Assessment In Social Work Practice

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AXIS 1: DSM-IV-TR

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clinical syndromes, Pervasive Developmental Disorder, Learning Disorder, Motor Skills Disorders, Communication Disorders, other disorders that may focus of clinical treatment

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AXIS II: DSM-IV-TR

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Personality Disorder
Mental Retardation

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AXIS III: DSM-IV-TR

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General Medical Conditions

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AXIS IV: DSM-IV-TR

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Psychosocial and Environmental problems/stressors. Takes into account the environment of the individual.

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AXIS V: DSM-IV-TR

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Global Assessment of Functioning
(1= minimal functioning to 100=highest level of functioning

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Borderline Intellectual Functioning

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IO 71 - 84

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Mental Retardation

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Mild - IQ 55-70 considered educable
Moderate - 35-55 considered trainable
severe - 20-40 institutionalized
Profound - IQ below 20 generally total care.

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Autistic Disorder

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SW Treatment: generally behavioral in nature. severe form, onset in infancy or childhood; self-stimulating, self-injuring behaviors often present; poor prognosis; 2/3 of Autistic individuals are MR/moderate range;
3x more common in male than females.

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hereditary factor, facilitative communication is used; development not related to parenting style.

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Learning Disability

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SW Treatment: generally behavioral in nature.
Etiology: uncertain
significant difficulties in acquisition of listening, speaking, reading, writing, reason, and math; significant delay in skill level (+2 standard deviations below for years of age); generally noted between ages 8-13; more common in males than females; continues into adulthood; behavior is characteristic of an earlier state of development.

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ADHD

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Treatment: evaluate by neurologist/physician; medication; help families at home; help teachers at school; may need academic "catch up"; allow more time to complete tasks; address self-esteem issues in counseling; behavioral & cognitive techniques; Etiology: unknown, hereditary link; not intellectual deficits. Symptoms required in tow or more settings.

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Conduct Disorder

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Treatment: Behaviors - identification of BC's (behaviors and consequences): Family treatment required reinforce BC's;
symptoms; 4 groups - 1. aggression to people and animals, 2 - destruction of property, 3- deceitfulness or theft, 4-serious violations of rules.

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Oppositional Defiant Disorder

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*similar to conduct disorder bu not nearly as severe. Does not repeatedly violate the rights of others.

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Enuresis

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Elimination of urine during the day and night. Must not be due to a physical disorder and always refer for a physical exam.

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Encopresis

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Repeated elimination of feces in inappropriate places, including constipation. Must not be due to a physical disorder and always refer for a physical exam.

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Separation Anxiety Disorder

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Excessive anxiety over separation from home and whom attached. Must last 4 weeks and begin before age 18. Use early onset if before age 6.
-fear of separation from caretaker.
Stranger Anxiety occurs in infancy, approximately 8 months.

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Delirium and Dementia

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Delirium - abrupt onset of symptoms that fluctuate, "clouded sensorium."
Dementia - relatively stable symptoms that do not fluctuate, no clouded sensorium, long duration, must have disturbance in occupational & social functioning, characterized by multiple cognitive deficits.
Diagnose - psychometric and other mental status testing, measurement of activities on a daily living skills, & radiological techniques.

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Assessment/Intervention with Dementia

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1. Measure Memory Psychometric - "Recent vs. Remote:" short portable mental status questionnaire.
2. Measure Judgement Ability - often first sign families notice, use a Family Questionnaire.
3. Understand Orientation to Person (oriented x1), Place (oriented x2), and time (oriented x3) plus Spatial or Situational Orientation for utilization in treatment.

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4. Look at Affect - Depression vs. Dementia.
5. Monitor Intelligence and Cognition Ability (confabulation) - use the clock test.
6. Use of the technique "Reality Orientation & Validation Therapy"

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Types of Dementia

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Alzheimer's - abnormal nerve cells containing tangles & fibers and clusters of degenerating nerve endings (neuritic plaque).
Vascular Dementia - small repeated strokes in the brain.

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HIV Disease and AIDS

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HIV - virus
AIDS - disease
-approx 12 weeks after infection an individual can have a positive test.
-can be transmitted very soon after infection, so individual may not know they were infected.
-Normal "t cell" count can vary from 400 - 1700.
-T cell falls below 200 the diagnosis of AIDS is made.
-Newborns takes approx 18 months to be sure whether or not baby is infected.
-Pregnant women given AZT seem to have less change of their baby acquiring positive HIV status.
-all medication, particularly AZT, can be given as a precautionary measure if someone suspects infection (ie, needle stick).

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Substance Use Disorder Types

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Substance Abuse
Substance Dependence
Substance Intoxication
Substance Withdrawal

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Substance Abuse

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Viewed as less severe, continue use knowing it is causing harm. Does not apply to caffeine and nicotine.
Treatment: counseling, rehab, support groups.

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Substance Dependence

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Taking larger amounts with unsuccessful attempts to quit.
Treatment: counseling, rehab, support groups.

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Substance Intoxication

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Development of substance specific (reversible) syndrome, condition related to recent ingestion of psychoactive substance.
Treatment: counseling, rehab, support groups.

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Substance Withdrawal

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Body is physically dependent on the substance. Generally associated with either intoxication, abuse or dependence; types include: alcohol, barbiturates, opiates, amphetamines, cannabis, cocaine, PCP, hallucinogens, nicotine, and inhalants.
Treatment: counseling, rehab, support groups.

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Schizophrenic Disorder

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Criteria for diagnosis include characteristic psychotic symptoms.
The A's associated with the diagnosis: -Associative Disturbances
-Autism
-Alogia
-Affective Disturbances
-Ambivalence
Avolition

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Primary symptoms: delusions and hallucinations.
Treatment: anti-psychotic medication most common treatment, psychodynamic, behavioral and social learning, family therapy, community-based treatments (ie - half-way houses).

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Mood Disorder

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Disturbance in mood that disrupts many areas of an individual's function.
Treatment: medication - antidepressants, Lithium carbonate for mania, anti-anxiety for anxiousness, ECT used for depression.

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Bipolar I Disorder

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One or more manic episodes, usually with a history of depressive episodes.

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Bipolar II Disorder

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One or more depressive with at least one hypomanic episode.
*manic-depressive no longer used.

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Depression Disorders

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Presence of one or more depressive episodes with out history of manic or hypomanic episodes.

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Anxiety Disorder

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An unpleasant state characterized by subjective feelings of worry, apprehension, cognitive difficulties concentrating, behavioral restlessness, irritability, insomnia,somatic sweat, shortness of breath, etc.
Presentation in Anxiety: anxious clients present to PCP first; few say problem is anxiety and/or nervous problems; many present with physical and/or mental symptoms; somatic symptoms of anxiety are similar to those of organic disease. look for two or more organic symptoms that are generally unrelated; remember that anxiety causes somatic symptoms and visa-versa.

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Treatment: Medication, counseling, stop stimulants, medical exam/physical must be completed;

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Addressing Suicidal Behavior

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Ask direct questions.
**Clients are most likely to attempt suicide when they begin to feel better, not when they are in a deep depression.
-a "no" suicide agreement is an important step for the social worker to document and implement whenever suicide potential is suspected.
-ideation and intent. if clear, the worker should immediately recommend/seek in-patient hospitalization and document this.

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Differences between the sexes

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Men: physical sex is the avenue towards emotional intimacy.
Women: Emotional intimacy is the avenue towards physical sex.

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Similarities between the sexes

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-Both sexes fear intimacy, with the greatest fear of most individuals as "being left alone."
-Both sexes deem "good looks" as important in establishing and maintaining intimacy.

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Anorexia Nervosa

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-Intense fear of gaining weight.
-usually underweight
-disturbance in body image
-wont eat
-over exercise
-Amenorrhea
-refusal to maintain minimum normal body weight
-Resistance to treatment with strong denial
-can die from starvation
-one half of all anorexics are bulimics
-common co-conditions: substance abuse and depression
Treatment: get them to gain weight, behavioral rewards contingent on eating strong family/genetic link.

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Bulimia Nervosa

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-Episodes of binge eating (recurring)
-self-induced vomiting with laxatives
-diuretics or fasting
-sense of lack of control during eating binges
-chronic concern with body weight and shape
-2 binges per week for 3 months.
Treatment: group confrontation
**individuals are generally of normal weight.

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Cluster A (odd/eccentric behavior) Personality Disorder

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Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

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Cluster B (dramatic/emotional/erratic behavior) Personality Disorder

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Antisocial Personality Disorder (psycho/sociopath)
Borderline Personality Disorder (instability of self)
Narcissistic (grandiose sense of self-importance)
Histrionic Personality Disorder (overly dramatic behavior)

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Cluster C (fearful/anxious behavior) Personality Disorder

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Avoidant Personality Disorder (pattern of social discomfort)
Dependent Personality Disorder (dependent submissive)
Obsessiveness Compulsive Personality Disorder (perfectionism and inflexibility)

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Malingering

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-Voluntary produce symptoms in presence of exaggerated voluntary physical symptoms *there is an obvious recognizable goal
-Occupational Problem, parent-child problem, interpersonal problem, marital problem, family circumstances, noncompliance with medical treatment, bereavement, phase of life problem.