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108 Cards in this Set
- Front
- Back
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Biopsychosocial
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Assessment of biological, psychological, and social factors
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Multidimentinal Framework
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integration of infor and theory from biologiacal, psychological, and social dimentions of human behavior
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Person In Environment
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View client as part of the environmental system and reciprocal relationships
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Ecosystem Theory
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Study of people and other living systems and transactions between them
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Assessment phases
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*Data Collection
*Organizing and studying the data - Inferential thinking and evaluate relevant aspects of the client's fuctioning |
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Guidelines for Conducting a Competent Assessment
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*Follow principles of relevance and Salience - focus by emphazing infor that is relevant to client's problem
*Address top priority first- start where the client is, check legal mandates, health or safety concerns, right to self determination, serious foreseeable, and imminent harm *gather information from a variety of sources, recognise the uniqueness of client and situation, adopt a strength perspective,consider how clinical judgement can affect an assessment -personal and cultural biases- discuss openly, spiritual domain, the client's response- Malingering (faking bad) defensiveness, view assessment as both a product and a process |
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Intake Procedures at Social Agencies
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used to make initial contact with client, fact finding, if client is in crisis postpone intake focus on providinfg immediate services, intake screening decide matches
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informational Interviews (obtaining Social History)
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Information may come from Client, relatives, friends, employer, other agencies
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Characteristics of a Competent Report
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Brevity, Clarity, Usefulness, Objectivity, relevance, Emphasis on client strenghts, Consideration of Confidentiality and Organised Presentation
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Etiological Diagnosis
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Problem causation is usually the result of the convergence of many factors in client's person situation complex
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dynamic Diagnosis
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examing how aspects of the client's personality interact to produce her fuctioning also interplay between client and other people and systems and interaction between them
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Classificatory Diagnosis
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Social Workers also classify aspects of their clients functioning - assigning a clinical diagnosis, also race, ethnicity, religion, SES etc
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Exploration, Engagement and assessment of Danger
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First telephone -explore presenting problem to determine appropriateness of service,
establish time and location for face to face |
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opening meeting
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Explore problem and establish rapport, begin with warm up (ice breaker)
explain limits to confidentiality, fees, meeting times, informed consent to tx, and client responsibilities |
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behavioral Assessment
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attempt to understand behavior by identifying the context in which it occurs
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Behaviorally Oriented interviews
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used to gain an impression of the presenting problem and of the variables that are maintaining it, as well as to assess the client's strength, obtain relevant historical data, and identify the clients past efforts to cope with problem.
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cognitive Behavioral assessments
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used to explore the client's cognitions and cognitive strategies and identify which ones contribute to the problem.
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Before Contacting any collateral source
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You should have a signed release of confidential information
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Collateral Sources
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*Family, teachers, Employers etc -Verify certain facts, solicit new or more elabrate infor, and insights on how they view client situ or problem.
*Life records and other documents- alert u to new areas of inquiry and provide reference against which you can evaluate client * |
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Collateral Sources - Other Professionals
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*Medical Doctor- physical hx or functioning is in question R/O physical and biological factors on clientpsych and social function. Physical exams if not been to one in a yr, consultations if client abuses alcohol or other drugs, problematic side effects to drugs need to be evaluated.
Psychiatrist-need for psych meds to manage chronic emotional or mental disorders. *Psychologist - Psych testing - for uncovering personality traits, intellectual capacity, patterns of motivation, coping behavior,self concept etc |
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Collateral Sources - Other Professionals
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Speech Language Pathologist -speech difficulties
occupational Therapist -performance skills Learning Specialist- testing learning diasabilties Child Psychologists child emotional problems, psych testing Other prof - help clarify nature and extent of the problem and , other indicators of client functioning. |
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Enactment
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Allows you to collect infor by creating a situation in which you can observe direct interactions.
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Home Visits
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Used to engage client
Obtain more accurate assessments thru observations in natural environmentBe courteous, never show signs of disaproval or shock |
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Clinical tools for understanding a Client and situation
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Life History Grid _graphical depiction of client's life- good for adolescents and children.
Life cycle Matrix- graphical depiction of developmental stages of individuals in a home. |
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Clinical tools for social assessment
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Genogram -patterns of hx
Ecomap- acquire a better understanding of social context Dual Perspective worksheet-- develop worksheet that depicts the locationof supports and barriers or problems that affect client in social environment social network map and Social network Grid |
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Behavioral Observations
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Used when client not old enough or are not able to provide a report because of cognitive deficits or nature of their disorder.
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Behavioral Observations Methods
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Formal methods - follow objective and standadized format
Less Formal Observ Procedures - oserv parent child interactions |
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Specific Behavioral Observations Methods
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Naturalistic Observations - observ in natural environ. eg classroom
Controlled Observation -enactment or role play then u observ Self Monitoring |
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Solution Focused interview
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Solution focus Therapy -focua on solutions, recognise strengths, and make steps to resolve problem
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Assessment using principles of Solution focus Therapy
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Explore exceptions
Ask Scaling Questions Ask The miracle question |
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Mental Status Exam (MSE)
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Evaluate Client Current mental functioning
helps u recognise key symptoms and refer for psych eval Can Have both behavioral and Cognitive aspects |
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Psychological Tests
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Personality tests
Intelligence tests Neuropsychological Tests Clinical Tests Vocational tests (Interest inventories) |
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Brief Symptom- Focused instruments
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*Rapid Assessment Instruments (RAIs) - Self Adm
-SF -36 Health Survey and SF-12 Health survey *Symptom Checklist -90R and Brief Symptom Inventory *beck Depression Inventory-II (BDI-II), Beck Hopelessnes Scale (BHS) |
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Youth Assessment Instruments
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*Child Behavior Checklist (CBCL)
*Conner's Rating Scale Revised *Behavior Assessment System for children-2 (BASC-2) * AIMS Assessment Tool, ChIld and Adolescent Fuctional Assesssment Scale (CAFAS), Behavioral And Emotional Rating Scale (BERS) Adolescent Drug Abuse Diagnosis (ADAd) |
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Screening Instruments For Subtance Abuse
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CAGE AID for all Subtance
CAGE and T-ACE - for alcoholism |
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Neuropsychological Screening Tests
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folstein Mini Mental Status Exam
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Self Repot Measures
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Aid tx planning and trackin progress
*Outcome questionaire-45 (oQ-45) Butcher treatment planning Inventory Behavior and Symptom Identification Scale (BASIC-32) |
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Personality tests
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The Minnessota Multiphasic personality Inventory -2 (MMPI-2), MMPI-A for ages 14-18
Milton Clinical Multiaxial Inventory (MCMI-III), MACI for 13 to 19 yrs The Rorschach |
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Objective Personality tests
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Edward Personal Preference Schedule (EPPS)
16 Personality factors Questionaire (16PF) NEO Personality Inventory (NEO-PI-R) |
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Projective Personality tests
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Thematic Apperception Test (TAT)
Roberts Apperception Test for children (RATC) Projective drawing tests |
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Measures of Intelligence
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Wechsler Adult intelligence Scale- forth Edition (WAIS-IV)WPPSI-III for children 2-6 yrs
*Satnford Binet Intelligence Scale, fifth th Edition (SB5) |
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Other Measures of Intelligence
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Kaufman Assessment Battery for Children (KABC-II)
Kaufman Brief intelligence test(KBIT-2) *Cognitive assessment system (CAS) |
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Infant Pre-school test
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Denver Developmental Screening test II (Denver II)
Bayley Scales of Infant Development, Second Edition (BSID-II) |
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Assessment for Mental Retardation
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Vineland Adaptive Behavior Scales, 2nd Edition (Vinland-II)
AAMR Adaptive Behavior scales |
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Assessment for Learning Disabilities
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The Illinois Test of Psycholinguistic Abilities, Third Edition (ITPA-III)
The Wide Range Achievement tests, revision 3 (WRAT3) |
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Measures of People with disabilities
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The Columbia Mental Maturity Scale (CMMS)
The Peabody Picture Vocabulary Test 3rd Edition (PPVT-III) The Haptic Intelligence Scale Hiskey-Nebraska Test of learning Aptitude |
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Culture Fair tests
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CMMS and K-ABC
Leiter International performance ScaleBRevised (Leiter-R0 Raven's progressive matrices Standard Progressive matrices The system of multicultural Pluralistic Assessment (SOMPA) |
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Neuropsychological Tests
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*Halstead-Reitan Neuropsychological Battery
*Luria-Nebraska Neuropsychological Battery *The Wechsler Memory Scale -III * |
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Other Neuropsychological Tests
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*The Bender Visual-Motor Gestalt Test, 2nd Edition (Bender-Gestalt-II)
*The benton Visual Retention Test (BVRT) *The Beery Development Testof Visual-Motor Integration |
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Interest Inventories (Vocational Tests)
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The strong Interest Inventories
The Kuder tests-, KPR-V,KOIS,Kuder career search. The self directed Search (SDS) |
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Other Assessments
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Computer Assisted Assessment-CBTI
Client focused measures- Indivdualized Rating Scale(IRS) -Goal Attainment Scale - Client Logs |
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Areas Explored During Assessed
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Overview of Problem
Clients Perception of the problem Physical signs and symptoms -medical hx, indicators of a potential serious medical problem, Vegetative symptoms,(Sleep disturbance,appetite,or weight, loss of appetite or energy or freq fatigue and sexual function. |
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Areas Explored During Assessed -subtance abuse
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subtance abuse and dependence- screening instruments, elicit drug hx,refer to Md for eval, Perf MSE, R/O Co-existing independent psych dis., perf direct ass for clt motiv for change, identify factors maintaining subtance use, interview collat sources, determine approp tx setting
BAL above.05 |
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Abbreviation for proper dosage
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Q =Every
QD =daily BID = twice daily TID = 3x /day QID = 4x/day HS = bedtime and PRN = As needed |
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Medication Psychoactive (Psychtropic ) drugs
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agent interact with CNS producing change in mood, consciousness, perception, and behavior.eg Antipsychotic drugss, drugs,Antidepressent Drugs,Mood stabilizing Drugs, Seductive Hypnotics, beta blockers, narcotic- Analgestics, psychostimulants, strattera,
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Anti-psychotic Drugs
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Major tanquilizers
Traditional (convertional and typical Atypical (novel) |
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Anti-psychotic Drugs-Traditional
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Phenothiazine(chlorpromazine/Thorazine and fluphenazine/permitil/ prolixin, thioxanthene(thiothixene/navane), and butyrophene (haloperidol/ Haldol.
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1. Anti-psychotic Drugs-traditional -uses
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alleviates hallucinations, delusions, agitation, and other positive symptom of schizophrenia (not effective with negative symptoms of apathy, blunted affect, and social withdrawal)
Effective for alleviating psychotic symptoms, acute mania, etc |
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2. Anti-psychotic Drugs-traditional - side effects
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Anticholinergic side effects-dry mouth, blurred vision, tachycardia, urinary retention, constipation, and delayed ejacultion
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3. Anti-psychotic Drugs-traditional - side effects
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Extrapyramidal -parkisonism, akathisia(extreme motor restlessness),and dystonia-muscle spasm in the mouth, face and neck. Tardive dyskinesia most serious side effect more in females & elderly -involuntary movement jaw, lips, tongue, & extremities.
Rare but potential side effect neuroleptic malignant Syndrome, and seizures |
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Atypical- Anti- psychotic Drugs- side effects
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Anticholinergic effects- blurred vision, dry eyes, constipation, and urinary retention, ) , lowered seizure threshold, and sedation, less likely to cause tardive dyskinesia
can produce agranulocytosis (loss of the white blood cells that fight infection) and other blood dyscrasias - need blood monitoring |
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Atypical- Anti- psychotic Drugs
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Dibenzodiazepine ( clozapine/clozaril), benzisoxazole( resperidone/risperdal), thienobenzodiazepine(olanzapine/zyprexa), and dibenzothiazepine(quetiapine/ seroquel)
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Atypical- Anti- psychotic Drugs - uses
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used to treat schizophrenia & other disorders with psychotic symptom -clozapine also effective in tx alcohol and drug addictions, resperidone -Autism
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Antidepressant drugs
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tricyclics, SSRIs', MAOIs
in children used with caution due to increased risk of suicide |
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Antidepressant drugs -Tricyclics
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amitriptyline, doxepin, imipramine and clomipramine
Used for depression with decreased appetite, weight loss, morning awakening,sleep disturbance, psychomotor retardation, and anhedonia. useful for vegetative somatic symtoms. also for panic disorders, agoraphobia, bulimia and obsessive compulsive disorder |
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Antidepressant drugs -Tricyclics - side effects
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Cardiovascular symtoms, anticholinergic effects
Cardiotoxic -tachycardia, palpitations, hypentension, severe hypotension, and cardiac arrrhymia. |
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Antidepressant drugs -SSRIs
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Fluxetine- prozac, fluvoxamine -floxyfral, paroxetine-paxil, sertraline -Zoloft and escitalopram oxalate-lexapro
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Antidepressant drugs -SSRIs -Uses
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OCD, bulimia, panic disorder, PTSD, lexapro for generalized anxiety, prozac for autism, anafranil for TCA, Luvox repetitive behaviors, decrease irritability, tantrums and agressive behavior.
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Antidepressant drugs -SSRIs - side effects
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gastrointestinal disturbances, insomnia, anxiety, headaque, dizziness, anorexia, tremor, frequent urination, and sxual dysfunction. Sonolence _prolonged drowsiness or sleepiness.
Use of SSRIs and MAOIs can cause serotonin syndrome leading to coma and death |
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Antidepressant drugs -MAOIs
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Isocarboxazid-marplan, phenelzine-nardil and tranylcypormine-parnate
used for trating nonendogenous and atypical depression that involve anxiety, reversed vegetative symptoms and interpersonal sensitivity. |
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Antidepressant drugs MAOIs
Side effects |
hypertensive crisis when MAOIs taken with barbiturates, amphetamines, antihistamines or drugs or food containing amino acid tyramine.
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Newer Antidepressants
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Welbutrin, effexor,serzone, desyrel and celexa
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Mood Stabilizing Drugs
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Lithium- tx of bipolar
Side effects - nausea, fine hand tremor,polyuria, and polydipsia -toxicity from high dose Carbamazepine(tegretol)-anti convulsant drug and effective for mania. Used for tx of bipolar when lithium not effective Side effects -dizziness, ataxia, visual disturbances, anorexia, nausea, and skin rash. Contraindicated for abnomalities in cardiac conduction- blood monitoring required. |
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Seductive Hypnotics
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Barbituates, anxiolytics and alcohol
Generalized CNS depresants effects are dose dependent Chronic use - tolerance and synergistic -combination of anxiolytic and babs or alcohol lead to lethal consequences |
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Seductive Hypnotics - barbiturates
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Amobarbital, pentobarbital, secobarbital and phenobarbital
Used as sedatives and anesthetic, but due to lethel effects not used much. Side effects-slurred speech, nystagmus, dizziness, irriatability, impaired motor and cognitive perfomance. Overdose -ataxia decrease in REm sleep and nightmares |
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Seductive Hypnotics - anxiolytics
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Minor tranquilizers and anti anxiety drugs benodiazepines most prescribed- diazepam(valium), Xanax, Serax, triazolam, Librium, and ativan.
Used to relieve anxiety, tx sleep disb,seizures, celebral p, and other involving muscle spasms and alcohol withdrawal |
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Seductive Hypnotics - anxiolytics
side effects |
drowsiness, lethargy, slurred speech, ataxia, and impaired psychomotor ability. other - irritability, hostility, paradoxical excitment, indreased appetite, weight gain, skin rash, blood dydcrasias, impaired sexual functioning, disorientation and confusion, sleep disturbance, anterograde amnesia and depression.
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Seductive Hypnotics- Azapirone
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Buspirone 1st anxiolytic that reduces anxiety without sedation. Non addictive, not habit forming and not subject ot abuse - takes several weeks to be effective
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Beta Blockers
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Used to treat HBP, angina, and other vascular disorders and other physical symptoms associated with anxiety
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Beta Blockers - side effects
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Bradycardia, shortness of breath, arterial insufficiency, nausea, depression, and dizziness
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Narcotic Analgestic
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Opioids ( opium, morphine, codeine)
Both seductive and analgesic properties uses to relieve chronic pain(analgesic),tx ofr diarrhea & cough suppressant Side effects constricted pupils, decreased visual acuity, increased perspiration,constipation, nausea, vomiting and respiratory depression. tolerance and dependence |
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Psychostimulants
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Amphetamines Used to tx narcolepsy and ADHD and methylphenidate (Ritalin, concerta) used to tx ADHD in adults and children.
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Psychostimulants - side effects
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Amphetamines-restless, insomnia, poor appetite, tremor, palpitations, and cardiac arrhythmia
Methtyphenidate-dysphoria (anxiety, irritability,depression, euphoria, sadness), nausea and abdominal pain, decreased appetite, and insomnia. |
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Strattera
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Atomoxetine hydrochloride -a norepinephrine reuptake inhibitor, is a non stimulant medication
tx for ADHD Side effects- mood swings, tiredness,dizziness, nausea, vomiting, decreased appetite.drugs monitored |
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Somatoform Disorders
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Mental disorder characterized by Physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder
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Somatoform Disorder
What to explore |
Production of symptoms - intentional or real
2. Review of systems -seven category of symptoms- :-amnesia, burning sensation in sexual organs or rectum,, diff swallowing, painful cycle, pain in extremities, shortness of breath, and vomitting. 3. hx factors - physical or sexual abuse, Dr. shopping, repeated med eval, med condi in childhood. secondary gain- receiving unavailable medical attention Marital or job problems |
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Areas Explored during Assessments
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A. Overview of problem
B. Clients perception of the problem C.Physical signs and symptoms D.Emotional and Psych signs and symptoms E. Personality traits and personality disorders F. Self concept (sense of self) |
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Areas explored during Assessment
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G. Social functioning and social role functioning
H. history of the problem I. Coping assessments J. Culture and social class K. Assessing the health of a family system L. Assessment of children |
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Emotional or effective signs and symptoms
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Emotional control,range, appropriateness of affect, anger, guilt and shame, ambivalence
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Psychiatric signs and symptoms
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Previous episodes, depression, anxiety, mania and hypomania, cognitive symptoms, psychotic symptoms
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Personality traits and personality disorders
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Personality assessment
functional personality and ego functions |
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Social functioning and social role fuctioning
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Assessment of social functioning
Assessment of social role functioning |
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History of the problem
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Onset, progression and severity
Stressors affecting the problem Antecedents and consequences of the problem Client's reaction about and reaction to her problem Developmental considerations Family, work, educational, and legal histories |
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Coping Assessment
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Response to stress,
considerations in coping assessment |
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Culture and Social Class
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1. Assessment of culturally diverse clients
2. Assessment of clients living in poverty |
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Assessing the health of a family
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Family composition
Family structure Communication Family goals family development Adaption to the environment |
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Assessment of children
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1. general guidelines for engaging a child and eliciting her problem
2. Guidelines for interviewing children 3. identification of developmental delays 4. Family/ parent assessment |
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sources of social role problems
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Role ambiguity, role conflict, self role incongruence, role overload, role loss, role incapacity, role rejection
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Types of social role problems
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Difficulty fulfiling a social role obligation or conflict in relationship
e.g power, ambivalence, responsibility, dependency, loss, isolation, victimization |
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Assessment of culturally diverse clients
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Cultural norms, fluency of english, degree of acculturation, attitudes toward external help, how cultures view illness, communication patterns
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Guidelines for interviewing children
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Modify your questions
offer alternatives to verbally answering questions use descriptive comments Use reflection provide labeled praise Avoid critical statements |
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Identification of developmental delays
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delays in speech development
delays in motor development delays in social and mental development visual problems hearing problems |
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4 Ps (Perlman, 1957)
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PROBLEM- cause intensity, freq, and duration
PERSON- various dimensions of client are related to the problem PLACE- perception of your involvement/agency PROCESS- best approach to acceptable to client |
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4Rs ( Doremus, 1976)
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ROLES- roles and responsibilities of client in life
REACTIONS- clients reaction to problems and situation RELATIONSHIPS-Significance, contribution of problem fro others RESOURCES- resources used in past to cope with problem |
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4 Ms
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MOTIVATION - what client wants to do about problem
MEANING- meaning assigned to problem MANAGEMENT- how can you use yr limited time to help MONITORING- how you will monitor impact on client, evaluate effectiveness |
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Formulating the problem and setting priorities
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Use 4 PS, Rs and Ms
use components of the problem statement Degree of impairment in adaptive functioning Use commonly used diagnostic taxonomies Set priorities for attention |
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Commonly used Diagnostic Taxonomies
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The person in the environment (PIE) system
Diagnostic and statistical manual of mental disorders (DSM-IV-TR) Telling a client about her clinical diagnosis |
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The person in the environment (PIE) system -
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PIE Factor 1-Problems in social role functioning,
PIE Factor II- problems in environment, PIE Factor III- mental health problems PIE Factor IV- physical health problems |
