratively with others to eradicate social problems 4) the lives of human beings can be enriched by achieving a better balance between resources available for social welfare and the social welfare needs of community members 5) the community needs to be understood and accepted as is 6) all elements of a population need to be included 7) work is with a variety of community entities 8) the different elements of a community are interdependent Community organizers need to be problems solvers and use the following process for problem-solving as a guideline: Step 1) Identify/analyze the problem (evaluate the state of the system, identify the social values that the targeted problem violates, identify who is affected directly or indirectly, analyze the scope of the targeted problem, identify the causes of the targeted problem, determine the willingness of the system to provide necessary demand for services and the fiscal resources that will be needed to to meet this demand) 2) Identify and recruitment of individuals who will provide various forms of support to the planning/organizational efforts, including funding, and the coordination of their efforts Step 3) Identify the goals and objectives of the change efforts Step 4) create a plan of action for the achievement of the identified goals that makes use of program supporters and funders, which involves negotiating with interest groups, and to a lesser extent, the use of the following rational processes (use of information obtained to describe the problem and to predict phenomenon associated with the problem; identification of all possible approaches to solving the problem; determination of the consequences that are likely to result from each approach identified; performance of cost-effectiveness evaluation of each approach) Step 5) Determine and obtain needed resources Steps 6) Implement and monitor the plan of action, which includes a variety of tasks, including the following (administrative tasks, policies and procedures, external public and private organizations and with other groups, recording or documentation of the process and actions of the participants Step 7) Evaluation of the impact of the intervention Step 8) Reassessment and stabilization of the problem situation Roles a community organizer plays: teacher, catalyst, facilitator, linking role Change strategies to community organization include: social protest, legal efforts, community education, self-help groups, negotiating, lobbying, action research, whistleblowing When selecting community organization strategies, a social worker should choose strategies that are consistent with his/her values, most likely to empower the community, most likely to clarify his/her perspective on the relevant issue, and consistent with his/her style of leadership. Models of Community Organization Practice: Locality development is a process of utilizing community members to create change Social planning--involves studying a problem situation in a targeted community and proposing a plan. The focus of planning is coordination of social services, rational problem-solving, research, system analysis and development of expertise and leadership Social action--use of power and control techniques to bring about change. Leadership and establishment ways of doing things are challenged. Social reform--work with other agencies to create change Social policy development--response to a society's social problems--social policy is made by local, state and national governments in the form of laws, regulations, court decisions and executive orders--policy analysis includes the description of the policy, goals, objectives, policy mission, benefits, services, evaluation criteria, financing and political and administrative feasibility. Social workers are encouraged to become involved in policy making, holding public office and in social action and advocacy.

Somatic Symptom and Related Disorders--Conversion Disorder (Functional Neurological Symptom Disorder)

Conversion Disorder is characterized by a loss of functioning in voluntary motor and sensory functions deemed not to be fully the result of a medical condition, a substance or a phenomenon sanctioned by culture. The loss of functioning is initiated or exacerbated by a stressful event and is not caused by pain or sexual dysfunction. The disorder is more common in women than men. The longer the duration of symptoms and the more regressed the individual is, the harder Conversion Order is to treat. Medications have not been proven reliable in treating Conversion Disorder. Stress and anxiety relief treatments are helpful. Anti-anxiety mediations such as benzodiazepines (Valium, Xanax, Ativan, Klonipin) or a beta blocker (Corgard, Atenolol) may be helpful. If there are depressive symptoms, anti-depressants may be helpful. Insight Oriented Psychotherapy or Behavioral Therapy may help treat symptoms of Conversion Disorder and prevent it from recurring. Hypnosis may help the individual. identify and resolve psychological issues. Physical Therapy may be helpful to prevent complications of Conversion Disorder.

Behavioral Therapy-Covert Conditioning

Convert Conditioning, developed by American psychologist Joseph Cautela, pairs images of undesirable behavior-for example smoking--with images of aversive stimulate--ie vomiting-in a systematic sequence designed to reduce the positive cues that have been associated with the behavior.

Family Theory and Therapy-Family Systems Therapy--Murray Bowen

Family Systems Theory extends general systems theory beyond the nuclear family. The goal of therapy is achievement of a higher level of differentiation of self on the part of each family member. Therapy often involves working with one family member, with the premise that when one family member changes, others will follow. Each family member is guided by the social worker to take responsibility for his/her role in the problematic issue. In order to keep tension to a minimum, the family members direct their comments to the social worker. Eight Interlocking Steps in Family Systems Theory: 1) Differentiation of Self--family members' ability to discriminate between their identities and experiences and that of other family members' (rather than having fused identities) 2) Nuclear Family Sustaining System--(formerly called undifferentiated family ego mass)--refers to a family in which members' identities are fused 3) Triangles--relationships that have periods of closeness and periods of distance--triangulation occurs during periods of distance--an outsider takes side with one person in the relationship --family problems are typically triangular 4) Societal Emotional Process--denotes that the emotional system governs behavior on a societal level, similar to that found in a family, promoting both regressive and progressive periods in society. 5) Emotional Cutoff is an unhealthy way of dealing with intergenerational undifferentiation (ie a young adult may sever ties with a parent) 6) Sibling Position is often associated with the development of specific personality traits. 7) Multigenerational Transmission Process--refers to the transmission, through generations, of the family's emotional process. Therapeutic Techniques in Family Systems Therapy include: Therapeutic Triangle--the social worker "joins" or engages in work with a couple--social worker avoids triangulation and helps couple address with each other the difficulties they are experiencing Genogram--a graphic representation of family relationships that includes a minimum of three generations. Circles are females, squares are males and marriage is represented with a solid line. The genogram often includes important information about family members such as birth and death rates, occupations, and the nature of relationships among members Questioning--uses process questions to explore the dynamics of family relationships. The purpose of these questions is to shift the focus of family members from how others are causing them grief to what they are doing to contribute to family difficulties. Detriangulation--a process in which the social worker avoids taking sides with partners and encourages each of them two take responsibility for their part in family problems. Coaching--a technique where the social worker helps the family along each step of the way so they know exactly what they are to do. Communications/Experiential Family Therapy was developed out of the Mental Research Institute in Palo Alto in the 1960s with Gregory Bateson, Don Jackson, Virginia Satir and Jay Haley. Communications/Experiential Family Therapy saw the primary purpose of symptoms being the maintenance of homeostasis in the family. Pathological families were seen as stuck in strong dysfunctional communication patterns and viewing any change as a threat to the integrity of the system. The primary goal of Communications/Experiential Family Therapy is to alter the interactional patterns that maintain the presenting systems. Communications/Experiential Therapy includes the following principles: 1) All communication has a report and command level or function. Reusch and Bateson (1951) labeled the information or content portion of communication the report. They lagelbed the relationship defining aspect of the communication as the command. The command aspect of the message suggests how the sender views the receiver and how the sender imagines the receiver views the sender, etc. Watzlawick et cal (1967) suggested that often the relationships aspects of the communication are sent and receive without the full awareness of the sender or receiver. Relationships are either symmetrical or complementary (not a value judgement). Symmetrical relationships are egalitarian relationships in which roles are mirror images. Complementary relationships are relationships that involve a fit between different roles. The Principle of Equifinality in Communications/Experiential Therapy means that the same results can be obtained by different means. The Circular Model of Causality refers to behaviors of different subsystems that reciprocally impact each other. Forms of dysfunctional communication include: blaming, criticizing, mind reading, making incomplete statements, making statements that imply that events are unbearable when they are not, over-generalizing, double bind communications (communication that involves contradictory demands and the recipient cannot comment on the contradictions and is unable to escape the inevitable consequences of only being able to meet one of the demands, denying that one is communicating, disqualification of the communication of another member of the family Virginia Satir--later in her career, Virginia Satir used a communications approach that increasingly emphasized feelings and self-esteem of individual family members. Her approach used a more humanistic model in clarifying family communications. Satir joined the family to facilitate a family process that promoted the well-being of family members. The family was seen as a system seeking balance. Satir looked at the cost to each family member of maintaining balance in the family. She saw a symptom of a family member as evidence of a blockage in the growth of a family. Satir saw implicit and explicit family rules as coming out of the parents' approach to their own self-esteem; these rules create the atmosphere of the family or the context for the development of the children's self esteem. In therapy, Satir assisted each family member in becoming as whole as possible thought deliberate efforts to build self-esteem and self-worth though the correction of dysfunctional communication patterns. 5 Styles of Family Communication (Virginia Satir) 1) the Placater--agreement, apologizing and efforts to please 2) The Blamer--accuses, criticizes and dominates 3) The Super-reasonable--maintains an outward appearance of calm and cool but inwardly detached 4) The Irrelevant--seeks to distract others and seemingly has difficulty relating to what is going on in the moment 5) The Congruent Communicator (only healthy communication style)--sends clear, straightforward messages and is genuine. Satir taught family members to communicate congruently by assisting them to use their senses fully, to get connected to their true feelings, and to be accepting of their feelings. Satir saw healthy communication in families as a means to change dysfunctional relationships. Satir identified a healthy family as one which family members can directly request what they need, get their needs met, and where individuality is supported and encouraged. The social worker is a model for the changes a family needs to make. He/she must be congruent and demonstrate how to change dysfunctional communication patterns. The social worker teaches family members how to connect with their own feelings, how to listen, and how to verify one's own understanding of another family member's communication.

Feeding and Eating Disorders

Feeding and Eating Disorders involve abnormal behaviors related to the consumption of food, which lead to significant physical health and psychosocial functioning impairment.

Laws and Legislation

Federal laws designed to protect the interests of vulnerable populations: 1. Social Security Act of 1935 (established social security and unemployment insurance, child welfare services, aid to dependent children, maternal and child health services and services for crippled children) and Social Security Amendments of 1950-developed an aid program for totally disabled persons and liberalized several other social service programs 2. The Civil Rights Act of 1957--created the Commission of Civil Rights 3) The Civil Rights Act of 1965--no discrimination in any federally funded program 4) The Older Americans Act of 1965--provides programs and services to older Americans and created an network to coordinate these services 5) The Medicare Act of 1965--established universal federal health insurance for every American age 65+ 6) The Medicaid Act of 1965--provided federal grants to assist states with the provision of medical services for the poor. 7) The Runaway and Homeless Youth Act of 1974 (Title III of the Juvenile Justice and Delinquency Act of 1974) as last amended by the Reconnecting Homeless Youth Act of 2008--provided grants to create runaway and homeless youth centers, shelters, counseling services, street-based and home-based services, drug abuse education, transitional living programs, rural demonstration projects, research and training. 8) The Child Abuse and Prevention and Treatment Act of 1974--established federal legislation to help states prevent, identify and treat child abuse and neglect. The Act required states to create an agency to investigate allegations of child abuse, create a reporting system and pass a law protecting children from abuse (CAPTA). 9) The Family Educational Rights and Privacy Act of 1974 (FERPA)--also called The Buckley Amendment--protects the privacy of the educational records of all students attending schools that receive federal funds. The law provides parents and students the right to review all educational records and requires consent in writing before records can be released to a third party. 10) The Education for Handicapped Children Act of 1974--guarantees a free appropriate public education with related services for all children between the age of 3 and 21. Schools are required to develop, with parents, an IEP for each child and place the child in the least restrictive environment. 11) The Indian Child Welfare Act of 1978 (ICWA)--enables Native American nations or organizations jurisdiction in cases here Native American children are in need of child welfare services and foster home placment. 12) The Adoption Assistance and Child Welfare Act of 1980--provides assistance for adoption and strengthening foster care assistance for dependent and needy children. The law requires states to establish preventative and reunification programs for children in foster care, place children in the lest restrictive setting and review the status of children every six months. 13) The Omnibus Budget Reconciliation Act of 1981--comprised the first budget of the Regan administration and proposed consolidation of existing grants into block grants for mental health services. Dozens of grants are consolidated into nine block grants. These grants provided 25% less funding than those that they replaced. 14) The Family Violence Prevention and Services Act of 1984--this is the only source of federal funding dedicated to domestic violence shelters and programs-this program expired in 2008 but was reauthorized in 2010 as part of the CAPTA. Additions to the Act included a definition of dating violence, a program for children who witness domestic violence, a Tribal formula grant program and an attempt to monitor violence in underserved populations. 15) The Family Support Act of 1988--was passed as a welfare reform act which emphasized self-sufficiency and employment for welfare recipients. States were required to reduce barriers to employment and provide means for Aid to Families with Dependent Children recipients to acquire the skills and education to find and keep a job. 16) The Americans with Disabilities Act of 1990--was passed to prevent discrimination on the basis of disability in the areas of unemployment, access to public services, access to public and private transportation and telecommunications services. 17) The Child Abuse, Domestic Violence, Adoption and Family Services Act of 1992--was passed to amend CAPTA to provide research and assistance regarding the relationship of cultural diversity to child abuse and neglect cases and provided grants to support community based child abuse and neglect programs. 18) The Family and Medical Leave Act of 1993 (FMLA)--requires employers who participate in this program to provide up to 12 weeks of unpaid leave to eligible employees for certain family and medical reasons without fear of losing their jobs. 19) The Multiethnic Placement Act of 1994 (MEPA) and the 1996 provision on the Removal of Barriers to Interethnic Adoption--laws passed to prevent delays in foster placements of adoptions due to racial or ethnic reasons n federally-funded agencies. The intent of MEPA and the 1996 was to increase the rates of adoption for children of color and decrease the amount of time they spend in foster care. The law prohibited adoption or foster care on the basis of race, natural origin or color and provided recruitment of appropriate homes that reflect the diversity of the children needing care. 20) The Violence Against Women Act of 1994 as Title IV of the Violent Crime Control and Law Enforcement Act--was passed to strengthen law enforcement and prosecution strategies for violent crimes against women and provided for developing and strengthening services for women who were victims of violent crimes. 21) The Temporary Assistance for Needy Families Act of 1996--replaced Aid to Families with Dependent Children--an outgrowth of the New Deal program--put term limits on public assistance and required that those who are enrolled in the program be employed. 22) The Adoption and Safe Families Act of 1997--amended Title IV-E of the Social Security Act to promote the adoption of foster children. The Act renamed the Family and Support Services Program as the Safe and Stable Families Program. The Act increased the accountability of states to accelerate permanent placement, promote adoptions, and ensure the safety of neglected and abused children. The Act was passed to ensure that children have their own rights and needs where safety is concerned. 23) The Foster Care Independent Act of 1999--amended part E of the Social Security Act to provide funding and greater flexibility in programs that help children transition from foster care to independent living. One of the provisions gave states an option to extend Medicaid coverage to emancipated foster children to age 21. 24) The Promoting Safe and Stable Families Amendments of 2001--provides support for the mentoring of children whose parents are incarcerated. The amendment also provided for education and training for youth transition from foster care. 25) The Keeping Children and Families Safe Act of 2003--amended CAPTA, the Adoption Opportunities Act, The Abandoned Infants Assistance Act and the Family Violence Prevention and Services Act. This Act enhanced the linkages between Child Protective Services agencies and mental health, public health and developmental disabilities agencies. 26) The Safe and Timely Interstate Placement of Foster Children Act of 2006--this Act was passed in an effort to improve protections for children. The Act called states to be accountable for the placement of children across state lines in a safe and timely manner. The Act also requires greater frequency in caseworker visits for children who were ;laced in foster care out of state as well as eliminating legal barriers and increasing consideration of placing children in other states. 27) The Adam Walsh Child Protection and Safety Act of 2006--names for Adam Walsh a victim of kidnapping and murder, the purpose of this Act is to protect young children from abuse, sexual exploitation, violent crime and child pornography. The law is also intended to prevent sex offenders from having any contact with children and to promote internet safety. The provisions in the Act focus largely on fingerprinting, background checks, national child abuse registry and privacy of information. 28) The Elder Justice Act of 2009 (part of the Patient Protection and Affordable Care Act)--authorizes funding in a number of areas regarding elder abuse, neglect and exploitation. The Act require owners, employees, and operators of long-term care facilities to report if they suspect crimes have been committed in the facility. Care facilities must also provide for adequate transfer and relocation of residents. Background checks are required on prospective employees who have direct patient contact in long-term care facilities. 29) Patient Protection and Affordable Care Act of 2010--together with the Health Care and Education Reconciliation Act of 2010 amendment, the Act represents the US healthcare system's most significant regularly overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. The ACA's major provisions came in to force in 2014.

Practice Evaluation--Program Evaluation and Outcomes

Program evaluation assists in the effort to improve human service programs and identify programs that work successfully for various groups or types of client problems and conditions. Policymakers, program funders and service providers want to see practice based on evidence rather than on testimonials. Evaluation activities must be an intrinsic component of program development and performance monitoring. Collecting and analyzing data fosters/enables self-evaluation of agency programs and is helpful in demonstrating effectiveness/efficacy to support program continuation. Program Evaluation Design based on the US Department of Justice, Office of Justice Programs document called "Evaluation Strategies for Human Service Programs: A Guide for Policymakers and Providers.": 1) Clarify the questions that the agency needs to know such as who is the target audience, what information does the audience require, and what is the timeline for that information. There are four different types of evaluation from which an agency can choose: 1) impact evaluations-did program have intended effect. 2) Performance Monitoring--used to assess a program's performance (how the program operates) and accomplishments (whether the program met its goals). 3) Process Evaluations--address the operation of the program as well as the service delivery activities and procedures. This type of evaluation is useful in identifying the problems that arise in delivering services and in coming up with strategies to deal with these problems. 4) Cost evaluations--compare the cost of a program with the identified benefits (ratio of cost to benefits) and can compare the cost of the program to the program output (cost per unit). 2) Develop a logic model--including program description (target population, resources to be used, types of service, levels of service), outputs (immediate program products or specified numbers of data--ie number of home visits), outcomes are the desired results of the program and can be categorized into two groups (immediate and long term); The logic model is applied to various types of evaluations. For example, with impact evaluations the logic model is intended to identify who the services are expected to benefit and how those benefits will come about. For performance monitoring, the logic model can be used to focus on the kinds of outcome indicators for specific target populations and time periods . For process evaluations, ideal program expectations are identified and then evaluated in terms of deviations in practice that may have occurred in the program and how these deviations can be corrected or avoided. 3) Assess Readiness for Evaluation--programs must be justifiable, feasible, and likely to result in information that is useful to the agency and population. Factors such as reasonable goals and evidence-based practice must be evaluated. The kinds of data that will be needed, the number of subjects required and already available data need to be identified. If existing data are not available on the type of program being considered, there must be enough resources available to collect the new data that is required. Other considerations include determining if there are adequate resources (funding, time, community and government support, expertise, etc0 and if there are factors that could limit or constrain the needed program resources. (Also consider if research will be completed in time to affect current programs and policies, does similar data already exist, and can the research be generalized to other agencies, populations and communities) 4) Selecting the Evaluation Design--this step occurs after the evaluation questions have been clarified, a logic model has been developed and the readiness for evaluation has been assessed. There are four major types of evaluation designs: 1) Impact evaluations--may use three possible designs for evaluation--experimental designs, quasi-experimental (non random selection of control and experimental groups) designs and non-experimental designs (no control group)--before and after comparisons of participants in program, time series design (extension of before and after design with multiple measures used) panel studies which involve repeated measurements of outcomes using the same group of participants and post-program comparisons of the groups that participated in the program. 2) Performance Monitoring--is a design evaluation that provides information regarding the key aspects of the operation of a program or system, the extent to which goals were achieved, and any failures in the programs ability to produce desired outcomes. Performance monitoring can also be useful in monitoring service quality and reporting on program efficacy. 3) Process Evaluation or Analysis--is used to develop a plan for collecting data to determine if the program is being implemented correctly, if there are consequences or outcomes that were neither intended nor anticipated and to understand the program from the viewpoint of the participants, the staff, and the community. The data can be collected from case studies, focus groups, and ethnographic interviewing. 4) Cost evaluation is used to determine direct program expenditures, the costs that are incurred when staff time and resources have been diverted from other uses, new costs for purchased services and the estimated value of donated materials and time. Social workers have been able to evaluate their service to clients via the use of assessment tools that show client progress. Assessment in social work is used to identify dysfunction or problem areas, formulate a treatment plan, and monitor client progress. Social workers use the process of gathering information about the client or client system in order to make a diagnosis of the client's problems, needs and strengths. Social workers can also use specific tools that will lead to an appropriate treatment plan and intervention. Social work screening tools and assessment instruments can be viewed in terms of the activities and tests for which social workers are trained and licensed to perform and administer and include some of the following: --DSM assessment --Data driven tools ;provide specific, measurable data that guide treatment plan goals and enable the client's progress to be monitored --pre and post testing protocols can be administered to individual clients or to groups of clients and are a good way to demonstrate progress --client progress over time can be evaluated by taking measurable baseline data on specific behaviors, providing an intervention, taking data after a specified amount of time and comparing the results.The treatment plan should be re-evaluated regularly to determine progress toward goals and altered as necessary. Selecting Evaluation Instruments--these should be chosen based on the following: purpose, symptoms and reasons for conducting an evaluation, appropriateness for setting, such as selecting evaluation instruments designed for high school age students, training and certification of the individual administering the instrument or test, cost, standardized tests tat are normed, reliable and valid. Here are examples of screening instruments and tests that may b appropriate for social workers to use in their practice-- Child and Adolescent Functionality Assessment Scale --Child and Adult Needs and Strengths Assessment --Global Clinical Impairment Scales --Spence Children Anxiety Scale --Center for Epidemiological Studies Depression Scale for Children --Diagnostic Interview Schedule for Children, Version 4 Adolescent Psychopathology Scale --Temperament and Atypical Behavior Scale Accreditation is usually associated with educational institutions while program review may be viewed as a collaborative process within an agency or institution that is intended to be formative and has the purpose of leading the program to improvement.

Social Work Record Keeping

Social workers keep records for the following reasons: 1) to document services provided; 2) to ensure continuity in services; 3) for purposes of communicating with other service providers about clients; 4) to facilitate supervision, peer review, and evaluative or research efforts. Following are the various types of records and record-keeping formats: --Intake Assessments--used for organizing information obtained from clients at intake into a written report and provide a basis for determining the service needs of the client --Process Recordings (progress notes)--a method of documenting the interactions between the social worker and the client during intervention --Treatment Plans--written records in which treatment goals and the interventions to be used in achieving these goals are specified SOAP--Subjective Data, Objective Data, Assessment, Plan--this is a system frequently used by social workers and other healthcare providers to organize their notes, including information on treatment and services provided. POR=Problem Oriented Record--increasingly being referred to as a Person Oriented Record among social workers in keeping with the strengths-based focus of the field. The POR is a record-keeping format developed primarily for use in health care contexts and often adapted for use in mental health settings. This type of documentation permits accountability and interdisciplinary communication and is also useful in peer review. Limitations is that it is time-consuming and costly and that it needs considerable modification to adequately reflect concerns of social work. The Problem Oriented Record system consists of the following four sections: 1) The Database--information obtained by members of the client's health team at the time of intake or admission. Presenting problem, daily activities, social involvement, health problems, history and results of examinations and lab work. 2) The Problem List--problems experienced during the data collection process--index to client's record and a basis for evaluating service provision and goal attainment. 3) Initial Plans--action plans for each item on the problems list and ongoing updates that are recorded in the progress notes 4) Progress Notes--recordings, during plan implementation, about client progress in problem areas. Progress Notes may take several forms, including the following: 1) Narrative Notes--ie SOAP--used to update the database and indicate changes in the treatment plan 2) Flowcharts; 3) Discharge summary--review at discharge that includes summary of each client problem and the result of treatment and services utilized for each problem Clients records are confidential and the social worker must have the client's written permission to share information with others. In general, social workers' sessions with clients are privileged information (a legal issue). This means that under most circumstances, the courts cannot compel a social worker to share information about a client. However, since the privilege belongs to the client, the social worker may be compelled to share confidential information about the client if the client waives his/her privilege. When sending information about a client outside the agency, it is best to summarize the information rather than sending a copy of the client's file.

Couples Theory and Therapy

The purpose of Couples therapy is to resolve relationship distress and restore overall functioning. There are multiple models from which couples can choose: 1) Psychoanalytical Couples Therapy (Fairbairn, Kouhut, Gilligan)--analyzes couple relations and mate selection as originating from the parent-child relationship during childhood. Psychoanalytic therapy attempts to uncover unresolved childhood conflicts with parental figures and early development and their impact on the current relationship. A critical part of Psychoanalytic Couples Therapy is Introjection --which is how the infant processes versions of the love object (mother or primary caretaker). The core of this model is dealing with the process of becoming a separate, distinct person from the caregiver-child interactions during childhood. 2) Object Relations Couple Therapy (Fairbairn, Kohut, Gilligan)--this model is based on the premise that marriage becomes a closed system that inhibits growth through mutual unconscious interactions between the partners. The social worker is seen as the agent of change by modeling and creates a neutral and impartial environment to understand the distortions and internalized conflicts that each partner brings to the relationship. Supposition is that the partner finds lost parts of his/her life in the other partner. 3) Ego Analytic Couples Therapy (Fenchiel, Gray, Apfelbaum, Wile)--this model of couples therapy fosters the ability of the couple to communicate important feelings. The Ego Analytic Couples Therapy model proposes that dysfunction originates from a person's incapacity to recognize and validate sensitivities and problems in the relationship. There are two major categories of problems in this model--dysfunction brought into the relationship from early chid trauma and experiences and the person's reaction to difficulties and sense that he/she is un-deserving because of shame and guilt. 4) Behavioral Marital Therapy (Stuart)--seeks to improve the relationship of a couple by increasing the frequency of positive exchanges and decreasing the frequency of negative and punishing interactions. Histories of the partners AND the environment are both seen as influences on the relationship. Social worker assesses strengths and weaknesses of relationship. Skills taught in Behavioral Martial Therapy are expression in clear behavioral teams, improved communication skills, establishment of a system to share power and decision making and improved problem solving skills. 5). Integrative Behavioral Therapy (Jacobson and Christenson)--focuses on the functioning of the couple. Negative interactions are believed to be repetitious and cause the problems in the relationship. Therapy is individualized, flexible and based on specific problems in the relationship. Basic assumptions of Integrative Behavioral Therapy are that talking about how a partner feels and thinks about problems is sometimes necessary before the partner can accept the other partner; most partners learn ways to alter negative emotional responses they have to problems and their partner; most partners are capable of learning new ways to resolve problems and the emotions that come with problems; and, couples who succeed in learning new skills can be happy and content. 6) Cognitive Behavioral Marital Therapy--is generally focused on the need to understand the couple's emotional and behavioral dysfunction and how it relates to inappropriate information processing. Therapy seeks to uncover and dispel negative thinking that drives negative behavior that causes relationship problems. Common cognitive distortions include overgeneralization, magnification and minimization,, black and white thinking, labeling and mislabeling, tunnel vision, biased explanation or suspicious thinking, mind reading, information taken out of context, personalization and arbitrary inference.7) Emotionally Focused Therapy (Greenburg and Johnson)--views emotions and cognition as interdependent and that emotions drive interpersonal expression. Emotionally Focused Couples Therapy has origins in Emotion Theory and Attachment Theory. Relationship distress is believed to be caused by unexpressed and unacknowledged emotional needs. The basic principles of Emotionally Focused Couples Therapy are: relationships are attachment bonds, partners are seen as coping well, despite current situation, reigid interaction patterns create and reflect absorbing emotional states, emotions are the target and agent of change and change involves a new experience of the self. Therapy is considered short-term. 8). Structural Strategic Marital Therapy (Haley and Madanes--Washinton School for Strategic Therapy)--views relationship difficulties as the inability to cope with environmental or personal life changes. The goal is to facilitate a solution to the presenting problem in the most efficient and ethical manner. Strengths are focused on rather than weaknesses,.Important features of Structural Strategic Marital Therapy are moving from who is to blame to what is to be done, relationship maintenance and encouraging converstations outside of therapy that are not happening.

Albert R. Roberts 1991: Seven Stage Crisis Intervention Model

1. conduct a thorough biopsychosocial and imminent danger assessment; 2) rapidly establish rapport with client; 3) identify major problems or crisis precipitants; 4) deal with client's feelings and emotions; 5) generate an explore alternatives and new coping strategies; 6) restore functioning through implementation of action plan; and, 7) plan a follow up time to meet with client.

The Substance Abuse and Mental Health Services Administration SAMSHA's 10 Principles of Trauma-Informed Care

1. Safety; 2) Trustworthiness and transparency; 3) Peer support and mutual help; 4) Collaboration and mutuality (power is shared and decision making is shared); 5) Empowerment; 6) Voice and choice; 7) Resilience and strength based; 8) Inclusiveness and shared purpose; 9) Cultural, historical and gender issues; 10) Change process is conscious, intentional and ongoing, consistently responding to new knowledge and developments.

Child Abuse and Neglect

(Physical abuse, emotional abuse, sexual abuse and neglect) Sexual abuse--any sexual contact that is forced upon a person against his or her will; results in significant emotional and behavioral problems in children and often results in the child being a perpetrator him/herself. Sexual abusers are most often men known to the child--long terms problems include issues with intimacy, self-esteem, sexual acting out, aggression, withdrawal, phobias, sleep disorders and eating disorders. Signs of sexual abuse include trouble walking or sitting sexual inappropriateness, avoidance of a particular person without reason, running away from home, reluctance to change clothing in front of others sexually transmitted diseases or pregnancy under the age of 14. Most common perpetrator of physical abuse of children under age 14 is the female parent.Social workers are required by law in all US states to report child abuse.

Phases of Crisis Intervention

1. Formulation of Problem- immediate focus on the event and assessment of functioning (first interview) 2. Implementation Phase- gain additional background information (first to fourth interviews) 3. Treatment Phase-last interview or two

Theories of the Etiology of Addiction

1.) Disease Model--addiction is chronic and progressive and a pathological condition; 2) Moral Model--defective spirit and weakness of character are causes; 3) Temperance Model--individual is powerless against addiction--the only form of treatment is abstinence; 4) Genetic Theories--rates of addiction are higher among relatives than the general population; 5) Personality Theory--addiction is a result of addictive personality with high levels of impulsiveness, aggression, emotionality, agitation, frustration, ineffectual coping mechanisms for stress, and a need to be in complete control but feels powerless/hopeless; 6) Psychodynamic Theory--problem drinking is associated with unsatisfied needs from childhood and how the individual learned to satisfy those needs in childhood; 7) Humanistic Theory--individuals use alcohol to satisfy a need for power and intoxication is accompanied by thoughts of increased social and personal power; 8) Exposure Model--introduction of a substance on a regular basis automatically leads to addiction; 9) Behavioral/Learning Theory--behavior is learned and substances provide immediate reinforcement in the form of reduction of anxiety, improved mood, and avoidance of withdrawal symptoms. The role of the environment is significant as is the process of socializing and observing behaviors of role models; 10) Tension-Reduction Hypothesis--substances reduce anxiety, fear, and other states of tension. Negative reinforcement occurs because tension is reduced by drinking more; 11) Cognitive Theory--addiction results from the belief that substance use will reduce tension or act as a euphoriant; 12) Sociocultural Theories--social and cultural factors determine levels of consumption; 13) Biopsychosocial models-addiction involves the interaction among biophysical, psychological and social factors. 13) Neurobiology is the current focus of addiction theories and identifies the pleasure center of the brain as reinforcing the addiction. Addictions have been expanded beyond substances to include gambling, hoarding, pornography, shopping and electronic devices.

1900 Sigmund Freud Psychoanalytic Theory of Personality/Psychosexual Theory of Development

3 Levels of Consciousness: conscious/preconscious/unconscious. Freud believed the unconscious makes up most of the mind and this is where he focused. Structure of Personality Id--pleasure principle--inherited/instincts Ego-reality principle--develops from id and intertwined with psychosexual development of child--keeps anxiety producing impulses to a manageable level Superego-morality principle Psychosexual Stages of Development Stage 1: Oral (mouth/sucking/biting) (birth to age 18 mos) Stage 2: Anal (restricting and excreting (2-3 years of age) Stage 3: Phallic (sources of pleasure) (Oedipus and Electra) (3-6) Stage 4: Latency Period (age 6-11) calmness/Superego maintains parental standards Stage 5: Genital (ages 12+) forming relationships Psychoanalytic Theory of Personality Psychoanalysis relieves people from neuroses (distressing psychological disorders that are not associated with an extreme distortion of reality) via the use of free association and dreams analysis. Psychoanalysis uncovers repressed conflicts by re-living them and a then developing a more mature understanding and healthier coping skills. Freud believed human personality develops primarily in childhood.

Global Development Delay

A child under the age of 5 who seems to be falling behind developmentally but the practitioner cannot reliably assess the degree of impairment. The child fails to meet expected developmental milestones in several areas of intellectual functioning. Reassessment is required after a period of time. No medication for treatment. Muti-disciplinary treatment modalities are recommended, including social skills development.

Motivational Interviewing

A collaborative, person-centered form of guiding to elicit and strengthen motivation for change. Useful to deal with client ambivalence and to elicit the client's own motivation to change rather than imposing change. Not a counseling technique but a way of being with a client while assessing the client's motivation to change. Useful for gambling addictions, substance dependence, dual diagnosis, brief intervention, mental disorders, parenting and in the court system. Explore the client's own reasons for change in an accepting and compassionate environment. MI sits between following and directing styles of communication. Designed to empower people to draw out their own meaning, importance and capacity to change. Natural curious and respectful and requires clinician to engage the client as an equal partner and refrain from unsolicited advice, confronting, instructing, directing or warning. MI is practiced with an underlying spirit in therapy not as a therapeutic form. (Miller and Rollick 1991)

Bipolar and Related Disorders

A manic episode is characterized by a mood that is abnormally elevated, expansive or irritable that persists for at least one week. In addition, the individual has at least three of the following symptoms (four if mood is irritable)--grandiosity or self-esteem that is inflated; decreased need for sleep; pressured speech; racing thoughts; easily distracted; psychomotor agitation or persistently increased goal-oriented behavior; excessive involvement in activities that are likely to cause negative consequences. A hypomanic episode involves symptoms associated with a manic episode but these are less extreme. Symptoms must be present for at least four days and have been present most of the day, every day. The episode doesn't cause significant impairment in functioning. A major depressive episode--involves at least two weeks of depressed mood or a loss of pleasure in most activities. Children and adolescents may present with irritability rather than sadness. In addition, at least five of the following symptoms must be present with a. marked change in functioning: change in appetite or significant loss of weight, sleep disturbance, either insomnia or hypersonic, reslestess, agitation or motor sluggishness, fatigue, feelings of worthlessness, guilt-laden, difficulty thinking, concentrating or making decisions, and recurrent thoughts of death. Treatment includes mood stabilizers (Lithium, Tegretol, Depakote) and atypical antipsychotics (Geoden, Risperdal, Zyprexa, Abilify, Seroquel) are more frequently prescribed because they can provide greater relief but have greater side effects and are more expensive. Therapy is considered beneficial in conjunction with medication management--key treatment components for Bipolar Disorder are strong eduction about the disorder, looking for and planning for signs of relapse, illness acceptance, regular sleep and activity patterns, and direct involvement with family.

Attention Deficit/Hyperactivity Disorder (ADHD)

A pattern of inattention and/or hyperactivity not accounted for by an individual's developmental stage. More common in males. Impairment must be present in at least two settings. Six symptoms or more in either or both hyperactivity and inattention must be present in children and at least 5 symptoms for those 17+. There is ADHD, ADHD predominantly inattentive type and ADHD predominantly hyperactive type. Treatment is typically focused on medications (Ritalin, Dexedrine or Adderall--psychostimulants). Also Strattera which is a non-stimulant that is prescribed for children and adults who do not tolerate psychostimulants. Tricyclic antidepressants are also effective in adults with ADHD. Psychotherapy helps children talk about upsetting thoughts and feelings and identify self-defeating behaviors and learn alternative ways to handle emotions and behaviors. Behavior therapy helps with immediate issues (ie organizing homework, wake up routine. Social skills training assists in maintaining good social relationships and understanding social cues. Psychotherapy and medication are the preferred treatment modalities for ADHD.

Schizophrenia Spectrum and Other Psychotic Disorders--Schizophrenia

A psychotic disorder characterized by a combination of specific positive and negative symptoms. Must be continuous signs of the disorder for at least six months and any mood episodes that occur during the active phase of the disease have to be relatively brief or a diagnosis of Schizoaffective Disorder or Mood Disorder with Psychotic Features should be made. Positive symptoms of schizophrenia include hallucinations, delusions, disorganized speech, inappropriate affect and disorganized behavior. Negative symptoms include flat or blunted affect, avolition (loss of willpower and decisiveness) logia (speech disturbance involving poverty of speech); decrease in amount of or poverty in content of speech; and anhedonia (loss of ability to experience pleasure). Three phases of schizophrenia--Prodromal Phase--decline in role functioning and precedes the activities phase; Active Phase--full blown symptoms of schizophrenia appear--has to last at least one month unless treatment causes symptoms to decrease; Residual Phase--psychotic symptoms have improved by impairment continues. Medication management for schizophrenia often requires a combination of antipsychotic, antidepressant and anti-anxiety medications. Antipsychotic medications help normalize biochemical imbalances. The biggest obstacle with individuals diagnosed with this disease is mediation compliance. Wrap around services are required for treatment, including social skills training, education about the disorder, independent living assistance, case management and medication compliance. Family therapy can significantly decrease relapse rates and self-help an, group and community support groups are helpful.

Family Life Cycle

A series of stages determined by a combination of age, marital status, and the presence or absence of children; include emotional and intellectual growth--similar to stages of human development but with stages of life relative to family unit. The family life cycle has five main stages: Independence--young adult starts out on own--differentiation of young adult from his/her family or origin and establishment of intimate peer relationships; Coupling--selecting a partner and adjusting to life as a couple--negotiation of family or origin issues into new family system is an issue in this stage--in healthy relationships, both members of the couple will understand importance of family of origin issues and create a new family system based on joint agreement; Parenting (infants through adolescents)--much of the family life cycle spent here--two-three sub-stages--parenting infants and young children, parenting school aged children and parenting adolescents--much of parents' time and energy devoted to nurturing and supporting the growth of their children during this stage; Launching Adult Children--"empty nest"--re-establish marital relationship as well as career needs and goals; Retirement/Senior Years--often marked by addition of new members into the family system--also time when family prepares to lose members.

Mental Status Exam MSE

A set of interview questions and observations designed to reveal the degree and nature of a client's abnormal functioning. Part of a psychiatric clinical assessment. Includes the following domains: attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgement. Purpose is to obtain signs of mental disorders, including danger to self and others, present at time of the exam. Includes open and closed interview questions and structured tests to assess cognition. Examples of abnormalities: Speech-- palilalia (repetition of own words) (echolalia--repetition of another's words). neologisms (made up words that have meaning to the individual who makes them up); Thought process--flight of ideas (thoughts are rapid and pressured), poverty of thought (reduction in quantity of thought) and perseveration (client keeps returning to the same set of ideas); A formal thought disorder may be exhibited by thought blocking (client's thoughts keep getting interrupted without apparent cause), loose associations (thoughts appear unconnected unbeknownst to the speaker), tangential thinking (replying in a oblique or irrelevant way); derailment (often occurring in people with schizophrenia, marked by frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea); and circumstantial (client includes a great deal of irrelevant details and makes frequent diversions). Thought Content--delusions (grandiose, paranoid, erotomanic, jealous, or delusions of reference --comment or reference has a special meaning to the client); thought withdrawal--belief that one's thoughts are being withdrawn from one's mind; Thought insertion--belief that others are inserting thoughts into one's mind; thought broadcasting--belief that one's thoughts are being broadcasted or are heard by others. Perception--key perceptual distortions are hallucinations--sensory perception in the absence of external stimulus)--can occur in all of the five senses although auditory are most common; also, depersonalization-distortion in sense of self; derealization--distorition in sense of reality;

Types of trauma specific interventions

ATRIUM--addiction and trauma recovery integration model (peer support, psychosocial education, interpersonal skills training, meditation, creative expression, spirituality and communication action combined). Essence of Being Real--peer-to-peer approach for victims of trauma that is particularly helpful for survivor groups, first responders and frontline service providers and agency staff. Goal is to promote relationships rather than focusing on trauma. Risking Connection--trauma-informed intervention that focuses on empowerment, connection and collaboration. Addresses issue of how trauma hurts, using relationship and connection as a treatment tool, working with dissociation and self-awareness and transforming vicarious traumatization. Sanctuary Model--assists children who have experienced interpersonal violence, abuse and trauma. The Sanctuary Model is intended for residential treatment centers for children, schools, domestic violence centers, homeless shelters, group homes and outpatient and community-based settings. The intent of the Sanctuary Model is to create a healing environment that improves efficacy in the treatment of traumatized children, reduces restraints and other coercive practices and improves staff morale and retention. Seeking Safety--the Seeking Safety Model of trauma specific interventions consists of therapy for trauma, PTSD and substance abuse and can be used in a variety of settings, Focuses on ideals to counteract the loss of ideals in both PTSD and substance abuse, plus knowledge of cognitive, behavioral, interpersonal and case management interventions. Trauma, Addiction, Mental Health and Recovery (TAMAR)--this program is a structured, manual, 10-week intervention combining psycho-educational approaches with expressive therapies. The focus is on the symptoms of trauma, current functioning, symptom appraisal and management, the impact of early chaotic relationships on health care needs, development of coping skills, preventative education regarding sexually transmitted diseases and sexuality and help in dealing with role loss and parenting issues.The Trauma Affect Regulation Guide for Education and Therapy (TARGET)--an educational and therapeutic approach for prevention and treatment of complex PTSD. Provides practical skills that can be used by trauma survivors and family members to de-escalate and regulate extreme emotion, manage intrusive trauma memories experienced in daily life and restore the capacity for information processing and memory. Trauma Recovery and Empowerment Model (TREM and M-TREM)--intended for use with trauma survivors, particularly those with exposure to sexual or physical abuse. The model is gender-specific and can be used in mental health, substance abuse, co-occurring disorders and criminal justice settings.

Ego Defense Mechanisms Not Identified by Anna Freud

Acting out: mechanism to deal with excessive anxiety or emotional conflict or stress by exhibiting observable behavior rather than by merely feeling or reflecting. For example, a teenager who gets in fights because he is upset with his mother and doesn't express this to her. Affiliation: mechanism used when a person shares with others his/her emotional conflict or stress to elicit help or support rather than placing the responsibility on someone else. For example, a husband who talks to his best friend to get help for managing his difficult marriage. Aim Inhibition: a mechanism used when an individual places a limit on his or her instinctual demands and accepts a modified fulfillment of goals or desires. For example, Brigid wants to be a doctor but decides to be a PA because wants to have kids young. Altruism: mechanism seen when an individual deals with his/her emotional conflict or stress by selflessly dedicating his or her life to meeting the needs of others, thereby receiving vicarious gratification. For example, a woman who wanted to be a wife and mother but didn't and dedicates her life to a nursing career. Anticipation: mechanism utilized when an individual deals with anxiety by practicing his/her emotional reactions to an anticipated future event and considering the responses or solutions that he/she may use to deal with that event. For example, practicing acting out someone on a date and how to respond given different reactions. Autistic Fantasy: also called Fantasy--mechanism where an individual daydreams excessively as a substitute for real action. For example, daydreaming about being a tennis pro and not practicing. Avoidance: mechanism where individual refuses to participate in activities or encounter situations or objects that represent unconscious, aggressive or sexual impulses and the potential punishment for those impulses. For example, a gay man who avoids contact with a man whom he is attracted to. Avoidance is often a defense mechanism employed to deal with phobias. Deflection: mechanism where a group member deflects attention from his/herself onto another group member. Devaluation: mechanism where an individual deal with his/her emotional conflict or stress by attributing negative qualities to him or herself or to others. For example, an attractive person who complains about not having any dates because she is so unattractive. Dissociation: mechanism of compartmentalism or separating activities or thoughts from the main portion of one's consciousness. For example, Bill Clinton. Fixation: interruption of normal personality development at a stage short of maturity--ie a father and husband who likes to hang with the bros rather than support his family. Help-Rejecting Complaining: mechanism where a person deals with emotional conflict or stress by asking for help and then rejecting the help. Often the requests for help are disguised feelings of hostility. For example, a person who complains about her weight and rejects helpful suggestions from thin friends. Humor: mechanism where individual deals with his/her own emotional conflict or stress by pointing out amusing aspects of the stress. Idealization: process of over-estimating the desirable qualities and underestimating the limitations of something that is important to an individual. For example, going on an on about how a massage will help relieve stress but ignoring the cost because you want someone to pay for it. Imitation: unconscious and conscious modeling of another person's behavior or style but less intense or complete than pathological identification. Incorporation: one of earliest mechanisms in development where child though observation assimilates into his/her ego and superego the values, attitudes and preferences of parents. Introjection: unconsciously incorporating ideas, attributes or mental images into one's own personality. For example, a husband is criticized by his wife and he criticizes himself. Omnipotence: individual deals with own stress/anxiety by feeling or acting in a superior manner. Passive Aggression: individual expresses aggression toward another person in an indirect/unassertive manner which gives the agitator the chance to avoid dealing with the emotional stress related to dealing with the other person's reaction. Projective Identification: like projection, falsely attributes one's own unacceptable impulses, feelings or thoughts to another person. But person is conscious of the attributes that are projected and considers them justifiable reactions to the other person. Projective identification is a primitive form of relating, while projection as identified by Anna Freud is intra-psychic dynamics and is less disturbing/difficult to deal with. Resistance: mechanism that prevents the bringing of repressed (unconscious) feelings or information to conscious awareness, sparing the anxiety that would arise from those memories or insights. For example, mom resists thinking about Mary's suicide because so traumatic and causes so much anxiety. Restitution: mechanism of relieving stress or guilt by doing something to make up for what one thinks is an error in behavior against another person. For example, being extra kind to someone you have been short with in the past. Self-Assertion: healthy mechanism where an individual deals with his/her emotional conflict or stress by expressing feelings/thoughts directly and in a non-coercive or non-manipulative manner. Somatization: mechanism where individual experiences physical symptoms of the body's sympathetic (responsible for stimulating fight or flight response) and parasympathetic (responsible for stimulating "rest and digest" or "feed and breed" responses when the body is at rest) nervous systems because of emotional conflict or stress. For example, a person who has stomach pain when an assignment is due. Splitting: mechanism where in order to relate to significant others, a person splits the significant other into two parts--good and bad--to cope with painful feelings associated with that person. For example, the child who sees the good features of a parent who abused her. Suppression: conscious and unconscious exclusion of data from consciousness. For example, a young woman refuses to think about her recent break up with a boyfriend because she has an important presentation coming up. Symbolization: handle emotional conflicts by turning them into symbols. For example, interpreting a dream as a symbol of a deeper feeling or desire.

Medical Terminology

Alert and oriented, complete blood count/CBC, congestive heart failure, chronic obstructive lung disease/COPD. SOAP notes (subjective observations, objective data, assessment and plan). BIRP notes--behavior of client, intervention of social worker on behalf of documented client behavior, response to intervention and plan. Other commonly used medical terms--bid (2x day), tid( 3x day), qid(4x day), @hs--at hour of sleep, prn-as needed, stat--immediately, f/u--follow up, hx-history, sx--symptoms, dx--diagnose, nka--no known allergies, dc--discontinue or discharge, lmp--last menstrual period, rx--prescription, r/o-rule out, uri--upper respiratory infection, uti--urinary tract infection, wnl--within normal limits, mri--magnetic resonance imaging.

1917 Alfred Adler: Individual Psychology

Alfred Adler is considered the founder of Individual Psychology. Theories include that humans start off life in a state of inadequacy or inferiority. Adler believed that humans have a basic drive toward self-actualization or superiority. A person's degree of functioning successfully in groups is a primary indicator of an individual's wellness. Children develop a "self-image" or fiction about themselves which influences how they interpret and respond to events in their lives. The social worker task is to help individuals identify dysfunctional fiction and develop a more positive self-image and life goals. Data collection includes assessing the patient's drive toward self-perfection, the degree of activity and the level of interest in contributing to the good of society. Psychoanalysis should be non-authoritarian, have equal patient-social worker interaction, use empathy and focus on the daily life experiences of the client.

1920 John Watson: Behavioralism

American psychologist developed behaviorism--an objective way of analyzing behavior. Conducted "Little Albert" experiment where he conditioned a child to fear a white rat and then generalized this fear to a white rabbit. Watson believed this showed that parents can influence the behavior of their children via stimulus-response conditioning. Watson emphasized the observable behavior or people, rather than their emotional or mental states.

1990s James Karl and Karen Wandrei: Person in Environment System (PIE) Theory

An assessment system specifically developed for social workers to assess the social functioning of adult clients. It seeks to balance problems and strengths. The system delineates problems in terms of severity, duration, and the client's ability to cope/problem solve. It is not a diagnostic system of cause and effect. The PIE System has four factors or dimensions and all four factors need to be present to provide a comprehensive picture of a client's issues: Factor One: Social Functioning; Factor Two: Environmental Problems; Factor Three: Mental Health Problems; Factor Four: Physical Health Problems. Social work focuses on factors one and two, those that form the core description of the client's social functioning issues.

The Assessment Process

Assessment is the process of arriving at tentative conclusions about the nature of a client's situation, including problems and resources. Assessment provides the basis for treatment planning. Assessment should be an ongoing process. Mary Richmond was one of the first casework practitioners to concentrate on assessment and diagnosis. Assessment needs to focus on many different aspects of a client's internal and external experience, including the following: Internal: biophysical functioning, use and abuse of substances, cognitive and perceptual functioning, emotional functioning, mental disorders, behavioral functioning, motivation, degree of acculturaltion, language fluency, problem solving skills. External: health and safety factors, social support systems, environmental needs of adults and children, cultural norms, educational support and needs, precipitating events that led to the seeking of social work services.

Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder--new in DSM-5 because is consolidated DSM-IV-TR disorders including Aspergers, Rett's Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder, NOS. Symptoms include reduced sharing of information and failure of normal back and forth conversation and stereotyped or repetitive motor movements or speech; insistence on sameness, no flexibility in routines, ritualized patterns of verbal or nonverbal behavior,fixated interests or focus and hyper or hypo sensitivity to sensory input. Severity is assessed separately for social communication AND restricted/repetitive patterns of behavior. Treatment needs to be tailored to specific individual. Many treatments applied are related to Applied Behavioral Analysis (Intensive Behavioral Intervention, Pivotal Training), speech therapy, language therapy and occupational therapy. Goals of treatment are to lessen associated deficits and family stress and increase quality of life and functional independence.

1977 Albert Bandura: Social Learning Theory

Bandura stressed that learning depends on environment, cognition and behavior, not just by learning from only one's own actions. He believed that behavior is not directed by reinforcement and was not strictly a behaviorist but believed that social learning operates through cognitive processes. "Bobo doll study" in 1961--adult beat a doll and behaved aggressively toward it and then children did when watching film of adults doing this--children were not directed or encouraged or reinforced--they learned by imitating when they observed--Bandura described this as observational learning consisting of attention, retention, reciprocation and motivation. Social Learning Theory has been described as a bridge between Behaviorism and Cognitivism. Bandura also stressed self-efficacy or believing in oneself to take action.

Methods of Assessment

Biopsychosocial--considers three elements of client's situation--biological component, psychological component and social component and how these contribute to current state. Traditional Medical Model--focus on the client's pathology or what is wrong with the client. Sometimes this leaves out the client strengths. Many traditional assessment tools focus on pathology or what is wrong with client. Strengths Perspective--based on the notion that client strengths are an essential ingredient in the healing process and that incorporating the strengths of the client will aid in empowering the client to achieve treatment goals.. The strengths perspective examines possible alternatives, empowers clients to solve their own problems, teaches competencies, creates more equity between social worker and client, builds self-confidence, helps clients see that problems are influenced by multiple factors, are interactive and are ever-changing.

Schizophrenia Spectrum and Other Psychotic Disorders--Delusional Disorder

Characterized by a minimum of one non-bizarre delusion and has to be evident for at least one month. Can be accompanied by tactile or olfactory hallucinations if related to the delusion. An individual's psychological functioning, apart from the delusions, is normal. Types of Delusional Disorder: Erotomanic Type--belief that another person, frequently of higher status, is in love with the individual; Grandiose Type--individual is convinced that he/she has a special talent or understanding or has accomplished something of great importance; Jealous Type--belief that spouse or lover is cheating based on faulty inferences; Persecution Type--belief that someone is conspiring against them; Somatic Type--belief that one or more parts of body omits noxious odor or that insects are crawling on skin or that a parasite has invaded the body or that one or more body parts are not functioning. Mixed Type--when a specific delusional theme does not predominate. Unspecified Type--delusion doesn't fall into any categories or social workers is uncertain about type.

Schizophrenic Spectrum Disorders--Brief Psychotic Disorder

Characterized by brief schizophrenic symptoms that have been evident at least one day and. no more than one month. Identifier "with marked stressors" if symptoms seemed to be caused by a stressful event and "w/out marked stressors" if not. With Postpartum onset if this is the case and with Catatonia if this is the case. Removing the stressor should be sufficient treatment if symptoms are minimally impairing and the stressor has been identified. Brief hospitalization may be needed for safety and evaluation. Antipsychotic medications may be necessary. After the acute episode is treated, individual, family and group therapy may be needed to help cope with stressors, resolve conflict, and improve self-esteem and self-confidence.

Definition and Models of Community Organization

Community organization refers to work with larger entities, rather than individual clients. Its purposes are as follows: to find solutions to social problems, to develop specific qualities in community members such as proactive behavior, to bring about needed changes in the quality of community relationships as well as the way decision making and power are distributed (Dunham, 1970). Community Organization involves planning, organizing and action. The basic tenants of Community Organization include: community is the client; communities may need assistance in learning how to best meet their needs; in the context of a democracy, people need to learn the skills that will enable them to work collaboratively with others to eradicate social problems; the community needs to be understood and accepted as it is; the different elements of a community are interdependent; it is essential to fully involve all elements of a population; the lives of human beings can be enriched by achieving a better balance between resources available for social welfare and the social welfare needs of community members. Models of Community Organization include: Locality Development or utilizing community members to create change--build a cohesive community via education, participation and leadership. Social Planning or studying a problem situation in a targeted community and proposing a plan. Social action--use power and control techniques to bring about change. Leadership and establishment ways of doing things are challenged. Social Reform--working with other agencies to create change--social workers can be instrumental in rearranging social institutions and changing institutional policies in order to achieve social justice or eliminate structural inequities.

Co-occuring disorders (COD)

Concurrent diagnosis of a substance use disorder and a psychiatric disorder; one disorder can precede and cause the other, such as the theorized relationship between alcoholism and depression--COD takes place of dual diagnosis.

(1928) Jean Piaget: Cognitive Development

Conducted qualitative interviews to study how children learn. Assimilation (incorporate aspects of environment into existing thought structure) and accommodation (change thought structure to incorporate a new perceived feature of the environment) are two ways that children learn or adapt. Piaget's Stages of Cognitive Development: Stage 1: Sensorimotor (0-2): Impulsive and reflex substage 1; primary circular substage 2; practicing secondary circular or repetitive actions substage 3; coordinating secondary schemes or substage 4; tertiary circular actions/continuation of experimentation with more variability or substage 5; Invention through mental combinations or substage 6; Stage 2: Pre-operational (2-7): new abilities used to represent objects but not in an organized, fully-logical way--play/pretend stage. Stage 3: Concrete Operations (7-11): logical thinking and new cognitive skills or reversibility and de-centration to think about steps in a process in any order; may be the highest stage of cognitive development achieved; Stage 4: Formal Operations: 11+: have ability to reason about tangible objects and events AND hypothetical or abstract ones. Adulthood if achieved at all.

Conflict Theory

Conflict Theory is a theoretical framework in which society is viewed as composed of groups that are competing for scarce resources. Conflict Theory is also known as Social Conflict Theory and was born out of philosophy of Karl Marx and later, Max Weber. Conflict Theory holds that society is actually held together through conflict, not function. According to Conflict Theory, the essence of societal change comes from each group's attempt to better its own social status at the expense of other social groups.Social relationships are about power and exploitation.Ever present economic value is placed on relationships as one tries to improve one's own social standing at the expense of another. Conflict Theory also proposes that groups in power place rules and laws to further perpetuate and reinforce their status. Other groups create an uprising that is the conflict that results in social change.

1953 BF Skinner: Operant Conditioning

Consequences are used to modify the occurrence and form of behavior. Learning is a function of one's history of reinforcements. Operant conditioning deals with the modification of voluntary behavior as opposed to the modification of involuntary behavior with Pavlov and classical conditioning. Operant conditioning deals with modification of behavior via consequences while classical conditioning deals with modification of behavior under new antecedent conditions.Positive and negative reinforcement strengthen behavior and punishment and extinction weaken behavior. Antecedent (Stimuli)---Response (Behavior)---Consequence.

Indicators of Internet Addiction

frequent feelings of guilt from spending too much time online; great difficulty avoiding the internet; losing track of time when online; strong feelings of frustration or tension when unable to go online; loss of interest and participation in hobbies or activities that were once enjoyed; tired, dry/red eyes; occasional marathon internet sessions lasting all day or night; deceiving others in the amount spent online; multiple attempts to reduce use with little/no success; unreasonable justification for unhealthy levels of use; preoccupation with going online when engaged in other activities; headaches, neck aches, back problems; irregular, unhealthy eating habits; relationship problems and frequent arguments stemming from one partner spending too much time online.

Indicators of a Food Addiction

inability to control cravings or food eaten; trying many different weight loss programs while still eating excessively; engaging in purging behaviors; avoiding social interactions; feeling depressed or sad; feeling ashamed; eating when not hungry; becoming anxious or irritable when eating certain foods; eating as a reward for a job well done; obsessing over food and how food is prepared and served; stealing food from others.

1935 Kurt Lewin: Social Psychology

German and American psychologist known for his work in social psychology, organizational management and applied psychology. Lewin investigated "group dynamics" and how individuals react to changing circumstances within a group. He was asked to find away to address prejudices and this led to the development of "sensitivity training" or "T-groups" in business schools and other types of group settings. Lewin's Equation for Behavior (B=f(P, E) acknowledged that personality and environment or nature and nurture interact in the shaping of humans. Lewin's "Force Field Analysis" work focused on identifying "helping forces" that drive humans toward a goal and "hindering forces" that block movement toward a goal.

1982 Carol Gilligan: Feminist Approach to Social Psychology

Gilligan felt Freud and Erickson and Piaget and other early theorists ignored and undervalued the psychological development of women in their theories of human development. Gilligan did her research primarily with girls and found gender differences in thinking and behaving. She concluded that men are concerned with rules and justice and women more inclined toward caring and relationships. Gilligan is known as the founder of "Difference Feminism."

Roberts 2000 Characteristics of Individuals Currently Going Through a Crisis or Traumatic Event

recognition of a threat; recognition that stress/trauma of event cannot be dealt with using existing coping skills; experience of fear, confusion and stress; symptoms of distress and discomfort appear; entrance into a state of imbalance where crisis seems insurmountable; Crisis Counseling can be very beneficial in helping people cope with a crisis--long term exposure to stressors and traumas can lead to PTSD and other anxiety disorders

Indicators of a Sex Addiction

sex dominates the person's life to the exclusion of other activities; inability to contain sexual urges and respect the boundaries of others; engagement in phone sex, computer sex, use of sex workers, pornography, or exhibitionism; practice of unsafe sex practices; multiple sex partners and cheats on partners; feelings of guilt and shame; pattern of recurrent failure to resist impulses to engage in extreme acts of lewd sex; attempts made to stop, reduce or control behavior; in extreme cases, the person engages in criminal behavior (stalking, rape, incest or child molestation).

Crisis Intervention Theory

Crisis Intervention Theory provides the basis for treatment of individuals, groups and families confronted with stressful events that exceed coping ability. Crisis is an upset in steady state that poses an obstacle usually important to the life goals and vital need satisfaction that an individual or family cannot overcome through usual methods of problem solving. A crisis is usually defined as short-term and overwhelming. (Caplan ini Hepworth, Rooney and Larsen, 1997). Three types of crises--situational, maturational and crisis due to social factors or cultural values. Goals of crisis intervention are to reduce symptoms, assist in developing effective coping skills via mobilization of internal and external resources and restoration to pre-crisis level of functioning. Active state of crisis and disequilibrium is best time to intervene (first 4-6 weeks after stimulus). Stages of crisis in most individuals include experience of crisis, increased tension and shock (including possible denial) and failure of customary coping skills, escalating tension, depression and feelings of being overwhelmed, confused, helpless or hopeless; individual tries new means of coping that can be maladaptive or adaptive.

DSM5

Diagnostic and Statistical Manual of Mental Disorders; divided into 22 categories (including Z codes or other conditions that may be the focus of clinical attention listed in chronological order of life stages. For disorders that don't meet the criteria for a particular diagnosis, the clinician uses other specific disorder or unspecified disorder. If the disorder is associated with a substance use or medical condition, the terms substance/medication induced disorder or disorder due to another medical condition are used. ICD-9 & ICD-10--International Classification of Diseases (DSM 5 was updated from DSM-IV-TR to make it more consistent with ICD). Specifiers are often added, including for duration, type, and severity.

Wainrib & Bloch 1998 Pyschological Responses to Crises/Traumatic Events (beyond normal life crises)

Disbelief, emotional numbing, nightmares and other sleep disturbances, anger, moodiness, irritability, forgetfulness, flashbacks, survivor guilt, hyper-vigilance, loss of hope, social withdrawal, increased use of alcohol and drugs, isolation from others

Communication Disorders

Disorders characterized by marked impairment in language and/or speech. Language Disorder--failure to acquire and use spoken and written language or sign language due to deficits in comprehension or production. Language difficulties are below those expected of a child of the specific age and deficits significantly interfere with socialization, academic achievement or occupational performance and effective communication. Speech Sound Disorder--new disorder that is defined as persistent difficulty with speech sound production that interferes with the intelligibility of the individual's speech. Speech sound disorder interferes with social interaction, academic achievement or occupational performance. Most children respond well to treatment with a speech and language therapist. Child-Onset Fluency Disorder (Stuttering)--child fails to use age and dialect speech sounds. Average age of onset is by age 6 but the range is 2-7 years. Disorder causes significant anxiety or limitations in effective communication. Stress and anxiety can exacerbate the disorder.Individual may avoid situations due to fear of humiliation and embarrassment. Symptoms include sound distortions, substitutions or omissions, articulation problems, words produced with excessive physical tension and monosyllabic word repetitions. Treatment is provided by a speech pathologist and parents are encouraged to practice positive speech modeling. Social (Pragmatic) Communication Disorder--a new disorder where the individual has persistent difficulties in the social use of verbal and nonverbal communication. Diagnosis appropriate after the age of 4-5 when the child should have adequate speech and language abilities. No evidence of restricted/repetitive patterns of behavior, interests or activities as would be seen in Autism Spectrum Disorder. Deficits in communication for social purposes, impaired ability to change communication patterns to match contexts, following rules of conversation like taking turns, understanding inferences and nonliteral or ambiguous meanings of language Treatment includes speech and language therapy and social skills training. Medications given for Autism Spectrum Disorder may also be used.

Theories of Group Development and Functioning

Group work is a method of social work that helps individuals to enhance their social functioning through purposeful group experiences social worker focuses on helping each member change his or her environment or behavior through interpersonal experience Three models of social group work have been identified by Pappell and Rothman (1980): 1) Social Goals Model--originated in settlement homes and neighborhood centers; goal of this model is to raise social consciousness, social responsibility, informed citizenry and to encourage political and social action. 2) Remedial Model--used in clinical outpatient and inpatient settings. Goal is to restore or rehabilitate individuals exhibiting dysfunctional behavior. The group leader is a change agent and utilizes assessment and interventions to assist group members to achieve their treatment goals. 3) Reciprocal Model--can be used in outpatient and inpatient settings and in neighborhood and community centers both--purpose is to provide mutual aid to group members in achieving optimal adaptation and socialization. Group worker is a moderator. Toseland and Rivas (1995): "Group therapy is goal directed activity with small groups of people aimed at meeting socio-emotional needs and accomplishing tasks directed to individual members of a group as a whole within a system of service delivery."

1950 Erik Erikson: Ego Psychology/Psychosocial Development

Eric Erikson built on Freudian theory and added an emphasis on adult development. Erikson thought Freud had carefully laid out the development of neurotic personalities but that Freud neglected the characteristics and development of healthy personalities. Erikson described the healthy personality as one that "actively masters the environment, shows a certain unity of personality and is able to perceive the world and self correctly." Erickson believed that development occurs across a lifetime, not just in childhood as Freud believed. Erickson developed give stages of childhood (that correspond with Freud's psychosexual stages) and three stages of adulthood. At each stage of development, Erikson believed that the individual is confronted with a different psychological crisis that he/she must work through to obtain ego identity and a healthy personality. Erikson's Psychosocial Stages: 1) Trust vs. Mistrust (birth to age one); 2) Autonomy vs. Shame/Doubt (2-3 years of age); 3) Initiative vs. Guilt (3-5 years of age); 4) Industry vs. Inferiority (6-11 years of age); 5) Identity vs. Identity Diffusion (role or identity confusion) 12-18 years of age; 6) Intimacy vs. Isolation (19-mid 30s); 7) Generativity vs. Stagnation/Self-Absorption (mid 30s- to mid 50s); 8) Integrity vs. Despair (old age-60+)

Exploitation and Trafficking Indicators

Excess cash, hotel keys, false ID/lying about age, dramatic changes in behavior, fear, untreated sexually transmitted disease, submissive, unable to access food, water, sleep, or medical care, lacks official identification documents, has unsuitable and unstable living conditions, is not allowed to go out in public alone, resides somewhere with abnormal or unusual security measures, chronic runaway or homeless youth, engagement in commercial sex acts for children and youth, stopping attendance at school for children and youth, tattoos/branding, avoids social interaction and eye contact, tries to protect pimp/trafficker from authorities, defers to person who accompanies him/her, seems to be coached on what to say, appears disoriented or confused or shows signs of emotional abuse

Elements of a Family System

External Boundary--separates the family inside from the neighborhood and community outside. Can be fluid or rigid; Family subsystems--internal boundaries such as sibling groups, family members of the same sex or of the same generation. Communication and interaction of the subsystems will trigger changes in the larger family systems; Alignments--similar to subsystems but may occur across subsystems. Alignments serve to carry out developmental tasks or meet emotional needs of the subsystem; Roles--roles, whether individually functional or not or fluid or rigid, are part of the overall functioning of the family system; Rules--members establish rules to dictate how family members relate to the external environment and to each other. Rules can be explicit or unwritten; Power Distribution--family members have certain patterns of power and influence within the family which create order when critical family decisions require action; Communication--critical element of family system--all behavior is communicative.

Family Systems and life Cycle

Family systems theory is the philosophy that looks at the interactions of members in the family system rather than individual etiology to look for causes of behavior. Essential elements of social structure created within a family do more to shape a person's life than any other known social system. Homeostasis refers to maintaining balance/what is normal for the particular family. Systems are comfortable in maintaining at its present level even if family is dysfunctional.

Adolescent Development

Generally age 12-18 but experience unique to each person and strongly influenced by genetics, culture, socioeconomic conditions, gender and disabilities. Cognitive development--transitioning from concrete operations to abstract thinking or formal operations. Adolescents try on different personalities during this period as their self-image beings to take form. Adolescents shift focus on family relationships to focusing on friendships. As adolescents mature, they being to develop more intimate relationships and strengthen ties with their families. Positive Youth Development=recent phrase, used to describe efforts of communities, families, schools, adults, government, agencies to create supportive environments for young people.

Schizophrenia Spectrum and other Psychotic Disorders--Definition and Terminology

Hallmark is a significant distortion in individual's perception of reality. Impairment in the capacity to reason, speak and behave rationally or spontaneously and in the individual's capacity to respond spontaneously with appropriate affect and motivation. Schizophrenia Spectrum and other Psychotic Disorders occur in the absence of impairment of memory or consciousness. Hallucinations-sensory distortions concerning the five senses that others do not observe. Most common is auditory, followed by visual but can also have tactical hallucinations, olfactory hallucinations and gustatory hallucinations. Delusion--false belief that is not held by others of an individual's culture. The individual cannot be dissuaded that the belief is not true even when presented with evidence to the contrary. Disorganized Speech--non-logical ideas including tangential speech (move from topic to next topic with little association to previous topic); loose associations (no logical progressions from one thought to another) and word salad--no rules of grammar are used and the words are jumbled. Negative Symptoms--including restricted, blunted emotional expression or flat affect. Lack of motivation characterizes negative symptoms as if something has been taken away from the individual.

Holmes and Rahe Stress Scale

Indicates stressful life events that can contribute to illness--from most stressful to least stressful, although this varies by individual personal reaction: Death of spouse or child, divorce, marital separation, jail, death of immediate family member, major injury or illness, marriage, being fired, marital reconciliation, retirement, major health changes, pregnancy, sexual difficulties, gaining a new family member, major business readjustment, major change in financial status, death of a close friend, changing to different type of work, major change in number of arguments with spouse, taking on a significant mortgage, foreclosure on mortgage or loan, major change in responsibility at work, son or daughter leaving home, in-law troubles, outstanding personal achievement, partner beginning or ceasing work outside the home, major change in living conditions, revision of personal habits, troubles with the boss, change in residence, change to a new school, major change in type or amount of recreation, major change in church or spiritual activities, major change in social activities, taking on a small loan, major change in sleeping habits, major change in number of family get-togethers, holiday or vacation, minor violations of the law (tickets).

Theories and Methods of Social Change

Most notable social change theorist is Karl Marx who believed that social organization was determined largely by economic factors and that social movements or revolutions were the result of tensions in society.Theories of social change are generally categorized in the following clusters: 1) Theories of Functionalism--linear models of social change that are associated with the Theory of Order and Stability or Equilibrium Theory--social change exists to restore equilibrium to sustain systems; 2) Conflict Theories--social structure strains result in inequality , which is the source of conflict. Conflict may be caused by cultural clashes, unregulated events like terrorism, economic conditions, random violence and other conflicts that result in movements that create change; 3) Interpretive Theories--define social change based on how events are interpreted. Interpretations of events are shaped by meanings the people have for events based on cultural influences. Interpretive theorists view society as an ongoing process not a structure or entity.

INTAKE

Intake interview starts the assessment process and gathers pertinent information, including basic background information and an extensive social history that leads to a strengths and problem areas statement or to a diagnosis, and then to a treatment plan. Data to gather via observation and interviewing during intake include: problem areas, strengths, motivation, support system, attitude, relationships, use of resources, appearance, health concerns, life sills, and danger to self or others. Referrals for additional evaluations may be needed to gather necessary information, including psychological testing, psychiatric evaluation, vocational testing or medical evaluations.

(1958) Lawrence Kohlberg: Moral Development

Kohlberg developed a theory of moral development out of Piaget's cognitive development theory. Kohlberg proposed that there are three general stages of moral development with each level having two substages resulting in a six-stage model of moral judgement: Level One : Pre-Conventional Morality (Stage 1--Punishment and Obedience Orientation and Stage 2--Naive Instrumental Orientation); Level Two: Conventional Morality (Stage 1--Good boy/nice girl orientation and Stage 2--law and order orientation). Level 3: Post-Conventional Morality: (Stage 5--Social contract orientation and Stage 6--Universal ethical principle orientation).

1950 Margaret Mahler: The Separation-Individuation Process

Mahler studied how infant differentiates him/herself from mother or individuation. Much of Mahler's work focused on Object Relations--or the process by which the infant struggles over the first few years to differentiate between self and non-self/others. This process of Object Relations reflects the early stage of the ego. Mahler believed that Borderline Personality Disorder and Narcissistic Personality Disorder might have their origins in in failure during the Rapprochement phase (15-24 months where infant makes efforts to be autonomous from mother--mother needs to respond with patience and availability). Mahler proposed a stage-based developmental theory as follows: 1) Stage 1: normal autism (age birth to one month of age)-Mahler later abandoned this phase but it still appears in some books; Stage 2: Symbiosis or normal symbiotic (1-4 months of age)--attachment of infant to mother or caregiver --infant and mother are one--no separation; Stage 3): Separation/Individuation: 4-8 months until 4 years of age. Hatching (child recognizes separate from mother), Practicing (child alternates between moving away and toward mother), Rapprochement (infant again close to mother; child realizes physical mobility demonstrates psychic separateness from mother; ) Achievement of Individuality (24-36 months of age until age 4) mother is now seen as separate. Object constancy is achieved.

1943 Abraham Maslow: Hierarchy of Needs

Maslow is associated with the Humanistic approach to Human Development & Behavior/Psychotherapy, along with Carl Rogers, Fritz Perls and Eric Berne. Maslow borrowed ideas from mentors such as Harry Harlow, Alfred Adler, Ruth Benedict and Max Wertheimer. Maslow studied human behavior with regard to basic needs, mental health and human potential. He viewed human needs as hierarchical --physiological needs (oxygen, water, food, sleep, sex)---safety needs (protection, security, structure, predictability)--belonging needs (affection, identification with a group, friendships, intimacy)--esteem needs (respect, recognition, appreciation)--self-actualization needs (developing full potential). Believed only 1-2% of the human population ever achieves self-actualization.

Family Systems Theory and Therapy--Milan Systemic Therapy (Maria Selvini Palazzoli)

Milan Systemic Therapy is a form of strategic family therapy influenced by three theoretical models: 1) systems, 2) cybernetics (studies the processes that control the flow of information in systems), and 3) communication theory (how people exchange information). Milan Systemic Theory focuses on two aspects of family interaction--the struggle for power (ie defining relationships) and the protective role of symptoms. Later, Maria Selvini Palazzoli focused her efforts on identifying and putting a stop to the "dirty games" that seriously maladaptive families engage in. Each session in. Milan Systemic Family Therapy includes a pre-session (initial formation of a hypothesis by the therapy team); the session (modification of the hypothesis based on the information gained in session); the intersession (identification by team members of the intervention strategy to be used); the intervention (members of the therapy team who are providing the therapy implement the agreed-upon strategy); and, post-session (team members discuss the family's response and plan the next session). Milan Systemic techniques include the following: 1) Hypothesizing--prior to the session, the therapy team formulates its initial hypothesis relative to the presenting problem. This hypothesis is subsequently modified by team members based on data obtained in session with family members. 2) Neutrality--equal acceptance of all family members by the social worker. 3) Rituals--engaging family members in repetitious behavior designed to counter dysfunctional family rules and reinforce the positive connotation of behaviors. 4) Counterparadox--a method of interrupting destructive paradoxes in disturbed families hat involves prescribing the problem behavior and all of the interactions that surround it. 5) Positive Connotation--technique that involves promoting family solidarity and reducing resistance to therapy via interpreting systems as family-preserving efforts. 6) Circular questions--are utilized as an interview technique where family members are asked questions that help them think in relational terms. The client asked to state what another person thinks. This enables the client to try to understand another person's perspective and increase his/her awareness of the similarities and differences in the perspectives of each family member.

Characteristics of Abusers

Most are known to victim, most sexual abusers are male and their victims are often female. Physical or emotional abuse or neglect is more likely to be unplanned and influenced by features of the care environment. Mother most often abuser of children under 14. Perpetrators of financial abuse are often opportunistic but in some cases are predatory--or seek out vulnerable people/situations in which theft is not likely to be detected or is hard to prove.

Behavioral Neuroscience (Biological Perspective/Human Genetics)

Psychobiology--scientific study of human behavior with specific attention to brain functioning, cells, neurons, plasticity and all biological factors. Human genetics plays a role in disease expression but there is strong evidence to suggest that individuals are not inevitably tied to a genetic marker.

Addictions

Physical or psychological craving for a drug (Macionis 2005). Co-dependent behavior can happen among family members who cover up problem or provide substances to keep the peace. Children of substance abusers often have issues with trust and are also often caretakers for abuser. These children commonly drop out of school and engage in delinquent behavior and often develop drug/alcohol addictions themselves.

1934 Lev Vygotsky: Child Development

Proposed ideas about human development that were largely focused on child development with relation to how children learn. Believed development doesn't occur in stages but proceeds in a complex and continuous process. Coined the term "Zone of Proximal Development or ZPD"--the range of tasks an individual can complete while learning new information. Vygotsky believed that children learn at a higher rate of ZPD when adults support learning rather than leaving children to learn on their own. Scaffolding is closely related to ZPD.

Elder Abuse

Risk factors include that the victim is argumentative resistant to care, non-compliant, hostile, verbally abusive, a cognitive impairment, mute manipulative or intrusive, a history of substance abuse, incontinence; Risk factors for elderly abuse in caregiver are alcohol or drug abuse, financial problems, poor training, excessive absenteeism, family problems, power conflicts, role reversal (ie looking for elder to fill caregiver needs).

Schizophrenia spectrum and other psychotic disorders--Schizoaffective Disorder

Schizoaffective disorder has a major depressive or manic episode in combination with symptoms of schizophrenia. The mood symptoms are a prominent feature of the disorder and there must have been a period of two or more weeks in the absence of mood symptoms during the lifetime of the illness. Specifiers--Bipolar type or Depressive type with Catatonia. Antipsychotic medications are the treatment of choice. Individual therapy is the most common choice of therapy. Supportive, client-centered, non-directive psychotherapy is best. A problem solving approach is effective and inpatient hospitalization may be needed with severe cases.

Schizophrenia Spectrum Disorders and Other Psychotic Disorders--Shizophreniform Disorder

Schizophreniform Disorder differs from Schizophrenia in two ways--1) the individual may or may not experience impairment in social or occupational functioning as opposed to schizophrenia; and 2) the individual has symptoms at least for one month and no more than six months Medications are same for schizophrenia and if Schizophreniform Disorder persists for more than six months, should be changed to a diagnosis of Schizophrenia.

Trauma and Violence

Sexual abuse and assault, physical abuse and assault, emotional abuse or psychological maltreatment, neglect, unintended injury or accident, victim of or witness to domestic violence, victim or or witness to community violence, historical trauma, school violence, bullying, natural and manmade disasters, forced displacement, military trauma, traumatic grief or separation, system induced trauma and re-traumatization. Domestic violence is often associated with drinking/drug use..

Social Change

Social change--alteration in social order of a society--can be driven by forces such as politics, culture, religion, economics, technology and science. Social change can occur in occur in social institutions, nature, social behavior or social relations and can happen naturally or because of efforts made by society. (social work began with attempt to influence social change through the Settlement Movement which assisted immigrants with living and employment needs. Attention was focused on poor working conditions, economic reform and obtaining basic services for people need. An historic and defining feature of social work is the profession's focus on individual well-being in social context and the well-being of society.

Motor Disorders-1--Developmental Coordination Disorder, Stereotypic Movement Disorder

a group of disorders characterized by motor symptoms such as tics, stereotypic movements, or dyscoordination Developmental Coordination Disorder--characterized by marked impairments in developmental acquisition and execution of skills requiring motor communication. Physical and occupational therapy are helpful but there is not specific treatment for Developmental Coordination Disorder. Stereotypic Movement Disorder--characterized by repetitive motor behaviors that have no apparent useful purpose. Head banging is more common in male and self-biting is more common in females. Behavior has to be present for a minimum of four weeks and not be the result of a compulsion or tic. Behaviors have the potential to cause physical injury requiring medical intervention and causes clinically significant impairment in daily activities. Antidepressants such as Prozac, Zoloft and Luvox (selective serotonin reuptake inhibitors or SSRIs) or Anafranil (a tricyclic antidepressant) may be helpful. Treatment goals are to ensure child's safety and improve the child's ability to function.Stress reduction and relaxation techniques are helpful.

Couples Development

Symbiosis/Bonding--honeymoon phase; Differentiation--address differences and find ways to resolve conflict--break-ups common during this stage); Practicing--exploration of independence, nurturing of outside relationships, redirection of person's attention and activities away from relationship and toward self; Rapprochement--restablish intimacy--move away from and return to each other. balance separation and connection; and Synergy/Mutual Dependence-- embrace intimacy, recognize couple together is stronger than person alone, constancy is hallmark of this stage, the foundation of relationship is no longer personal need but appreciation and love of the other and support and respect for mutual growth.

Task Groups

Task Groups are groups composed of individuals brought together to complete a specific job task; their existence is often temporary because when the task is completed, the group disbands. Typically involve formal rules and agendas. Communication focuses on task at hand and roles may be assigned. Members of task groups have to have requisite interest, knowledge base and skills to achieve the purpose of the group. Meetings may be closed or open and there is low self-disclosure. Standard for success is accomplishment of the task.

Resilience

The personal strength that helps most people cope with stress and recover from adversity and even trauma. In general, resilient individuals have an optimistic attitude and positive emotions and are able to balance positive emotions with negative ones. Resilience is a process, not a trait of an individual. Factors that sustain an individual's resilience include a supportive and caring relationships within and outside the family, ability to manage strong impulses and feelings, positive self-concept and confidence in one's strengths and abilities, ability to make realistic plans and take steps to follow through on these plans, communication and problem solving skills. 10 Ways to Build Resilience American Psychological Association: 1) maintain good relationships with family and friends; 2) avoid seeing crises or events as unbearable problems; 3)accept circumstances that can't be changed; 4)develop realistic goals and move towards them; 5)take decisive action in adverse situations; 6)look for opportunities of self-discovery after a struggle with a loss; 7)develop self-confidence; 8)keep a long-term perspective and consider the stressful event in a broader context; 9)maintain a hopeful outlook, expecting good things and visualizing what is desired; and, 10)take care of one's mind and body, including regular exercise and attending to one's needs and feelings.

Child Development

The physical, cognitive, social, and emotional changes that children go through from conception on. Including cognitive and intellectual development, language development, physical development, social and emotional development, sexual development, gender development, and behavioral development. (Language development (sounds--phonology) encoding messages (semantics) understanding the way words are combined (syntax) and using language in different contexts (pragmatics). Some areas in child psychopathology are first noticed during the language developmental period--for example autism)

Social Planning

The process by which a group or community decides its goals and strategies relating to societal issues. Involves government, nonprofit agencies and social service programs and agencies. Social planning in neighborhood settings can also be referred to as neighborhood planning. Social planning is considered by some to be a model of community organization, along with community development and social action. Social planning is separate and distant from clinical practice, although clinical workers may be involved in agency-level planning. Planning involves gathering information, diagnosing the social problem, and formulating a treatment plan that is appropriate for the situation--similar to clinical work planning with individual clients. Genuine and honest inclusion of "have nots" in social planning is required by social work profession. Social workers need to be facilitators of action, not perpetrators of the status quo.

Social History

The social history taken during the assessment process should focus on strengths and problem areas and be gathered using both interviewing and observation and gathered from multiple sources. Include client strengths, support system, attitude of client, client motivation, client's use of resources, danger to self and others, appearance, health and life skills. Also, family history, client identification of presenting problem, as well as agency identification of presenting problem and family identification of presenting problem. (All perspectives should be addressed in social history even though one presenting problem will be identified and treated first.) Also, sexual history, available records, assessment instruments, collateral contacts, and violence risk.

Ethnographic Approach to Studying Culture

The view that culture is fluid, evolving, heterogeneous and conflictual rather than static, fixed, cohesive and unified. Three broad categories related to culturally competent social work are: 1) attitude of social worker, 2) knowledge of social worker, and 3) skills of the social worker. Ethnographic Interviewing is one of the ways a social worker can ascertain the meaning of a client's cultural experiences--listen for underlying cultural meanings rather than just underlying feelings. Restating and incorporating terms used by the client is done rather than rephrasing and reframing terms. Cultural Assessment Tools use is another means to increase cultural awareness. Dr. Elaine Congress--Culturagram--reasons for relocation, legal status, time in community, health beliefs, language spoken at home and in community, crisis events, holidays and special events, contact with cultural and religious institutions, values about education and work, values about family including structure, power, myths and rules. A Cultural Evaluation can be done during the assessment phase to learn about the client's cultural beliefs, values, behaviors and support systems. For example, to whom does the client turn when he/she has a problem; what worries or problems brought the client in to see the social worker; how long has the client been struggling with the problem; who besides the social worker does the client think can help him/her; what does the client believe causes the problem and what will make it go away; how does the client view illness; whom does the client view as healers; what are the client's beliefs about child rearing; what is the client's concept of time, of work, of modesty, of cleanliness, of status; what is the client's family hierarchy; what are the client's language needs; how does the client usually make decisions; what are the client's spiritual beliefs; is there someone else the social worker should contact about the clients problem.

Motor Disorders-2-Tic Disorders

Tic Disorders--"are sudden, rapid, recurrent nonrhythmic, stereotyped movements or vocalizations." (DSM-5) Tics are generally involuntary but can be voluntarily suppressed for periods of time. Palilalia involves repetition of one's own sounds and words. Echolalia involves repetition of sounds or words of another individual. Copraxia involves obscene gestures and words. Tics wax and wane in terms of severity. Typical onset is 4-6 years and peak severity is between 10-12 with declines after this. Types of Tic Disorders: Tourette's Disorder-- includes both motor tics and vocal tics and onset is before age 18. Tics wax and wane in frequency but have persisted for more than 12 months. Persistent (Chronic) Motor or Vocal Tic Disorder--not both and over at least 12 months. Onset before 18 and wax and wane in frequency. Provisional Tic Disorder--single or multiple and/or vocal tics that are present for less than a year. Onset before age 18. Individual has not previously met the criteria for Tourette's Disorder or Persistent (Chronic) Motor or Vocal Tic Disorder. There are no specific medications for Tic Disorders--antipscychotic medications and anti-hypertensive agents are used to decreased tics when tics cause significant distress or impairment. Comprehensive Behavioral Intervention for Tics (CBIT) includes habit reversal training (HRT), education and lifestyle changes.

Treatment Groups

Treatment groups have formal or informal procedures and have a goal of increasing the ability of members to meet their socio-emotional needs. Roles of members naturally evolve over time. Open communication is encouraged. Members are expected to increasingly self-disclose over time. Confidently is expected to be maintained by all group members. Standard for success is achievement of individual and group goals. Types of treatment groups include: Support groups (ie for single fathers); Educational groups--groups to teach adolescents about consent; Growth Groups--provide group members with opportunities for growth (ie marriage enrichment group); Therapy Groups--provide members with remediation/rehabilitation (ie groups for vets with PTSD); and, Socialization Groups--assist members in negotiating developmental stages and adapting to changes in roles and environment (freshman adaptation group in college).

1873 WILLIAM WUNDT STRUCTURALISM

Wundt is credited with founding Experimental Psychology. Created the first laboratory setting in Germany where the mind was researched. He analyzed the mind via Introspection or asking subjects to observe their own feelings and emotional responses to a controlled experience. Wundt focused on conscious/did not believe in subconscious/unconscious and believed there are basic elements to the mind or basic structures and that consciousness can be broken down into sensations and feelings. Wundt believed people's emotions experience first and then cognitive understanding and behavioral reactions follow.

Specific Learning Disorder

a marked deficit in a particular area of learning that is not caused by an apparent physical disability, or by an unusually stressful home environment. The disorder may bot manifest itself until the demands of school exceed the individual's abilities. This disorder is m most common in males and significantly impairs the person's ability to perform activities of daily living or in academic areas. Specified types include with impairment in reading, with impairment in written expression and with impairment in mathematics. Severity specifiers include mild, moderate or severe. There are no specific medications to treat Specific Learning Disorder. Educational learning specialists provide treatment by strengthening skills the child already has and developing new learning strategies and the use of multimodal teaching to take advantage of the child's strengths.

Organic Disorder

disease process due to a medical or physical condition that affects mental function. For example, delirium, dementia and amnestic--most common organic disorders . Other organic disorders include traumatic brain injury, hypoxia (body or region of body deprived of oxygen) cardiac arrhythmias, and degenerative disorders (Parkinson's disease, MS, Huntington's Chorea, infections)