Lcsw Study Cards For Aswb Exam

Front 1

SOCIAL WORK PROCESS: Stages in the helping relationship

Back 1

A. Beginning, Middle & Ending Phases
B. Contact, Contract, Action, Termination

Front 2

SOCIAL WORK PROCESS: Problem-Solving Process

Back 2

1. Engagement; 2. Gathering Information; 3. Assessing/diagnosis; 4. Goal Setting; 5. Intervention; 6. Evaluation; 7. Termination

Front 3

SOCIAL WORK PROCESS: Interventive Roles

Back 3

* Consultant
* Advocate
* Case Mger.
* Catalyst
* Enabler
* Broker
* Mediator
* Facilitator
* Instructor
* Other

Front 4

SOCIAL WORK PROCESS: Interventive Skills

Back 4

* Relationship
* Communication (listening, observing, interviewing, verbal/nonverbal)
* Helping/problem-solving
* Resource Finding, linking & developing
* Professional use of self
* Working with different sizes of systems - individuals, group, institutions, communities

Front 5

SOCIAL WORK PROCESS: The Referral Process (6 stages)

Back 5

Stage 1: Clarifying the need/purpose
Stage 2: Researching resources
Stage 3: Discussing & selecting options w/client
Stage 4: Planning for initial contact
Stage 5: Initial contact b/w client & referral source
Stage 6: Follow up to see if need was met

Hint 5

*Keep in mind the client's right to self-determination*

Front 6

MODELS OF TX & THEORIES: Social Casework Models - Systems Theory

Back 6

A system is interacting parts contained w/in a boundary.
Systems are purposeful & have goals/objectives.

Hint 6

Focus: On the interaction among the parts of the system - whole effects each part.
Concepts: whole system greater than the sum of its parts; what affects one part of the system affects the whole system

Front 7

MODELS OF TX & THEORIES: Social Casework Models - Systems Theory - TERMS

Back 7

*Homeostasis - steady state order necessary for movement
*Input - accept input from environment
*Feedback - when output from systems is put back into the system
*Output - produce
*Throughput- processing the input/using

Hint 7

input---> throughput--->output

Front 8

MODELS OF TX & THEORIES: Social Casework Models - Systems Theory - TERMS

Back 8

*Entropy - no energy from the outside - using up its own energy and expiring - CLOSED
*Negative Entropy - counteracting, successful use of available energy

Front 9

MODELS OF TX & THEORIES: Social Casework Models - Systems Theory - TERMS

Back 9

*Equifinality - capacity to receive identical results from different initial condition

Front 10

MODELS OF TX & THEORIES: Social Casework Models - Systems Theory - Implications for practice

Back 10

1. Problems are defined in transactional terms - responsibility for change does not rest on identified client alone.
2. Client/worker unit of attention is expanded to include the LIFE Space/Field of relevant systems.
3. Human beings = active, purposeful, goal-seeking organisms whose development and functioning are outcomes of TRANSACTIONS b/w their GENETIC potential & their ENVIRONMENT plus degrees of freedom from the determining influence of either
4. Reorienting interventions toward growth, adaptive transactions & improved environments

Front 11

MODELS OF TX & THEORIES: Social Casework Models - Ecological/Life Systems Model

Back 11

Theory - Focuses on INTERRELATEDNESS between people & their environment
Emphasized "degree of fit" between person & environment.

Hint 11

Holistic & transactional (rather than linear).
Transactional relationships - problems arise as consequences of maladaptive transactions b/w person & his/her environment

Front 12

MODELS OF TX & THEORIES: Social Casework Models - Ecological/Life Systems Model - focus of intervention

Back 12

Interface b/w the client (person, family, group) and clients environment.
Aim of intervention: make client's environment more RESPONSIVE to his/her needs & to release the C's ADAPTIVE POTENTIAL by ALTERING THE TRANSACTIONS between C & environ.

Hint 12

Terms:
* Adaptedness - "goodness of fit" w/in the environ. Adaptation is a continuous process.
* Niche: status occupied by an individual/group w/in a given social system - associated with power and oppression.
* Habitat - individuals' physical & social setting w/in a cultural context.
* Positive stress - environmental demand perceived as a challenge & associated with POSITIVE feelings.
* Negative stress: discrepancy b/w demand & capacity for coping with it & associated w/Neg. feelings.
* Coping: psychological, physiological, behavioral response that is set in motion as a result of experience of emotional stress. Effective coping patterns lead to elimination of stress.

Front 13

MODELS OF TX & THEORIES: Social Casework Models - Functional Approach

Back 13

Based on a psychology of GROWTH W/THE CENTER OF CHANGE RESIDING IN THE CLIENT - NOT IN THE WORKER. Emphasis is on releasing client's power for choice/growth - Helping NOT treating.

Hint 13

Principles: time phases (beginning, middle, end); use of structure; de-emphasize dx; function of agency; use of relationship.
Worker & C enter into relationship w/lack of knowledge re: how it will turn out; W&C discover it together.

Front 14

MODELS OF TX & THEORIES: Social Casework Models - PLANNED SHORT TERM OR TASK-CENTERED TX

Back 14

Reid & Epstein
* RESTRICT duration of tx at outset - use interventions from learning theory & behavior mod to promote completion of a well-defined task

Hint 14

ASSESS, SET GOALS, DEFINE TASKS

Front 15

MODELS OF TX & THEORIES: Social Casework Models - PLANNED SHORT TERM OR TASK-CENTERED TX - CONT

Back 15

Primary Aim: quickly ENGAGE C's in the problem-solving process & to MAXIMIZE THEIR RESPONSIBILITY for tx outcome

Hint 15

Problem partialized into clearly delineated tasks to be addressed consecutively. C MUST be able to identify a precise psychosocial problem & a solution, C must be willing to WORK on the problem.
ASSESSMENT focuses on helping C identify the primary problem & explore circumstances surrounding the problem.

Front 16

MODELS OF TX & THEORIES: Social Casework Models - Problem Solving Approach

Back 16

ASSUMPTIONS: all human living is a problem-solving process, ego seen as mechanism for solving problems. Inability to cope with problem is due to some lack of motivation, capacity, or opportunity to solve problems in an appropriate way.

Hint 16

C's are people whose usual problems-solving capacities/resources have BROKEN DOWN, are IMPAIRED, MALADAPTIVE. Relationship with W is reality based.

Front 17

MODELS OF TX & THEORIES: Social Casework Models - Problem Solving Approach - goals of action

Back 17

1. RELEASE, ENERGIZE, GIVE DIRECTION to C's motivation by minimizing disabling anxiety/fears; PROMOTING the support/safety that encourage a lowering of disabling defenses, heightening of reward expectation, freeing of ego energies for investment in task @ hand.
2. RELEASE, REPEATEDLY EXERCISE the C's mental, emotional & action capacities for coping w/problem and/or himself
3. Make accessible to the C RESOURCES & OPPORTUNITIES necessary to the solution

Hint 17

FOUR P'S: PERSON, PROBLEM, PLACE (AGENCY) PROCESS (THERAPEUTIC RELATIONSHIP).

Front 18

MODELS OF TX & THEORIES: Social Casework Models - Psychosocial Approach

Back 18

considers C in the context of his interaction/transactions w/the external world - formal medical, psychological, social hx is obtained.
DX based on history.
Tx is differentiated according to needs of C and results in a modification of person/environment or both and exchange b/w them

Front 19

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - FREUD & PSYCHOANALYTIC THEORY

Back 19

Man = product of his past & tx involves dealing w/the repressed material in the UNCONSCIOUS

Hint 19

ID, EGO, SUPEREGO viewed as the stable structures in the anatomy of the personality

Front 20

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - FREUD & PSYCHOANALYTIC THEORY: id, ego, superego

Back 20

ID = unconscious source of MOTIVES & DRIVES; PLEASURE PRINCIPLE - seeks immediate gratification.
EGO: emerges @ approx. 6 months. Represents LOGIC & REASON. Mediates b/w Id, Superego & reality - reality principle.
SUPEREGO: incorporates parental & societal values/standards into personality - develops b/w 4-5 yrs.

Front 21

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - FREUD & PSYCHOANALYTIC THEORY: concepts

Back 21

UNRESOLVED CONFLICT: basis for psychopathology. Inability of ego to reconcile demands of the id, the superego & reality produces conflict which leads to state of psychic distress (anxiety)

Hint 21

FIXATION: failure to resolve a conflict @ any stage of development

Front 22

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - FREUD & PSYCHOANALYTIC THEORY: assumptions

Back 22

1. DETERMINISM: functioning of mind & ordering of ideas are NOT random - all thoughts, feelings, behaviors related to PRIOR experiences.
2. STRUCTURAL MODEL: Mind has 3 layers of mental activity: UNCONSCIOUS; PRECONSCIOUS; CONSCIOUS.
3. DYNAMIC PRINCIPLE: understand individual in terms of conflicts - unresolved conflict = anxiety.
4. GENETIC PRINCIPLE: early years of childhood extremely important in personality dev.

Front 23

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - FREUD & PSYCHOANALYTIC THEORY: stages of psychosocial development

Back 23

1. Oral
2. Anal
3. Phallic
4. Latency
5. Genital

Hint 23

libidinal energy invested in a different organ system at each stage. Cathexis = investment of energy

Front 24

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - FREUD & PSYCHOANALYTIC THEORY: 4 Processes/technique

Back 24

1. Clarification
2. Confrontation
3. Interpretation
4. Working through goal to resolve intrapsychic conflict

Hint 24

Primary technique in psychoanalytic psychotherapy is ANALYSIS (dreams, resistances, transferences, free association)

Front 25

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - EGO PSYCHOLOGY (Anna Freud/Erik Erikson)

Back 25

FOCUSES ON: rational, CONSCIOUS processes of the ego.
Personality = open system with progressive development of personality THROUGHOUT THE LIFE CYCLE (versus Freud - personality fixed in childhood)

Hint 25

Here and Now assessment.
Tx focuses on: ego functioning of individual:
1. how the person behaves in relation to situation
2. reality testing - situation/persons' perception of situation
3. coping abilities - ego strengths
4. capacity for relating to worker(s)

Front 26

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - EGO PSYCHOLOGY - terms

Back 26

Ego support - support of functions of ego (strengths, defenses, reality testing)
Ego defensive functions - unconscious, involved in resolving conflicts
Ego autonomous functions - conscious, conflict-free, adaptive functions

Hint 26

Goal of tx: maintain and enhance ego's control & mgmt. of reality stress and its effects

Front 27

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - INDVIDUAL PSYCHOLOGY (Alfred Aldler)

Back 27

Individuals have a single drive/motivation behind all their behavior and that motivation is a "striving for perfection"

Hint 27

Person always drawn towards the future to reach fulfillment & perfection.
Aim of THERAPY: develop a more adaptive lifestyle by OVERCOMING FEELINGS OF INFERIORITY AND SELF-CENTEREDNESS and to contribute more towards WELFARE OF OTHERS.

Front 28

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - INDVIDUAL PSYCHOLOGY (Alfred Aldler): terms

Back 28

FEELINGS OF INFERIORITY: when children experience a sense of perceived/real weakness, they develop feelings of inferiority for which they COMPENSATE ADAPTIVELY (ie - work hard and become good at something else) or MALADAPTIVELY (ie - overcompensate by striving for superiority & power from others).
LIFESYLE: way individuals live/cope w/their lives - determined early in life by factors (birth order, pampering or neglect by his/her parents.

Hint 28

SOCIAL INTEREST/COMMUNITY FEELING: healthy people have broad social concern & want to contribute to the welfare of others. Unhealthy people (overwhelmed by feelings of inferiority) overcompensate by striving for superiority & power over others, become very self-centered.

Front 29

MODELS OF TX & THEORIES: PSYCHODYNAMIC MODELS - Self Psychology - Kohut

Back 29

Defines self as CENTRAL organizing & motivating force in personality.
As result of receiving EMPATHIC RESPONSES from early caretakers (SELF-OBJECTS), childs needs are met and child develops a strong sense of self-hood.
"EMPATHIC FAILURES" by caretakers result in self disorder or lack of self-cohesion.

Hint 29

Goal of tx: help individual develop a greater sense of self cohesion through THERAPEUTIC REGRESSION; pt. re-experiences frustrated selfobject needs.
Three self-object needs:
1. Mirroring - validates child's sense of a perfect self;
2. Idealization: child borrows strength from others; identifies w/someone more capable.
3. Twinship/twinning: child needs alter ego for a sense of belonging or humaneness.

Front 30

MODELS OF TX & THEORIES: HUMANISTIC/EXISTENTIAL MODELS - Rogerian counseling/Person/Client-Centered Therapy

Back 30

Individuals have a single force in life/motivation (actualizing tendency) to develop to their fullest potential.
To strive towards growth, personality must remain organized and unified. When there is incongruity b/w the concept of self and experience self becomes disorganized, feels anxiety, behaves maladaptively.

Hint 30

Anxiety is dealt w/by denying, selectively perceiving, or distorting external information.

Front 31

MODELS OF TX & THEORIES: HUMANISTIC/EXISTENTIAL MODELS - Rogerian counseling/Person/Client-Centered Therapy - tx

Back 31

Tx: in right therapeutic environ., C achieves congruence b/w herself and experience, and moves toward fullest potential. Core conditions needed in therapist include:
1. Unconditional positive regard
2. Empathic understanding/Accurate empathy
3. Therapeutic genuineness, or congruence.

Hint 31

Conditions that must be met by the client:
1. C's incongruence (aware of hurting and wants to do something about it)
2. C's perception of therapist's conditions ( able to recognize and accept T's efforts to reach them).
3. C's self-exploration: basic activity of engaging in self-exploration - self disclosure; exploration of self; self-awareness

Front 32

MODELS OF TX & THEORIES: HUMANISTIC/EXISTENTIAL MODELS - Gestalt Therapy (Fritz Perl)

Back 32

A person seeks heightened awareness through DRAMATIZATION of split-off parts of the self. THOUGHT, FEELING, ACTIVITY.
Process-oriented approach - focuses on awareness, wholeness, contact, and self-regulation. Integration of mind, body, thoughts, action are central to approach.

Hint 32

Emphasis on here and now. Therapist deals directly with whatever she observes and helps C to be more aware of his/her experiences, grow through experiental learning, develop good contact skills, and take responsibility for his thoughts/feelings/actions.

Front 33

MODELS OF TX & THEORIES: HUMANISTIC/EXISTENTIAL MODELS - Gestalt Therapy (Fritz Perl) - tools

Back 33

Contraindicated for C's who have problems maintaining self-control.
Dramatization is key to approach - psychodrama, role plays, empty chair technique.
Directed awareness.

Front 34

MODELS OF TX & THEORIES: HUMANISTIC/EXISTENTIAL MODELS - Transactional Analysis (Eric Berne)

Back 34

3 Ego states - PARENT, ADULT, CHILD. Interactions b/w persons are transacted between certian ego states of one individual with certain ego states of another individual.
Each child writes a LIFE SCRIPT based on who is "ok". Script is acted out through individuals' life unless they recognize script and change it.

Hint 34

4 LIFE POSITIONS:
1. I'M OK - YOU'RE OK
2. I'M NOT OK - YOU'RE NOT OK
3. I'M OK - YOU'RE NOT OK
4. I'M NOT OK - YOU'RE OK.
Game analysis - client made aware through psychodrama/direct confrontation.
Scrip tx: worker clarifies life script, gives counter injunction to bring about script reversal.
Strokes - physical contact
Contracting: change defined by tx contract that is made b/w adult and adult ego states - client and therapist make agreement about goals and methods of tx

Front 35

MODELS OF TX & THEORIES: POSTMODERN MODEL

Back 35

POSTMODERN MOVEMENT is based on the premise that truth is not absolute. This movement arose in rxn to modernism, a movement committed to using scientific inquiry in the search for individual laws and truths that would explain all natural phenomena.

Front 36

MODELS OF TX & THEORIES: POSTMODERN MODEL - NARRATIVE THERAPY

Back 36

No objective reality - people construct knowledge about themselves out of conversation & social interaction. Meaning of events involves constructing a "story" to make sense out of life experiences.
Key concepts:
EXTERNALIZING THE PROBLEM: separating the C from the problem.
PROBLEM-SATURATED STORIES: these are the stories that the C has co-constructed in interactions w/others.
MAPPING THE PROBLEM'S DOMAIN: effect of the problem over time & domains.
UNIQUE OUTCOMES: uncovering new truths/strengths.
SPREADING THE NEWS: letting others know when C's start experiencing positive change (celebrations, awards - public acknowledgment)

Hint 36

Goal of Narrative therapy: help clients deconstruct their story lines and change the stories so they can discover new realities & truths for themselves.
Client is expert.

Front 37

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: SOCIOBEHAVIORAL SCHOOL

Back 37

THEORY OVERVIEW: analysis and tx of behaviors - behaviors determine feelings. changing behaviors will also change/eliminate undesired feelings. Goal - modify behavior.
FOCUS: on observable behavior, focus of intervention is on a target symptom, a problem behavior or environmental condition RATHER THAN PERSONALITY.

Hint 37

2 classes of behavior:
* RESPONDENT - involuntary (anxiety, sexual response) - automatically elicited by certain behavior (stimulus elicits a response).
* OPERANT: voluntary (walking/talking) - controlled by its consequences in the environment.

Front 38

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: symptoms

Back 38

Symptoms are NO DIFFERENT from other behavioral responses:
1. they involve respondent or operant behavior or both
2. they were learned through process of conditioning
3. they obey the same laws of learning & conditioning as "normal behavior"
4. they are amenable to change

Hint 38

targets of change = specific behavior.
Best know applications of behavior modification are: SEXUAL DYSFUNCTION, PHOBIC DISORDERS, COMPULSIVE BEHAVIORS (OVEREATING/SMOKING), TRAINING OF MR AND AUTISTIC CHILDREN.

Front 39

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PARADIGMS - respondent/classical conditioning (Pavlov)

Back 39

Stimulus--->Response approach to behavior.

Responding to a neutral stimulus in the same was as to a unconditioned stimulus.

Learning occurs as a result of pairing previously neutral (conditioned) stimulus with an unconditioned (involuntary) stimulus so that the conditioned stim. eventually elicits the response normally elicited by unconditioned stim.

Hint 39

unconditioned stim -----> uncond. response
unconditioned stim + conditioned stim -----> uncond. response
conditioned stim ------> conditioned response (neutral)

Conditioned nausea in a person receiving CHEMO for cancer = classical conditioning.

Front 40

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PARADIGMS - Operant Conditioning (BF Skinner)

Back 40

Behavior has an effect/operates on the environment.
Antecedent -----> Response (Behavior) -------> Consequence (+ or -)

Antecedent events(stimuli) precede behaviors, which are followed by consequences.

Hint 40

REINFORCING CONSEQUENCES: increase the occurrence of the behavior.
(ex: child eats diner to get dessert)
PUNISHING CONSEQUENCES: decrease the occurrence of the behavior (ex: employee finishes work on time to avoid being fired)

Front 41

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PARADIGMS - MODELING

Back 41

Observational learning - learn by observing others

Front 42

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PARADIGMS - Operant Techniques

Back 42

1. POSITIVE REINFORCEMENT: increases probability that behavior will occur (ex: worker praises, gives tokens).
2. NEGATIVE REINFORCEMENT: behavior increases because of negative (aversive) stimulus is removed (ie - remove shock)
3. POSITIVE PUNISHMENT: presentation of undesirable stimulus following behavior for purpose of decreasing/eliminating that behavior (ie - hitting, shocking)
4. NEGATIVE PUNISHMENT: removal of desirable stimulus following a behav. for purpose of decreasing/eliminating that behavior (ie - removing dessert, token).
5. CHAIN: exist when one performance produces the conditions that make the next one possible.
7. FADING: used to describe a procedure for gradually changing one stimulus controlling a behavior to another stim.
7. EXTINCTION: withholding a reinforcer that normally follows a behav. w/consequent decline in the behavior. behav. that fails to produce reinforcement will eventually cease.
8. PRESCRIPTIONS: worker tells C specifically how to behave in certain situations & expects the C to behave in that way

Hint 42

Reinforcement - increases frequency of behavior.
Punishment - decreases frequency of behav.

Front 43

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: SYSTEMATIC DESENSITIZATION

Back 43

anxiety inhibiting response cannot occur @ the same time as the anxiety response.

Anxiety producing stim. is paired w/relaxing producing response so that eventually anxiety-producing stim produces a relaxation response. Fear of dreaded object, person, situation is gradually approached, at each step the C's rxn of fear is overcome by pleasant feelings engendered as the new behav. is reinforced by receiving a reward.

Hint 43

Reward could be a compliment, gift, or relaxation

Front 44

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: In Vivo Desensitization

Back 44

pairing and movement through anxiety hierarchy from LEAST to MOST provoking situation.

Takes place in "real" setting

Front 45

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Aversion Therapy

Back 45

Any tx. aimed at reducing the ATTRACTIVENESS of a stimulus or a behavior by repeated pairing of it with an AVERSIVE STIMULATION of real or covert nature.

Hint 45

exameple of this in treating alcoholism with antabuse

Front 46

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Shaping

Back 46

Method used to train a new behavior by prompting & reinforcing successive approximations of the desired behavior

Front 47

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Flooding

Back 47

tx. procedure in which an individuals' anxiety is extinguished by prolonged imaginal or in vivo exposure to high-intensity feared stimuli

Front 48

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Modeling

Back 48

method of instruction that involves an individual (model) demonstrating the behavior to be acquired by the observer

Front 49

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Assertiveness Training

Back 49

procedure used to teach people how to express their positive & negative feelings and to stand up for their rights in ways that will not alienate others

Front 50

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Contingency contract

Back 50

agreement between 2 or more individuals that specifies behavior change to take place in one or more of the individuals; the positive & negative consequences that will result if agreement is not honored

Front 51

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: RET - Rational Emotive Therapy

Back 51

cognitively oriented therapy which the therapist seeks to change the C's irrational beliefs by argument, persuasion, & rational reevaluation & by teaching the C to counter self-defeating thinking with new, nondistressing self-statements

Front 52

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Sensate Focus

Back 52

An in vivo desentization & communication enhancement procedure used in sex therapy - MASTERS & JOHNSON.
involves couple providing each other with pleasure sensory stimulation through structured body massage (pleasuring). Pleasure & relaxation are paired with graded sexual contact. Used to desensitize couples TO PERFORMANCE ANXIETY

Front 53

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Squeeze technique

Back 53

procedure for delaying ejaculation

Front 54

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Self-Instructional training

Back 54

CB mod. procedure in which C learns to covertly emit a set of task-relevant self-instructions that guide behavior & that can help reduce anxiety and increase problem-solving ability

Front 55

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Time Out

Back 55

time-out from positive reinforcement - removal of opportunity to obtain positive reinforce.

Front 56

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - BEHAVIOR MODIFICATION: BEHAVIORAL PROCEDURE: Token Economy

Back 56

intervention environment in which an individual/individuals receive tokens as reinforcement for performing specified behaviors.
Tokens function as currency within the environment & can be exchanged for desired goods, services, privileges

Front 57

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - COGNITIVE & COGNITIVE BEHAVIORAL THERAPIES: Cognitive Therapy - Beck & Ellis

Back 57

What a client tells himself (cognitions/perceptions) influences his behavior & his feelings and how he responds to problematic situations.
Knowledge about HOW a person thinks is critical to understanding/influencing behavior change.
MOST EMOTIONAL/BEHAVIORAL DYSFUNCTION IS THE RESULT OF MISTAKEN BELIEFS AND FAULTY PATTERNS OF THOUGHT. CT helps C's identify, evaluate, and change dysfunctional thinking patterns and mistaken beliefs (COGNITIVE RESTRUCTURING) that impair their ability to effectively function & problem solve.
Basic tenets of Cognitive Therapies:
* Thinking is a basic determinant of behavior
* focus of tx is on present - present thinking motivates behavior
* Clients must realize connection b/w their problems & their misconceptions (faulty thinking) and must be responsible for changing them

Hint 57

Approach is ACTIVE, COLLABORATIVE, STRUCTURED, TIME-LIMITED, GOAL-ORIENTED, PROBLEM FOCUSED

Front 58

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - COGNITIVE & COGNITIVE BEHAVIORAL THERAPIES: Cognitive Therapy - Steps in Cognitive Restructuring

Back 58

1. accepting that their self statements, assumptions & belifs determine/govern their emotional rxn to life events
2. Identifying dysfunctional beliefs & patterns of thoughts that underlie their problems
3. Identifying situations that evoke dysfunctional cognitions
4. Substituting functional self-statements in place of self-defeating thoughts
5. Rewarding themselves for successful coping efforts

Front 59

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - COGNITIVE & COGNITIVE BEHAVIORAL THERAPIES: CBT

Back 59

many modes of therapy & combines theoretical & practice approaches of cognitive & behavioral approaches.
Techniques: problem-solving, assertiveness, relaation training, desensitization, exposure techniques.
Very versatile, modified for use with many different disorders, settings, populations

Hint 59

managed care companies/requirements - brief tx, well-delineated techniques, goal and problem-oriented, empirically-supported evidence of its effectiveness!

Front 60

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - COGNITIVE & COGNITIVE BEHAVIORAL THERAPIES: ELLIS (RET)

Back 60

Rational Emotive Therapy

Albert Ellis focuses on IRRATIONAL beliefs and the chain of effects.

External event (A)---> Irrational belief (b)-----> Emotion/Behavior (C)

Front 61

MODELS OF TX & THEORIES: BEHAVIORAL THERAPIES - COGNITIVE & COGNITIVE BEHAVIORAL THERAPIES: BECK (Cognitive Therapy of Depression)

Back 61

3 specific concepts to explain depression:
1. Cognitive triad - three major cognitive patterns: 1 - negative view of self; 2. negative interpretation of ongoing experiences, 3. Negative view of the future
2. Schemas (stable, cognitive patterns)
3. Cognitive errors or faulty information processing

Front 62

MODELS OF TX & THEORIES: BRIEF THERAPY

Back 62

Assessment, Client Engagement, Rapid Implementation of Change Strategies.
6-20 Sessions.
Goal: provide C's w/tools to change basic attitudes and behaviors, and to handle a variety of underlying problems rather than long-scale or pervasive change.
Focus is on PRESENT.
Best outcomes for brief therapy may depend upon: clinician skills, comprehensive assessments, and selective criteria for eligibility

Hint 62

* Problem/solution focused - target symptoms NOT cause of symptoms.
* Clearly defined goals related to specific change.
* Approaches are understandable to both C and therapist.
* Produce immediate results.
* Easily influenced by personality & counseling style of therapist.
* Rapid establishment of strong working relationship.
* Therapeutic style is highly active, empathic, sometimes directive.
* C is responsible for change
* Early in process - focus in enhancing C's sense of self-efficacy and sense of hope that change is possible.
* Termination is discussed from the beginning.
*Outcomes are measurable.

Front 63

MODELS OF TX & THEORIES: FAMILY THERAPY (OVERVIEW)

Back 63

* Tx family as a unified whole - system of interacting parts in which change in any part affects the functioning of the whole.
* Social roles and interpersonal interaction are focus.
* Real behaviors & communication that affect the current life situation are emphasized.
* Goal: interrupt the circular pattern of pathological communication & behaviors and replace it with a new pattern that will sustain itself w/o the dysfunctional aspects of the original pattern.

Hint 63

A healthy family has:
Flexibility; Consistent structure; Effective exchange of information

Front 64

MODELS OF TX & THEORIES: FAMILY THERAPY (OVERVIEW - Issues)

Back 64

* Estb. contradt w/the family
* Examining alliances/groupings w/in the family
* Identifying where the power resides.
* Relationship of each family member to the problem.
* How the family relates to the outside world
* Influence of family hx on current family interactions
* Communication patterns - complementarity or symmetrical
* Family rules that regulate patterns of interaction
* Meaning of presenting symptom in maintaining family homeostasis
* Flexibility of structure/accessibility of alternative action patterns
* Familys' developmental stage
* Sources of external stress/support
* Family homeostasis

Front 65

MODELS OF TX & THEORIES: FAMILY THERAPY (OVERVIEW - Interventions)

Back 65

Define family stages & tasks. Worker explains normal family development & life cycle crises to family & relates material to family's current problems

Front 66

MODELS OF TX & THEORIES: FAMILY THERAPY Interventions - Emotional Cutoff

Back 66

Enmeshed family member has attempted to break all emotional ties to family members - this is an unsuccessful technique. Worker helps the client to re-establish contact and to learn successful techniques for disengaging emotionally from family members

Front 67

MODELS OF TX & THEORIES: FAMILY THERAPY Interventions - Triangulation

Back 67

Worker points out how family members - by words or behaviors - talk through others. Encourages them to communicate directly with each other

Front 68

MODELS OF TX & THEORIES: FAMILY THERAPY Interventions - Coaching

Back 68

young adults/adults are guided in their efforts to differentiate themselves from their families of origin

Front 69

MODELS OF TX & THEORIES: FAMILY THERAPY Interventions - Family Rules

Back 69

Worker explicitly defines the rules by which the family operates. Previously, family members have not consciously recognized the rules

Front 70

MODELS OF TX & THEORIES: FAMILY THERAPY Interventions - Genogram

Back 70

Family history is diagrammed

Front 71

MODELS OF TX & THEORIES: FAMILY THERAPY Interventions - Restructuring Roles

Back 71

Establishing generational boundaries w/the parents in charge.
Modifying patterns in alcoholic/violent/incestuous and other dysfunctional family systems by (1) shifting family interaction within the interview (2) assigning HW tasks (3) defining interactional patterns (4) sculpting/using other psychodrama techniques

Front 72

MODELS OF TX & THEORIES: FAMILY THERAPY APPROACHES: Multigenerational/Intergenerational Approach, Murray Bowen

Back 72

Problems are a result of fusion among family members due to INADEQUATE INDIVIDUATION. Tension in family resolved by TRIANGULATING a third party into interaction.
NO direct communication - people tend to talk through other people. Therapist becomes a coach who teaches clients effective interactional patterns.
Goal of therapy: increase differentiation of individuals w/in the family & avoid need for triangulation

Hint 72

Triangulation - formation of triangles w/in the family - usually serves to lessen the difficulties in the initial dyad

Front 73

MODELS OF TX & THEORIES: FAMILY THERAPY APPROACHES: Structural Family Therapy, Salvador Minuchin

Back 73

stresses importance of FAMILY ORGANIZATION for functioning of group and well being of its members.
Worker - JOINS/ENGAGES the family in an effort to restructure it.
FAMILY STRUCTURE: invisible set of functional demands organizing interaction among family members.

Hint 73

Boundaries and rules determining who does what/where/when are crucial in three ways:
1. interpersonal boundaries define INDIVIDUAL family members & promote their differentation & autonomous yet interdependent functioning. Dysfunctional families tend to be characterized by either a pattern of RIGID ENMESHMENT OR DISENGAGEMENT.
2. Boundaries w/the outside wold define the family unit - but boundaries must be PERMEABLE enough to maintain a well-functioning OPEN system allowing contact and RECIPROCAL EXCHANGES WITH THE SOCIAL WORLD.
3.HIERARCHICAL ORGANIZATION IN FAMILIES of all cultures are maintained by: generational boundaries, rules differentiating parent/child roles, rights & obligations.
Term: ENACTMENT OF SITUATIONS: enacting the problem situation during the interview

Front 74

MODELS OF TX & THEORIES: FAMILY THERAPY APPROACHES: Strategic Family Therapy (Jay Haley/Palo Alto Group)

Back 74

Goal of therapy: solve the particular problem that is presented. The symptom is regarded as a communicative act that is part of a repetitive sequence of behaviors among family members, serving a function in the interactional network.
Therapy focuses on problem resolution by ALTERING THE FEEDBACK CYCLE that maintains the symptomatic behavior.
Workers task is to formulate problem in solvable, behavioral terms and design an intervention plan to change the dysfunctional family pattern.

Hint 74

TECHNIQUES: RELABLING, REFRAMING, DIRECTIVES, PARADOXICAL INSTRUCTIONS

RELABLING: alter meaning of behavior or redefine the situation so the perceived meaning of the behavior is less negative.

PARADOXICAL INSTRUCTION: prescribe the symptomatic behavior so the pt. realizes they can control it; uses the strength of the resistance to change in order to move them toward goals

Front 75

MODELS OF TX & THEORIES: FAMILY THERAPY APPROACHES: Communication/Interaction Family Therapy (Virginia Satir)

Back 75

uses communication theory to examine dysfunctional family patterns.
Worker develops working alliance w/the family, teaches family members how their system is dysfunc. through "in vivo" therapeutic experiences, and helps family members overcome their fear of change.

Hint 75

Family roles based on communication patterns: PLACATER, BLAMER, LEVELER, DISTRACTER

Front 76

MODELS OF TX & THEORIES: FAMILY THERAPY APPROACHES: Psychodynamic Approach - Ackerman

Back 76

Integrates ideas from psychoanalytic and object relations theory w/principles of family systems.
Family dynamics are reflection of interactions b/w intrapsychic factors, and social cultural and environmental factors.
Worker tries to develop empathic working alliance to help clients achieve greater harmony b/w individual and family needs.

Front 77

MODELS OF TX & THEORIES: FAMILY THERAPY APPROACHES: Behavioral Family Therapy Approach

Back 77

based on social learning theory and exhange theory - behavior is learned and maintained by contingencies in the individuals social environment.
Goal; teach more effective ways of dealing w/one another by changing the consequences of the behavior/altering reinforcements

Front 78

MODELS OF TX & THEORIES: GROUP THERAPY: Social Group Work

Back 78

Goal of SW groups is to help individuals maximize their own social functioning.
Worker focuses on helping each member change his/her environment or behavior through interpersonal experience.
Emphasis on conscious components (rather than unconscious motives).
Members help each other change/learn social roles in a the particular positions hey hold or would like to occupy in the social environment.

Hint 78

Common group goal: worker comes to an agreement w/group regarding purpose, function, and structure of group.
Group is the major helping agent:
* common social tasks in a particular situation observed by members/leaders; * Management of self in such a way to cope w/social relations and tasks; * Socially functional behavior is emphasized - effectiveness of task performance, responsibility to others, and satisfaction of self

Front 79

MODELS OF TX & THEORIES: GROUP THERAPY: Group Psychotherapy Overview and Stages

Back 79

Unique microcosm in which members gain more knowledge & insight into themselves for purpose of making changes in their lives.
Focus of group psychotherapy: tx of pathology or illness

Hint 79

STAGES OF GROUP DEVELOPMENT:
1. Pre-affiliation - trust (forming)
2. Power & Control - struggles for indiv. autonomy & group identification (storming)
3. Intimacy - utilizing self in service of group (norming)
4. Differentiation - acceptance of each other as distinct individual (preforming)
5. Separation/termination - independence (adjourning)

Front 80

MODELS OF TX & THEORIES: GROUP THERAPY: Group Psychotherapy - How Groups Help/Curative Universal Factors

Back 80

* Instillation of hope
* Universality
* Altruism
* Interpersonal learning
* Self-understanding & insight
* Existential learning

Front 81

MODELS OF TX & THEORIES: GROUP THERAPY: Group Psychotherapy - factors in group cohesion

Back 81

* Group side: 5-10
* Homogeneity: similarity of group members
* Participation in goal/norm setting for group
* Interdependence: dependent on one another for achievement of common goals
* External threat: increases cohesiveness
* Member stablility: frequent change in membership results in less cohesiveness

Hint 81

Contraindications for group:
* Crisis
* Suicidal
* Compulsive need for attention
* Actively psychotic
* Paranoid

Group concepts:
GROUP POLARIZATION: during group decision making when discussion strengthens a dominant point of view & results in a shift to a more extreme position than any of the members would adopt on his/her own.
GROUPTHINK: when high group cohesion & loyalty to group and group member seriously undermines decision making in order to maintain the sense of "we-ness", group members fail to consider ALL their alternatives & options possibly resulting in a poor decision. Group leader can counteract groupthink by placing positive value on open inquiry

Front 82

MODELS OF TX & THEORIES: CRISIS INTERVENTION

Back 82

Lime-limited. 4-6 weeks
Process of actively influencing the psychosocial functioning of individuals during a period of disequilibrium/crisis.
Goals are to alleviate stress & mobilize psychological capabilities and social responses.

Hint 82

Goals:
1. relieve impact of stress w/emotional and social resources;
2. return a person to previous level of functioning (equilibrium); 3. help strengthen coping mechanisms during crisis period and develop adaptive coping strategies.

Here & Now; therapist highly active/involved. Sets specific goals and tasks in order to increase the clients sense of MASTERY AND CONTROL.

ANTICIPATORY GUIDANCE: this is a preventative measure that helps prepare C's for dealing w/future stresses by planning coping strategies to use in those situations.

PRECIPITATING EVENT OF CRISIS: does not have to be a major event... may be the "last straw" in a series of events that exceed the clients ability to cope

Front 83

MODELS OF TX & THEORIES: SOCIAL ROLE THEORY

Back 83

Role: behavior prescribed for an individual occupying a designated status.

Role behavior: how status occupant should act toward an individual with whom his status rights & obligations put him in contact - a basic script for behavior which is learned in the process of socialization.

STATUS: generally implies a relationship to another person - set of rights/obligations that regulate transactions with individuals of other statuses (ie - mother, middle class)

SOCIAL AND INDIVIDUAL DETERMINANTS OF ROLE BEHAVIOR: person's needs; persons ideas of mutual obligations and expectations that have been invested in the particular status he undertakes; compatibility or conflicts between persons conception of obligations and expectations and those held by the other person with whom he is in a reciprocal relationship.

Front 84

MODELS OF TX & THEORIES: SOCIAL ROLE THEORY - Terms

Back 84

ROLE AMBIGUITY: roles for which no place has been made in the social system - lacks regularized expectations.

ROLE COMPLEMENTARITY: exists when the reciprocal role of a role partner is carried out in the expected way - ie- parent/child

ROLE DISCOMPLEMENTARITY: results when different roles conflict or when the role expectations assigned by others differs from one's own

ROLE REVERSAL: roles are opposite to that which is appropriate.

FAILURE IN ROLE COMPLEMENTARITY: cognitive discrepancy; discrepancy of roles; allocative discrepancy; absence of instrumental means; discrepancy in cultural value orientation

ROLE ALLOCATION: Ascribed - automatically by age, sex; Achieved - by occupation; Adopted - satisfy some need of the individual; Assumed -

EXPLICIT ROLES: concious and exposed to observation

IMPLICIT ROLE: uncousious (client acting like dependent child)

ROLE CONFLICT: incompatible or conflicting expectations

PRESCRIPTION: behavior that should/ought to be preformed

SANCTIONING: behavior with the intent of modifying another's behaivor, usually toward conformity

LOCUS OF CONTROL: the extent to which an individual believes that life events are under his control (internal locus of control) or under the control of external forces (external locus of control)

Front 85

MODELS OF TX & THEORIES: SOCIAL ROLE THEORY - Bases of social power

Back 85

* COERCIVE: power from control of punishments

* REWARD: power from control of rewards.

* EXPERT: power from superior ability or knowledge

* REFERENT: power from acceptance as standard for self evaluation, likeability, attracted to or identifies with person with power.

* LEGITIMATE: power from having legitimate authority.

* INFORMATIONAL: content of message leads to new cognitions

Front 86

MODELS OF TX & THEORIES: STRENGTH PERSPECTIVE

Back 86

People have capacity to grow, change, and adapt. Humans are resilient and survive and thrive despite difficulties.

Strength (def): any ability that helps an individual/family confront and deal with a stressful life situation or encounters with the environment and to use the challenging situation as a stimulus for growth

Focus: understanding clients on the basis of their strengths/resources and mobilizing the resources to improve the clients situation. Focusing on strengths and actively collaborating with the client equalizes the power balance b/w C and SW'er.

Front 87

MODELS OF TX & THEORIES: RESILIENCE

Back 87

ability to withstand and rebound from adversity.
Traits associated w/resiliency: social competence; autonomy; problem solving; sense of purpose/belief in future.

3 protective factors in a persons environm. that are important in eliciting/fostering resilience:
1. caring relationships that establish safety & basic trust; 2. high expectations that convey a belief that a person can rise to a challenge; 3. Opportunities to participate and contribute.

Front 88

MODELS OF TX & THEORIES: THE PHASES OF HELPING - BEGINNING PHASE

Back 88

1. engagement
2. assessment of situation in order to select appropriate goals and means of attaining them
3. planning how to employ these means

* Goals/means then incorporated into a contractual agreement b/w client and worker.

Hint 88

important to consider how client feels about coming for help & to deal w/any negative feelings (involuntary tx) - very little in the C can be changed until negative feelings are reduced.

Contract specifies: problems to be worked on, goals to reduce the problem, C and worker's roles in process, time, place, fee, frequency of mtgs.

Front 89

MODELS OF TX & THEORIES: THE PHASES OF HELPING - MIDDLE PHASE

Back 89

Implement change plan & carry out activites to attain goals.
Change in one system may bring about changes in others.
Modify feelings by letting clients ventilate.

Hint 89

Change strategies:
MODIFY THOUGHTS: teach how to problem solve, alter self concepts by modifying self-defeating statements, make interpretations to increase the C's understanding about the relationship b/w events in his life.

MODIFY ACTIONS: use behavior mod techniques (reinforcement, punishment, modeling, role playing)

SYSTEM INTERVENTIONS: C's problem is response to forces w/in larger system and whether change can be most readily attained by change in the impact of that system on the individual.

Thoughts can be modified by feedback from others, behaviors can be modified through actions of others in a system.

Worker can also advocate for C and seek to secure change in a system on behalf of the C.

Worker can be a mediator by helping the C and/or system to negotiate w/each other so that each may attain their respective goals.

Front 90

MODELS OF TX & THEORIES: THE PHASES OF HELPING - ENDING PHASE

Back 90

W & C:
1. Evaluate the degree to which the C's goals have been attained;
2. Cope w/a series of issues related to the ending of the relationship
3. Plan for subsequent steps the client may take relevant to the problem that do not involve the SW

Evaluation process helps C determine if goals have been met and if the helping relationship was beneficial. As result of evaluation process, worker can become more effective practitioner & provide better services.
Worker helps C cope with feelings associated with termination - help C cope with future terminations.

By identifying changes accomplished and planning how the C is going to cope with challenges in the future, worker helps the C maintain these changes

Front 91

MODELS OF TX & THEORIES: THE PHASES OF HELPING - COGNITIVE DISSONANCE THEORY

Back 91

Arises when a person has to choose between 2 contradictory attitudes & beliefs. Most dissonance arises when two options are equally attractive.

3 ways to reduce dissonance:
1. reduce importance of conflicting beliefs
2. Acquire new beliefs that change the balance
3. Remove the conflicting attitude/behavior

Theory is relevant when making decisions or solving problems.

Front 92

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION (definition)

Back 92

method of intervention whereby individuals, groups, organizations engage in planned action to influence social problems.

2 major processes: Planning and Organizing

Hint 92

Planning - identifying problem areas, diagnosing causes, formulating solutions.
Organizing - developing constituencies and deriving the strategies necessary to effect action

Front 93

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION (characteristics)

Back 93

1. Focus is on social NOT psychological needs.
2. Develop resources in response to needs.
3. Values underlying definitions: a) enhance participatory skills of citizens (work with not for); b) developing leadership - local first; c) strengthen communities so they can deal w/future problems - community members can develop capacity to resolve problems; d) Redistribute resources to increase the resources of disadvantaged; 3) Planned changes - systematic steps are planned; f) problem-solving process: rational approach of studying & defining a problem, considering possible solutions, creating, implementing and evaluating a plan.
g) advancing interests of disadvantaged so they have a say about distribution of resources

Front 94

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION (assumptions underlying CO practice)

Back 94

a) community members can develop the capacity to resolve problems; b) members want to improve thei rsituations; c) members must participate in change efforts (rather then imposed); d) systems approach is more effective; e) participation is democratic, commu. member must learn skills of democ. functioning; f) members can gain from organizers skills in dealing w/problems they cannot resolve on their own

Front 95

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION - Models of Practice/Community Development: Locality Development

Back 95

Neighborhood work aimed @ improving the quality of community life through participation of a broad spectrum of people @ the local level.

Hint 95

Democratic procedures, participation of all, majority rule.

Those in power need education about community problems.

Front 96

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION, MODELS OF PRACTICE/COMMUNITY DEVELOPMENT: Social Planning

Back 96

rational study of community's problem as the basis of determining a solution. Power elite in community is not considered the enemy but often part of the process of solving the problem.

Hint 96

Power elite can be a sponsor or employer

Front 97

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION, MODELS OF PRACTICE/COMMUNITY DEVELOPMENT: Social Action

Back 97

The enemy are those in the commun. who control community resources. Victims are the disadvantaged & oppressed, who possess little/no resources.

Community cannot solve the problem through discussion/fact gathering but ONLY THROUGH DIRECT ACTION. (ex - rent strike) against power elite.

Hint 97

DIRECT ACTION is the onlyw ay to force those in power to relinquish some resources and power.

Cooptation = including the enemy in your group

Front 98

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION, MODELS OF PRACTICE/COMMUNITY DEVELOPMENT: Social Reform

Back 98

Work w/other organizations on behalf of the disadvantage. Workers role is to develop coalitions of various groups to pressure for change.

By changing laws, workers may be able to overcome community resistance to local programs (ie - residence for homeless)

Front 99

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION, PREVENTION - PRIMARY

Back 99

To prevent a problem before its initial onset, aimed @ reducing the prevalence of a problem by reducing the incidence of new cases; creating environments that promote mental health.

Front 100

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION, PREVENTION: Secondary

Back 100

treat symptoms, reduce prevalence by reducing the duration through early detection & interventions.

To prevent recurrence/exacerbation of an already dx problem or disorder.

Front 101

MODELS OF TX & THEORIES: COMMUNITY ORGANIZATION, PREVENTION: Tertiary

Back 101

to reduce disability in chronic problems; reduce duration of problems by reducing negative after effects (ie - drug rehabs)

Front 102

DIRECT PRACTICE: PROBLEM SOLVING PROCESS (6 STEPS)

Back 102

1. Acknowledge the problem
2. Analyze/define the problem
3. Generate possible solutions (brainstorm)
4. Evaluate each option
5. Implement the option of choice
6. Evaluate outcome of problem-solving process

Hint 102

Keep this general format in mind when thinking about problem solving - whether you are working with individuals, a policy, or task group - basic format will be the same (although the steps may be relabled)

Front 103

DIRECT PRACTICE: COLLABORATION

Back 103

Involves:
* Interpersonal Communication
* Group process skills
* Empathy - identify & understand the perspective of others

Front 104

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION: Beginning Phase

Back 104

Involves:
* problem recognition
* problem definition
* Assessment of info re: a problem

Hint 104

Problem recognition: may have to redefine what a community defines as a problem; occurs on many levels

Problem definition: seeks to focus & identify the causes of particular community problems

Information gathering: seeks to put factual info together based on problem definition

Needs assessment: sometimes preformed 1st in order to provide basis for problem recognition; Range from simple (informal discussion w/community members) to more detail/factual (stats); May link up w/university researchers w/questionnaire for scientific picture of community needs; In beginning phase, needs assessment serves a DUAL PURPOSE:
* 1) generates facts
* 2) involves community members in activities that concern the community.
Community change worker sensitive to process needs and task needs - important to involve community members in assessing community needs in order to avoid the efforts from going awry & from having a limited impact.

Front 105

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION: Middle Phase

Back 105

Emphasis on:
* Goal selection
* Prioritization
* Goal achievement

Hint 105

GOAL SELECTION: worker needs to cont. a process of interaction/encouragement w/community members around the process of selecting a goal & prioritizing efforts needed to get to that goal.

Community decision instrument: what person/group should make a decision for the community. Set up by worker & community leaders.

Worker helps a decision to occur and also raises questions/concerns about particular courses of action to be sure all implications have been taken into consideration - help them understand impact of actions they are contemplating.

Worker also raises questions re: the specific steps needed to move toward implementation - community members must take primary responsibility in CARRYING OUT THE COMMUNITY'S GOAL.

Front 106

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION:Ending Phase

Back 106

2 Subparts: (1) Operation; (2) Termination

Hint 106

Operation - implementation of actual activities decided on in goal selection. Worker assists the community in the actual carrying out of the plan and may even take part in operationalizing the plan but does not become the implementer. The change activity worker joins in but does not replace community effort.

Evaluations - range from simple debriefings of comm. members to complex stats about impact, percent of change, etc. THE WORKER MUST INITIATE THINKING ABOUT EVAL DURING THE IMPLEMENTATION STAGE B/C CERTAIN ACTIVITIES OF AN EVAL NEED TO GO ON SIMULTANEOUSLY W/IMPLEMENTATION.

Recycling: focuses on channeling the energy developed by one successful community intervention to the next comm. intervention that is needed.
Termination:
Once a successful cycle has been completed, community will be able - using its own leadership that has been developed, continue the kinds of activities it has completed.
Workers discuss w/community members the workers' need to move to other communities where needs are present.
Whenever termination occurs, worker seeks to engage w/the client system and works to help that system set up mechanisms for its own continued involvement/development

Front 107

DIRECT PRACTICE: PROBLEM SOLVING PROCESS (6 STEPS)

Back 107

1. Acknowledge the problem
2. Analyze/define the problem
3. Generate possible solutions (brainstorm)
4. Evaluate each option
5. Implement the option of choice
6. Evaluate outcome of problem-solving process

Hint 107

Keep this general format in mind when thinking about problem solving - whether you are working with individuals, a policy, or task group - basic format will be the same (although the steps may be relabled)

Front 108

DIRECT PRACTICE: COLLABORATION

Back 108

Involves:
* Interpersonal Communication
* Group process skills
* Empathy - identify & understand the perspective of others

Front 109

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION: Beginning Phase

Back 109

Involves:
* problem recognition
* problem definition
* Assessment of info re: a problem

Hint 109

Problem recognition: may have to redefine what a community defines as a problem; occurs on many levels

Problem definition: seeks to focus & identify the causes of particular community problems

Information gathering: seeks to put factual info together based on problem definition

Needs assessment: sometimes preformed 1st in order to provide basis for problem recognition; Range from simple (informal discussion w/community members) to more detail/factual (stats); May link up w/university researchers w/questionnaire for scientific picture of community needs; In beginning phase, needs assessment serves a DUAL PURPOSE:
* 1) generates facts
* 2) involves community members in activities that concern the community.
Community change worker sensitive to process needs and task needs - important to involve community members in assessing community needs in order to avoid the efforts from going awry & from having a limited impact.

Front 110

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION: Middle Phase

Back 110

Emphasis on:
* Goal selection
* Prioritization
* Goal achievement

Hint 110

GOAL SELECTION: worker needs to cont. a process of interaction/encouragement w/community members around the process of selecting a goal & prioritizing efforts needed to get to that goal.

Community decision instrument: what person/group should make a decision for the community. Set up by worker & community leaders.

Worker helps a decision to occur and also raises questions/concerns about particular courses of action to be sure all implications have been taken into consideration - help them understand impact of actions they are contemplating.

Worker also raises questions re: the specific steps needed to move toward implementation - community members must take primary responsibility in CARRYING OUT THE COMMUNITY'S GOAL.

Front 111

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION:Ending Phase

Back 111

2 Subparts: (1) Operation; (2) Termination

Hint 111

Operation - implementation of actual activities decided on in goal selection. Worker assists the community in the actual carrying out of the plan and may even take part in operationalizing the plan but does not become the implementer. The change activity worker joins in but does not replace community effort.

Evaluations - range from simple debriefings of comm. members to complex stats about impact, percent of change, etc. THE WORKER MUST INITIATE THINKING ABOUT EVAL DURING THE IMPLEMENTATION STAGE B/C CERTAIN ACTIVITIES OF AN EVAL NEED TO GO ON SIMULTANEOUSLY W/IMPLEMENTATION.

Recycling: focuses on channeling the energy developed by one successful community intervention to the next comm. intervention that is needed.
Termination:
Once a successful cycle has been completed, community will be able - using its own leadership that has been developed, continue the kinds of activities it has completed.
Workers discuss w/community members the workers' need to move to other communities where needs are present.
Whenever termination occurs, worker seeks to engage w/the client system and works to help that system set up mechanisms for its own continued involvement/development

Front 112

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION: Terms - Discrete

Back 112

Distinct or separate; limited to single occurrence or action

Front 113

DIRECT PRACTICE: PHASES OF COMMUNITY INTERVENTION: Terms -Continuous

Back 113

ongoing or repetitive

Front 114

ASSESSMENT/DX, DSM-IV, TX PLANNING: Diagnostic Hierarchies

Back 114

2 Principles:
1. When a substance or general medical condition can account for the symptoms, it preempts the dx of any other disorder that could produce the same symptoms. Therefore, it is assumed that these factors must be ruled out BEFORE making any DSM-IV diagnosis.

2. When a more pervasive disorder - such as schizophrenia - commonly has associated symptoms that are the defining symptoms of a less pervasive disorder - such as dysthymia - only the MORE PERVASIVE DISORDER IS DX IF BOTH ITS DEFINING SYMPTOMS AND ASSOCIATED SYMPTOMS ARE PRESENT

Hint 114

always rule out a medical cause or substance abuse for symptoms before making psychiatric dx.

Front 115

ASSESSMENT/DX, DSM-IV, TX PLANNING: Diagnosis

Back 115

When a person receives more than one dx, the PRINCIPLE DIAGNOSIS IS THE CONDITION THAT WAS CHIEFLY RESPONSIBLE FOR OCCASIONING THE EVAL/ADMISSION, usually the main focus of tx.

Front 116

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions: Psychotic Symptoms

Back 116

Do not necessarily indicate schizophrenia. Other conditions in which one might see psychotic symptoms:
* Bipolar I Disorder
* Major Depression
* Substance Induced Mental Disorders
* Mental Disorders due to a General Medical Condition (ie - Amphetamine Induced Psychotic D w/Delusional features, Hallucinogen Induced Psychotic Disorder w/Hallucinations)
* Delusional Disorder
* Borderline personality D.
* Brief Psychotic D.
* Schizophreniform D.
* Schizoaffective D.

Front 117

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Schizophrenia diagnosis

Back 117

Schizo: Not diagnosed UNLESS there is a period when the pt. experiences ACTIVE PSYCHOTIC SYMPTOMS.

If:
* Bizarre behavior
* impaired communication
* impaired social interaction
* restricted repertoire of activities & interests
BUT NO DELUSIONS OR HALLUCINATIONS in a child - consider Autistic Disorder

Front 118

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Time Frame for Dx of: Brief Psychotic D; Schizophreniform D; Schizophrenia

Back 118

Brief Psychotic Disorder - symptoms less than a month

Schizophreniform D - symptoms less than 6 months

Schizophrenia - more than 6 months

Front 119

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Dx of Bipolar I Disorder

Back 119

REQUIRES AT LEAST ONE PERIOD OF MANIA

Front 120

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Separation Anxiety D. & Dx

Back 120

Although it is a form of phobic reaction, dx of SAD is related to anxiety of separation from parental figures

Front 121

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Drug Induced Disorders versus Medical Condition

Back 121

If panic attack and/or depression caused by substance - Dx: Substance Induced Anxiety Disorder or Substance Induced Mood Disorder. Ex: person taking Reserpine experiences symptoms of major depression.

If panic attack is caused by a MEDICAL ILLNESS, dx: Anxiety Disorder or Mood Disorder due to a General Medical Condition (ie - hyperthyroid condition - can cause panic attacks

Front 122

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Antisocial Personality D. vs. Conduct D.

Back 122

Dx. of Antisocial Personalty D: over age of 18 years, with symptoms present prior to the age of 15.

Dx. of Conduct Disorder: antisocial symptoms in an individual UNDER THE AGE OF 18

Front 123

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Delusions

Back 123

Delusions occur in both dx of Delusional D & Paranoid Schizophrenia.

Paranoid Schizophrenia - delusions are more specific: prominent AUDITORY HALLUCINATIONS and BIZARRE DELUSIONS, that are NOT characteristic of delusional disorder.

Delusional Disorder = less impairment

Front 124

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Substance Related Disorders

Back 124

Include:
Drug/Alcohol Intoxication and Withdrawal
Drug/Alcohol Abuse and Dependence

Front 125

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - "Reaction" Disorders

Back 125

Include:
PTSD
ACUTE STRESS DISORDER
ADJUSTMENT DISORDER
BEREAVEMENT

Front 126

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - "Chronic or Relatively Chronic" Disorders

Back 126

Include:
ALL PERSONALITY DISORDERS
SCHIZOPHRENIA (>6 MONTHS)
DYSTHYMIC DISORDER
CYCLOTHYMIC DISORDER (>2 YEARS)
GENERALIZED ANXIETY DISORDER (>6 MONTHS)
HYPOCHONDRIASIS (>6 MONTHS)
SOMATIZATION DISORDER (several years)

Front 127

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Paraphilia vs. Sexual Dysfunction

Back 127

Paraphilia - inappropriate sexual object or practice
Sexual dysfunction - inhibition of sexual response

Front 128

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Parasomnia vs. Dyssomnia

Back 128

Parasomnia - abnormal event that occurs during sleep or between sleep and waking.
Dyssomnia - disturbance in amount, timing, or quality of sleep

Front 129

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Neurovegetative (Classic) symptoms of depression

Back 129

* Changes in appetite & weight
* Sleep disturbance
* Fatigue
* Decrease in energy
* Decrease in sexual desire & function

Front 130

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Conversion Disorder

Back 130

Associated with actual loss of motor function/symptoms and deficits that affect voluntary motor function - patient DOES NOT PRODUCE OR CONTROL them voluntarily

Front 131

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Factitious Disorder vs. Malingering vs. Munchausen Syndrome (by Proxy)

Back 131

In both Factitious & Malingering the pt. intentionally produces symptoms but the INCENTIVES ARE DIFFERENT.


Malingerer - fakes or produces symptoms in order to obtain an external reward or achieve a goal.

Factitious D pt. produces symptoms due to a psychological NEED TO ADOPT THE SICK ROLE

Munchausen Syndrome: when someone with factitious disorder produced physical symptoms

Munchausen's Syndrome by Proxy: when a caregiver, primary a parent, produces DELIBERATE medical symptoms in a child. Medical personnel usually become suspicious when a child has repeated, unexplainable illnesses - is considered a form of child abuse

Front 132

ASSESSMENT/DX, DSM-IV, TX PLANNING: High Probability Topics for Questions - Schizotypal Personality Disorder

Back 132

associated with Magical thinking - condition that causes the patient to experience irrational fear of performing certain acts or having certain thoughts because they assume a correlation with their acts and threatening calamities

Front 133

ASSESSMENT, DX, DSM-IV, TX PLANNING: High probability topics for questions: Hyperthyroidism, Hypothyroidism

Back 133

Hyperthyroidism - can mimic symptoms of mania

Hypothyroidism - present with symptoms similar to depression

Front 134

ASSESSMENT, DX, DSM-IV, TX PLANNING: High probability topics for questions - Delirium

Back 134

* Changes in level of consciousness & orientation
* Change in cognition and/or perceptions
* Difficulty shifting and maintaining attention (delirious)
* Cause = general medical condition, or substance abuse, or combo of both
* usually a medical emergency
* RAPID, ACUTE ONSET OF SYMPTOMS; symptoms fluctuate over time - better in morning, worse in the night

Front 135

ASSESSMENT, DX, DSM-IV, TX PLANNING: High probability topics for questions - Dementia

Back 135

* DISTURBANCE INVOLVING MEMORY IMPAIRMENT & OTHER COGNITIVE IMPAIRMENTS
* Most commonly known dementia: Alzheimers
* Cause = general medical condition, can result from a series of strokes (vascular dementia) with patchy cognitive symptoms
* INSIDIOUS - becomes progressively worse over time

Front 136

ASSESSMENT, DX, DSM-IV, TX PLANNING: High probability topics for questions - Personality Disorder Clusters

Back 136

Cluster A: ODD & ECCENTRIC = Paranoid; Schizotypal; Schizoid

CLUSTER B: DRAMATIC, EMOTIONAL, ERRATIC = Borderline, Antisocial; Histrionic; Narcissistic

CLUSTER C - ANXIOUS AND FEARFUL = Avoidant; Dependent; Obsessive-Compulsive

Front 137

ASSESSMENT, DX, DSM-IV, TX PLANNING: High probability topics for questions - Dissociation

Back 137

Def: disturbance or change in the usually integrative functions of memory, identity, perception, or consciousness.

Often seen in pts with a history of trauma

Front 138

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Comorbid

Back 138

existing with or at the same time; for instance, having 2 different illnesses/dx at the same time

Front 139

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Contraindicated

Back 139

Not recommended or safe to use.

Hint 139

For instance, a clinician would not prescribe a med or tx that is contraindicated b/c it could have serious medical/emotional consequences

Front 140

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Endogenous Depression

Back 140

depression caused by a BIOCHEMICAL IMBALANCE rather than psychosocial stressor/external factors.

Symptoms - more severe, consist of "classic" neurovegetative symptoms of depression:
loss of appetite
fatigue
sleep disturbance
decrease in libido
weight loss
psychomotor retardation
agitation

Hint 140

ENDO = FROM WITHIN

Front 141

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Exogenous Depression

Back 141

Caused by EXTERNAL EVENTS/PSYCHOSOCIAL STRESSORS.

Symptoms are less severe than endogenous depression.

Hint 141

EXO = EXTERNAL/OUTSIDE OF SELF

Front 142

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Folie a deux

Back 142

SHARED DELUSION

A person may develop a delusional system as a result of a close relationship with a person who already has an established delusional system.

Hint 142

Shared Delusional Disorder

Front 143

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Hypomanic

Back 143

ELEVATED, EXPANSIVE, IRRITABLE mood that is LESS SEVERE than full-blown manic symptoms.

Hypomanic symptoms are NOT SEVERE ENOUGH TO INTERFERE W/FUNCTIONING AND ARE NOT ACCOMPANIED BY PSYCHOTIC SYMPTOMS

Hint 143

Hypo = less severe

hyper = severe

Front 144

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Postmorbid

Back 144

subsequent to the onset of an illness

Hint 144

POST = after

Front 145

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Premorbid

Back 145

Prior to the onset of illness

Hint 145

PRE = BEFORE

Front 146

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Prodromal

Back 146

PERIOD OF TIME BEFORE THE ONSET OF A SERIOUS ILLNESS DURING WHICH THERE MAY BE SUBTLE SYMPTOMS

Hint 146

Ie - before the onset of a full-blown psychotic episode, pt. may manifest a somewhat guarded suspicious and angry affect as well as disorganized behavior and thought processes

Front 147

ASSESSMENT, DX, DSM-IV, TX PLANNING: Terms - Common Psychological Tests

Back 147

* NAIS - Wechsler Adult Intelligence Scale
* WISC-R - for children, revised
* Standford-Binet - Intelligence test for children
* Draw-A-Person Test - provides info about a childs self-image
* MMPI - predominant personality traits or behavior
* Projective tests: Rorschach Test (inkblot); TAT (thematic Apperception Test)
* Beck Depression Inventory: Depression

Front 148

PSYCHOTROPIC MEDICATIONS: Anti psychotic Drugs (Neuroleptics/Major Tranquilizers) Overview

Back 148

* Used to tx psychotic symptoms
* Most frequent drugs used in tx of Schizophrenia
* Available in injectable forms

Hint 148

* POSITIVE symptoms most likely to respond to anti psychotics:
AGITATION; HALLUCINATIONS; DELUSIONS; COMBATIVENESS/BELLIGERENT BEHAVIOR; SLEEP DISTURBANCE; TENSION; PARANOID BEHAVIOR; DISORGANIZED THINKING.

* NEGATIVE symptoms less likely to respond: impaired judgment; lack of insight; depression; withdrawal; poor motivation

Front 149

PSYCHOTROPIC MEDICATIONS: Anti psychotic Drugs (Neuroleptics/Major Tranquilizers) Side Effects

Back 149

1. Sedation; Weight Gain; Sexual dysfunction; Breast swelling; Anticholinergic side effects - dry mouth, blurred vision, constipation, urinary hesitation

2. Tardive dyskinesia: abnormal involuntary movements of tongue, lips, jaw face, twitching/snakelike movement of extremities. Symptoms may persist indefinitely after discontinuation of meds. RX/Prevention: limit exposure to antipsychotic drugs, no cure.

3. Extrapyramidal Symptoms: a) Parkinsonian Syndrome - tremor, rigidity, slowed movement. Akinesia (without movement/shuffle)
Rx: Benedryl, Artane, Cogentin.
b) Akathisia - inner restlessness, compulsion to be in motion; rx: lower dose of med

4. Acute Dystonic Reactions: involuntary muscle spasms/tightening of mouth/jaw/face/neck; oculogyric crisis - eyes involuntarily look @ certain direction
a) Rx: Benzodiazepines; antihistamine drugs; anticholinergic antiparkinson drug

5. Neuroleptic Malignant syndrome - medical emergency; fever, muscle rigidity, mental status changes, tachycardia
a) Rx: stop neuroleptic

Front 150

PSYCHOTROPIC MEDICATIONS: Anti psychotic Drugs (Neuroleptics/Major Tranquilizers) Common Typical Antipsychotic Drugs

Back 150

Thorazine (chlorpromazine)
Mellaril (thioridazine)
Stelazine (trifluoperazine)
Prolixin (fluphenazine)
Navane (thiothixene)
Haldol (Haloperidol)

Injectable forms: Haldol D; Prolixin D.

Hint 150

Injectable forms of meds are useful for pt's who are noncompliant w/oral meds

Front 151

PSYCHOTROPIC MEDICATIONS: Anti psychotic Drugs (Neuroleptics/Major Tranquilizers) Common Atypical Antipsychotic Drugs

Back 151

* Clozapine (Clozaril) - need blood monitoring for white blood cells

* Resperidone (Risperdal)

Newer Antipsychotics
* Seroquel (quetiapine)
* Zyprexa (olanzapine)

Hint 151

More effective for negative symptoms of schizophrenia (impaired judgment; lack of insight; depression; withdrawl; poor motivation).

Less extrapyramidal symptoms

Lower risk for Tardive Dyskinesia

Front 152

PSYCHOTROPIC MEDICATIONS: Anti Depressant Drugs - TCA's (Tricyclic Antidepressants)

Back 152

Most common TCA's:
* Tofranil (imipramine)
* Elavil (amitriptyline)
* Aventyl, Pamelor (Nortiriptyline)
* Norpramin (desipramine)
* Adapin/Sinequan (doxepin)

Front 153

PSYCHOTROPIC MEDICATIONS: Anti Depressant Drugs - TCA's (Tricyclic Antidepressants) - Side Effects

Back 153

A) Autonomic, Anticholinergic: dry mouth, blurred vision, constipation
B) Cardiovascular: tachycardia
C) Precipitation of hypomania in some bipolar pts

Hint 153

Contraindicated in individuals with certain types of heart disease.

For pt's w/high suicide risk, this med can be very lethal when taken in overdose.

Therapeutic effects may not start for period of 2-3 weeks after initiation of tx.

Front 154

PSYCHOTROPIC MEDICATIONS: Anti Depressant Drugs - MAOI'S (Monoamine Oxidase Inhibitors)

Back 154

* Nardil (phenelzine)
* Parnate (tranylcypromine)
* Marplan (isocarboxazid)

Hint 154

**** MOST EFFECTIVE IN TX FOR ATYPICAL DEPRESSIONS & NON-ENDOGENOUS DEPRESSIONS

Front 155

PSYCHOTROPIC MEDICATIONS: Anti Depressant Drugs - MAOI'S (Monoamine Oxidase Inhibitors) - Side Effects

Back 155

Hypertension if: high dose of MAOI is taken; TCA or stimulant taken in conjunction; high tyramine containing food substance is consumed.

Adverse drug interactions - stimulants; appetite suppressants; cold remedies; cocaine derivatives (novocaine); any medication or food stubstance that raises blood pressure levels is contraindicated.

Hint 155

Dietary restrictions: foods that contain high levels of TYRAMINE - beer,ale, wine, cheese, smoked/pickled fish, beef/chicken liver; fava/bean pods

Front 156

PSYCHOTROPIC MEDICATIONS: Anti Depressant Drugs - SSRI's (Selective Serotonin Re-uptake Inhibitors) & Side Effects

Back 156

* Prozac (fluoxetine)
* Zoloft (sertraline)
* Paxil (paroxetine)

Hint 156

Side effects: does related - slight weight loss; nausea; nervousness; insomnia

SSRI's are less toxic to heart & safer in overdose than TCA's.

Overall therapeutic efficacy comparable to TCA's in pts with unipolar depression

Front 157

PSYCHOTROPIC MEDICATIONS: Anti Depressant Drugs

Back 157

* Asedin (amoxapine)
* Desyrel (trazadone)
* Ludiomil (maprotiline)
* Wellbutrin (bupropion)
* Effexor (venlafaxine)
* Serzone (nafazodone)

Hint 157

Similar to effectiveness to TCA's and MAOI's but reduced/different side effects & adverse effects

Front 158

PSYCHOTROPIC MEDICATIONS: Mood Stabilizers: Lithium

Back 158

* Tx of Bipolar D.
* Need blood monitoring - small difference b/w toxic and therapeutic levels
* Period check of thyroid & kidney functioning
* Sometimes combined w/another antipsychotic drug/antidepressant
* 70-90% of pts with typical bipolar illness respond. MOST EFFECTIVE IN PREVENTING RECURRENCES OF MANIA THAN RECURRENCES OF DEPRESSION. MUST CONTINUE TAKING MEDS TO PREVENT EPISODES OF MANIA

Hint 158

Side Effects:
* Thyroid Gland
* Renal/Kidney - increased drinking/urination
* GI - abdominal cramps, vomiting
* CNS/Neuromuscular: mental dullness, decreased memory/concentration; headache; fatigue
* Weight gain - major factor in noncompliance
* Avoid during 1st Trimester of pregnancy

Front 159

PSYCHOTROPIC MEDICATIONS: Mood Stabilizers - Anticonvulsants

Back 159

* Tegretol (carbamazepine)
* Depakote (Valproic acid) - more effective for rapid cycling & mixed bipolar d.
* Neurontin (gabapentin); Lamictal (lamotrigine); Topomax (topiramate)

Front 160

PSYCHOTROPIC MEDICATIONS: Anti Anxiety Medications - Benzodiazepines

Back 160

* Valium (diazepam)
* Librium (chlordiazepoxide)
* Ativan (lorazepam)
* Tranxene (clorazepate)

Hint 160

* Less abuse potential than barbituates
* Generalized Anxiety D.
* Detox from alcohol/other depressant drugs
* Tx issues: chronic versus PRN tx - relapse versus withdrawal symptoms after medication discontinued = abuse liability.
* Drug most frequently used in overdoses
* SIDE EFFECTS - IMPAIRED MUSCLE COORDINATION; IMPAIRMENT OF SHORT-TERM MEMORY

Front 161

PSYCHOTROPIC MEDICATIONS: Anti Anxiety Medication - Barbituates (Minor Tranquilizers)

Back 161

* Quaaludes, Sopors (methaqualone)
* Atarax, Vistaril (hydroxyzine)
* Miltown (meprobarnate)

Hint 161

* High abuse potential, safety problem.
* dangerous when combined w/alcohol

Front 162

PSYCHOTROPIC MEDICATIONS: Anti Anxiety Medications - Meds for Phobia

Back 162

Specific Phobia/Social Phobia: can use Beta blockers (propanolo) - used to tx. somatic symptoms of stage fright. Paxil has been approved to treat social phobia

Front 163

PSYCHOTROPIC MEDICATIONS: Anti Anxiety Medications to tx Panic Disorder w/w/o Agoraphobia

Back 163

TCA's
MAOI's
Canax (alprazolam)
SSRI's

Front 164

PSYCHOTROPIC MEDICATIONS: Anti Anxiety Medications - Meds used to tx Obsessive Compulsive Disorder

Back 164

TCA's - anafranil
MAOI's
SSRI's (luvox, Zoloft)

Front 165

PSYCHOTROPIC MEDICATIONS: Anti Anxiety Medication - Buspar (Buspirone)

Back 165

for GAD, takes 2-6 weeks to relieve symptoms. Requires daily dosage, not useful for taking on PRN basis

Front 166

PSYCHOTROPIC MEDICATIONS: Hypnotic Drugs

Back 166

Benzo's:
* Dalmane (flurazepam)
* Halcion (triazolam)
* Restoril (temazepam)

Front 167

ASSESSMENT, DX, DSM-IV, TX PLANNING: Schizophrenia

Back 167

2 or more of symptoms during a 6 MONTH period:
Positive symptoms:
* Delusions; Hallucinations; Disorganized speech; Grossly disorganized behavior
Negative symptoms:
* Affective flattening; poverty of speech; avolition or reduction in initiate or persist goal-directed activity

Hint 167

Other symptoms commonly associated w/Schiz:
Inappropriate affect
Unusual motor behavior
Depersonalization
Derealization
Disorganized thoughts, confusion, disorientation, memory problems
Sleep and appetite disturbance
dysphoric mood- anxious, irritable, agitated, depressed
Difficulty concentrating/focusing
Anhedonia

Front 168

ASSESSMENT, DX, DSM-IV, TX PLANNING: Major Depression

Back 168

Must have 5 or more symptoms for a 2 WEEK PERIOD and must represent a change in functioning.

ONE OF SYMPTOMS MUST BE EITHER DEPRESSED MOOD OR LOSS IN INTEREST OR PLEASURE (ANHEDONIA):

Depressed mood
Markedly diminished interest or pleasure in daily activities
weight gain or weight loss
Insomnia or hypersomnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Feelings of worthlessness or guilt
Diminished ability to think or concentrate
Recurrent thoughts of death, with/wo plan

Front 169

ASSESSMENT, DX, DSM-IV, TX PLANNING: NOS Category - not otherwise specified

Back 169

means pt. presents w/a symptom pattern that conforms to the general guidelines for a mental disorder but symptoms do not meet all the criteria for any of the specific disorder(s)

Front 170

ASSESSMENT, DX, DSM-IV, TX PLANNING: Bipolar Disorder (Manic Depression)

Back 170

Bipolar I D. = presence of only one manic episode and no past Major Depressive episodes

Bipolar II D. - Presence or hx of one or more Major depressive episodes and presence or history of at least one hypomanic episode. THERE HAS NEVER BEEN A MANIC EPISODE.

Hint 170

Manic symptoms:
* Distinct period of abnormally & persistently elevated, expansive, or irritable mood - LASTING AT LEAST 1 WEEK
* 3 or more of the following symptoms during mood disturbance:

inflated self esteem/grandiosity
Decreased need for sleep
Pressured speech
Flight of ideas or racing thoughts
Distractibility
Increased goal-directed activity or psychomotor agitation
Excessive involvement in pleasureable activities that have a high risk for painful consequences

Front 171

ASSESSMENT, DX, DSM-IV, TX PLANNING: Personality Disorders (Axis V) Overview

Back 171

Enduring pattern of inner experience & behavior that deviates markedly from expectations of individuals culture. Pattern is manifested in 2 (or more) of these areas:
* Cognition - perceiving & interpreting self, others, events
* Affectivity - range, intensity, lability, appropriateness of emotional response
* Interpersonal functioning
* Impulse control

Hint 171

Onset - adolescence or early adulthood
Pattern is stable & long duration
Leads to distress & impairment

Front 172

ASSESSMENT, DX, DSM-IV, TX PLANNING: Borderline Personality Disorder (Cluster C)

Back 172

pattern of unstable self-image, relationships, emotions, affects, and impulse control.
Must have 5 or more of following criteria:
* Intense, unstable relationships
* Frantic efforts to avoid abandonment
* Impulsive behavior - spending, sex, SA, reckless driving, binging
* Identity disturbance
* Recurrent suicidal behav., gestures, threats, self-mutilation
* Chronic feelings of emptiness
* Inappropriate, intense anger
* Can be transient, stress-related paranoid ideation or severe dissociative symptoms

Hint 172

Use splitting as defense mechanism - quickly idealize and devalue

Front 173

ASSESSMENT, DX, DSM-IV, TX PLANNING: Antisocial Personality Disorder

Back 173

Pervasive pattern of disregard for & violation of rights of others since age of 15.
Must have 3 or more of the following:
* Repeatedly performing acts that are grounds for arrest
* Deceitfulness
* Impulsivity
* Irritability & aggressiveness
* Reckless disregard for safety of self & others
* Consistently irresponsible
* Lack of remorse

Hint 173

Must be at least 18 years old and have a HISTORY OF CONDUCT DISORDER with onset before age 15!

Front 174

ASSESSMENT, DX, DSM-IV, TX PLANNING: Anxiety Disorders - Panic Attacks & Agoraphobia (overview)

Back 174

Panic attacks - sudden onset of intense feelings of fear, apprehension, terror, and impending doom accompanied by physiological symptoms

Hint 174

Agoraphobia: fears about being in situations or places where escape would be embarrassing or difficult, or help would not be available in event a panic attack were to occur.

Person w/agora. may fear being away from home, riding in a car, elevator, etc.

Front 175

ASSESSMENT, DX, DSM-IV, TX PLANNING: Anxiety Disorders & Dx

Back 175

Panic d. w/or w/o agoraphobia - recurrent, unexpected panic attacks w/ or w/o agorap.
* Agoraphobia w/o hx of Panic Disorder - presence of agorap. or panic-like symptoms w/o hx of panic d.
Specific phobia - anxiety & fear about specific object/situation that is usually avoided
Social Phobia - anxiety about exposure to certain social or performance situations; tend to avoid those situations.
Obsessive Compulsive Disorder - obsessions ( thoughts) and/or compulsions (actions) that serve to neutralize anxiety
PTSD - exposure to traumatic event. Symptoms include flashbacks of trauma, increased arousal, avoidance of stimuli associated w/trauma. Onset of symptoms can be delayed for days, months, or years

Hint 175

Acute stress D - similar to PTSD but occur immediately after exposure to traumatic event
Generalized Anxiety D. - persistent, excessive anxiety & worry that last at least 6 months
Anxiety D. due to a general medical condition
Substance-Induced Anxiety D. - anxiety is direct physiological consequence of exposure to drug, medication or toxin
Anxiety D. NOS

Front 176

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Disruptive Behavior Disorders: ADHD

Back 176

ADHD: failure to remain attentive in various situations, especially in school & home. Possibly biologically based.

Hint 176

Dx requires symptoms to occur in at least 2 different settings or situations.
Symptoms can increase under stressful situations or can decrease when a child is strictly controlled or in a novel situation

Front 177

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Disruptive Behavior Disorders: Conduct D.

Back 177

repetitive & persistent pattern of conduct which violates basic rights of others or age-appropriate social norms/rules.

unsocialized conduct d - fail to estb. normal degree of affection/empathy w/others. Superficial peer relationships, egocentric/manipulative, lack concern for welfare of others, w/o guilt remorse

socialized types - capable of attachment to others (ie peers) but callous/manipulative towards persons whom they are not emotionally attached.

Aggressive - physical violence, vandalism, fire setting, burglary, break rules at home/school, truant, substance abuser, runaway

Hint 177

must have dx of conduct d. as a child/adolescent in order to be dx w/Antisocial personality d. as an adult.

Most effective tx for CD involves the pt., family, schools & community. Provide parenting skills and behavior modification at home and school.

Front 178

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Disruptive Behavior Disorders: Oppositional Defiant Disorder

Back 178

display aggressiveness by patterns of obstinate but passive behavior. Appear to be conforming, but continually provoke adults and other children.

By use of negativism, stubbornness, dawdling, procrastination they covertly show their underlying aggressiveness.

Hint 178

these pt's do NOT HAVE SYMPTOMS OF CONDUCT DISORDER such as violating rights of others

Front 179

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Anxiety Disorders: Separation Anxiety

Back 179

school phobia is a form of separation anxiety brought about by the necessity of leaving home and family members to attend school. Usually a situational problem, but can be a serious psychiatric emergency if not dealt w/when it first occurs.

Hint 179

When children w/school phobia refuse to go to school, they may panic unless permitted to stay at home. Often, the longer the children are permitted to stay out of school, the more severe are their social & educational impairments

Front 180

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Anxiety Disorders: Avoidant Disorders

Back 180

avoid establishment of new interpersonal contacts or ordinary relationships w/strangers so that there is a noticeable interference w/development of peer relationships & general social functioning.

Children may enjoy relationships at home or w/familiar persons and may seek new social relationships when non-threatening conditions exist.

Front 181

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Anxiety Disorders: Overanxious Disorder

Back 181

diffuse fears & worries that cannon be traced to specific problems or stresses. Worry excessively about examinations, potential injuries, friendships, group acceptance.

Anxiety may be expressed in various physiological symptoms such as headaches, respiratory distress, stomach aches, or other recurring problems

Hint 181

expressed somatically

Front 182

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Anxiety Disorders: Simple Phobia

Back 182

persistent irrational fears of specific object, activity, situation.
onset of phobia does not usually occur until late teens or early adulthood

Front 183

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Anxiety Disorders: PTSD

Back 183

re-experiencing of traumatic event is common.

Young children may repeat the event in their play.

Other symptoms: avoiding thoughts or feelings about event and avoiding activities/situations that remind them of event.
May feel detached from other people, take less pleasure in previously enjoyed activities, trouble sleeping, nightmares, difficulty concentrating.
May experience physical symptoms - stomachaches & headaches

Young children may lose recently acquired developmental skills such as toilet training or language skills.

Front 184

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders, Developmental Disorders, Autistic D.

Back 184

primary disturbance is in the acquisition of motor, language, social, or cognitive skills.

Specific developmental D = delay in one are of skill development

Pervasive developmental disorder = multiple ares of development are affected (social, motor skills, language, attention, perception, and reality testing).

Hint 184

utistic D: onset before age 3; failure to develop the usual relatedness to parents and other people.

As infants, lack social smile, avoid eye contact, and fail to cuddle.
Children also fail to develop normal language and may use non-verbal commands in place of speech - echolaia = meaningless repetition of what is said by others.

play schemes - rigid, repetitive, lack variety - may manifest over/under responsiveness to sensory stimuli (sound or pain).

IQ - range from MR to normal. 50% are MR; 25% mildly R; 25% have IQ's of 70 or more.

*** AUTISM OCCURS 4-5 TIMES MORE FREQUENTLY IN MALES ***

Front 185

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Mood Disorders - Bipolar D.

Back 185

distinct period of predominant mood that is elevated, expansive, irritable; usually accompanied by depressive episode.

Manic symptoms: inflated self-esteem, decreased need for sleep while feeling full of energy; loud & rapid speech that is difficult to interrupt; continuous flow of speech w/abrupt changes of topic; distractibility; restlessness; increased sociability; disorganized; flamboyant; or bizarre activities. may be rapid shifts of elevated mood to anger or depression.

Depressive symptoms - sadness, loss of interest, sleep and appetite disturbances. Older children may express feelings of worthlessness and guilt, difficulty thinking/concentrating; suicidal thoughts or recurring thoughts of death

Front 186

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Mood Disorders - Major Depressive Episode

Back 186

"Childhood depression"

Depression manifested in different ways in children: children may be irritable & fail to make expected weight gains.

Young children may feign illness, be hyperactive, cling to parents and refuse to go to school, and may express fears that their parents may die.

Older children: sulky, refuse to cooperate in family & social activities, get into trouble @ school, may abuse alcohol or drugs. May give less attention to their appearance, become negativistic, & express feelings of not being understood. They may become restless, grouchy, or aggressive.

Hint 186

May be strictly seasonal - october through november

BEHAVIORAL AND SOMATIC SYMPTOMS OF DEPRESSION ARE MOST PROMINENT IN CHILDREN/ADOLESCENTS.

80% OF TEEN SUICIDES ARE LINKED TO DEPRESSION.

Front 187

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Identity Disorder

Back 187

severe subjective distress re: a youngster's inability to integrate various aspects of his/her acceptable sense of self. Aspects relate to career choice, friendship patterns, sexual orientation, religious identification, moral value systems and group loyalties.

Front 188

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Adjustment Disorders

Back 188

maladaptive rxn to an identifiable source of stress.

Onset - w/in 3 months of the source of stress; the duration of symptoms may be up to six months

Hint 188

characteristics of these disorders include:
1. impairment in normal level of social/educational functions
2. Disturbance of mood
3. Conduct disturbance and/or
4. Physical symptoms that do not have a medical basis

Front 189

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Encopresis

Back 189

elimination disorder that involves repeated passage of feces in inappropriate places. More often it is involuntary but can be intentional.
Must occur 1x/month for 3 months in a child with a chronological age of at least 4 years.
Child feels embarrassed and avoids situations that lead to embarrassment (camp, sleep-overs). May suffer rejection from peers/parents

Hint 189

common

Front 190

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Stereotypic Movement Disorder

Back 190

Involves motor behavior that is seemingly driven, repetitive, w/o function and interferes w/activities. If not prevented, motor behavior has potential to cause self-inflicted bodily injury to child.

Hint 190

very uncommon disorder

Front 191

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Rhett's Disorder

Back 191

development of persistent & progressive developmental regression after a period of normal development.

Onset -- usually before age of 4, norm is b/w 1st and 2nd year.

Associated w/stereotypic hand movements; problems w/coordination of gait and trunk movements; profound MR; and severe expressive and receptive language development.

*** SEEN ONLY IN FEMALES

Front 192

ASSESSMENT, DX, DSM-IV, TX PLANNING: Childhood Disorders: Asperger's Disorder

Back 192

NO clinically significant delays in language, cognitive dev., self-help skills, curiosity about environment & adaptive behavior (COMPARED TO AUTISTIC D.)

main characteristics: severe and sustained impairment of social interactions and restricted repetitive patterns of behavior, interests, and activities.

Hint 192

More common in boys

Front 193

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Risk Factors

Back 193

Demographic: male, inner city/rural residence w/low socioeconomic status, lack of employment opportunities

Family: parents/siblings/spouse use substances; family dysfunction (inconsistent discipline, poor parenting skills, lack of positive family rituals, routine); family trauma (divorce, death)

Social: peers, social/cultural norms condone use of substances; expectations re: positive effects of drugs/alcohol; drugs/alcohol are available & accessible.

Genetic: inherited predisposition to dependency

Psychiatric: depression, anxiety, low self-esteem, low tolerance for stress, other D's; desperation, loss of control over one's life.

Behavioral: use of other substances; aggressive behav. in childhood; conduct D.; antisocial PD; Avoidance of responsibilities; impulsivity/risk taking; rebelliousness; reckless behavior; school based academic/behavioral probs; drop-out; involvement in CJ system/illegal activities; poor interpersonal relationships

Hint 193

For exam: family hx of alcoholism is the strongest predictor for developing an alcohol problem.

Front 194

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Causes of SA

Back 194

Biopsychosocial model: hereditary predisposition, emotional/psych probs; social influences; environmental probs.

Medical/Biological Model: addiction is chronic, progressive, relapsing, potentially fatal medical disease:
a) genetic causes - vulnerability to addiction, alcoholism
b) brain reward mechanisms - reinforcement through continued use by producing pleasurable feelings
c) altered brain chemistry - habitual use alters chemistry, cont use of substances required to avoid feelings discomfort from imbalance

Self medication - relieve symptoms of psych D.; continued use is reinforced by relief of symptoms

Family & Environ. Model: behavs. shaped by family/peers; constitutional/personality factors; physical/sexual abuse; disorganized communities; school factors.

Clinical model: drug abuse linked to emotional probs; use substances to escape painful problems of life. Psych characteristics: low self esteem, poor coping mechan.; feelings of rejection.

Social model: drug use is learned & reinforced from members of subculture who serve as role models. No controls to prevent use of substances - racism, poverty, sexism (social, eco, political factors)

Front 195

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Assessment Instruments

Back 195

AUDIT - alcohol use disorders identification test - screens for alcohol problems through structured interview or self-report quest.

CAGE-AID: have you felt you ought to *cut down* on your drinking/drug use; have people *annoyed* you by criticizing your drinking or drug use; have you felt bad or *guilty* about your drinking/drug use; have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover *eye opener* - score 0 for no; 1 for yes. more than 2 - clinically significant.

TWEAK test - to screen pregnant women (3 or more indicates woman is likely to be a risk drinker). T = TOLERANCE; W = WORRIED; E = EYEOPENER; A = AMNESIA; K (C) = CUT DOWN

Michigan Alcoholism Screening Test (MAST) - series of yes/no questions re: alcohol use. MAST-G - geriatric version for pts over 60.

Hint 195

Assessment instruments assist in gathering consistent info, clarifying & elaborating on info obtained through pt. hx and physical examin.; and ESTABLISHING A BASELINE AGAINST WHICH PT. PROGRESS CAN BE MONITORED.

CLINICIANS SHOULD CONSIDER: literacy levels; language/comprehension problems; questions both appropriate/sensitive to kinds of problems encountered in setting; whether time & costs involved are reasonable.

Assessment parameters: info gained through assess. will clarify the type & extent of prob and will help determine appropriate tx response.

At minimum, pt's must be assessed for:
1. acute intoxication and/or withdrawal potential
2. biomedical conditions & complications
3. Emotional/behav. conditions (psych eval)
4. tx acceptance or resistance
5. Relapse potential/continued use potential
6. Recovery/living environment

Front 196

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Comprehensive, Multidimensional Approach of Assessment

Back 196

Insures variety of factors that impinge on an individuals SA (level, pattern, hx of use; signs & symptoms of use; consequences of use) are considered when evaluating individual pt. probs and reccomending tx

Hint 196

Standard medical hx & physical exam

Alcohol & other drug use Hx

Family/social Hx

Sexual Hx

Mental health hx

Collateral reporting - family/friends help validate SA and answer questions re: hx

Supporting Laboratory tests - BAC levels (blood alcohol content); urine screens; breathalyzer; liver damage, etc.

Front 197

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Exam Questions to Know re: SA TX and DX

Back 197

FOR EXAM: if client has long standing SA problem, refer for SA treatment before beginning psychotherapy

Wernicke's encephalopathy vs. Korsakoff's Syndrome: disorders associated w/chronic abuse of alcohol. Caused by thiamine (Vitamin B1) deficiency resulting from chronic consumption of alcohol.
Korsakoff's syndrome has memory problems. Tx - administration of thiamine. KS is also called Alcohol-Induced Persisting Amnestic D.

Front 198

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Making the Diagnosis

Back 198

Substance Abuse vs. Substance Dependence:

1. SA: maladaptive pattern of abuse leading to significant impairment in functioning or distress. Pt. con't to use abuse despite persistent/recurrent negative consequences & probs re: employment, school, interp. relationships, social situations & legal issues.

Substance Dependency: physiologic tolerance in which increasing amounts of substances are required to achieve intoxication and withdrawal symptoms occur. Pt. takes larger amts of substance while trying to cut down or control substance use. Life centers around obtaining and using substance despite ongoing negative consequences associated w/it's use.

Hint 198

For Exam:

To make dx of Substance Dependence, you do not need to have tolerance or withdrawal symptoms (tolerance & withdrawal are only 2 of 7 criteria).
* You do need evidence of significant impairment in functioning or distress - family, legal, employment probs.

Front 199

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Signs & Symptoms of Intoxication (Know for Exam)

Back 199

Symptoms of Alcohol Withdrawal Delirium: delirium, hallucinations, delusions, agitated behavior, autonomic hyperactivity (sweating & rapid pulse)

Cocaine Intoxication - physiological and behavioral sings: high feeling, euphoria, hyperactivity, restlessness, anxiety, impaired judgment, tachycardia, dilated pupils; perspiration/chills; nausea/vomiting; muscle weakness; increased blood pressure.

* With chronic cocaine use, you may see depression of pulse; blood pressure; mood and psychomotor activity

Front 200

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Treatment Overview

Back 200

Once dx; next step w/pt. is determining the level and type of services pt. needs.

Pt's level of care & service mix change as tx needs change. When selecting level of care, goal should be tx in the LEAST RESTRICTIVE SETTING that will be effective in meeting pt's needs

Front 201

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Goals of Tx

Back 201

1. Abstinence from substances
2. Maximizing life functioning
3. Preventing/reducing frequency and severity of relapse

Front 202

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Stages of Tx

Back 202

1. Stabilization - focus on estab. abstinence, acceptance of SA problem, committing self to making changes. Detoxification

2. Rehabilitation/habilitation: focus on remaining substance free by estab. stable lifecycle, developing coping & living skills, increasing supports, grieving loss of subs. use.

3. Maintanence - focus is on stabilizing gains made in tx, relapse prevention; termination

Front 203

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx: Substance Abuse Stages of Treatment - Detoxification

Back 203

Detoxification - sometimes necessary first step in tx process but is not a designated tx modality. Body must be stabilized physically & psychologically until it is free of substances.

Hint 203

3 categories of substances requiring detox:
1. Central nervous system depressants - alcohol, barbituates, benzodiazapines
2. Opiates (heroin)
3. Cocaine

Opiates and benzos require GRADUAL tapering off of drug during detox

Front 204

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Modalities: Biologically Based

Back 204

pharmacotherapies that discourage consuming alcohol/other drug use; suppress withdrawal symptoms, block or diminish euphoric effects/cravings; replace an illicit drug w/prescribed meds; or tx co-existing psych problems

Hint 204

***Know for exam:
a) ANTABUSE - medication which produces highly unpleasant side effects (nausea, vomiting, hypotension, anxiety, flushing) if pt. drinks alcohol. Is a form of AVERSION THERAPY.

b) METHADONE: synthetic narcotic taken instead of OPIATES - can be legally prescribed. Pt. uses it to detox from opiates or on a daily basis as a substitute for heroin.

c) Naltrexone: drug used to reduce cravings for alcohol, also blocks effects of opiods.

Front 205

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Modalities: Psychosocial/Psychological Interventions

Back 205

modify maladaptive feelings, attitudes, behaviors through group, individual, marital, or family therapy

Front 206

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Modalities: Behavioral Therapies

Back 206

ameliorate or extinguish undesirable behaviors & encourage desired ones - behavior mod

Front 207

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Modalities: Self-Help Groups

Back 207

AA, NA
Mutual support & encouragement while becoming abstinent or to remain abstinent.

12 step groups utilized throughout all phases of tx; after completing formal tx, the recovering person can cont attendance indefinitely as means of maintaining sobriety

Front 208

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse - Critical components of effective tx

Back 208

1. assessment
2. pt. and tx matching
3. comprehensive services
4. Relapse prevention
5. Accountability

Front 209

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Approaches - Minnesota Model of Residential Chemical Dependency Tx

Back 209

Incorporates biopsychosocial disease model of addiction that focuses on abstinence as primary tx goal and uses AA 12-step program as major tool for recovery and relapse prevention

Front 210

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Approaches - Drug-Free Outpatient Tx

Back 210

variety of counseling & therapeutic techniques, skills training, educational supports, little/no pharmacotherapy to address specific needs of individuals

Front 211

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Approaches - Methadone Maintenance/Opioid Substitution Tx

Back 211

Targets chronic heroin/opioid addicts who have not benefitted from other tx approaches.

Replacement of licit or illicit morphine derivatives w/longer acting, medically safe stabilizing substitutes. Approach is more controversial than any other tx. approach.

Hint 211

Methadone programs are effective in reducing use of illicit opioids and criminal activity as well as improving health, social functioning, amployment

Front 212

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Approaches - Therapeutic Community Residential Tx

Back 212

best suited for pt's with substance probs who have serious psychosocial adjustment probs and require resocialization in highly structured setting.

Very structured, use behav. techniques to develop self-control and social responsibility

Hint 212

long term, intensive program

Front 213

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx Approaches: Re: Treatment Settings

Back 213

Goal is to match pt's needs with the LEAST RESTRICTIVE TX ENVIRONMENT THAT IS SAFE AND EFFECTIVE

Hint 213

Pt. is moved along continuum of care as he/she demonstrates capacity and motivation to cooperate w/tx.

Settings from most intensive to least intensive:
inpatient hospitalization (including inpatient detox & rehab)
Residential tx
Intensive outpt. tx
Outpt. tx

* Pt. usually attends AA while participating in other modes of tx.

Front 214

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx - Relapse Prevention (Overview)

Back 214

Recovery is ongoing process.

Relapse occurs when attitudes, behaviors, values revert to what they were during drug/alcohol use.

Hint 214

Relapse most frequently occurs during EARLY STAGES OF RECOVERY but can occur at any time.

Prevention of relapse is critical part of tx.

Relapse prevention is a form of counseling that helps a recovering individual identify and change thoughts, feelings, behavior that are precursors to relapse.

WARNING SIGNS OF RELAPSE: specific series of thoughts, feelings, actions, that, when triggered by situation or condition, lead back to active SA.

Front 215

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx - Relapse Prevention Models (1/2): Marlatt and Gordon

Back 215

Empirically based, cognitive behav. approach emphasizes self-management and self-control.

Based on social learning theory - teach indivs how to anticipate and cope w/relapse process.

ABSTINENT VIOLATION EFFECT (AVE) - if person slips/relapses, he experiences sense of decreased self-efficacy that is attributed to failure of internal/global factors rather than lack of adequate coping skills (external factors) to deal w/situation. COMBO OF USING SUBSTANCES AGAIN AND AVE INCREASES LIKELIHOOD FOR FULL-BLOWN RELAPSE. Coping successfully w/relapse is more likely when person ATTRIBUTES RELAPSE TO EXTERNAL FACTORS

Hint 215

RELAPSE IS REFRAMED AS AN OPPORTUNITY TO LEARN NEW COPING SKILLS TO FURTHER RECOVERY. Pts are taught to regard relapse as a process. By identifying high risk situations and early symptoms indicating relapse, the pt. can implement cognitive and behavioral techniques to prevent or minimize effects of relapse and stay engaged in recovery.

SITUATIONS THAT CREATE HIGHEST RISK FOR RELAPSE: NEGATIVE EMOTIONAL STATES; INTERPERSONAL CONFLICT; SOCIAL PRESSURE

Front 216

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx - Relapse Prevention Models (2/2): Gorski - Developmental Model of Recovery (DMR)

Back 216

Based on disease model of addition & biopsychsoc approach to tx.

6 stages: TRANSITION; STABILIZATION; EARLY RECOVERY; MIDDLE RECOV; LATE RECOV; MAINTENANCE.
Each stage has characteristic behaviors, recovery tasks and risks for relapse.

Hint 216

Post Acute Withdrawal (PAW): group of biopsycsoc symptoms that occur after acute withdrawal from chemical substances (7-14 days into recover). PAW symptoms are caused by:
1 - brain dysfunction resulting from chemical use; 2 - psychosoc stressors that accompany recovery. PAW Symptoms include: decreased cog functioning; probs w/memory; probs w/emotion regulation; motor coord.; balance probs; probs w/managing stress.

Process of relapse characterized by progressive increase in distress & dysfunction - sequence of steps leading to relapse: 1. internal warning sympts; 2. return of denial; 3. avoidance/defensive behav; 4. crisis building; 5. immobilization; 6. confusion & overreaction; 7. depression; 8. loss of control; 9. recog. of loss of control; 10. option reduction; 11. return to use of substance or physical/emotional collapse.

DMR is a systematic method that teaches recovering pts. to recognize & manage warning symptoms associated w/relapse.

Front 217

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx - Effectiveness of Tx

Back 217

Pt. actively participating in tx
Prolonged abstinence following tx is good predictor of continuing success.
90% of those who remain abstinent for 2 yrs are also drug and alco free for 0 yrs.

pts who remain in tx for longer periods of time are also likely to achieve max benefits.

Lover levels of premorbid psychopathology and other serious social, voc, legal prbs are likely to have successful recoveries

Front 218

ASSESSMENT, DX, DSM-IV, TX PLANNING: Substance Abuse Tx - Effectiveness of Tx (cont)

Back 218

findings from study on alcoholism @ Institute of Medicine:

no single tx approach is effective for all persons

No overall advantage for residential or inpatient tx. over outpt. care

Tx of other life probs associated w/drinking improves outcome

Therapist & pt (and prob) characteristics, tx process, posttreatment adjustment factors and interactions among variables determine outcomes

Pts who significantly reduce alcohol consumption or become totally abstinent usually improve their functioning in other areas

Front 219

ASSESSMENT, DX, DSM-IV, TX PLANNING: Dual Diagnosis/Coexisting Conditions: Overview

Back 219

Def: person has both SA problem (abuse or dependence) and one or more coexisting psychiatric D's.

Nature of dual disorders: difficult to assess; tx & manage. More severe distress & functional impairment in comparison to person w/single D. Psych and SA D interact and exacerbate symptoms of one another, making dx and tx very difficult.

Symptoms of one D can mimic/mask symptoms of the other.

Dual dx pts require both mental health and SA tx but often fall through cracks b/c neither system of care is fully qualified to tx them.

Tx philosophies underlying mental health & chemical dependency are very different re: use of meds during recovery

Hint 219

Pts are more resistant to tx and experience greater levels of DENIAL, making them less responsive to conventional tx approaches.

Increased risk for relapse of either one or the other disorders (or both).

Can become locked in repeated cycles of stabilzation and acute decompensation following SA.

Takes a lot of effort to engage and maintain them in tx; tend to overtax and exhaust providers and systems as well as their families.

Front 220

ASSESSMENT, DX, DSM-IV, TX PLANNING: Dual Diagnosis/Coexisting Conditions: Indications that support/confirm presence of psychiatric illness

Back 220

* if pt's hx INDICATES ONSET OF PSYCHIATRIC D. PRIOR TO ONSE OF SA PROBLEM

* nature/severity of symptoms/probs presented by pt differ qualitatively from those seen in those clients with only substance-related probs

* After period of time (4 weeks) sufficient for symptoms of SA to disappear, pt. conts to experience psych. symptoms

* Family hx of mental illness

* Pt. has hx of multiple tx failures in SA or mental health tx

* Positive response to tx w/psychotropic meds

Front 221

ASSESSMENT, DX, DSM-IV, TX PLANNING: Dual Diagnosis/Coexisting Conditions: Treatment Considerations

Back 221

* severity of some psych d's interferes w/way pts process info

* traditional methods used in SA programs (direct confrontation & intense group work) are NOT tolerated well by these pts and can exacerbate or worsen symptoms.

* pt.s often management problems and disrupt routines of chemical dependency programs

* Many substance A. tx programs do not have medical resources (psychiatrist) to manage psych illnesses

* Dual dx pts require simultaneous tx of both disorders using multimodal, integrated tx program combining mental health and substance abuse tx approaches

Front 222

ASSESSMENT, DX, DSM-IV, TX PLANNING: Dual Diagnosis/Coexisting Conditions: Know for Exam

Back 222

Standard of care in treating dual disorders: use alternative tx options to treat psychiatric disorders - ie) non-psychoactive drugs; support groups; *INDIVIDUAL PSYCHOTHERAPY*, and self-help groups

Hint 222

although standard of care in tx is to use meds - particularly in pts where meds are crucial (ie - schizophrenia and bioplar d.)

Front 223

ASSESSMENT, DX, DSM-IV, TX PLANNING: Dual Diagnosis/Coexisting Conditions: Principles of Care

Back 223

Acceptance - each clinical contact is welcoming, empathic, hopeful, culturally sensitive, consumer centered.

Accessibility - 24 hour crisis services to provide competent assessment & intervention

Integration - persons get needs comprehensively addressed w/in one setting by one set of providers

Continuity
Individualized Tx
Comprehensiveness
Emphasis on Quality
Responsible Implementation
Optimism & Recovey

Front 224

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - Demographic Factors

Back 224

8th leading cause of death for all americans; 3rd leading cause of death for people aged 15-24. Native Americans - higher rates than general population.

More people die of suicide than homicide.

Diagnosable mental or substance abuse disorder (or both); majority have depressive illness.

Rates increase with age, highest among americans aged 65+ (highest rate are for white males over 85).

Males are 4x more likely to commit suicide than females; females are more likely to attempt suicide than males

Gay and lesbian youth are 2 to 3x more likely to commit suicide than other youth

Front 225

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - Assessing Risk; Risk Factors

Back 225

* Hx of previous attempt - BEST PREDICTOR OF FUTURE ATTEMPT; medical seriousness of attempt is also significant

* white male over 65 or under 30

* single, separated, divorced, widowed

* lives alone; lack of social supports

* presence of psych disorder - depression; anxiety; personality d; schizophrenia

* Substance abuse

* Family history of suicide

* Presence of medical condition

** Severe hoplessness - indicates strong potential for suicide

* Losses - relationships, financial, job, social

* Presence of firearm or easy access to other lethal methods

* In adolescents - impulsive, aggressive, antisocial behavior, family violence

* recent dx from psychiatric hospital

Front 226

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - Assessing Risk; Protective Factors

Back 226

* effective/appropriate clinical care for mental, physical, substance abuse disorders

* easy access to variety of clinical interventions/support

* Restricted access to lethal methods of suicide

* Family and community support

* Learned skills in problem solving, conflict resolution, nonviolent handling of disputes

* Cultural and religious beliefs that discourage suicide/support self-preservation
* ABSENCE OF DEPRESSION OR SUBSTANCE ABUSE

* PRESENCE OF DEPENDENT CHILDREN

Front 227

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - Assessing Risk; Behavioral Warning Signs

Back 227

* Giving away belongings

* taking care of legal issues (will)

* Dramatic increase in mood (might indicate that pt has made decision to end his life)

* Verbalizes threats to commit, or feelings of despair and hopelessness: I wish i were dead; nobody wants me anymore

* has plan to commit; composes note

* visits medical provider

* engages in high risk behaviors

* Asks about donating body to science

* Symptoms of severe depression: inability to sleep or concentrate; decreased eating and weight loss; decreased self-esteem; irritability; agitation; suicidal ideation

Hint 227

For exam: increased mood = higher risk of committing because they have made a decision to commit.

Person also greater risk after being discharged from hospital or after being started on antidepressants as he may now have the energy to implement a suicide plan.

Front 228

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - Assessing Risk; Assessing Lethality

Back 228

Review:
* risk and protective factors
* psych symptoms and SA
* social supports/deterrents to taking action
* THOROUGH ASSESSMENT OF PLAN FOR SUICIDE:
frequency/intensity/duration of ST
access to/availability of method(s)
ability/inability to control ST
Ability not to act on thoughts
what makes pt. feel worse/better
what will be consequence of acting on thoughts
any deterrents to acting on thoughts
has pt. been rehearsing suicide and imagining his funeral
has pt. been using drugs/alcohol to cope
* What measures does pt. require to maintain safety

Hint 228

Hospitalization & Managed care Companies - if determine pt. is at risk for committing suicide, may need approval from managed care company prior to hospitalization - and could disagree w/you.
Medical necessity criteria for involuntary commitment to hospital: DANGER TO SELF, DANGER TO OTHERS, INABILITY TO CARE FOR SELF

Front 229

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - YOUTH Suicide - demographics

Back 229

3rd leading cause of death for youth b/w 10-19 yrs old.

White males have highest risk of suicide; Native american males also have high rate.
Firearms most common method

Front 230

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - YOUTH Suicide - Risk Factors

Back 230

* previous suicide attempt
* mental disorder or co-occurring mental/alcohol or SA d. majority have depressive d.
* Family hx of suicide
* Stressful life event/loss
* Easy access to lethal methods, esp. guns
* exposure to suicidal behavior of others - peers/media
* incarceration

Front 231

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - YOUTH Suicide - Protective Factors

Back 231

* genetic makeup/neurological
* attitudinal/behavioral
* environmental
* Learned skills - problem solving, impulse control conflict res.
* Family/community support
* Access to effective/appropriate mental health care
* Support
* Restricted access to lethal means
* cultural/religious beliefs

Front 232

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - YOUTH Suicide - Prevention Strategies

Back 232

Early detection/tx of depression, SA and aggressive behaviors

Limit access to lethal agents

Media education/limited coverages
Access to metal health services for family, friends, peers

Front 233

ASSESSMENT, DX, DSM-IV, TX PLANNING: Suicide - YOUTH Suicide - Warning Signs

Back 233

* change in eating/sleeping
* withdrawal
* Violent actions
* Drug/alcohol use
* unusual neglect of personal appearance
* Marked personality change
* persistent boredom/difficulty concentrating
* Physical complaints - stomachaches, headaches, fatigue
* loss of interest in pleasurable activities
* not tolerating praise or rewards

Hint 233

may also:
complain of being a bad person or feeling rotten inside
verbal hints: i won't be a problem for much longer
Putting affairs in order/giving away possessions
Suddenly cheerful after being depressed
signs of psychosis

Front 234

ASSESSMENT, DX, DSM-IV, TX PLANNING: Accessing Risk of Violence (overview)

Back 234

no single means of accurately predicting potential for violence.

circumstances of eval and length of time over which clinician is making a prediction - two important factors

Front 235

ASSESSMENT, DX, DSM-IV, TX PLANNING: Accessing Risk of Violence - Risk Factors

Back 235

* PAST HX OF VIOLENT BEHAVIOR IS BEST PREDICTOR OF FUTURE VIOLENCE. each prior act of violence increases change of future episode(s).

* past hx of violent suicide attempts

* Hx of using weapons against others

* Criminal hx, antisocial behavior

* Drug & alcohol use

* Psychiatric d. w/co-existing SA

* Certain psych symptoms: psychotic (suspiciousness, anger, fear, threat, unhappiness, loss of control); Depression; Brain injury/illness; Personality d (borderline, antisocial; low iq and antisocial p is bad combo).

* Hx of impulsivity, low frustration tolerance, inability to tolerate criticism, entitlement, recklessness

* Angry affect w/o empathy for others

* Military hx

* Frequent job terminations

* Younger age group (18-24 yrs old)

* Male

* Lower socioeconomic status

* Poverty

* Lower IQ, mild MR

* Lower level of education

Hint 235

other info to consider:

take all threats seriously/evaluate level of dangerousness by obtaining specific info about how threat would be carried out and expected consequences of doing so.

elicit info re: potential grudge lists

* Access suicide risk as homicidal pts also experience SI.

Front 236

ASSESSMENT, DX, DSM-IV, TX PLANNING: Accessing Risk of Violence - Practical Strategies

Back 236

static risk factors - past hx of violent behavior/demographic info

dynamic risk factors - can be changed by interventions such as change in living situation, tx of psych symptoms, abstaining from D/A abuse; access to weapons

Front 237

ASSESSMENT, DX, DSM-IV, TX PLANNING: Accessing Risk of Violence - Interventions to Reduce Risk Factors

Back 237

Pharmacotherapy
SA tx
Psychosocial interventions
Removal of weapons
Increased level of supervision

Hint 237

Two processes that increase likelihood of making an accurate prediction - obtaining a detailed past hx of violence and using appropriate risk assessment instrument.

Front 238

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - Individual Domain & Risk Factors/Protective Factors

Back 238

Risk factors - early onset: (6-11 yrs):
general offenses;
substance abuse;
male;
aggression**;
psychological condition (hyperactivity);
problem behavior (antisocial); exposure to tv violence; medical/physical; l
ow IQ;
antisocial attitudes/dishonesty**.

Risk factors late onset (12-14 yrs):
general offenses;
psych. condition (restlessness, difficulty concentration (males); risk taking);
Aggression (male);
male;
physical violence;
antisocial attitudes;
crimes against persons;
problem behavior (antisocial);
Low IQ;
SA

Hint 238

Protective factors:
intolerant attitude toward deviance
high IQ
Being female
Positive social orientation
Perceived sanctions for transgression

Front 239

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - Family Domain & Risk Factors/Protective Factors

Back 239

Risk factors (early onset, ages 6-11):
low socioeconomic status/poverty;
antisocial parents;
poor parent-child relations - harsh, lax, inconsistent discipline;
Broken home (separation from parents);
Abusive parents

Risk factors late onset (age 12-14):
Poor parent-child relations (harsh, lax, inconsistent discipline);
Low parental involvement;
antisocial parents;
broken home;
poverty/low SES;
Abusive parents;
Family Conflicts

Hint 239

Protective factors:
Warm/supportive relationships w/parents or other adults
Parents' positive eval of peers
Parental monitoring

Front 240

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - School Domain & Risk Factors/Protective Factors

Back 240

Risk factors early onset (age 6-11):
Poor attitude

Risk factors late onset (age 12-14):
poor attitude/performance (academic failure)

Hint 240

Protective factors:
Commitment to school
Recognition for involvement in conventional activities

Front 241

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - Peer Group Domain & Risk Factors/Protective Factors

Back 241

Risk factors early onset (6-11):
weak social ties
antisocial peers

Risk factors late onset (age 12-14):
weak social ties
antisocial delinquent peers
gang membership

Hint 241

Protective factors:
friends who engage in conventional behavior

Front 242

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - Community Domain & Risk Factors/Protective Factors

Back 242

Risk factors late onset (age 12-14): neighborhood crime, drugs, neighborhood disorganization

Hint 242

protective factors - unknown

Front 243

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - Pathways to Violence

Back 243

2 trajectories - before puberty and adolescence

youths who become violent before age 13 generally commit more crimes, more serious crimes for a longer time.

Most youth violence begins in adolescence and ends w/transition into adulthood.

Most highly aggressive children/behav. disorders do NOT become serious violent offenders.

Serious violence is part of a lifestyle that includes drugs; guns; precocious sex; other risky behaviors. Successful interventions must confront violent behavior and lifestyle.

Hint 243

EARLY CHILDHOOD PROGRAMS THAT TARGET AT-RISK CHILDREN AND FAMILIES ARE CRITICAL FOR PREVENTING ONSET OF A CHRONIC VIOLENT CAREER - but programs must also be developed to combat late-onset violence.

Front 244

ASSESSMENT, DX, DSM-IV, TX PLANNING: Youth Violence - Prevention

Back 244

Most highly effective programs address: INDIVIDUAL RISKS AND ENVIRONMENTAL CONDITIONS - indiv. skills and competencies; parent effectiveness training, changes in type & level of involvement in peer groups.

Interventions target change in social context (schools).

Involvement w/delinquent peers/gang members are 2 of most powerful predictors of violence - yet few effective interventions have been developed to address these problems.

Hint 244

Program effectiveness - depends on quality of implementation and type of intervention - quality of implementation must be strong.

Front 245

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse (Overview)

Back 245

child abuse & neglect: any recent act or failure to act on the part of a parent/caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation or 2 - an act or failure to act which present an imminent risk of serious harm

Front 246

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - forms of abuse

Back 246

physical - infliction of physical injury
neglect - failing to meet childs basic needs physically, emotionally, educationally;
Sexual abuse - inappropriately exposing or subjecting child to sexual contact, activity or behavior;
Emotional abuse - psychological, verbal, mental injury

Hint 246

Different forms of abuse occur separately but are often seen in combination - emotional abuse almost always accompanies other forms of abuse.

Child abuse occurs across all socioeconomic, ethnic, racial groups although child abuse is more prevalent in impoverished areas.

Front 247

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - Factors Associated w/Abuse

Back 247

Parents stressors - hx of abuse; single parent; isolated w/lack of social supports; lack of knowledge re: child development; low sense of self-competence/self-esteem; low IQ; poor self-control; poor communication/problem solving/interpersonal skills.

Hint 247

Poor parenting skills: rigid, authoritarian, poor limit setting, little knowledge re: development/rearing practices

Environmental stressors - unemployment, financial probs; poverty

Families - marital discord; imbalanced relationship w/marital partner (dominant or noninvolved); DV, SA

Society: acceptance of physical punishment, viewing children as possessions, poverty & eco. depression

Child: behavioral probs/special needs; premature child; chronic illness or physical disability; behavior in some way seems to overwhelm parent's ability to cope.

Front 248

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - Effects of child abuse

Back 248

* Intellectual/cognitive deficits secondary to brain damage
* socioemotional probs - developmental age of child, duration/intensity of abuse; post abuse environ.
* Withdrawal, increase in aggression, bedwetting, tantrums, SI or self-mutilation, hypervigilance; compulsivity; sleep probs; depression/anxiety.

Hint 248

Drop in school performance
juvenile delinquency
running away
truancy

Front 249

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - Sexual Abuse

Back 249

Girls sexually abused 3x more than boys

Factors that increase risk for SA: 7-14 yrs old; parent absent from home; isolated/depressed/lonely child.

Most perps of SA are known to child.
90% of perps are male - described as unassertive/withdrawn/emotionless. Have hx of abuse, Subst. Abuse, little satisfaction w/sexual relationships; lack of control over emotions. Usually create opportunities to be alone w/child. When females are perps; they use persuasion rather than coecsion.

Hint 249

Know for exam: ***Common characteristics of families in which sexual abuse occurs:

Social isolation
Few boundaries
Parents have hx of physical or sexual abuse
Presence of domineering father and mother who is physically or emotionally absent
Child is parentified

Front 250

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - Sexual Abuse - Indicators of Abuse

Back 250

Physical signs/injuries

Behavioral signs: any extreme changes in behavior - regression to infantile behaviors; fears & anxieties; withdrawal; sleep disturbances; recurrent nightmares. Child also show an unusual interest in sexual matters or know sexual information inappropriate for his/her age group. May engage in self-injurious behaviors, delinquent behaviors, truancy, running away. School performance fails.

Older girls - 3 sexual indicators may signal abuse: sexual promiscuity; sexual victimization; adolescent prostitution.

Traumatic sexualization: aversive feelings re: sex; overvaluing sex, sexual identity probs, hypersexual behaviors, avoidance or negative sexual encounters.

Stigmatization - damaged goods syndrome - feelings of shame/guilt/feeling responsible for abuse are reflected in self-destructive behaviors (Subst. abuse; self-mutilation; SI/gestures; acts that aim to provoke punishment).

Betrayal - lack of trust, unwilling to invest in others, become involved in exploitive relationships; angry and acting-out behaviors.

Powerlessness - perception of vulnerability and victimization; desire to control others; identification w/the aggressor; may also have avoidant response - dissociation, running away anxiety, phobias, sleep probs, elimination probs, eating probs, revictimization.

Hint 250

ALL CHILDREN EXPERIENCE: PROBLEMS RELATING TO PEERS; SCHOOL DIFFICULTIES; SUDDEN/NOTICEABLE CHANGES IN BEHAVIOR.

Sexually abused children can manifest a range of symptoms - chances of abuse are greater if child has several indicators of abuse, including combo of nonsexual and sexual indicators. ie - teenage girl could be sexually promiscuous, suicidal and a subst. abuser.

Front 251

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - Sexual Abuse - Factors Influencing effect of sexual abuse on a child

Back 251

age of victim (at time of abuse and time of assessment)

sex of victim and sex of offender

extent/duration of SA

relationship of offender to victim

reaction of others to abuse

other life experiences

interval b/w abuse and info gathering

Hint 251

immediately after disclosing the abuse, the child is more at risk for emotional mistreatment rather than further sexual abuse. emotional abuse may consist of:

disbelief by other or other family members

blamed for abuse

rejected by family

blamed for consequences of disclosing sexual abuse

child may be pressured to recant disclosure

** one of the most significant factors contributing to childs adjustment after abuse is the LEVEL OF PARENTAL SUPPORT.

Front 252

ASSESSMENT, DX, DSM-IV, TX PLANNING: Child Abuse - Child Protective Services

Back 252

goal of cps - protect children from harm and to rehabilitate families.

6 stages of cps process:
intake
initial assessment/investigation
family assessment
case planning
service provision
evaluation of family progress & case closure

Hint 252

successful intervention w/families who abuse requires comprehensive approach that addresses concrete and interpersonal/intrapersonal needs. effective way to engage family during initial period is to direct intensive resources towards family so members can experience immediate behavior change.

Front 253

Human Behavior/Development: Developmental Phases of Freud vs. Piaget vs. Erickson

Back 253

Freud:

Age: Phase:
0-1 Oral
2-3 Anal
3-6 Phallic/Oedipal
6-11 Latency
12-18 Puberty/Genital
18-mid 20s NA
Adulthood NA
Maturity NA


Erickson

Age: Phase:
0-1 Basic Trust/Mistrust
2-3 Sense of Autonomy/Shame/Doubt
3-6 Initiative vs. Guilt
6-11 Industry vs. Inferiority
12-18 Identity vs. Identity Diffusion
18-mid 20s Intimacy vs. Isolation
Adulthood Generativity vs. Self-Absorption
Maturity Integrity vs. Disgust

Hint 253

Piaget:

Age: Phase:
0-2 Sensorimotor Thought
21/2-6/7 Preoperational Thgt.
6-11 Concrete Operations
12-18 Formal Operations
18-mid 20s NA
Adulthood NA
Maturity NA

Front 254

Human Behavior/Development: Freud, Structural Theory

Back 254

Id - primitive drives, instinctual needs; features - impulses; process thinking (primary); unconscious, discharges tension.

Ego - moderates b/w drives and internalized prohibitions. Mediator b/w id and external reality; adaptive. Features: reality testing, judgment, modulating/controlling impulses; modulating affect; object relations; regulates self esteem, mastering developmental challenges.

Superego - seat of conscious, morals, judgment, guilt. Features - uses internal and external rewards, punishments to control and regulate ID impulses

Hint 254

3 levels of mind:
unconscious - unaware of thoughts, feelings, desires, memories.

Preconscious - thoughts/feelings can be brought to conscious easily

Conscious - mental activities of which we are fully aware

Front 255

Human Behavior/Development: Piaget, Cognitive Theory

Back 255

4 stages of cognitive development:
1. Sensorimotor (0-2 yrs) - primitive logic, intentional actions, play, signals - meaning in event, symbol - begins using language.

2. Preoperational (2-7 yrs): begin with concrete thinking and move to abstract; comprehend past, present, future; codes; magical thinking; thinking not generalized; concrete; irreversible; egocentric; centered on detail/event.

3. Concrete Operations (7-11 yrs): abstract thought; plays games w/rules; cause/effect understood; thinking independent of experience; logic.

4. Formal Operations (11-maturity): increased abstract thinking; planning for future; hypothetical thinking; de-centers (vs. ego centric); through peer interaction assumes adult roles and responsibilities; construction of ideals, morals, values.

Front 256

Human Behavior/Development: Erickson - Theory on Psychosocial Development - 8 Stages

Back 256

* Each stage represents a crisis - must be fought successively if next stage is to be reached.

Stage 1: Infancy - TRUST VS. MISTRUST: trust in self and environment. Quality of care - transmits sense of trustworthiness and meaning. Discontinuities in care = increase a natural sense of LOSS - child gradually recognizes separateness from mother (2nd part of stage) - basic sense of mistrust may cast through life.

Stage 2: Early Childhood - AUTONOMY VS. SHAME & DOUBT - muscular maturation allows child to experiment w/hold on and letting go - attaches enormous value to his autonomous will. Deep sense of shame & doubt - occurs if opportunity to explore (earn a sense of will) - if this is not allowed child will learn to expect defeat in any battle of wills with those who are bigger/stronger.

Stage 3: Play age - INITIATIVE VS. GUILT: imagination expanded with increased ability to move around freely & communicate. Age of intrusive activity, curiousity, consuming fantasies that lead to feelings of guilt/anxiety. Age of establishment of conscious. If tendency to feel guilty is overburdened by too eager adults, child may develop deep seated conviction that he is essentially bad - with a result of stifling of initiative or conversion of moralism to vindictiveness.

Stage 4: School Age - INDUSTRY VS. INFERIORITY: child wants to learn how to do/make things w/others. Learns how to accept instruction and win recognition by producing things - opens way for capacity of work enjoyment. If recognition is not received for efforts - develops sense of inadequacy & inferiority.

Hint 256

Stage 5: Adolescence - IDENTITY VS IDENTITY DIFFUSION: puberty, rapid body growth, sexual maturity forces person to question all sameness/continuities relied on in childhood and to refight many earlier battles. Task - integrate childhood identifications. Danger - upheaval result in permanent inability to take hold or developing fixed negative identity devoted to what parents, class, community do not want him to be.

Stage 6: Young Adulthood - INTIMACY VS. ISOLATION: if secure in identity, able to establish intimacy w/himself (inner life) and w/others - friendships; love based mutually satisfying sexual relationships. Cannot enter intimate relationship b/c fear of losing identity, leads to deep sense of isolation.

Stage 7: Adulthood - GENERATIVITY VS. SELF-ABSORPTION: interest in establishing/guiding next generation (children) - lack of generativity - self absorption, pervading sense of stagnation and interpersonal improverishment.

Stage 8: Senescence - INTEGRITY VS. DOUBT: ego integrity formed through satisfying intimacy w/others, children difficulties, co-workers, etc. acceptance of his own responsibility for what his life is/was and place in flow of history - w/o ego integration there is despair, marked by display of displeasure & disgust

Front 257

Human Behavior/Development: Margaret Mahler - Object Relations

Back 257

Stages:

0-3 months; 2-6 months: Attachment (autistic/symbiotic) - alert inactivity, no differentation b/w self and other

6-12 months: *Separation/Individuation* - Stranger Anxiety/Differentiation (8 months);

Practicing - disengagement from mother - 7-18 months - narcissism - anticipates if run away from mother, mother will re-engage;
Rapprochement - integration phase (18-24 months); splitting of object - good/bad - intense demand for attention and leave mother (rather than be left).

24-38 months - * Object Constancy*:
Consolidation of individuality and object constancy; can substitute reliable internal image during absence of mother/caregiver; unified self-image inception

Front 258

Human Behavior/Development: Attachment Theory/Bowlby

Back 258

** Know for exam:

Stranger/Anxiety and Separation Anxiety:

Stranger Anxiety - 6-8 months

Separation Anxiety - 12 months

Prolonged Separation Anxiety - 18 months

Front 259

Human Behavior/Development: Kohlberg - Theory of Moral Development

Back 259

Moral development parallels cognitive development.

3 major levels for moral reasoning; 2 stages in each level.

Person must pass through each successive stage w/o skipping for "moral maturity"

Hint 259

Level 1: Pre-conventional:
* age = elementary school
stage 1 - obedience/punishment
stage 2 - rules to achieve rewards

Level 2: Conventional:
* age = early adolescence
Stage 3 - acts to gain approval from others
Stage 4 - obeys laws - rules to avoid guilt/censure

Level 3: Post-Conventional
* age = adult (level not achieved by most adults)
Stage 5 - genuine interest in welfare of others
Stage 6 - universal ethical principle - concern for larger universal issues of morality

Front 260

Human Behavior/Development: Stages of Death & Dying

Back 260

Cognitive development - concept that death is irreversible begins at age 7 (Piaget)

Elizabeth Kubler Ross - 5 Stages of Psychological Response to Awareness of Dying:

1. Denial and Isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Hint 260

Hope - not a separate stage but possible @ any stage

Front 261

Human Behavior/Development: Maslow's Hierarchy of Needs

Back 261

Assumptions - optimism - human nature trustworthy, rational movement towards self fulfillment, full functioning, personal adequacy/self-actualization.

All 5 levels of need are operational at any developmental stage - hierarchial - parallels development in temporal sense.

person must satisfy lower level basic needs before moving onto meet higher level growth needs. After meeting lower level needs, a person can reach the highest level of self-actualization.

***Concept of hierarchy of needs can be applied when answering other questions on Exam***: ie - pt. has acute medical condition, needs/focus should be on gathering medical evaluation first. (physical = basic need); Refugee - 1st priority/need = meeting basic survival needs - shelter, food, income, clothing, takes priority over higher level needs (self-esteem, self-absorption, safety, love/belonging)

Hint 261

5 Levels of Hierarchy
Basic level of needs =

1. Physiological Needs (biological = baby, physiological needs dominate - food, shelter).

2. Safety Needs (childhood = safety & love needs dominate, regularity, predicability).

3. Love & Belonging Needs (childhood - unconditional acceptance).

4. Esteem Needs (adolescents - self-respect, respect from others)

5. Self-Actualization (Adulthood - self-actualizing - ongoing process)

Front 262

Human Behavior/Development: Parenting Patterns (3)

Back 262

3 Major patterns of parental control & Patterns of child behavior:

1. Authoritarian Parenting: very restrictive, no explanation of rules; punitive discipline (power/withdrawal of love) to force compliance.

2. Authoritative Parenting: flexible; allow autonomy, explain restrictions; responsive to childs needs/pt. of view; expect child to comply w/restrictions and will use power & reason if necessary to gain compliance.

3. Permissive Parent: lax pattern of parenting, few demands from children, permit children to freely express feelings and impulses; do not closely monitor children's activities; rarely exert firm control over behavior

Hint 262

Patterns of child behavior:

1. Authoritarian: conflicted/irritable; fearful; unfriendly, moody; passively hostile; vulnerable to stress

2. Authoritative: energetic, friendly, self-reliant, copes well w/stress, curious, cooperative w/adults.

3. impulsive and aggressive; rebellious; low in achievement; low self control

Front 263

Human Behavior/Development: Divorce, Effects on Parenting

Back 263

Phases of divorce: 1 - Crisis phase - 1 year +; 2. Adjustment phase

Children at different developmental stages will react differently to stress of divorce. May feel anger, fear, confusion.

Hint 263

Long term effects of Divorce on children:
* fear of unhappy marriages
* process painful, however may result in more positive benefits for children - removal from stressful, conflict-ridden nuclear family.
* conflict b/w parents - intact family or post-divorce family - appears to create more risk for children regardless of divorces (or not).

Divorced mothers - parenting skills tend to decrease due to increased responsibilities for single parent child rearing/homemaking; post-divorce emotions.
Become less sensitive to needs of children; approaches to parenting become more punitive & forceful.
Children reactions - disobedience; disrespect - coercive lifestyle, becomes disruptive to lives of children.

Front 264

Human Behavior/Development: Domestic Violence (Overview)

Back 264

Abusers = need for power and control over his/her partner

Front 265

Human Behavior/Development: Domestic Violence - Risk Factors

Back 265

* Status of relationship - rates of abuse 2x as high in cohabitating couples compared to legally married couples

* SES - poverty/unemployment

* Age - younger age, increased risk for being abuse and being an abuser

* Childhood experience with violence: experiencing abuse as child increases changes of being an abusive man and an abused woman.

* Alcohol use - 35-95% batters problem drinkers

Front 266

Human Behavior/Development: Domestic Violence - Warning Signs of Abuse

Back 266

* Suspicious injury/injuries - delay in receiving tx

* somatic complaints w/o specific dx - chronic pain, head, abdominal, pelvic, neck

* sexual/gyn/GI probs

* Psychological probs - anxiety/panic attacks; depression; low self-esteem; SI attempt; eating disorder; sedative use; increased request for meds.

* Pregnancy/pregnancy related probs - extreme worry re: health of unborn child; preg. complications; alcohol/drug use; teen pregnancy; inadequate prenatal care/nutrition

Hint 266

* Behavioral presentation - minimizing, lack of emotional expression

* Change of pattern of office visits

* Controlling/coercive behavior of partner - fear of speaking in front of partner, overly concerned, won't leave pt. unattended; pt. defers to partner

Front 267

Human Behavior/Development: Domestic Violence - Cycle of Violence (3 Phases)

Back 267

Phase I - Tension building - starts after long courtship phase; batterer demonstrates loving behavior; woman/man - makes commitment to batterer - tension begins to build; woman/man - thinks she can control and diffuse tension

Phase II - Acute Battering Incident - shortest period of cycle; batterer = control; battered individual = no control.

Phase III: Loving Contrition - honeymoon phase, absence of tension. Batterer declares profuse apologies, assures attacks won't happen again; declares love & caring for battered individual

Front 268

Human Behavior/Development: Domestic Violence - Characteristics of Batterer/Risk Factors

Back 268

*witness/victim of violence during childhood/adolescence - most consistently identified risk factor for becoming a batterer.

* Chronic alcohol abuse
* likely to be violent towards children
* increased levels of marital conflict
* low SES
* Deficits in interpersonal communication skills
* Traits of personality disorders - schizoid, borderline, antisocial, narcissistic, passive dependent, compulsive

Hint 268

* view victims as possessions - objects. Victims dehumanized to justify the battering
* self centered, feel entitled to have their needs (physical, emotional, sexual) met, no matter what
* have control over impulses - give themselves permission to be abusive

Front 269

Human Behavior/Development: Domestic Violence - Battered Women Syndrome

Back 269

group of psychological symptoms, including cognitive disturbances (flashbacks); high avoidance; isolation & withdrawal; depression; increased arousal/anxiety

Hint 269

consistent w/criteria for DSM IV for PTSD

Front 270

Human Behavior/Development: Domestic Violence - Victims & Social Exchange Theory

Back 270

def: totaling potential benefits and losses to determine behavior

People make decisions about relationships based on amount of rewards they receive from them - a woman remains in an abusive relationship b/c of the high cost of leaving lowers the attractiveness (outweighs the benefits) of the best alternative.
Women will leave when the best alternative promises a better life - rewards outweigh the costs

Hint 270

Reasons why women(men) stay in abusive relationship:
* hope abuser will change - leaving = loss of committed relationship
* isolation/lack of support systems
* fears no one will believe seriousness of experienced abuse
* abuser puts up barricades to prevent abused person from leaving relationship - increased threats of violence; threatens to kill her/other family members; threatens suicide
* Dangers of leaving - pose greater danger than remaining w/batterer
* economic
* Leaving is a process

Front 271

Human Behavior/Development: Domestic Violence - Interventions/Guidelines

Back 271

Not appropriate interventions:
Family therapy
Marital/Couples Therapy

Medical needs and safety = priorities
Trust - major issue for establishing therapeutic alliance. Listen, believe, validate feelings nonjudgmental stance. Avoid blaming the victim or confronting prematurely.
Implement crisis intervention strategies
Avoid revictimization - allow pt. to assist in decisions
Assist in obtaining economic, voc, social supports.

Hint 271

SW - not under legal obligation to report DV - ethical point - encourage abused person to protect him/herself.

Provide: info; educ.; resources; options; supports & help develop a safety/escape plan for herself/himself and children; referrals to battered womens shelter; attorney; physicians.

Major issues = safety; trust; validation; re-empowerment

Front 272

Professional/Therapeutic Relationship: SW/Client Relationship

Back 272

Key bond
SW create warm, trusting, accepting, dependable relationship

Respect for individuality; self-determination; fully involved in helping process

Empathy

Positive relationship = positive outcome. Competence & motivation also impact outcome

Hint 272

Empathy = start where client is; empathic response least likely of all interventions to cause harm to patient.

Front 273

Professional Values & Ethics - NASW Code of Ethics (overview)

Back 273

when ethical dilemma presents; sw should consult NASW code of ethics FIRST.

Hint 273

SW profession - focus - individual well being in social context and well-being of society.

Front 274

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Informed Consent

Back 274

Make certain client understands the forms he/she is signing; clear and understandable language.

Front 275

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Conflicts of Interest

Back 275

Avoid situations interfering w/impartial judgment

Should not engage in dual/multiple relationships w/current or former clients where there is a risk of exploitation and potential harm to the client

Front 276

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Privacy & Confidentiality

Back 276

ONLY solicit information essential for providing service.
May disclose if have VALID consent, no 3rd party disclosure unless client ok's it.

Confidentiality, Minors and Right to consent:
Minors have right to privacy in their psychotherapy records that is separate from that of their custodial parents if - by courts determination - access by parent may interfere w/childs tx.

Hint 276

Exceptions: to prevent srious foreseeable, or imminent harm to a client or other identifiable person.

Tarasoff Decision - duty to warn 3rd party harm via client (homicidal ideation). Therapist may call and warn intended victim or others likely to apprise victim of danger (notify police)

Confidentiality broken for: reporting Child sexual/abuse
& Elder abuse.

Front 277

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Privacy & Confidentiality and the Courts/Psychotherapist Privilege

Back 277

Court requires disclosure with out consent and disclosure could cause harm to the client - SW should request that court withdrawal or limit the order as narrowly as possible and/or maintain records under seal.

Jaffee vs. Redmond - psychotherapist privilege - content of sessions are protected; bars disclosure of psychtherapeutic records in legal proceedings.

Hint 277

Exceptions:
Privilege belongs to the client BUT if client sues SW, SW is no longer obligated to maintain confidentiality.

Client waiver of privilege - psychotherapy clients are permitted to waive right to privilege ie - using mental health legal claim or defense.

Front 278

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Access to Records

Back 278

Reasonable access
Must hold onto records up to 7 years after termination (FL)

Front 279

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Sexual Relationships

Back 279

Not permissible for current, former, clients' relatives; nor future clinical services to an individual whom worker has had a prior sexual relationship

Front 280

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Payment for Services

Back 280

ensure fair & reasonable w/consideration given to clients ability to pay

** No bartering

Front 281

Professional Values & Ethics - NASW Code of Ethics; Ethical Standards: Termination of Services

Back 281

When: services no longer needed or when they no longer serve the clients interests/needs

Avoid abandoning clients still in need of services

May terminate services to clients still in need of services if:
* client is not paying overdue balance if financial contractual agreement has been clear to client
* client not in imminent danger to self/others
* has been addressed & discussed w/client

Hint 281

when making a referral, critical that you refer to a competent clinician.

Front 282

Professional Values & Ethics - Ethical Responsibilities to Colleagues: Referral for Services

Back 282

when: other professionals specialized knowledge/expertise is needed to serve clients fully; or when client is not making reasonable progress

Hint 282

Prohibited from receiving payment for referral - no splitting of fees

Front 283

Professional Values & Ethics - Ethical Responsibilities to Colleagues: Sexual Relationships

Back 283

No sexual contact w/supervisees; students; colleagues w/whom they exercise authority

Hint 283

Avoid sexual relationships with colleagues where there is a potential for conflict of interest

Front 284

Professional Values & Ethics - Ethical Responsibilities to Colleagues: Impairment of Colleagues

Back 284

SW w/direct knowledge of colleagues impairment due to personal problems; substance abuse; psychosocial distress that interferes w/practice effectiveness MUST consult w/colleague when feasible and assist colleague in taking remedial action.

Hint 284

If colleague does NOT take necessary steps to address impairment; worker should contact supervisor; employer; agency; NASW; regulatory bodies.

Steps for whistle blowing:
1. colleague
2. supervisor
3. agency
4. Professional organization
5. Licensing/regulatory board

Front 285

Professional Values & Ethics - Ethical Responsibilities in Practice Settings

Back 285

1. Supervision/consultation/training:students = clients routinely informed when services are provided by a student.

2. Client records - accurate; timely; protect clients' privacy; store records for reasonable future access.

Front 286

DEFENSE MECHANISMS: Dissociation

Back 286

Splitting off clusters of mental contents from conscious awareness

Hint 286

ie - hysterical conversion; dissociative disorders

Example: a politician works vigorously for integrity in government, but at the same time engages in a business venture involving a conflict of interest without being consciously hypocritical and seeing no connection between the two activities.

Some dissociation is helpful in keeping one portion of one's life from interfering with another (e.g., not bringing problems home from the office). However, dissociation is responsible for some symptoms of mental illness; it occurs in "hysteria" (certain somatoform and dissociative disorders) and schizophrenia, The dissociation of hysteria involves a large segment of the consciousness while that in schizophrenia is of numerous small portions. The apparent splitting of affect from content often noted in schizophrenia is usually spoken of as dissociation of affect, though isolation might be a better term.

Front 287

DEFENSE MECHANISMS: Intellectualization

Back 287

Person engages in excessive abstract thinking to avoid confrontation w/conflicts or disturbing feelings

Front 288

DEFENSE MECHANISMS: Introjection

Back 288

Taking characteristics of another person into the self in order to avoid direct conflict. The emotions originally felt about the other person are now felt toward the self.


loved or hated external objects are symbolically absorbed within oneself

Hint 288

opposite of projection

defense against recognition of intolerable hostile impulses.

ex) depression - individual may unconsciously direct unacceptable hatred, or aggression toward himself/herself.

Ex) An abused woman feels angry with herself rather than her abusing partner, because she has taken in his belief that she is an inadequate caregiver. Believing otherwise would make her more fearful that the desired relationship might end.


Related to primitive fantasy of oral incorporation (freud)

Front 289

DEFENSE MECHANISMS: Projection

Back 289

Attributing unacceptable thoughts and feelings to others.

what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others

Hint 289

Examples: (1) a man, unable to accept that he has competitive or hostile feelings about an acquaintance, says, “He doesn’t like me.” (2) a woman, denying to herself that she has sexual feelings about a co-worker, accuses him, without basis, of flirt and described him as a “wolf.”

(3) A man does not want to be angry at his girlfriend, so when he is upset with her he avoids owning his emotion by assuming that she is instead angry with him.

This defense mechanism is commonly over utilized by the paranoid.

Front 290

DEFENSE MECHANISMS: Rationalization

Back 290

Using convincing reasons to justify ideas, feelings, or actions so as to avoid recognizing their true underlying motives.

individual attempts to justify or make consciously tolerable by plausible means, feelings, or behaviors that otherwise would be intolerable

Hint 290

The person rationalizing is not intentionally inventing a story to fool someone else, but instead is misleading self as well as the listener. Examples: (1) a man buys a new car, having convinced himself that his older car won't make it through the winter. (2) a woman with a closet full of dresses buys a new one because she doesn't have anything to wear.

(3) A student copes with the guilt normally associated with cheating on an exam by reasoning that he had been too ill the previous week to prepare for it.

Front 291

DEFENSE MECHANISMS: Reaction Formation

Back 291

Replacing an unwanted unconscious impulse with its opposite in conscious behavior.

a person adopts affects, ideas, behaviors that are opposite of impulses harbored either consciously or unconsciously

Hint 291

ex) excessive moral zeal may be a reaction to strong repressed asocial impulses

Examples: (1) a man violently dislikes an employee; without being aware of doing so, he "bends over backwards" to not criticize the employee and gives him special privileges and advances. (2) a person with strong antisocial impulses leads a crusade against vice. (3) a married woman who is disturbed by feeling attracted to one of her husband's friends treats him rudely. (4) A person cannot bear to be angry with his boss, so during a conflict he convinces himself that the boss is worthy of loyalty and goes out of his way to be kind.

Intentional efforts to compensate for conscious dislikes and prejudices are sometimes analogous to this mechanism.

Front 292

DEFENSE MECHANISMS: Substitution

Back 292

an unattainable/unacceptable goal, emotion, or object is replaced by one that is more acceptable or attainable

Hint 292

unconscious

Front 293

DEFENSE MECHANISMS: Sublimination

Back 293

Converting an impulse from a socially unacceptable aim to a socially acceptable one.

Instinctual drives (sexual), consciously unacceptable, are diverted into personally and socially acceptable channels

Hint 293

ie) drug dealer becoming counselor educator on negatives of drug use

An angry aggressive young man becomes a star on his school's debate team

Front 294

DEFENSE MECHANISMS: Denial

Back 294

Negating an important aspect of reality that one may actually perceive.

Failure to acknowledge a problem

Hint 294

* major defense used by pts with sexual abuse hx as a child

Denial - common factor for habitual cocaine users

Examples: (1) a person having an extramarital affair gives no thought to the possibility of pregnancy. (2) persons living near a volcano disregard the dangers involved. (3) a disabled person plans to return to former activities without planning a realistic program of rehabilitation.

(4) Anorexic woman acknowledges her actual weight & dieting practices, but believes she is maintaining good self-care by doing so.

Front 295

DEFENSE MECHANISMS: Compensation

Back 295

Individual developing skills in one area to compensate to make up for a real or imagined deficiency to maintain positive self image

Hint 295

ex) short un-athletic male becomes life of the party and stylish dresser

Front 296

DEFENSE MECHANISMS: Regression

Back 296

Resuming behaviors associated with an earlier developmental stage or level of functioning in order to avoid present anxiety. The behavior may help to resolve the anxiety.

Hint 296

dependency, attention seeking, fetal position, bed wetting, drinking from bottle = behaviors to relieve anxiety.

Ex) A young man throws a temper tantrum as a means of discharging his frustration when he cannot master a task on his computer. startled computer technician, who had been reluctant to attend to the situation, now comes forth to provide assistance.

Front 297

DEFENSE MECHANISMS: Displacement

Back 297

Shifting feelings/conflicts about one person/situation onto another

Hint 297

Permits expression of the impulse into an insignificant/non-threatening situation

Front 298

DEFENSE MECHANISMS: Repression

Back 298

Keeping unwanted thoughts and feelings entirely out of awareness so that they are not expressed in any way.

Keeps highly anxiety-producing situations out of conscious awareness

Hint 298

The involuntary exclusion of a painful or conflictual thought, impulse, or memory from awareness. This is the primary ego defense mechanism; others reinforce it.

Front 299

DEFENSE MECHANISMS: Undoing

Back 299

Nullifying an undesired impulse with an act of reparation.

Performance of an action that partially negates previous action - symbolic reversal

Hint 299

ie) obsessive compulsive disorder - individual compulsively washes hands to deal with obsessive thoughts

Examples: (1) two close friends have a violent argument; when they next meet, each act as if the disagreement had never occurred. (2) A man who feels guilty about having lustful thoughts about a co-worker tries to make ammends to his wife by purchasing a special gift for her.

Front 300

DEFENSE MECHANISMS: Projective Identification

Back 300

As in projection, the individual deals with emotional conflict or internal or external stressors by falsely attributing to another his or her own unacceptable feelings, impulses, or thoughts.

Hint 300

Unlike simple projection, the individual does not fully disavow what is projected. Instead, the individual remains aware of his or her own affects or impulses but mis-attributes them as justifiable reactions to the other person. Not infrequently, the individual induces the very feelings in others that were first mistakenly believed to be there, making it difficult to clarify who did what to whom first.

Front 301

DEFENSE MECHANISMS: Somatization

Back 301

Converting intolerable impulses into somatic symptoms.

Conflicts are represented by physical symptoms involving parts of the body innervated by the sympathetic and parasympathetic system.

Hint 301

Example: a highly competitive and aggressive person, whose life situation requires that such behavior be restricted, develops hypertension.

A person who is unable to express his negative emotions develops frequent stomach aches.

Front 302

DEFENSE MECHANISMS: Isolation of Affect

Back 302

Consciously experiencing an emotion in a a"safe" context rather than the threatening context in which it was first unconsciously experienced.

The splitting-off of the emotional components from a thought.

Hint 302

The mechanism of isolation is commonly over utilized by obsessive compulsives.

Example: a medical student dissects a cadaver without being disturbed by thoughts of death. Isolation may be temporary (affect postponement).

Example: a bank teller appears calm and cool while frustrating a robbery but afterward is tearful and tremulous

Ex) A person does not experience sadness at the funeral of a family member but the following week weeps uncontrollably at the death of a pet.

Front 303

DEFENSE MECHANISMS: Incorporation

Back 303

The assimilation of the object into one's own ego and/or superego. This is one of the earliest mechanisms utilized.

Hint 303

The parent becomes almost literally a part of the child. Parental values, preferences, and attitudes are acquired.

Front 304

DEFENSE MECHANISMS: Help-Rejecting Complaining

Back 304

The individual deals with emotional conflict or internal or external stressors by complaining or making repetitious requests for help that disguise covert feelings or hostility or reproach toward others, which are then expressed by rejecting the suggestions, advice, or help that others offer. The complaints or requests may involve physical or psychological symptoms or life problems.

Front 305

DEFENSE MECHANISMS: Fixation

Back 305

The cessation of the process of development of the personality at a stage short of complete and uniform mature independence is known as fixation.

Front 306

DEFENSE MECHANISMS: Displacement

Back 306

Shifting negative feelings about one person or situation onto another.

Hint 306

Ex: a students anger at her professor, who is threatening as an authority figure, is transposed into anger at her boyfriend - a safer target.

Front 307

Elder Abuse: Causes

Back 307

* Caregiver stress
* Cycle of Violence
* Personal problems of abusers
* Impairment of dependent elderly

Front 308

Elder Abuse: Types of Abuse

Back 308

Physical
Sexual
Emotional
Neglect
Financial/material exploitation
Self-abuse/neglect
Other

Front 309

Elder Abuse - Interventions

Back 309

3 main categories:
Social Services
Health and mental health services
Criminal Justice system

Hint 309

prevention, protection, case mgmt., counseling/tx, respite/assistance; empowerment; law enforcement/courts; living arrangements

APS

Front 310

Working with Elderly - Relationship Building

Back 310

Warm, supportive, non-confrontational relationship
Structure/direction
There & Then focus
Formal names
Active/structured stance - solicit input and feedback by paraphrasing, prompting, questioning
May have some resistance/reluctance - re: utilizing services/resources

Sense of self (versus gaining new insights) - will use therapeutic relationship to help fortify sense of self-esteem, competency, mastery, normalcy

Front 311

Working with Elderly - Direct Intervention Techniques

Back 311

Stimulate life review/reminiscence - past experiences

Sensory training and remotivation techniques - frail

Strategies for cognitively impaired - reality orientation for mild dementia and validation intervention for severe dementia

Group work - socialization and therapeutic benefits - support, social/rec; family caregiving groups

Front 312

Working with Elderly - special considerations

Back 312

Issues of autonomy & self-determination - placement issues

Late-life depression and risk of suicide

Substance abuse

Need for guardian if incompetent

Front 313

COMMUNICATION: Social Work Interview (Overview)

Back 313

interviewer and interviewee - interview designed to serve the interest of the client.

Purpose - informational, diagnostic, therapeutic.

Solicit least amount of information needed

Front 314

COMMUNICATION: Overview

Back 314

verbal/non verbal communication; interactive and interrelational; during communication each person affects the other person.

Communication involves the message, message encoded, transmitted, received, processed, decoded.

Front 315

COMMUNICATION: Communication Theory (Overview)

Back 315

Involves ways in which information is transmitted - the effects of information on human systems, how people receive information from their own feelings, thoughts, memories, physical sensations, environments; and how they evaluate this info, how they subsequently act in response to the info.

Front 316

COMMUNICATION: Communication Theory Terms: Feedback

Back 316

how one's behavior has affected his or her internal states and surroundings; perceive what follows actions and evaluate perceptions as feedback

Front 317

COMMUNICATION: Communication Theory Terms: Relationships - Symmetrical

Back 317

two have equal power

Defined by messages implicit or explicit in communication

Front 318

COMMUNICATION: Communication Theory Terms:Complementary Relationship

Back 318

one up/one down position - unequal power

Front 319

COMMUNICATION: Communication Theory Terms: Double Bind

Back 319

Offering two contradictory messages and prohibiting the recipient from noticing the contradiction

Front 320

COMMUNICATION: Communication Theory Terms: Paradox

Back 320

Prescribing the symptom - if patient obeys, they give up control; symptoms are no longer serving purpose and can disappear

Front 321

COMMUNICATION: Communication Theory Terms: Non Verbal Communication

Back 321

facial expressions, gestures, posture, potent forms of communication

Front 322

COMMUNICATION: Communication Theory Terms: Metacommunication

Back 322

the context within which to interpret the content of the message - nonverbal communication, body language, vocalizations

Front 323

COMMUNICATION: Communication Theory Terms: Metacomplementary relationship

Back 323

one person lets the other have control or forces him to take it

Front 324

COMMUNICATION: Communication Theory Terms: Symmetrical escalation

Back 324

power struggle, trying to be one-up at the same time

Front 325

COMMUNICATION/Verbal Barriers to communication (main points)

Back 325

Providing reassurance prematurely or w/out genuine basis - it is clinician's responsibility to explore and acknowledge the clients feelings no matter how painful they are

Giving advice or solutions prematurely before through exploration of problem.

Sarcasm - used with caution

Empathic responses to clients negative feelings

structure and direction

*** Social worker (code of ethics) should only solicit information essential to providing services - minimum necessary to achieve purpose

Front 326

COMMUNICATION/Axioms of Human Communication (Overview)

Back 326

One cannot not communicate - even when one is silent one is communicating, and another person is reacting in the silence.

Every communication has a context and a relationship aspect such that the latter classifies the former (metacommunication - need to communicate directly and openly)

All communicational interchanges are either symmetrical or complementary, depending on whether they are based on equality or difference.

Front 327

PROFESSIONAL RELATIONSHIPS/THERAPEUTIC RELATIONSHIPS: Social Worker/Client Relationship

Back 327

Positive relationship is an important tool of helping - must create warm, accepting, trustworthy and dependable relationship w/clients.

SW must convey sense of respect for clients individuality as well as his/her right and capacity for self-determination and for being fully involved in helping process from beginning to end.

Empathic understanding - nonjudgmental, accepting, genuine

Most consistent factor associated w/positive outcome of helping relationship is positive relationship b/w client and clinician; as well as clinicians competence, motivation, involvement of client

Front 328

PROFESSIONAL RELATIONSHIPS/THERAPEUTIC RELATIONSHIPS: The Helping Relationship

Back 328

Clarification and definition of objectives often become important part of helping process.

The receiver of help has the most power.

Trust

Joint exploration

Front 329

PROFESSIONAL RELATIONSHIPS/THERAPEUTIC RELATIONSHIPS: Empathy

Back 329

Establishing rapport with clients - bridging the gap b/w client and clinician particularly in transcultural relationships.

Start where the client is at and stay attuned to client throughout encounter.

Accurately assessing clients' problems

Responding to nonverbal messages

Facilitates confrontation by blending confrontation w/empathic responses

Empathic responding encourages more rational discussion and diffuses strong emotions.

*** Empathic response is least likely of all interventions to cause harm to patient.

Front 330

PROFESSIONAL VALUES AND ETHICS: Overview

Back 330

*** when an ethical dilemma arises, the SW'er should first consult the code of ethics - it is most widely accepted source of information about ethics for SW'ers.

Primary mission of SW profession is to enhance human well-being and help meet basic needs of all people

Front 331

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Values and principles

Back 331

Core values/ethical principles:
Service
Social Justice
Dignity and worth of the person
Importance of human relationships
Integrity
Competence

Front 332

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Ethical Standards: Ethical Responsibilities to Clients

Back 332

Right to self-determination

** Informed consent - provide services only in the context of a professional relationship based on valid informed consent. Clear and understandable language/ensure client comprehends consent before audiotaping/videotaping or THIRD PARTY observation of clients

Competence/cultural competence

Knowledge of clients' cultures/sensitive

Conflicts of Interest - avoid situations interfering with impartial judgment; should not engage in dual/multiple relationships w/clients or former clients where there is risk of exploitation or potential harm

Front 333

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Ethical Standards: Ethical Responsibilities to Clients (2)

Back 333

Privacy and confidentiality: only solicit info essential for providing service.
May disclose confidential info when you have VALID consent from client or person legally authorized to consent.
Exceptions:::
to prevent serious foreseeable or imminent harm to a client or other identifiable person - Tarasoff decision; child sexual abuse; elder abuse.

No disclosure to third party payers unless clients have authorized disclosure.

When court of law requires disclosure with out clients consent and such disclosure could cause HARM to the client, SW should request that court withdraw or limit the order as narrowly as possible and/or maintain the records under seal

Front 334

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Ethical Standards: Ethical Responsibilities to Clients (3)

Back 334

Access to records - reasonable

Sexual relationship - no sexual activities/contact with current clients, whether such contact is forces/consensual; not w/clients relatives; not w/former clients; no clinical services to individuals w/whom worker has had a prior sexual relationship

Payment for services - fair and reasonable; avoid bartering

Termination of services: when services no longer needed or when they no longer serve the clients needs/interests; avoid abandoning clients still in need of services; may terminate w/clients who have not paid overdue balance if contractual agreements re: financial contract have been made and client is not in imminent danger to self/others

Front 335

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Ethical Standards: Ethical Responsibilities to Colleagues (1)

Back 335

Respect
Confidential info shared
Participate in collaboration
Referral for services - other specialized knowledge needed to serve clients fully; when NOT making reasonable progress.
No splitting of fees
Sexual relationships - no contact w/supervises/students/colleagues

Front 336

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Ethical Standards: Ethical Responsibilities to Colleagues (2)

Back 336

Impairment of colleagues:

SW with direct knowledge of impairment should consult with that colleague when feasible and assist colleague in taking action.
If colleague does not take adequate steps to address impairment, worker should take action through appropriate channels.

Incompetence of colleagues - consult w/colleague

Unethical conduct of colleagues - discourage/prevent/expose

Hint 336

whistle blowing entails taking action through appropriate channels:
1. colleague
2. supervisor
3. Agency administrator
4. Professional organization
5. Licensing/regulatory boards

Front 337

PROFESSIONAL VALUES AND ETHICS: Social Work Code of Ethics - Ethical Standards: Ethical Responsibilities to SW profession

Back 337

evaluation and research - obtain voluntary and written informed consent from participants, inform of right to withdraw at anytime w/o penalty

Assure anonymity or confidentiality of data

Front 338

SW Profession and Legal Statutes: Privileged Communication and Confidentiality

Back 338

Confidentiality - ethical term; social workers obligation to client.

Privileged communication is legal term - client is the holder of the privilege.

Jaffee vs. Redmond (1996): clinicians have obligation to protect confidential client information, using the legal process in necessary. this case creates an absolute privilege or bar to disclose of confidential psychotherapeutic records in legal proceedings.

Psychotherapy clients are permitted to waive (give up) the right to privilege.

W/out signed waiver from client, psychotherapists would be required to resist disclosure of client information sought in legal proceedings and claim privilege on behalf of the client until a judicial determination was made as to admissibility of records.

Front 339

SW Profession and Legal Statutes: Duty to Warn, Tarasoff vs. Regents of Univ. of California

Back 339

When clinician determines that patient presents a serious danger of violence to another, the SW incurs an obligation to use reasonable care to protect the intended victim against such danger. May call for SW to warn intended victim/police.

Front 340

SW Profession and Legal Statutes: Subpoenas

Back 340

Absent client consent or imminent threat - SW is to wait until ordered by court before disclosing client info in legal proceedings.

Duty to claim privilege

After means to protect clients interests have been exhausted, judicial order to produce records may still be issued by court. SW'ers should request that court limit the order as narrowly as possible and maintain the records under seal, unavailable for public inspection.

Consult w/attorney - need to file motion to quash

Front 341

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Overview and Primary Objective

Back 341

Primary objective of management is the enhancement of service resources and service effectiveness

Front 342

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Purpose of Social Welfare Administ.

Back 342

Goal attainment and organizational maintenance activities. Administration is essentially a political process that is concerned with when, why, how, and to whom services are allocated

Front 343

SOCIAL WORK MANAGEMENT & ADMINISTRATION: 4 Theoretical Approaches

Back 343

1. Scientific Management Theory - pay is most effective motivator.

2. Human Relations Theory - employees are self directed (theory y); more likely to lead to an effective organization.

3. Structural Functional Theories - focus on application of goals, power, centralization.

4. Systems Theories - structuralist and human relations approach

Front 344

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Administrative Functions & Tasks (Overview)

Back 344

Maintenance: efficiency issues; problem solving; maintain resources; standardization of procedures; controlling agency functions.

Service: quality; goal setting; staff development; evaluation - program/staff; public relations

Front 345

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Process of Policy Planning Phases

Back 345

Problem
Proposal
Decision
Planning
Programming
Evaluation

Front 346

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Budgeting Techniques (Performance-based)

Back 346

1. Zero-Base Budgeting
2. Program Planning Budget System
3. Cost Effectiveness and Cost Benefit Analysis
4. Management by objectives

Front 347

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Program Evaluation (Overview)

Back 347

Benefits of PE: key to optimizing organizational effectiveness.

Tool for satisfying social & professional demands for accountability

Front 348

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Program Evaluation - Obstacles

Back 348

negative evaluations
staff resistance
lack of funds
lack of interest

Front 349

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Program Evaluation - Criteria

Back 349

effort
impact
effectiveness
efficiency
Quality

Front 350

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Program Evaluation - Process

Back 350

1. Should eval be done
2. Identify programs objectives for client service/outcomes
3. Collection, classification, measurement of data - formative versus summative evaluations

Front 351

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Program Evaluation - Data

Back 351

Formative evaluations - evaluate a program as it is being developed; result in modification of programs rather than termination. Focus on what was done/process

Summative evaluations - done on existing programs - focus on results/outcome

Front 352

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Staff Development

Back 352

continuing education
performance appraisal - criteria & techniques
Supervision
Consultation

Front 353

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Supervision

Back 353

3 functions - administrative; supportive; educational

Front 354

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Consultation

Back 354

role: 1 - purpose of consult; 2 - nature of problem; 3 - overall process.

Consultants authority comes from his knowledge and skills. A consultant has NO authority over staff. Must be sanctioned by the agency

Front 355

SOCIAL WORK MANAGEMENT & ADMINISTRATION: Public Relations

Back 355

3 Key service tasks - education (educate public about social problems, and services it provides); advocacy (persuade something needs to be done); outreach (educative task)

Front 356

SOCIAL WORK MANAGEMENT & ADMINISTRATION: The Board of Directors (Public vs. Private)

Back 356

Public agencies - no broad powers or responsibilities - boards perform advisory and/or administrative role

Private/Voluntary organizations - general control and direction of organization. Responsibility for fiscal and programmatic aspects are collectively shared. Accountable to - funding sources, community, regulatory bodies, consumers.

Front 357

SOCIAL WORK MANAGEMENT & ADMINISTRATION: The Board of Directors Functions

Back 357

Ultimately responsible for functioning of the agency and performance of staff.

Policy development
Program development
Personnel
Finance
Public relations
Accountability

Front 358

SOCIAL WORK MANAGEMENT & ADMINISTRATION: The Board of Directors - Boundary violations **

Back 358

important to delineate and maintain clear boundaries between board of directors and agency staff.

It would be a boundary violation and conflict of interest for a member of the board to become a paid employee or consultant of the agency for which he/she services on the board.

Front 359

SOCIAL WORK RESEARCH: Types of Research Studies

Back 359

1. Exploratory/Formulative Studies - purpose to gain familiarity w/or achieve new insights into it.

2. Descriptive studies - ie) narrative case study

3. Correlational studies - determine way in which something is associated w/something else.

4. Hypothesis studies - causal relationship between variables

Front 360

SOCIAL WORK RESEARCH: Experimental Studies (overview)

Back 360

Experimental studies - study in which the investigator manipulates & controls at least one independent variable and observes the way that this manipulation affects a dependent variable.

Non experimental studies - does not allow one to rule out in advance the possibility that the effect was created by some other factor that is associated w/the presumed causal factor.

Independent variable - variable manipulated or controlled by experimenter - treatment often the independent variable.

Dependent variable - affected by independent variable. Outcome is dependent variable.

Front 361

SOCIAL WORK RESEARCH: Common Research Designs

Back 361

1. Experimental group design - comparison of control group w/experimental group

2. Pre-Post (AB) Design - comparison of some variable before and after tx.
Before tx/pre-tx/baseline = A
After tx/post-tx = B

3. Single Subject Designs - allow experimental study of a single individual. Ex) Reversal Design - ABA = baseline - tx - withdrawal of tx. (Has poor external validity and generalizability).

** For exam - in some cases it would be unethical to withdrawal tx if patient were at risk for harm.

Also - in crisis, you would NOT delay tx in order to obtain baseline data (BAB = crisis situation).

Front 362

SOCIAL WORK RESEARCH: Reliability

Back 362

Can you get the same answer repeatedly? Are the measures obtained "true" measures of what you are measuring?

Front 363

SOCIAL WORK RESEARCH: Validity

Back 363

Validity of a measuring instrument - are we measuring what we think we are measuring, or something else?

Types: external validity - can results be generalized to other groups, settings, or times or from one measure to another?

Internal validity - did experimental tx's make a difference?

Content validity - is the content of this measure representative of the content of the property being measured?

Construct validity
Predictive validity
Face validity

Front 364

SOCIAL WORK RESEARCH: Statistics

Back 364

Descriptive stats - describe the data
Inferential stats - generalizations are made about a population by studying a subset, or sample. Inferential stat tests are: ANOVA, t-test, chi-square

Front 365

SOCIAL WORK RESEARCH: Measurement Scales

Back 365

Nominal (name) scale - categories

Ordinal scale - logical ordering

Interval scale

Ratio scale

Front 366

SOCIAL WORK RESEARCH: Random Sampling & Random Assignment

Back 366

random sampling - each individual w/in a population has an equal change of being selected for study

Random assignment - individuals selected for study are assigned to experimental/control groups according to chance

Front 367

SOCIAL WORK RESEARCH: Measures of Central Tendency

Back 367

Mode - most frequent score

Median - point below which one half (50%) of scores lie (50th percentile)

Mean - average of scores. Most strongly affected by extreme scores

Front 368

SOCIAL WORK RESEARCH: Null Hypothesis

Back 368

statement of no difference/no relationship b/w variables tested; no difference b/w control and experimental group

Front 369

SOCIAL WORK RESEARCH: Level of Significance

Back 369

Statistical significance - probability that difference is due to chance. Typically p< 0.05 or p<0.01 are used in behavioral research

Front 370

SOCIAL WORK RESEARCH: Stages of Research Process

Back 370

1. Problem formulation
2. Research measurement design
3. Data Analysis

Front 371

SOCIAL WORK RESEARCH: T-Test

Back 371

Test of statistical significance difference between sample means

Front 372

SOCIAL WORK RESEARCH: Chi Square

Back 372

Test of statistical significance that measures the difference b/w observed frequencies and expected frequencies due to chance. Values less than 0.05 are statistically significant

Front 373

SOCIAL WORK RESEARCH: Random Error

Back 373

Assessed by instrument reliability

Front 374

Case Management: Overview

Back 374

Involves working w/multiple agencies and coordinating services.
Concerns are not to duplicate services & to watch for any gaps in services.

Encompasses:
Assessment
Planning
Coordinating
Facilitating
Monitoring of Services

Front 375

DIVERSITY: Define Manage Diversity

Back 375

Managing in a fair and respectful manner the ideas and interests of all individuals in the organization

Front 376

DIVERSITY: Homogeneous Group

Back 376

group consisting of entirely one type of race (ie - pacific islanders).

where members share many of the same characteristics - such as age, ethnicity, gender, beliefs or values

Front 377

DIVERSITY: Multicultural Group & Problem Solving

Back 377

Most probable benefit that this type of group would have when trying to solve a problem is more alternative solutions to the problem

Front 378

DIVERSITY: Parochialism (defined)

Back 378

viewing the world through the narrow perspective of limited cultural exposure

Front 379

DIVERSITY: Diversity in Groups

Back 379

Advantage - better problem definition; better creativity

Front 380

DIVERSITY: Barriers to Management of Diversity

Back 380

ignorance
organizational culture
lack of mentoring

Front 381

DIVERSITY: Equifinality (defined)

Back 381

the view that there are many culturally distinct ways of reaching the same goal, of working and living ones' life

Front 382

DIVERSITY: Ethnocentrism (defined)

Back 382

the tendency to believe that one's ethnic or cultural group is centrally important, and that all other groups are measured in relation to one's own.

The ethnocentric individual will judge other groups relative to his or her own particular ethnic group or culture, especially with concern to language, behavior, customs, and religion.

These ethnic distinctions and sub-divisions serve to define each ethnicity's unique cultural identity.

Front 383

DIVERSITY: Heterogeneity (defined)

Back 383

refers to a society or group that includes individuals of differing ethnicities, cultural backgrounds, sexes, or ages

Front 384

DIVERSITY: Diversity (defined)

Back 384

being different, dimensions, non-uniformity; being respectful; having different people in an organization (NOT a majority)

Front 385

DIVERSITY: Heterogeneous Group

Back 385

heterogeneous - name given to a group whose members are not the same.

Front 386

DIVERSITY: Cultural Relativism

Back 386

Notion that beliefs, values, and behavior must be viewed in relation to the culture from which they originate