HBSE: Midterm (Expanded)

Fetal Alcohol Syndrome (FAS)

A condition in a child that results from alcohol exposure during the mother's pregnancy - fetal alcohol syndrome causes brain damage and growth problems - it is a common birth defect - no evidence currently exists to suggest exactly how much alcohol might be considered safe to consume during different stages of pregnancy Physical Defects: - distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip - deformities of joints, limbs and fingers - slow physical growth before and after birth - vision difficulties or hearing problems - small head circumference and brain size - heart defects and problems with kidneys and bones Brain and Central Nervous System Problems: - poor coordination or balance - intellectual disability, learning disorders and delayed development - poor memory - trouble with attention and with processing information - difficulty with reasoning and problem-solving - difficulty identifying consequences of choices - poor judgment skills Social and Behavioral Issues - difficulty in school - trouble getting along with others - poor social skills - trouble adapting to change or switching from one task to another - problems with behavior and impulse control - poor concept of time - problems staying on task - difficulty planning or working toward a goal

Inductive Reasoning (bottom-up)

A method of reasoning in which the premises are viewed as supplying some evidence for the truth of the conclusion - makes broad generalizations from specific observations - we make many observations, discern a pattern, make a generalization, and infer an explanation or a theory - its place in the scientific method is that researchers use it to form hypotheses and theories Example: "The coin I pulled from the bag is a penny. That coin is a penny. A third coin from the bag is a penny. Therefore, all the coins in the bag are pennies." - even if all of the premises are true in a statement, inductive reasoning allows for the conclusion to be false

Ecological Systems Theory (Bronfenbrenner)

A method of understanding human development through the interaction between the individual and his or her environment. - events in a person's life and the way that person reacts to the events, shapes the person and impacts his or her developmental processes - clients do not live in a vacuum; people have positive and negative interactions with others - people both receive and expend energy from surrounding systems - human beings have the ability to adapt to changes and cope with negative experiences or events - people are interdependent; all humans rely on one another in mutually beneficial and necessary relationships; additionally, humans rely on and impact the environment in which they live *Fundamental Tenet*: perception impacts well being - and the meaning we place on events can differ from person to person (e.g. unemployment) Key Concepts: *Adaptation*: The ability of individuals to adjust to their environments *Coping*: The ways in which individuals deal with negative events and situations *Energy*: The active engagement of people with their environments. Energy can take the form of input or output *Interdependence*: The reciprocal and mutually reliant relationships that people have with one another and with their environments *Social Environment*: The conditions, circumstances, and human interactions that encompass human beings *Transactions*: Communication, interactions, or exchanges that occur between people and their environments - these can be positive or negative communications or exchanges ---- Focus: Individual & environment Assumptions: People are active in their environmental settings Strengths: • Comprehensive approach to problems • Easy to apply concepts in practice • Considers dynamic interaction between person and environment Limitations: • Too broad to easily predict behavior • Difficult to test constructs empirically and predict behavior • Not enough focus on biological aspects of behavior and problems ---- The organization of ecological theory is very similar to the micro-mezzo-macro conceptualization, but with five levels: 1. *Microsystem*: Most immediate environment - where all the roles and relationships that a person has in the immediate environment take place (e.g. physical places such as home, school, work, and the neighborhood) 2. *Mesosystem*: Interaction of the different microsystems - the interactions among two or more environmental settings in which people live (e.g. the dynamics in a person's work and home lives often impact one another; this is exemplified when a person brings home the tensions from her work) 3. *Exosystem*: Pertains to the linkages that may exist between two or more settings - one of which may not contain the individual, but still affects the individual nonetheless (e.g. parent's anger due to employment and hitting their kid; improvised neighborhoods having a lack of resources which causes stress for students to focus when hungry) 4. *Macrosystem*: Encompasses all the ways in which larger cultural factors affect the other levels of a person's environment and, consequently, how they affect a person's development - cultural patterns, social/legal/economic systems (e.g. policies affecting children and families; political context; societal attitudes against gay marriage, laws prohibiting it, and resulting discrimination in benefits) 5. *Chronosystem*: the environmental events and transitions that occur throughout a child's life, including any sociohistorical events (e.g. changes over the life course in family structure; socioeconomic status; employment; placement of residence)

The Disease Model

A problem-oriented approach concerned with identifying a problem or dysfunction, and providing an intervention to "cure" the behavioral or physiological problem - concerned with individual illness and dysfunction, which con tribute to its problem-oriented focus - maintains that there is a clear and identifiable relationship between "dis-ease" and people's functioning and behaviors and problems Assumptions: - diseases can be identified through a list of symptoms - these symptoms can be alleviated through logical and scientific examination of the patient. - problems and ills are viewed as something that is treatable

Theory

A set of ideas or concepts that, when considered together, help to explain certain phenomena and allow people to predict behavior and other events

Why is theory important?

A variety of theories can help social workers organize information and provide contexts for approaching client problems - knowledge-base to guide practice - assessment - intervention

Conflict Theory

An approach that views social behavior from the perspective of conflict or tension among two or more groups, particularly in terms of understanding those in power and how this power is used to perpetuate inequality - based off of Karl Marx's theory that social inequality is rooted in class conflict (namely, the exploitation of the bourgeoisie/proletariat) within capitalist societies - social classes are constantly competing for resources and power; tensions among groups shape social structures • Upper classes (bourgeoisie) take more resources • Subordinate groups (proletariat) fight status quo ---- Applying Conflict Theory *Family*: The conflict perspective views families as institutions that both reflect and perpetuate the unequal distribution of power and resources within the larger society - institutions that maintain and advance the larger society's unequal distribution of power and resources - wealth, power, poverty, privilege, and inequality are passed from one generation to another - legitimizes male power and dominance - validating and perpetuating the lower status of women and children (e.g. health care, reproductive choices, and freedom to move about and express themselves. For example, women are still more likely than men to leave their jobs and relocate when they get married, when the man receives a promotion, or when child or elder care is needed. Women are also more likely to postpone their education or career goals after marriage) *Health Care*: From the perspective of conflict theory, medicine and medical professionals hold a great deal of status in U.S. society - the medical institution has the power to define wellness and illness - many view medical professionals as possessing special knowledge and expertise that make them uniquely qualified to evaluate health-related issues - *medicalization of society* to describe the influence of the health profession; as the range of expertise in medicine has grown over the decades, the medical profession has acquired the power to influence knowledge, attitudes, opinions, and even social policy (e.g. one prominent example of the medicalization of society is childbirth • formerly the realm of female midwives, in the early 20th century childbirth was turned over to a mostly male medical profession which foisted largely unnatural childbirth practices onto women • physicians undermined the credibility of midwives by creating a perception that their practices were "unscientific" • it took nearly a century for midwives to begin to recapture their reputation and their influence over childbirth practices) ---- Focus: Social groups Assumptions: Tensions among groups shape social structures Strengths: • Can be used to conceptualize interventions in community-based practice • Helps social workers understand the complexity of client problems • Focuses on how power can be misused to create inequality and to disenfranchise clients Limitations: • Focus is limited to the macro level • Interventions based on conflict can be difficult to carry out • Can be difficult to define and empirically test constructs

Neurons

An electrically excitable cell that receives, processes, and transmits information through electrical and chemical signals - process information in the brain Made up of... Cell Body with *nucleus* *Dendrites*: Receive input from other neurons *Axon*: Carries information to other neurons

Applying the Medical Model

As Carlos's social worker, if you were using the medical model you would focus on the biological and disease-based issues impacting Carlos's problems and affecting his well-being. Because of Carlos's age and his diagnosis of Alzheimer's disease, you would concentrate your efforts on how these factors may be causing problems as well as how to prevent further problems from developing as Carlos ages and his disease progresses. To do a thorough job, you would need to spend some time asking Carlos about his symptoms and other problems affecting his functioning. You could begin by assessing Carlos's symptoms using diagnostic criteria in the DSM-5: • Because Carlos has already been diagnosed with Alzheimer's disease, this fact would likely be noted as an area for attention. • You could request medical information from Carlos's physician to ascertain whether health issues are complicating the Alzheimer's disease or vice versa. You could also request information from other professionals, such as a psychiatrist, who might have treated Carlos in the past. This additional information would offer a historical view of his problems and help to inform the current diagnoses. • Several psychosocial and environmental problems might be noted, such as problems with Carlos's primary support group, social environment, and potentially with housing, as his disease progresses. • You would want to determine to what degree Carlos's problems interfere with his daily functioning. After making an assessment, you would develop an intervention based on Carlos's diagnoses. The intervention would most likely focus mainly on his Alzheimer's disease and the problems associated with it. Carlos might want to consider trying new medications that target various neurotransmitters in the brain in an attempt to slow the development of Alzheimer's symptoms. In addition to problems related to Alzheimer's disease, you may choose to examine Carlos's physical health to determine whether he has any problems associated with his age or general health status, such as diabetes, heart disease, or high blood pressure. For example, he could be referred to a physician to check for testosterone levels and medication side-effects that could contribute to or exacerbate his symptoms. Ensuring that he is as healthy as possible can help prevent or minimize some of the complications that may result from Alzheimer's disease. Moreover, improving or maintaining Carlos's physical health will add to his overall well-being and functioning as he ages.

Parietal Lobe

Attention, spatial location, and motor control

Conflict Theory in Social Work Contexts

Because conflict theory fits so well with the underly ing values and ethics of social work, including empowerment and social justice, social workers can find many uses for it - conflict theory offers one perspective from which to view these problems, which can be used as a springboard for devising interventions that will lead to system change - it is often social workers who bring attention to ethical, cultural, and other issues that may clash with the predominant medical model, thereby helping to initiate changes that can benefit clients ---- Example: The cycle of wealth and poverty in families - unequal distribution of resources and access to opportunities that cause and perpetuate poverty - children inherit the poverty or privilege of their parents - children born to wealthy, educated, well-connected parents benefit from quality housing, education, health care, and access to opportunity; these children are at an advantage as they grow older due to their inherited resources - conversely, children born to poor and uneducated parents are exposed to debt, limited growth experiences and opportunities, and inferior education and health care, all of which can hinder their ability to get ahead in life

Case of Juan

Juan is a 16-year-old Latino whose parents migrated to the United States from Mexico before he was born. Recently, Juan has been struggling in school. His grades have been dropping over the past two years, his attendance has been poor, he often falls asleep or gets bored in class, and he fights frequently with other students. Juan does not have many friends, but he does get along with several of his teachers. Juan's home life has also been in turmoil over the past several years. His father was laid off from his job at a manufacturing plant and has not been able to find a new job. His mother was diagnosed with cancer about a year ago. Because the family lost their health care and other benefits when Juan's father lost his job, his mother has been unable to receive proper treatment. Since her diagnosis, Juan's father has been drink ing heavily, and when he is drunk, he gets violent with Juan. Juan stays away from home as much as possible, mostly wandering the neighbor hood or spending time at his church. Juan has a good relationship with the priest at his church, and he likes to volunteer when he is not in school. Juan has been referred to the school social worker regarding his academic problems.

Practice Based Knowledge

Knowledge acquired through practice experience

Applying the Micro-Mezzo-Macro Approach (Rogers, pp. 27)

Let us look at how the micro-mezzo-macro conceptualization could be applied to Juan's situation. As the social worker in his case, you would pay attention to Juan's situation on all three levels: • Micro: You would explore facets of Juan's individual, or micro, system, such as his spirituality, impulse control, progress in school, ethnic identity, physical and mental health, and cognitive and emotional development. • Mezzo: At the mezzo level, you would consider small groups and aspects of the immediate environment that impact Juan's functioning, such as family dynamics, relationships with peers and teachers, his connection with his church, and resources in his neighborhood. • Macro: You would assess how components of the larger social environment impact Juan's situation. You might look at school policies, issues of discrimination, cultural factors that may be impeding the efforts of Juan and his family to fit into the community, and lack of access to resources such as health care and employment opportunities. Based on this assessment, you would identify the major problems affecting Juan's behavior and then design interventions to address them. Given that all three levels of analysis work together to define a person's situation, intervention on one level should impact Juan's functioning on other levels. For example, you might find that, based on a physical exam, Juan has some health problems that need to be addressed. Theoretically, improving Juan's health would likely enhance his performance in school, which in turn might improve his feelings of social and academic competence. Specifically, as his health and academic performance improve, he is likely to feel more motivated and self-assured, which may give him more confidence in his interactions with peers. These improvements may also help him cope more effectively with the problems he faces at home. If Juan has areas in his life in which he feels successful, he may be less likely to blame himself for problems such as his father's violence or his mother's illness. In essence, his feelings of competence at school and with his peers will act as a buffer against other problems over which he has little or no control. Similarly, you could intervene on the mezzo and macro levels by helping the family to access resources such as unemployment and health benefits and resources such as Medicaid or health services in the Latino community. As the family's situation improves, the members' relationships with one another are likely to improve as well. For instance, Juan's father may become more motivated to control his drinking and his violent behavior, which in turn will have a positive impact on Juan's physical and mental well-being. You might also look at factors in the community, such as hostile attitudes against ethnic minority groups or discriminatory policies that might have detrimental effects on Juan and his family. You could work to improve the larger environment and its impacts on Juan's well-being. Improvements in these areas may help Juan to improve his academic performance, and he may feel more confident in his interactions with his peers. Increasing these feelings ultimately might help him to address his problems at school and at home. Because the micro-mezzo-macro levels are interrelated, there is a ripple effect when intervention takes place at one level in one particular area.

Parental Biological, Psychological, and Emotional Health

Perinatal mental health (period of weeks before and after birth) are linked to psychological and developmental problems in children According to Stein et al. (2014), effects can include: - Emotional: Internalizing problems and problems with social skills - Behavioral: Externalizing problems and disorders - Attachment problems - Problems with cognitive development - Child physical growth and development ---- There are many factors that you will want to address that can increase Josie's chances of having a healthy baby, if that is what she chooses to do. To begin with, you can assess Josie's physical health and psychosocial status. Further, at this point you might decide to use a theoretical perspective (or perspectives) to help guide your assessment and intervention. For example, just by examining the individual factors affecting Josie, you are using both the BioPsychoSocial and micro levels of conceptualization. Further down the road, you can consider mezzo- and macro-level factors such as family functioning and economic and cultural issues. Ecological theory might also be useful in organizing all of the individual and environmental factors impacting Josie and her situation. Erikson's theory of psychosocial development could also be very helpful. Josie is likely in stage five, Identity vs. Identity Confusion. She will have to make deci sions about issues such as her health, her role as a mother, and all of the emotional, financial, and logistical circumstances surrounding having a child at this point in her development. The ramifications could be serious, not only for the way in which Josie approaches these decisions at this point in her development but also for the way in which her identity ultimately develops based on the decisions she makes. The developmental tasks of this stage and how she deals with them impact how she sees herself both now and in the future and in relation to her peers. Her decisions will have consequences for her tasks and development in future stages, such as her intimate relationships (both with her child and others), her productivity, and her overall well-being later in life. At the same time that you are looking at individual factors, you may want to employ narrower psychosocial theories for ideas about how Josie might cope with her situation. For instance, components of the medical model will come into play as you consider Josie's physical health. In assessing Josie's cognitive and emotional status, you can apply concepts of Piaget's theory to determine how far along Josie is in her cognitive development; this determination will be important in assessing how well Josie will cope with her situation. Perspectives on temperament may also be useful (these are discussed in Chapter 7), particularly if Josie decides to parent her child. Determining the "fit" between Josie and her baby could help Josie deal with potential problems with her baby such as fussiness and excessive crying. Erikson's theory might also be useful to help you think through which developmental tasks Josie might be facing and how a new role of parent might affect Josie's growth in the future. Bringing in aspects of the strengths perspective will help to empower Josie, as will exploring relevant cultural and religious issues. Finally, you may want to consider Josie's current stage of moral development (discussed in Chapter 9), which may affect her decisions about proceeding with her pregnancy. All of these approaches, whether used in isolation or in combination with other theories, will offer suggestions for how to conduct the intervention with Josie. Depending on the outcome of the assessment, the theories and perspectives used, and Josie's wishes, you can choose from several intervention strategies.

Evidence Based Practice (EBP)

Practice utilizing the interventions and knowledge deemed most valid and effective through scientific studies - process by which practitioners make practice decisions in light of the best evidence available - involves integrating scientific evidence, practice expertise, and knowledge of the client and circumstances to address client needs. - bridges research and practice to improve client outcomes

Eclectic Practitioners

Practice with a wide range of ideas, theories, methods, and constructs when working with clients - adherence to *only* a single theory or method may seriously limit your perspective and ability to see "the big picture" and help a client

Steps in Evidence Based Practice

↘︎ question formulation ↘︎ searching for the best evidence ↘︎critically appraising the evidence ↘︎selecting an intervention/practice/policy → monitoring client and evaluate progress

NASW Code of Ethics: 6 Core Values

1. *Service*: Help people in need and address social conditions and concerns 2. *Social Justice*: Challenge social injustice 3. *Dignity and Worth of the Person*: Respect the inherent dignity and worth of the person 4. *Importance of Human Relationships*: Recognize the central importance of human relationships 5. *Integrity*: Behave in a trustworthy manner 6. *Competence*: Practice within areas of competence, and develop and enhance professional expertise "Core values and the principles that flow from them, must be balanced within the context and complexity of the human experience."

Key Neurotransmitters and Their Effects on Behaviors

*Acetylcholine, ACh*: Stimulates neurons to fire; involved in muscle movements, learning, and memory - botox, made from botulin, destroys ACh, paralyzing facial muscles that cause wrinkling - people with Alzheimer's disease have a deficiency of ACh *Dopamine*: Controls voluntary movements; affects sleep, mood, learning, and attention - activation of dopamine receptors can cause excitement, alertness, and elevated mood - too little dopamine is implicated in Parkinson's disease *Endorphin*: Stimulates neurons to fire and depresses nervous system activity - an increase in endorphins helps to reduce pain and increase feelings of pleasure *GABA*: Inhibits neurons from firing - low levels of GABA are associated with fear, anxiety, and depression *Glutamate*: Stimulates neurons to fire; involved in learning and memory - too much glutamate can cause migraine headaches and seizures - it has been implicated in anxiety, phobias, depression, schizophrenia, and Alzheimer's and Parkinson's diseases *Norepinephrine*: Inhibits firing of neurons in the central nervous system; stimulates neurons to fire in the heart, muscles, intestines, and urogenital tract; controls alertness - too little norepinephrine can cause depressed mood; too much can cause agitation *Oxytocin*: Associated with love and bonding - an increase in oxytocin happens with vaginal birth, facilitating bonding, lactation, and breastfeeding - oxytocin also increases during orgasm, facilitating emotional attachment *Serotonin*: Regulates sleep, mood, attention, and learning - too little serotonin can cause depressed mood

Developmental Milestones of the Fetus

*First Trimester* (Week 0-13): Considered most critical with regards to prenatal care and fetal exposure to maternal and environmental toxins - Zygote = fertilized ovum (egg); Embryo = 2-8 weeks; Fetus = after 8 weeks 1 month - critical functions: - primitive brain, heart, lungs, digestive and nervous systems - beginnings of arms and legs - baby is considered an embryo after 2 weeks 2 months: - eyes, nose, mouth become identifiable - heartbeat is detectable - after 8 weeks, the baby is now referred to as a fetus (and looks more like a human!) 3 months: - formation of arms, hands, legs, feel, fingernails, hair, eyelids - gender is distinguishable (although it may not be seen until around 16 weeks) - can smile, frown, suck, swallow - by end of first trimester, baby is about 3 inches long and weighs one ounce *Second Trimester* (Weeks 14-27): Development continues - differentiation of organs and systems proceeds - toes and fingers separate - hair, eyelashes, eyebrows are present - regular heartbeat - wake and sleep cycle established - by end of 2nd trimester, baby is 11-14 inches long and weighs 1-1.5 ounces - mom may feel "butterflies" or fluttering in lower abdomen *Third Trimester* (Weeks 28-40): The final stages of development - if born at 28 weeks, fetus has good chance of survival; preterm - organs become functional - fetus is very active until time of delivery - responds to sound - by end of 3rd trimester, baby is about 19 inches long and weighs 6+ pounds - baby is full term and ready for outside life between 38-41 weeks ---- Pregnancy Complications - High blood pressure: Preeclampsia - Gestational diabetes: Hormonal changes dysregulates insulin, creating glucose buildup in bloodstream. - Infections/STIs: Some can be passed on to fetus during pregnancy or during childbirth - *Preterm* labor (before 35 weeks) - Pregnancy loss/*miscarriage*: Before 20 weeks (10% of pregnancies) - *Stillbirth*: Loss after 20 weeks

Diagramming Family Systems

*Genograms*: A visual representation of a family system - they offer a visual guide for families and social workers, allowing both to see how the family is structured and how various dynamics might be playing out in a family system - also allow families and social workers to identify strengths within the family system that can be used to help solve problems *Ecomaps*: Visually shows how members of a family interact with and are affected by the environment - may highlight strong connections to outside systems as well as weak or stressful ones, and they can provide a visual representation of support systems for the family as well as sources of strain on the family system - can be extremely useful in assessing resources for the family, uncovering hidden strengths, and determining places where services are needed or duplicated

Empirical vs. Practical Knowledge

*Practice-based knowledge (Practice wisdom)* - knowledge based on practical experience in the field Strengths: • Limitations: • new challenges, new knowledge, new populations, new contexts, etc. • can challenge practice-based knowledge *Empirical knowledge* - knowledge based on data, observation Strengths: • (e.g. evidence-based practice, EBP) Limitations: • empirical knowledge or EBP may be untested in certain populations and contexts

What are some problems with the quality of knowledge and theory?

*Problems with observations*: Human beings have notoriously faulty memories, and our own experiences of events can be very unreliable - we tend to look for evidence to support our assumptions about certain phenomena, ignoring evidence that contradicts what we think we know *Overgeneralizations*: We tend to assume that what we experience can be generalized to other people and circumstances *Biases and value judgments*: We often impose our own values, inclinations, expectations, and experiences onto an event to help make sense of it *Lack of inquiry*: We stop asking questions about an event because we think we understand it or have pursued it sufficiently

Why is it important to learn about human behavior in the social environment?

- it will help you to place your knowledge into a meaningful and coherent context as you work with clients, organizations, and communities - it will challenge you to use your existing knowledge of human behavior and social environments while incorporating it into new ideas and perspectives on the human condition - it will give you more complex ways to think about assessment and intervention, which in turn will help you to become a more creative and effective social worker

Case of Carlos

Carlos is a 61-year-old Cuban immigrant whose family came to the United States when he was 15. After 20 years of marriage, Carlos's wife died five years ago, and he has not been in a serious relationship since. Carlos retired from his job in sales two years ago after he noticed that he was having trouble remembering client names and orders. Shortly after noticing these symptoms, Carlos was diagnosed with Alzheimer's disease. Carlos has three adult children, all of whom live at least 100 miles away. Carlos misses his children, and he has not been able to spend much time with his grandchildren because of the distance and his children's busy schedules. Carlos also has two siblings, both of whom moved back to Cuba 10 years ago, and he does not get to see them much, either. Carlos describes his relationships with his children and siblings as "close," and he feels lonely because of his lack of contact with them. He misses the strong family ties that characterized his life in Cuba. Carlos has a few close friends in his church and his neighborhood, but he is afraid that he will lose these connections if he moves into a care facility when his symptoms get worse. When he thinks about having to move, Carlos gets depressed over losing his independence and his sharp intellect, which he has always prized. Moreover, Carlos is worried about how he will pay to live in a care facility, particularly if he is there for a long time. Lately, Carlos has been feeling depressed, and he finds himself struggling with the meaning of life. He is not sure what all his hard work was for, and he feels as though all that he has done for his family has been in vain, especially because he knows how he will "end up" in the final stages of the disease. Carlos has been referred to a social worker at the health clinic where he receives care.

Neurotransmitters

Chemicals that transmit information from one neuron to another - carry information from one neuron to another across the synaptic gap - neurotransmitters play a crucial role in facilitating communication between neurons - some neurotransmitters stimulate neurons to fire while others inhibit neurons from firing, some do both

Frontal Lobe

Controls personality, intelligence, and voluntary control of muscles - damage to these lobes can create changes in personality among other problems (e.g. Phineas Gage)

Piaget's Theory of Cognitive Development

Developed by Jean Piaget beginning about 1920 - he observed and described children at different ages - his theory describes how people develop their capacities to think, learn, and process information from birth through their teenage years - a progressive reorganization of mental processes resulting from biological maturation and environmental experience ---- Stages of Cognitive Development: *Sensorimotor Stage* (0-2 years) • Object permanence: When a child learns that objects continue to exist even if the objects are out the range of child's senses • Actions such as sucking and rooting; crying • Focus shifts from self to outside world • Develop beginning symbolic capacities that allow them to hold rudimentary pictures of objects, or words for objects, in their minds Activities for children in the sensorimotor stage: - Peek-a-boo - Roll a ball back and forth - Practice filling and emptying containers - Shape sorters - Hide-and-seek with objects *Preoperational Stage* (2-7 years) • Egocentrism: Children cannot take into account the perspectives of others when thinking about objects or events - world revolves around the child; they cannot understand a situation or event from another's perspective • Classification is Limited: Children can differentiate between two objects based on their differences and unique properties - children are able to differentiate objects only based on one difference at a time • Children cannot understand conservation (objects remain the same even if its characteristics change) and seriation (differentiate objects based on size, weight, and length) Activities for children in the preoperational stage: - Smell games; guess items based on smell - Planting seeds - Cooking and baking *Concrete Operations Stage* (7-11 years) • Understand events from another's perspective • Comprehend complex relationships among variables • Learn to use symbols to communicate, such as those used in math and writing • Classification: Children are able to differentiate objects in multiple ways based on color and shape • Seriation: Children are able to differentiate objects based on size, weight, and length • Master classification, conservation, seriation Activities for children in the Concrete Operations stage: - More complex puzzles - Competitive games, such as Capture the Flag and Monopoly - Scavenger hunts - Legos - Reading *Formal operations stage* (11-16 years) • Hypothetical-deductive reasoning: Children can engage in abstract thinking, consider multiple aspects of an object or event at one time, formulate hypotheses, analyze properties of objects/events • Advanced problem solving abilities • Able to consider possible outcomes and predict consequences of actions Activities for children in the Formal Operations stage: - Give problems with multiple variables (Chemistry experiment) - Read Sherlock Holmes - Play the "What If" game or 20 Questions ---- Strengths: - one of the first to theorize cognitive development - his theory has improved the understanding of cognitive development Limitations: - observations based on his own children. Focus on the "average" child, but what does that mean across ethnic, class, and cultural differences? - underestimated children's abilities, when you use language they understand - children may not be as ego-centric as Piaget believe

The Medical Model

Disease-based model focused on identifying a disease based on symptoms, and then curing or alleviating the problem through scientific examination and intervention ---- Focus: Individual Assumptions: People are passive agents in their development Strengths: • Places emphasis on biological issues that can cause problems, which often get overlooked in assessment • Physiological problems and their interventions can be empirically tested • Diagnostic criteria offer clinicians a common language to use when working with clients (e.g. the use of the Diagnostic and Statistical of Mental Disorders, DSM-5) • Pinpointing problems can offer clients hope for a cure Limitations: • Diagnostic information is contained in health records, so appropriate and ethical use of model is important • Use of diagnostic criteria for mental illnesses can be unreliable among clinicians, there is still much room for speculation and error • Reduces clients to a set of symptoms, which may leave them feeling powerless to change; tends to focus exclusively on the individual • Not enough focus on how environmental issues affect client problems; Client strengths and resources are not always acknowledged

Erikson's Theory of Psychosocial Development

Erikson's psychosocial theory of development considers the impact of external factors, parents and society on personality development from childhood to adulthood - though influenced by Freud, Erikson was interested in development over the entire lifespan - individuals follow a sequence of life stages or "conflicts" that result from biological forces and age-related social/cultural expectations • every person must pass through a series of eight interrelated stages over the entire life cycle • successfully resolving a conflict at each life stage allows for psychological growth Epigenetic Principle: Each stage builds on the preceding stages, and paves the way for subsequent stage Each stage is characterized by a psychosocial crisis, which is based on physiological development, but also on demands put on the individual by parents and/or society - ideally, the crisis in each stage should be resolved by the ego in that stage, in order for development to proceed correctly ---- Stages of Psychological Development: 1. *Trust vs. Mistrust* (0-18 months) • Children learn to trust others (e.g. caregivers for food, shelter, love 2. *Autonomy vs. Shame/Doubt* (18 months - 3 years) • Children learn to do some things independently, such as eat and dress 3. *Initiative vs. Guilt* (3-6 years) • Children learn to pursue goals and interests - e.g. taking initiative to learn, explore, and manipulate their surroundings 4. Industry vs. Inferiority (6-12 years) • Children learn to be productive and successful - e.g. academically and socially 5. *Identity vs. Identity Confusion* (Adolescence) • Adolescents explore and develop their identities 6. *Intimacy vs. Isolation* (Young Adulthood) • Young adults look for closeness and intimacy in relationships 7. *Generativity vs. Stagnation* (Adulthood) •Adults are invested in work, family, and communities; the focus is on others. 8. *Integrity vs. Despair* (Old Age) • People develop a sense of well-being based on reflection and resolution of the past ---- Strengths: - provides a broad, integrative framework - provides insight into the directions of healthy development across the lifespan - explains culture and its affects towards development - concept of psychosocial crises considers individual differences within a framework of normal development Limitations: - there is so much variation in development; these stages can be limiting and too linear - the constructs are abstract and hard to measure and test - social norms and expectations are always changing - may not be valid across cultures

Case of Josie

Josie is a 15-year-old Japanese-American who has just found out that she is two months pregnant. The father of the baby is Josie's 17-year-old boyfriend of one year. They both are in high school, have a lot of friends, and are doing well in their classes. Josie's parents are first-generation Americans and hold conservative views on family, dating, marriage, religion, and roles for family members. For this reason, Josie is afraid of how her parents will react if they find out she is pregnant. In fact, her parents do not even know she has been dating. At the insistence of her friends, Josie went to a local Planned Parenthood when she did not seem to be recovering from flulike symptoms. The social worker at Planned Parenthood was not required to get parental permission to run a pregnancy test, but she wants to work with Josie to include her parents in Josie's decisions about how to proceed. Josie is reluctant to tell her parents: She is afraid her parents will disown her, and she is not sure if her extended family will offer any support, regardless of whether she decides to keep the baby. Josie's boyfriend has told her that he will not help her if she chooses to keep the baby. Josie also does not want to drop out of school, so she is trying to explore all of her options with the social worker.

Compare and Contrast: Low Birth Weight and Premature Births

Full-term pregnancy generally lasts 38 to 41 weeks - babies born before the start of the 37th week are called preterm (CDC, Mayo Clinic). • about 10% of all babies in 2016 (CDC). - a critical issue around premature babies is low birth weight (5.5 pounds or less at birth). - contributing factors include: smoking, disease, maternal age, drug abuse, malnutrition, excessive stress, race Example: African-American babies are twice as likely as Caucasian or Hispanic babies to suffer from low birth weight (Children's Defense Fund, 2012) due to factors associated with unequal access to health care and other health-related disparities All of these problems have other ramifications for children and their families. Example: Depending on the circumstances, low-birth-weight children and their families can face economic problems, increased stress, lack of support, inadequate access to health care, and educational issues throughout life - moreover, the cost of caring for low-birth-weight babies is one of the contributors to rising health care costs - this is not to say that there are no positive outcomes to situations involving preterm births - nevertheless, social workers must be aware of the potential problems, for clients and society, that tend to be correlated with preterm and low-birth-weight babies in order to provide appropriate, responsible, and effective services ---- In Josie's case, she is very young, which puts her at higher risk for having a preterm, low-birth-weight baby. However, with early intervention that includes good prenatal care, you can help Josie with education and other supportive resources to increase the chances that she will have a healthy baby, should she choose to continue with the pregnancy.

Science Based Knowledge

Information gained through research and theoretical tenets (also empirical) - using objective methods to test hypotheses

Empirically Based Knowledge

Information that is considered the most updated, valid, and reliable in regard to specific issues - knowledge based in observable fact - used to help guide practice and selection of interventions

Prenatal Development

Prenatal development is an important concept that social workers need to under stand in the course of their work - they often have frequent contact with pregnant clients and their partners, which means that they can have great impact on clients' decisions and behaviors regarding prenatal and other issues - according to the NASW Code of Ethics (NASW, approved 1996, revised 2008), social workers have a responsibility to promote clients' desire to set and pursue their own goals unless the social worker determines that those goals may pose an imminent threat to clients or others; *self-determination* - social workers need to consider with prospective mothers and fathers are their strengths, developmental and emotional levels, cognitive functioning, mental readiness for parenting, spiritual and religious beliefs, economic situation, relationship issues (particularly if domestic violence has been a problem), access to quality supports and other resources, problems stemming from discrimination, and postnatal and parenting preparation ---- Medical professionals often track fetal growth not by the date of actual conception, but rather by *gestational age*, which means that the age of the fetus is based on the start of a woman's last menstrual period, or LMP - calculated fetal age based on the date of conception is the *fertilization or conception age* ---- Common Hazards to Prenatal Development: Psychoactive Drugs • Alcohol • Nicotine • Illegal drugs (for example, cocaine, marijuana, heroin) Incompatible Blood Types • Rh positive/Rh negative Environmental Toxins • Radiation • Pesticides • Chemicals • Emissions Maternal and Paternal Factors • Disease (for example, rubella, syphilis, herpes, AIDS, toxoplasmosis) • Nutrition • Stress • Age • Genetic abnormalities Potential outcomes associated with stress: - preterm delivery - lower birth weight - emotional & behavioral problems - hyperactivity & attention deficits - increased risk of infections (ear, skin, respiratory diseases) - reduced brain volume, head circumference, and IQ

Occipital Lobe

Processes information such as color, shape, and motion - an injury to this lobe can cause blindness or damage to part of a person's visual field

Temporal Lobe

Responsible for hearing, language, and memory - damage to these lobes can result in problems with long-term memory

The Strengths Perspective

Seeks to identify, use, build, and reinforce the abilities and strengths that people have in contrast to the pathological perspective, which focuses on their deficiencies - based on the assumption that all human beings have the capacity for growth, change, and adaptation Core Principals: - every system (individual, group, family, community) has strengths - difficulties (trauma, abuse, illness, other struggles) can injure but can also be sources of change, growth, and opportunity - every system has aspirations for change that we should take seriously - we best serve clients by collaborating with them; social workers begin "where the client is" - every environment is full of strengths, resources, and assets to bring to bear on current situation Practice Beliefs: - the client is an expert - service user's have capacities - people are more then their problems - not a past-oriented approach but a forward looking approach ---- Focus: Individual & environment Assumptions: People are active agents in the change process Strengths: • Positive, empowering approach to working with clients • Easy to apply concepts in practice Limitations: • Too focused on individual responsibility and autonomy • Difficult to test constructs empirically and predict behavior • Too present-oriented for use in some agency settings • Are you setting up clients for disappointments?

Applying the BioPsychoSocial Approach (Rogers, pp. 31)

Some of Juan's problems involve absenteeism, falling grades, sleepiness in the daytime, lack of interest in school activities, and fighting with peers. He also seems to be having problems with his relationships with his parents, which directly and indirectly could affect him physically, emotionally, and financially. His father's drinking, violence, and unemployment as well as his mother's illness all have potential ramifications for Juan's overall functioning. Here are some of the issues in Juan's situation, broken down by level: • *Biological* level: You might look at Juan's physical health and functioning. You might examine his nutrition and general health habits, assess his overall physical development in comparison to his peers, and refer him to a doctor for a physical exam. It could be that poor nutrition, lack of sleep, or hormonal imbalances are contributing to some of Juan's symptoms such as aggression and poor concentration. You might also want to assess whether Juan is getting enough exercise or is using drugs or other substances, as these issues can exacerbate some of his problems. • *Psychological* level: You might assess Juan's emotional and cognitive development. You could refer him to a psychologist for intelligence (IQ) and other tests to determine whether he has any learning disabilities or related problems that might account for his low academic performance. You can assess various emotional and psychological realms to determine whether his problems with academics or peers might be caused by problems in functioning in these areas. For instance, you might look for signs of depression that could be impacting all aspects of his life or assess factors such as impulse control that could be causing his aggressive behavior. • *Social* level: You might focus on family issues and dynamics, the quality of Juan's peer relations, and his interactions and relationships with others, such as his teachers and his priest. In addition, you would rely on information from theories that address specific developmental processes to help assess Juan's level of psychosocial development. Many of these theories are discussed in the following chapters. Depending on the outcomes of these assessments, you would prioritize Juan's problems and choose interventions that best target them.

The Cerebral Cortex

The intricate fabric of interconnected neural cells covering the cerebral hemispheres; the body's ultimate control and information-processing center - responsible for complex mental functions such as planning and thinking Divided into 2 hemispheres: 1. *Right Hemisphere*: Responsible for processing emotion, nonverbal communication, and sensations 2. *Left Hemisphere*: responsible for processing language and fine motor movements. *Corpus callosum*: Bridge of communication between the 2 hemispheres, made of a large bundle of axons.

Deductive Reasoning (top-down)

The process of reasoning from one or more statements (premises) to reach a logically certain conclusion - starts out with a general statement, or hypothesis, and examines the possibilities to reach a specific, logical conclusion - we hold a theory and based on it we make a prediction of its consequences; we predict what the observations should be if the theory were correct Example: "All men are mortal. Harold is a man. Therefore, Harold is mortal." - for deductive reasoning to be sound, the hypothesis must be correct - it is assumed that the premises, "All men are mortal" and "Harold is a man" are true - therefore, the conclusion is logical and true

The Brain and the Nervous System

The structures of the brain are organized in a way that reflects their evolutionary development -lower, primitive structures, such as the brainstem that regulates physiological functions like sleep, temperature, and heart rate, make up the base of the brain. - the higher, advanced structures of the brain are newer from an evolutionary standpoint and thus make up the outer part of the brain - planning and thinking are functions of the cerebral cortex, the principal outer structure of the brain The nervous system is a complex electrochemical communication system for the body - the central nervous system consists of the brain and the spinal cord, and the peripheral nervous system connects the brain and spinal cord to other parts of the body - on the cellular level, the nervous system sends the body information through a complex interaction of nerve cells, chemicals, and electrical impulses

Person-In Environment (PIE)

This approach views client problems within the environmental *context* in which they occur, and it is the cornerstone of social work practice - the individual is impacted by the environment; the environment is likewise impacted by the individual - individuals are active agents whose lives, relationships, and environments are interdependent - this approach is used to describe and understands human behavior and dilemmas in relation the person's interaction with the environment It is a practice-guiding principle that highlights the importance of understanding an individual's behavior in light of the various environmental contexts in which that person lives

Functionalist Theory

This theory attempts to explain how various aspects, or functions, of a society work together to maintain stability - specifically, functionalist theory is concerned with the ways in which values, norms, institutions, and organizations contribute to the overall good of society - society can be thought of as a living organism consisting of parts that work together as a whole. - aspects of society that are functional and contribute to society will be maintained and passed on in the future, (e.g. role of technology) - focuses on social stability and shared public values The functionalist perspective is based largely on the works of Herbert Spencer, Emile Durkheim, Talcott Parsons, and Robert Merton - according to functionalism, society is a system of interconnected parts that work together in harmony to maintain a state of balance and social equilibrium for the whole. For example, each of the social institutions contributes important functions for society (e.g., family, law, education, etc.) - the stability of a society is impacted by various aspects of that society, such as diverse organizations, programs, institutions, beliefs, ethics, traditions, and norms ---- Theorists: *Emile Durkheim* (1858-1917) - early architect of the field of sociology - behavior must be understood within its social context - for society to function well and maintain homeostasis, it must meet various needs (social, physical, emotional, economical) of its members and institutions - concerned with how people lose their sense of meaning in life and become isolated, "anomie" *Robert K. Merton* (1910-2003) Manifest functions: Functions that are evident, usually written into the laws, mandates, or organizational constitutions and bylaws of a program - whose purpose is intentional and obvious easily recognized and anticipated purposes for actions Latent functions: Functions that are unstated and either assumed or hidden (also developed notion of "unintended consequences") - underlying purposes not immediately apparent or expected; typically secondary to manifest functions ---- Example: How does the education institution contribute to social stability? - education contributes to society by imparting knowledge to children • schools teach children many skills, from reading and writing to understanding complex mathematical equations • this is a manifest function of education. - schools impart social status to children, depending on the school that children attend (for example, well-funded or poorly funded, private or public, focused on academics or on practical skills) • the students become a reflection of the type, quality, and reputation of the school's instruction. • this, too, is a manifest function of education - schools also serve many latent functions • they intentionally or unintentionally pass along social norms, values, beliefs, and philosophies, and they "train" children to control their behavior and obey authority ---- Focus: Social groups Assumptions: Aspects, or functions, of a society work together to maintain stability Strengths: • Offers clients an alternative viewpoint to problems • Understanding manifest and latent functions of social institutions can help social workers target interventions • Tenets of theory fit well with ideas from systems and ecological theories • Focusing on changing dysfunction within a system could be an empowering approach for clients Limitations: • Little attention given to the complexity of interactions that take place among systems • Does not address the inequity that may result from a system's manifest and latent functions • Can be difficult to use for developing interventions • Can be difficult to define and empirically test constructs

BioPsychoSocial Approach

Understanding human behavior through assessing an individual's interrelated biological, psychological, and social functioning - unlike the micro-mezzo-macro model, the level of functioning in these areas is usually assessed on the individual level; that is, each area is assessed as it relates to the client or person with the presenting problem *Biological/Biophysical* dimension: - biophysical growth and development - biophysical strengths - biophysical hazards and risk factors (e.g. the client's diet, health (both past and present), exercise patterns, sexual functioning, medication and substance use, and family health and genetic history) *Psychological* dimension: - cognitive development and information processing - communication - attitudes and emotions - self and identity - social cognition and regulation - psychological strengths - psychological hazards and risk factors (e.g. the client's self-esteem, coping skills, mental health (both past and present), personality characteristics, family history of mental illness, spiritual development, and cognitive and emotional development) *Social* dimension: - groups and families - communities and social supports - organizations and social institutions - multicultural and gender considerations - social strengths - social hazards and risk factors (e.g. the client's work stability, engagement with social activities and recreation, and relationships with family, friends, and co-workers) ---- Focus: Individual & immediate environment Assumptions: Some emphasis is placed on people's active involvement in their immediate environment Strengths: • Some focus on biological aspects of behavior and problems • Helpful in guiding assessment and intervention process Limitations: • Too focused on immediate environment • Difficult to test constructs empirically and predict behavior • Too problem-oriented

Micro-Mezzo-Macro Approach

Used to better understand people as active agents whose lives, relationships, and environments impact one another - although it does not provide testable constructs that help to predict behavior, it does offer a visual framework that is useful when organizing a great deal of information about a client and thinking about how various aspects of a person's life and environment can interact with one another: *Micro*: Aspects of the individual - biological, psychological, social, cultural, and spiritual - also includes factors such as age, gender, income, and ethnic background *Mezzo*: Aspects of the individual's immediate environment - social interactions and small communities (e.g. families, school, work, social clubs, organizations) *Macro*: Aspects of the larger social environment - government policies, laws, economic forces, religious and political ideologies, cultural norms, forms of oppression, even historical events Focus: Individual & environment Assumptions: People are active in their environment Strengths: • Comprehensive approach to problems • Useful in assessment of client problems • Considers dynamic interaction between person and environment • Looks for causes of problems at individual and environmental levels Limitations: • Too broad to easily predict behavior • Difficult to define and test constructs empirically • No consistent set of concepts that can be applied to client situations

Systems Theory

Views human behavior as a result of interactions between people and their social systems - systems can include any formal or informal grouping of people or organizations (i.e. family, school, government, agencies, etc.) Key Concepts: *Boundaries*: Patterns of behavior that define relationships within systems and give systems their identity (e.g. departments, family boundaries allowing outside interactions) *System*: Set of parts that are interdependent and make up an organized whole (e.g. families, schools, districts) *Subsystem*: Secondary, smaller systems within a larger system - social workers intervene within subsystems help improve functioning of the larger system. (e.g. one CSU school, a department within a school, parents) *Homeostasis*: The tendency that systems have to work toward and maintain stability and equilibrium - a change in one part of the system will affect other parts of the system. - all systems strive to maintain homeostasis *Roles*: Socially or culturally sanctioned patterns of behaviors expected of individuals within a system (e.g. leader, caretaker, peacemaker within family; student vs. teacher vs. coach vs. administrator in schools) *Input*: The information, communication, or resources coming into a system from other systems (e.g. how parents/home life affects a student's academic performance at school) *Output*: What happens to this information, communication, or resource after it has been received by a system that affects other systems in the environment (e.g. how students unable to graduate on time affect enrollment at continuation schools or online credit programs) *Differentiation*: A system's movement from a simple existence toward a more complex form of functioning, while still maintaining its unique characteristics (e.g. School policies to address campus climate and violence on campus) *Entropy*: A system's movement toward disorganization and death (e.g. Schools unable to maintain enrollment/achievement are are forced to close) *Negative Entropy*: A system's movement toward growth and development (e.g. Schools gaining community recognition and adding more programs) ---- Focus: Individual & environment as part of various systems Assumptions: Systems are interactive Strengths: • Comprehensive approach to problems • Easy to apply concepts in practice • Considers dynamic interaction among systems Limitations: • Too broad to easily predict behavior • Difficult to test constructs empirically and predict behavior • Not enough focus on biological aspects of behavior and problems • Too problem-oriented