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108 Cards in this Set

  • Front
  • Back
Biopsychosocial
Assessment of biological, psychological, and social factors
Multidimentinal Framework
integration of infor and theory from biologiacal, psychological, and social dimentions of human behavior
Person In Environment
View client as part of the environmental system and reciprocal relationships
Ecosystem Theory
Study of people and other living systems and transactions between them
Assessment phases
*Data Collection
*Organizing and studying the data - Inferential thinking and evaluate relevant aspects of the client's fuctioning
Guidelines for Conducting a Competent Assessment
*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
Intake Procedures at Social Agencies
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
informational Interviews (obtaining Social History)
Information may come from Client, relatives, friends, employer, other agencies
Characteristics of a Competent Report
Brevity, Clarity, Usefulness, Objectivity, relevance, Emphasis on client strenghts, Consideration of Confidentiality and Organised Presentation
Etiological Diagnosis
Problem causation is usually the result of the convergence of many factors in client's person situation complex
dynamic Diagnosis
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
Classificatory Diagnosis
Social Workers also classify aspects of their clients functioning - assigning a clinical diagnosis, also race, ethnicity, religion, SES etc
Exploration, Engagement and assessment of Danger
First telephone -explore presenting problem to determine appropriateness of service,
establish time and location for face to face
opening meeting
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
behavioral Assessment
attempt to understand behavior by identifying the context in which it occurs
Behaviorally Oriented interviews
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.
cognitive Behavioral assessments
used to explore the client's cognitions and cognitive strategies and identify which ones contribute to the problem.
Before Contacting any collateral source
You should have a signed release of confidential information
Collateral Sources
*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
*
Collateral Sources - Other Professionals
*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
Collateral Sources - Other Professionals
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.
Enactment
Allows you to collect infor by creating a situation in which you can observe direct interactions.
Home Visits
Used to engage client
Obtain more accurate assessments thru observations in natural environmentBe courteous, never show signs of disaproval or shock
Clinical tools for understanding a Client and situation
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.
Clinical tools for social assessment
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
Behavioral Observations
Used when client not old enough or are not able to provide a report because of cognitive deficits or nature of their disorder.
Behavioral Observations Methods
Formal methods - follow objective and standadized format
Less Formal Observ Procedures - oserv parent child interactions
Specific Behavioral Observations Methods
Naturalistic Observations - observ in natural environ. eg classroom
Controlled Observation -enactment or role play then u observ
Self Monitoring
Solution Focused interview
Solution focus Therapy -focua on solutions, recognise strengths, and make steps to resolve problem
Assessment using principles of Solution focus Therapy
Explore exceptions
Ask Scaling Questions
Ask The miracle question
Mental Status Exam (MSE)
Evaluate Client Current mental functioning
helps u recognise key symptoms and refer for psych eval
Can Have both behavioral and Cognitive aspects
Psychological Tests
Personality tests
Intelligence tests
Neuropsychological Tests
Clinical Tests
Vocational tests (Interest inventories)
Brief Symptom- Focused instruments
*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)
Youth Assessment Instruments
*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)
Screening Instruments For Subtance Abuse
CAGE AID for all Subtance
CAGE and T-ACE - for alcoholism
Neuropsychological Screening Tests
folstein Mini Mental Status Exam
Self Repot Measures
Aid tx planning and trackin progress
*Outcome questionaire-45 (oQ-45)
Butcher treatment planning Inventory
Behavior and Symptom Identification Scale (BASIC-32)
Personality tests
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
Objective Personality tests
Edward Personal Preference Schedule (EPPS)
16 Personality factors Questionaire (16PF)
NEO Personality Inventory (NEO-PI-R)
Projective Personality tests
Thematic Apperception Test (TAT)
Roberts Apperception Test for children (RATC)
Projective drawing tests
Measures of Intelligence
Wechsler Adult intelligence Scale- forth Edition (WAIS-IV)WPPSI-III for children 2-6 yrs
*Satnford Binet Intelligence Scale, fifth th Edition (SB5)
Other Measures of Intelligence
Kaufman Assessment Battery for Children (KABC-II)
Kaufman Brief intelligence test(KBIT-2)
*Cognitive assessment system (CAS)
Infant Pre-school test
Denver Developmental Screening test II (Denver II)
Bayley Scales of Infant Development, Second Edition (BSID-II)
Assessment for Mental Retardation
Vineland Adaptive Behavior Scales, 2nd Edition (Vinland-II)
AAMR Adaptive Behavior scales
Assessment for Learning Disabilities
The Illinois Test of Psycholinguistic Abilities, Third Edition (ITPA-III)
The Wide Range Achievement tests, revision 3 (WRAT3)
Measures of People with disabilities
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
Culture Fair tests
CMMS and K-ABC
Leiter International performance ScaleBRevised (Leiter-R0
Raven's progressive matrices
Standard Progressive matrices
The system of multicultural Pluralistic Assessment (SOMPA)
Neuropsychological Tests
*Halstead-Reitan Neuropsychological Battery
*Luria-Nebraska Neuropsychological Battery
*The Wechsler Memory Scale -III
*
Other Neuropsychological Tests
*The Bender Visual-Motor Gestalt Test, 2nd Edition (Bender-Gestalt-II)
*The benton Visual Retention Test (BVRT)
*The Beery Development Testof Visual-Motor Integration
Interest Inventories (Vocational Tests)
The strong Interest Inventories
The Kuder tests-, KPR-V,KOIS,Kuder career search.
The self directed Search (SDS)
Other Assessments
Computer Assisted Assessment-CBTI
Client focused measures- Indivdualized Rating Scale(IRS)
-Goal Attainment Scale
- Client Logs
Areas Explored During Assessed
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.
Areas Explored During Assessed -subtance abuse
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
Abbreviation for proper dosage
Q =Every
QD =daily
BID = twice daily
TID = 3x /day
QID = 4x/day
HS = bedtime and PRN = As needed
Medication Psychoactive (Psychtropic ) drugs
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,
Anti-psychotic Drugs
Major tanquilizers
Traditional (convertional and typical
Atypical (novel)
Anti-psychotic Drugs-Traditional
Phenothiazine(chlorpromazine/Thorazine and fluphenazine/permitil/ prolixin, thioxanthene(thiothixene/navane), and butyrophene (haloperidol/ Haldol.
1. Anti-psychotic Drugs-traditional -uses
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
2. Anti-psychotic Drugs-traditional - side effects
Anticholinergic side effects-dry mouth, blurred vision, tachycardia, urinary retention, constipation, and delayed ejacultion
3. Anti-psychotic Drugs-traditional - side effects
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
Atypical- Anti- psychotic Drugs- side effects
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
Atypical- Anti- psychotic Drugs
Dibenzodiazepine ( clozapine/clozaril), benzisoxazole( resperidone/risperdal), thienobenzodiazepine(olanzapine/zyprexa), and dibenzothiazepine(quetiapine/ seroquel)
Atypical- Anti- psychotic Drugs - uses
used to treat schizophrenia & other disorders with psychotic symptom -clozapine also effective in tx alcohol and drug addictions, resperidone -Autism
Antidepressant drugs
tricyclics, SSRIs', MAOIs
in children used with caution due to increased risk of suicide
Antidepressant drugs -Tricyclics
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
Antidepressant drugs -Tricyclics - side effects
Cardiovascular symtoms, anticholinergic effects
Cardiotoxic -tachycardia, palpitations, hypentension, severe hypotension, and cardiac arrrhymia.
Antidepressant drugs -SSRIs
Fluxetine- prozac, fluvoxamine -floxyfral, paroxetine-paxil, sertraline -Zoloft and escitalopram oxalate-lexapro
Antidepressant drugs -SSRIs -Uses
OCD, bulimia, panic disorder, PTSD, lexapro for generalized anxiety, prozac for autism, anafranil for TCA, Luvox repetitive behaviors, decrease irritability, tantrums and agressive behavior.
Antidepressant drugs -SSRIs - side effects
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
Antidepressant drugs -MAOIs
Isocarboxazid-marplan, phenelzine-nardil and tranylcypormine-parnate
used for trating nonendogenous and atypical depression that involve anxiety, reversed vegetative symptoms and interpersonal sensitivity.
Antidepressant drugs MAOIs
Side effects
hypertensive crisis when MAOIs taken with barbiturates, amphetamines, antihistamines or drugs or food containing amino acid tyramine.
Newer Antidepressants
Welbutrin, effexor,serzone, desyrel and celexa
Mood Stabilizing Drugs
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.
Seductive Hypnotics
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
Seductive Hypnotics - barbiturates
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
Seductive Hypnotics - anxiolytics
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
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.
Seductive Hypnotics- Azapirone
Buspirone 1st anxiolytic that reduces anxiety without sedation. Non addictive, not habit forming and not subject ot abuse - takes several weeks to be effective
Beta Blockers
Used to treat HBP, angina, and other vascular disorders and other physical symptoms associated with anxiety
Beta Blockers - side effects
Bradycardia, shortness of breath, arterial insufficiency, nausea, depression, and dizziness
Narcotic Analgestic
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
Psychostimulants
Amphetamines Used to tx narcolepsy and ADHD and methylphenidate (Ritalin, concerta) used to tx ADHD in adults and children.
Psychostimulants - side effects
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.
Strattera
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
Somatoform Disorders
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
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
Areas Explored during Assessments
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)
Areas explored during Assessment
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
Emotional or effective signs and symptoms
Emotional control,range, appropriateness of affect, anger, guilt and shame, ambivalence
Psychiatric signs and symptoms
Previous episodes, depression, anxiety, mania and hypomania, cognitive symptoms, psychotic symptoms
Personality traits and personality disorders
Personality assessment
functional personality and ego functions
Social functioning and social role fuctioning
Assessment of social functioning
Assessment of social role functioning
History of the problem
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
Coping Assessment
Response to stress,
considerations in coping assessment
Culture and Social Class
1. Assessment of culturally diverse clients
2. Assessment of clients living in poverty
Assessing the health of a family
Family composition
Family structure
Communication
Family goals
family development
Adaption to the environment
Assessment of children
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
sources of social role problems
Role ambiguity, role conflict, self role incongruence, role overload, role loss, role incapacity, role rejection
Types of social role problems
Difficulty fulfiling a social role obligation or conflict in relationship
e.g power, ambivalence, responsibility, dependency, loss, isolation, victimization
Assessment of culturally diverse clients
Cultural norms, fluency of english, degree of acculturation, attitudes toward external help, how cultures view illness, communication patterns
Guidelines for interviewing children
Modify your questions
offer alternatives to verbally answering questions
use descriptive comments
Use reflection
provide labeled praise
Avoid critical statements
Identification of developmental delays
delays in speech development
delays in motor development
delays in social and mental development
visual problems
hearing problems
4 Ps (Perlman, 1957)
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
4Rs ( Doremus, 1976)
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
4 Ms
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
Formulating the problem and setting priorities
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
Commonly used Diagnostic Taxonomies
The person in the environment (PIE) system
Diagnostic and statistical manual of mental disorders (DSM-IV-TR)
Telling a client about her clinical diagnosis
The person in the environment (PIE) system -
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