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292 Cards in this Set

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Social Work Problem-Solving Process
1) Engagement
2) Gathering Information
3) Assessing/Diagnosis
4) Goal Setting
5) Intervention
6) Evaluation
7) Termination
The Referral Process
1) Clarifying the need or purpose
2) Researching resources
3) Discussing and selecting options with client
4) Planning for the initial contact
5) Initial contact between client and referral source
6) Follow-up to see if need was met

* Keep in mind the client's right to self-determination
Systems Theory
The concept of a system as interacting parts. The basis of the model is the dynamic interaction of the components.

* If you change one part of the system, the entire system changes.

- Homeostasis: Steady state
- Input: From environment
- Output: Produce to environment
- Throughput: Using the input
- Entropy: Closed system; no energy from outside
- Negative Entropy: Successful use of available energy
- Equifinality: Capacity to receive identical results from different initial condition.
Feedback: When output from systems is put back into the system
Input - Throughput - Output

Implications for practice:

1. Problems are defined in transactional terms; the responsibility for change does not rest on the client alone
Feedback: When output from systems is put back into the system
2. Development and functioning are outcomes of transactions between their genetic potential and their environment.
3. Reorienting interventions toward growth, adaptive transactions, and environments
Ecological/Life Systems Model
Focuses on the interrelatedness between people and their environment

- Emphasizes the degree of fit between person and environment

- Person is involved in an ongoing circular exchange with his/her environment (Transactional relationship)

Focus of Intervention:

- The interface between the client and the client's environment

Aim of Intervention:

-To make the client's environment more responsive to his her needs and to release the client's adaptive potential by altering the transactions between the client and the environment
Ecological/Life Systems Model Terms
Terms:
Adaptedness: Goodness of fit with the environment (right, needs, goals, etc.)
Adaptation is a continuous process

Niche: Status occupied by an individual or group within a given social system (associated with power/oppression)

Habitat: Physical setting

Positive Stress: Environmental demand perceived as as channel and associated with positive feelings

Negative Stress: Discrepancy between demand and capacity for coping with it and associated with negative feelings

Coping: Psychological, physiological, behavioral response
Functional Approach
Based on a psychology of growth with the center of change residing in the client, not in the worker.

- Emphasis is on releasing client's power for choice and growth.

- "Helping" rather than treating.

Principles:
-Time phases (Beginning, middle, ending)
- Use of structure
- De-emphasize diagnosis
- Function of the agency
- Use of relationship

Clinician and client enter into relationship with a lack of knowledge regarding how it will turn out; client and worker discover it together
Planned Short-Term or Task Centered Treatment
Hallmarks:
Restricting the duration of treatment at the outset and using interventions from learning theory and behavior modification to promote completion of a well-defined task
(Assess, set goals, define tasks)

- Highly structured, 8-12 sessions

Primary Aim: To quickly engage clients in the problem-solving process and to maximize their responsibility for treatment outcome

- Problem partialized into clearly delineated tasks to be addressed consecutively

- Assessment focuses on helping the client to identify the primary problem and explore the circumstances surrounding the problem

- Consideration is given to how the client would ideally like to see the problem resolved
Problem Solving Approach
Assumptions:
-All human living is a problem-solving process, and the ego is seen as a mechanism for solving problems.
- In ability to cope is die to come lack of motivation, capacity, or opportunity to solve problems in an appropriate way.
- Clients are people whose usual problem-solving capacities or resources have broken down, are impaired, or maladaptive

Goals of Action:
1) To release, energize, amd give direction to client's motivation by minimizing disabling anxiety and fears
2) To release, and then repeatedly exercise, the client's mental, emotional, and action capacities for coping with his problem
3) To make accessible to the client the opportunities and resources necessary to the solution of the problem

Four P's:
-Person
-Problem
-Place (Agency)
-Process (therapeutic relationship)
Psychosocial Approach
This approach considers the client in the context of his interactions or transactions with the external world

- The diagnosis is based on a psychosocial history

- Treatment requires a modification of the person/environment or both, and of the exchange between them
Psychoanalytic Theory
Man is seen as the product of his past and treatment involves dealing with the repressed material in the unconscious

Three Personality Structures:
Id, ego, superego

Concepts:
- Unresolved conflict is the basis for psychopathology
- Conflict between id, ego, and superego lead to anxiety
- Fixation: Failure to resolve a conflict at any stage of development

Assumptions:
- determinism: Functioning of mind and ordering of ideas are not random; all thoughts, feelings, and behaviors are related to prior experiences
- Structural Model: Mind has 3 layers of mental activity (Unconscious, Preconscious, Conscious)
- Dynamic Principle: Conflict between id, ego and superego. Unresolved conflict = anxiety
- Genetic Principle: Early years of childhood extremely important in personality development

Stages of Psychosexual development: Libidinal energy is invested in a different organ system at each stage (Cathexis - investment of energy); Oral, Anal, Phallic, Latency, Genital

- Involves 4 processes:
1. Clarification
2. Confrontation
3. Interpretation
4. Working through goal to resolve intrapsychic conflict

- In psychoanalytic psychotherapy, the primary technique used is analysis (of dreams, resistance, transferences, free associations)
Id
Unconscious source of motives and drives; Pleasure principle, seeks immediate gratification
Ego
- Emerges at 6 months
- Represents logic and reason
- Reality principle
- Mediates between id, superego, and reality
Superego
- Moral
- Develops between ages 4-5
- Incorporates parental and societal values and standards into personality
Ego Psychology
Focuses on the rational, conscious processes of the ego

- Assessment based on the person as he presents himself in the present (Here and Now)

- Treatment focuses on the ego functioning of the individual (healthy behavior is under the control of the ego)
a) How the person behaves in relation to the situation
b) Reality testing: Situation; person's perception of situation
c) Coping abilities: ego strengths
d) Capacity for relating to workers

- Ego Support: Support the functions of the ego (Strengths, defenses, reality testing)
- Ego Defensive Functioning: unconscious; involved in resolving conflicts
- Ego Autonomous Functions: conscious; conflict-free, adaptive functions

Goal: To maintain and enhance ego's control and management of reality stress and its effects
Alfred Adler
- Individual Psychology

Developed a holistic theory of personality development and psychotherapy.

- Individuals have a single drive or motivation behind all their behavior, and that motivation is a "striving for perfection"
Individual Psychology
Feelings of inferiority: When children experience a sense of weakness, they compensate adaptively by working hard and becoming good at something else, or maladaptively by striving for superiority and power over others

- Lifestyle: The way that individuals live and cope with their lives
- Social Interest or community feeling: Healthy people have a broad social concern and want to contribute to the welfare of others. Unhealthy people or those who are overwhelmed by feelings of inferiority strive for superiority and power over others.

Aim of therapy: To develop a more adaptive lifestyle by overcoming feelings of inferiority and self-centeredness and to contribute more towards the welfare of others.
Self Psychology
Defines the self as the central organizing and motivating force in personality
- Empathic responses in childhood from caretakers lead to a strong sense of selfhood
- Empathic failures from caretakers result in a self disorder or lack of self-cohesion

- Object of self psychology: To help an individual develop a greater sense of self cohesion

3 Self-Object Needs:
a) Mirroring: Validates the child's sense of a perfect self
b) Idealization: Child burrows strength from others; identifies with someone more capable
c) Twinship/Twinning: Child needs an alter ego for a sense of belonging or humaneness
Nondirective/Client-Centered Therapy
Human beings are basically good and have a single force in life (the actualizing tendency) to develop to his/her fullest potential

- To strive towards growth, the personality must remain organized and unified
- When there is incongruity between the concept of self and experience (the evaluation of others), the self becomes disorganized, feels anxiety, and behaves maladaptively.
- Anxiety is dealt with by denying, selectively perceiving, or distorting the external information

-Therapist Needs:
a) Unconditional positive regard
b) Accurate empathy
c) Therapeutic genuineness

Client needs:
- Incongruence: Aware of hurting and wants to do something about it)
- Perception of therapist's condition
- Self-exploration
Ego Psychology
Focuses on the rational, conscious processes of the ego

- Assessment based on the person as he presents himself in the present (Here and Now)

- Treatment focuses on the ego functioning of the individual (healthy behavior is under the control of the ego)
a) How the person behaves in relation to the situation
b) Reality testing: Situation; person's perception of situation
c) Coping abilities: ego strengths
d) Capacity for relating to workers

- Ego Support: Support the functions of the ego (Strengths, defenses, reality testing)
- Ego Defensive Functioning: unconscious; involved in resolving conflicts
- Ego Autonomous Functions: conscious; conflict-free, adaptive functions

Goal: To maintain and enhance ego's control and management of reality stress and its effects
Alfred Adler
- Individual Psychology

Developed a holistic theory of personality development and psychotherapy.

- Individuals have a single drive or motivation behind all their behavior, and that motivation is a "striving for perfection"
Individual Psychology
Feelings of inferiority: When children experience a sense of weakness, they compensate adaptively by working hard and becoming good at something else, or maladaptively by striving for superiority and power over others

- Lifestyle: The way that individuals live and cope with their lives
- Social Interest or community feeling: Healthy people have a broad social concern and want to contribute to the welfare of others. Unhealthy people or those who are overwhelmed by feelings of inferiority strive for superiority and power over others.

Aim of therapy: To develop a more adaptive lifestyle by overcoming feelings of inferiority and self-centeredness and to contribute more towards the welfare of others.
Self Psychology
Defines the self as the central organizing and motivating force in personality
- Empathic responses in childhood from caretakers lead to a strong sense of selfhood
- Empathic failures from caretakers result in a self disorder or lack of self-cohesion

- Object of self psychology: To help an individual develop a greater sense of self cohesion

3 Self-Object Needs:
a) Mirroring: Validates the child's sense of a perfect self
b) Idealization: Child burrows strength from others; identifies with someone more capable
c) Twinship/Twinning: Child needs an alter ego for a sense of belonging or humaneness
How many days per month of leave does a Service Member earn?

a. 1
b. 2
c. 2.5
d. 3
C
Gestalt Therapy
A person seeks heightened awareness through dramatization of split-off parts of the self.

- Process oriented approach
- Focuses on awareness, contact, and self-regulation
- The integration of mind, body, thoughts and action are central to the approach
- Here and now focuse
- The therapist helps the client to take responsibility for his/her thoughts, feelings, and actions
- Contraindicated for clients who have problem maintaining self control
- Dramatization is key to the approach (psychodrama, role plays, empty chair technique)
Transactional Analysis
Each person has 3 ego states: Parent, adult, and child

- Each child writes a life script based on who is O.K.The script is acted out throughout the individual's life unless he/she recognizes and changes it.

Four life positions:
- I'm OK - You're OK
- I'm not OK - You're not OK
- I'm OK - You're not OK
- I'm not OK - You're OK

Game Analysis: Client is made aware of his habitual defective interactions through psychodrama or direct confrontation
Script Treatment: The worker clarifies the client's life script and gives a counter injunction to bring about script reversal
Strokes: Physical contact between people. Lets people know they are OK and valued
Contracting: Change is defined by a treatment contract that is made between adult and adult ego states
Postmodern Model
The postmodern movement is based on the premise that truth is not absolute

- Movement arose in reaction to modernism, a movement committed to using scientific inquiry in the search for universal laws and truths that would explain all natural phenomena
Narrative Therapy (Goal)
- There is no objective reality
- Individuals create stories to make sense out of life experiences

Goal of Narrative Therapy:
- To help clients deconstruct their story and change their stories so they can discover new realities and truths for themselves
Narrative Therapy Key Concepts
- Externalizing the problem: Separating the client from the porblem

- Problem-saturated stories: The stories the client has co-constructed in interactions with others

Mapping the Problem's Domain: Effect of the problem over time and domains

- Unique Outcomes: uncovering new truths or strengths

- Spreading the News: Letting others know when clients start experiencing positive change. Involve public acknowledgment of success (celebrations, awards, etc)
Behavior Modification: Sociobehavioral School
The systematic application of principles of learning to the analysis and treatment of behaviors

- Behavior determines feelings, thus changing behaviors will also change or eliminate undesired feelings

Goal: To modify behavior

- Focus is on observable behavior
- The focus of the intervention is on a target symptom, problem behavior, or environmental condition rather than on the personality of the patient

Behaviorists specify the behaviors that define the problem and become the targets of change
Two Fundamental Classes of Behavior
Respondent & Operant

- Respondent: Involuntary behavior (ex: anxiety) that is automatically elicited by certain behavior. A stimulus elicits a response.

- Operant: Voluntary behavior (ex: Walking) that is controlled by its consequences in the environment

Symptoms are no different from behavioral responses; they involve respondent or operant behavior, or both
Best Known Applications of Behavior Modification
- Sexual dysfunction
- Phobic disorders
- Compulsive disorders
- Training of mentally retarded children
Respondent or Classical Conditioning (Pavlov)
Stimulus-response approach to behavior
- Does not involve new stimulus
- Connection of existing responses to a new stimulus; involves involuntary responses
- Learning occurs as a result of pairing previously neutral (conditioned) stimulus with an unconditioned (involuntary) stimulus
- eventually the conditioned stimulus elicits the response normally elicited by the unconditioned stimulus

US (Food)→ UR (Salivation)
US (Food) + CS (Bell) →UR (Salivation)
CS (Bell) →CR (Salivation)
Operant Conditioning (B.F. Skinner)
Antecedent events or stimuli precede behaviors, which in turn are followed by consequences
- Reinforcing consequences
- Punishing consequences

A→B→C
Antecedent→Behavior→Consequence
Reinforcing Consequences (Reinforcement)
Increase the frequency of the behavior
Punishing Consequences (Punishment)
Decrease the frequency of the behavior
Modeling or Observational Learning
Learning by observing others
Operant Techniques
- Positive Reinforcement

- Negative Reinforcement

- Positive Punishment

- Fading

- Extinction

- Prescriptions

- Negative Punishment

- Chain
Positive Reinforcement
Increases probability that the behavior will occur (worker praises, gives tokens, or rewards positive behavior)
Negative Reinforcement
Behavior increases because negative (aversive) stimulus is removed (Ex: Remove shock)
Positive Punishment
Presentation of undesirable stimulus following a behavior for purpose of eliminating that behavior (Ex: Hitting, shocking)
Negative Punishment
Removal of a desirable stimulus following a behavior for purpose of decreasing or eliminating that behavior (Ex: Removing video games, or dessert)
Chain
When one performance produces the conditions that make the next one possible
Fading
A procedure for gradually changing one stimulus controlling a behavior to another stimulus
Extinction
Withholding a reinforcer that normally follows a behavior with consequent decline in the behavior. Behavior that fails to produce reinforcement will eventually cease
Prescriptions
The worker tells the client specifically how to behave in certain situations and expects the client to behave in that way
Specific Behavioral Procedures
- Systematic Desensitization
- In Vivo Desensitization
- Aversion Therapy
- Shaping
- Flooding
- Modeling
- Assertiveness Training
- Contingency Contract
- Rational Emotive Therapy (RET)
- Sensate Focus
- Squeeze Technique
- Self-Instructional Training
- Time Out
- Token Economy
Systematic Desensitization
An Anxiety stimulus is paired with a relaxing response so that eventually the anxiety-producing stimulus produces a relaxation response.

- The fear is gradually approached
- At each step the client's reaction of fear is overcome by pleasant feelings engendered as the new behavior is reinforced by receiving a reward
In Vivo Desensitization
Pairing and movement through anxiety hierarchy from least to most anxiety provoking situation

- Takes place in a real setting
Aversion Therapy
Any treatment aimed at reducing the attractiveness of a stimulus or behavior by repeated pairing of it with an aversive stimulation of a real or imaginal nature. (Ex: Treating alcoholism with antabuse)
Shaping
Method used to train a new behavior by prompting and reinforcing successive approximations of the desired behavior
Flooding
A treatment procedure in which an individual's anxiety is extinguished by prolonged imaginal or in vivo exposure to high-intensity feared stimuli
Modeling
Method of instruction that involves an individual (the model) demonstrating the behavior to be acquired by the observer
Assertiveness Training
Procedure used to teach people how to express their positive and negative feelings and to stand up for their rights in ways that will not alientae otehrs
Contingency Contract
An agreement between two or more individuals that specifies a behavior change that is to take place in one or more of the individuals, and the positive and negative consequences that will result if the agreement is not honored
Rational Emotive Therapy (RET)
A cognitively oriented therapy in which the therapist seeks to change the clients' irrational beliefs by argument, persuasion and rational reevaluation and by teaching he client to counter self-defeating thinking with new, non distressing self-statements
Sensate Focus
An in vivo desenitization and communication-enhancement procedure used in sex therapy that involves a couple providing each other with pleasurable sensory stimulation through a structured body massage; also known as "pleasuring". Pleasure and relaxation are paired with graded sexual contact.

- Used to desensitize couples to performance anxiety

- Masters and Johnson
Squeeze Technique
A procedure for delaying ejaculation
Self-Instructional Training
A cognitive behavior modification procedure in which the client learns to covertly emit a set of task-relevant self-instructions that guide behavior and that can help reduce anxiety and increase problem-solving ability
Time-Out
- Time out from positive reinforcement

- Removal of the opportunity to obtain positive reinforcement
Token Economy
An intervention environment in which an individual or individuals receive tokens as reinforcement for performing specified behaviors
Cognitive Therapy (Beck and Ellis)
- Most behavioral and emotional dysfunction is the result of mistaken beliefs and faulty patterns of thought.

Basic Tenets of Cognitive Therapies:
- Thinking is a basic determinant of behavior
- Focus of therapy is on the present; present thinking motivates behavior
- Clients must realize the connection between their problems and their misconceptions and must be responsible for changing their misconceptions and cognitions

- Cognitive restructuring: Helping clients to identify, evaluate, and change the dysfunctional thinking patterns and mistaken beliefs

- Active, collaborative, structured, time-limited, goal-oriented, and problem-focused approach
Cognitive-Behavioral Therapy (CBT)
- Combines the theoretical and practice approaches of cognitive and behavioral approaches

- Lends itself to the requirements posed by managed care companies: Brief treatment, well-delineated techniques, goal and problem-oriented, and empirically-supported evidence of its effectiveness
Steps in Cognitive Restructuring
Assist Clients In:

1. Accepting that their self-statements, assumptions and beliefs determine or govern their emotional reaction to life's events

2. Identifying dysfunctional beliefs and 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
Rational Emotive Therapy (RET) Ellis
Albert Ellis focuses on irrational beliefs and the chain of events

A (External Event)→ B (Irrational Belief)→ C (Emotion/Behavior)
Three Specific Concepts to Explain Depression
1. The cognitive Triad (three major cognitive patterns):
a) Negative view of self
b) Negative interpretation of ongoing experiences
c) Negative view of the future

2. Schemas (Stable, cognitive patterns)

3. Cognitive errors or faulty information processing
Brief Therapy
- Systemic, focused process that relies on assessment, client engagement, and rapid implementation of change strategies

- 6 - 20 Sessions

- Goal of therapy: To provide clients with tools to change basic attitudes and behaviors and to handle a variety of underlying problems rather than long-scale or pervasive change

- Problem or solution focused

- Clearly defined goals related to specific change or behavior

- Patient is responsible for change

- Termination is discussed from the beginning

- Outcomes are measurable
Family Therapy
Treats the family as a unified whole; a system of interacting parts in which change in any part affects the functioning of the whole

A Healthy Family Has:
- Flexibility
- Consistent Structure
- Effective exchange of information
Family Therapy Interventions
- Define family stages and tasks.

- Emotional Cutoff

- Triangulation

- Coaching

- Family Rules

- Genogram

- Restructuring roles
Emotional Cutoff (+ the worker's task)
The enmeshed family member has to attempted to break all emotional ties to family members.

- The worker needs to help the client to re-establish contact and learn successful techniques
Triangulation (Worker's task)
The worker must point out how family members talk through others, and encourage them to communicate directly with each other
Coaching
Young adults and adults are guided in their efforts to differentiate themselves from their families of origin
Family Rules
The worker explicitly defines the rules by which the family operates
Genogram
The family history is diagrammed
Restructuring Roles
Establishing generational boundaries with 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 homework tasks
3. Defining interactional patterns
4. Sculpting or using other psychodrama techniques
Multigenerational/Intergenerational Approach (Bowen)
- Family therapy approach

- Problems are a result of fusion among family members due to inadequate individuation

- Triangulation: Two people triangling a third into their relationship. Usually serves to lessen the difficulties in the initial dyad.

Goal of Therapy: To increase differentiation of individuals within the family
Structural Family Therapy (Minuchin)
- Stresses the importance of family organization

- The worker joins (engages) the family in an effort to restructure it

- Boundaries and the rules determining who does what, where, and when are crucial in three ways:
1. Interpersonal boundaries define individual family members and promote their differentiation and autonomous yet interdependent functioning. Dysfunctional families tend to be characterized by either a pattern of rigid enmeshment or disengagement
2. Boundaries with the outside world define the family unit, but boundaries must be permeable enough to maintain a well-functioning open system
3. Hierarchical organization in families of all cultures are maintained by: generational boundaries , the rules differentiating parent and child roles, and rights and obligations

Enactment of Situations: Enacting the problem situation during the interview
Communication/Interaction Family Therapy
- Uses communication theory to examine dysfunctional family patterns

- Implicit family rules are made explicit

- In Vivo Therapeutic experiences

- Communication Patterns:
a) Placater
b) Blamer
c) Leveler
d) Distracter
Strategic Family Therapy
A presenting problem is viewed as a symptom of and a response to current dysfunction in family interaction

Goal of Therapy: To solve the particular problem that is presented

- Therapy focuses on problem resolution by altering the feedback cycle that maintains the symptomatic behavior

Techniques used to achieve specific behaviorally defined objectives:

- Relabeling: To redefine the situation so the perceived meaning of the behavior is less negative

- Reframing

- Directives

- Paradoxical instruction: Prescribe the symptomatic behavior so the patient realizes they can control it
Psychodynamic Approach
Family dynamics are the reflection of interactions between intrapsychic factors and societal, cultural, and environmental factors

- Worker tries to develop empathic working alliance to help clients achieve greater harmony between individual and family needs
Behavioral Family Therapy Approach
Behavior is learned and maintained by contingencies in the individual's social environment

Goal: To teach more effective ways of dealing with one another by changing the consequences of the behavior/altering the reinforcements
Social Group Work
- Dates back to the Settlement House Moevement

- Goal: To help individuals maximize their own social functioning; enhancement of social functioning

- Worker focuses on helping each member change his/her environment or behavior through interpersonal experience.

- Emphasis is on conscious components rather than unconscious motives
Social Group Work (Common Group Goal)
Common Group Goal: Worker comes to agreement with group regarding purpose, function, and structure of group

- Group is the major helping agent


Individual self-actualization occurs through:
- Release of feelings that block social performance
- Support from others
- Orientation to reality
- Reappraisal of self

- Emphasize social functionality rather than pathology

- Psychodrama: A treatment approach in which roles are enacted in a group context. Members of the group re-create their problems and devote themselves to the role dilemmas of each member
Psychodrama
A treatment approach in which roles are enacted in a group context. Members of the group re-create their problems and devote themselves to the role dilemmas of each member
Types of Groups
- Counselign groups
- Groups centered on a shared problem
- Activity groups
- Action groups
- Self-help groups
- Natural groups
- Closed vs Open groups
- Structured groups
- Crisis groups
- Reference groups (similar values)
Group Psychotherapy
- The focus of group psychotherapy is treatment of pathology or illness

- Stages of Group Development

- Curative Universal Factors/How Groups Help (Yalom):

- Factors in Group Cohesion
Stages of Group Development
1. Preaffilliation (Forming): Development of trust

2. Power and Control (Storming): struggles for individual autonomy and group identification

3. Intimacy (Norming): Utilizing self in service of the group

4. Differentiation (Performing): Acceptance of each other as distinct individuals

5. Separation/Termination (Adjourning): Independence
Curative Universal Factors/How Groups Help (Yalom)
- Instillation of hope
- Universality
- Altruism
- Interpersonal learning
- Self-understanding and insight
- Existential learning
Factors in Group Cohesion
- Group size: Optimal is 5 to 10

- Homogeneity: similarity in group members

- Participation in goal and norm setting for group

- Interdependence: Dependent on one one another for achievement of common goals

- External threat: Increases cohesiveness

- Member stability: Frequent change in membership results in less cohesiveness
Contraindications for Groups
- Client in crisis, suicidal
- Compulsive need for attention
- Actively psychotic
- Paranoid
Group Polarization
A process that occurs during group decision making when discussion strengthens a dominant point of view and results in a shift to a more extreme position than any of the members would adopt on their own
Groupthink
When high group cohesion and loyalty to the group and group members seriously undermines decision making in order to maintain the sense of "We-ness"
Crisis Intervention
- Time-Limited
- Actively influencing the psychosocial functioning of individuals during a period of disequilibrium or crisis

Goals: To alleviate stress and mobilize psychological capabilities and social resources

- An individual in crisis may be incapable of effective functioning or making good choices and decisions.
- Ego patterns may be more open to influence and correction
- The person or family is at a crucial turning point of coping either adaptively or maladaptively

- Focuses on the here and now
- Directive
- Requires high levels of activity and involvement from the therapist
- The therapist sets specific goals and tasks in order to increase the client's sense of mastery and control
Goal of Crisis Intervention
1. To relieve the impact of stress with emotional and social resources

2. To return to a previous level of functioning (regain equilibrium)

3. To help strengthen coping mechanisms during the crisis period and develop adaptive coping strategies
Anticipatory Guidance
A preventative measure that helps prepare clients for dealing with future stresses and crises by planning coping strategies to use in those situations
Precipitating Event of Crisis
Does not have to be a major event. It may be the "last straw" in a series of events that exceed the client's ability to cope
Social Role Theory
- Role

- Role Behavior

- Status

- Social and individual determinants of role behavior
Role
Behavior prescribed for an individual occupying a designated status
Role Behavior
A basic script of behavior which is learned in the process of socialization
Status
Generally implies a relationship to another person; sets of rights and obligations that regulate transactions with individuals of other statuses (Ex: Mother, Middle-Class)
Social and individual determinants of role behavior
Person's needs; person's ideas of mutual obligations and expectations that have been invested in the particular status he undertakes; compatibility of conflicts between person's conception of obligations and expectations and those held by the other person with whom he is in a reciprocal relationship
Role Ambiguity
Role 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 expected way (Ex: Parent-child; Social worker-Client)
Role Discomplementarity
Results when different roles conflict or when the role expectations assigned by others differ 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, etc.
- Achieved: By occupation
- Adopted: Satisfy some need of the individual
- Assumed: "Let's Pretend"
Explicit Roles
Conscious and exposed to observation
Implicit Roles
Unconscious (ex: Client acting like a dependent child)
Role Conflict
Incompatible or conflicting expectations
Prescription
Behavior that should or ought to be performed (Ex: Social Worker prescribed client behavior)

If not congruent with client expectations → strain
Sanctioning
Behavior with the intent of modifying another's behavior; 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)
Bases of Social Power ***
- Coercive: Power from control of punishment

- Reward: Power from control of rewards

- Expert: Power from superior ability or knowledge

- Referent: Power from acceptance as standard for self-evaluation; likability; attracted to or identifies with person with power

- Legitimate: Power from having legitimate authority

- Informational: Content of message leads to new cognitions
Strength Perspective
- People have the capacity to grow, change, and adapt (humanistic approach)

- Strengths vary from one situation to another; they are contextual

- Focus:
Understanding clients on the basis of their strengths and resources and mobilizing the resources to improve the client's situation
- Active collaboration equalizes the power balance

Methods to enhance strengths:
- Collaboration and partnership
- Creating opportunities for learning or displaying competencies
- Environmental Modification: environment is both a resource and a target of intervention
- Advocacy
Resilience
The ability to withstand and rebound from adversity

Responsive environments elicit and foster the traits associated with resiliency.
Resilience Traits
- Social competence: Ability to form close relationships
- Autonomy: Sense of self-identity and self-efficacy
- Problem-Solving: Ability to think critically and creatively
- Sense of purpose and belief in the future
Three protective factors in a person's environment that are important in eliciting and fostering resilience
- Caring relationships (Love, trust, connectedness)
- High expectations that convey a belief that a person can rise to a challenge (Respect, challenge, structure)
- Opportunities to participate and contribute (Belonging, power, meaning)
Focus of Resilience programs
- Process, not the content is important

- Creating opportunities to experience connection, belonging, trust, meaning, etc. should be the focus of the program
Phases of Helping
Beginning Phase:
- Activities of the social worker and the client to be helped are directed at:
a) Becoming engaged with one another
b) Assessing the client's situation in order to select appropriate goals and the means of attaining them
c) Planning how to employ these means

Middle Phase:
- Change Strategies:
a) Modify thoughts
b) Modify actions
c) System interventions

Ending Phase:
- The worker and the client:
1. Evaluate the degree to which the client's goals have been attained
2. Cope with a series of issues related to the ending of the relationship
3. Plan for subsequent steps that the client may take relevant to the problem, that do not involve the social worker
Cognitive Dissonance Theory
Cognitive dissonance arises when a person has to choose between two contradictory attitudes and beliefs. The most dissonance arises when two options are equally attractive.

Three ways to reduce dissonance are:
1. Reduce the importance of conflicting beliefs

2. Acquire new beliefs that change the balance

3. Remove the conflicting attitude or behavior.

- This theory is relevant when making decisions or solving problems
Communication Organization
A method of intervention whereby individuals, groups, and organizations engage in planned action to influence social problems

Involves two major processes:
1. Planning (Identifying problem areas, diagnosing causes, and formulating solutions)
2. Organizing (developing the constituencies and deriving the strategies necessary to effect action)
Common Characteristics of Communication Organization
1. Focus is on social, not psychological needs
2. Develop resources in response to need
3. Values underlying definition:
a) enhance particaptory skills of citizens by working with them and not for them
b) Developing leadership
c) Community members can develop capacity to resolve problems
d) Redistribute resources to increase the resources of the disadvantaged
e) Planned changes- Systematic steps are to be taken in a planned way
f) Problem-Solving Process: Studying and defining a problem; considering possible solutions; creating, implementing and evaluating a plan
g) Advancing the interests of the disadvantaged so they can have a say about the distribution of resources
Assumptions Underlying Community Organization Practice
1. Community members can develop the capacity to resolve problems
2. Members want to improve their situations
3. Members must participate in change efforts rather than have change imposed
4. A systems approach taking the social community into consideration is more effective
5. Participation must be in a democratic format, and the community member must learn the appropriate skills of democratic functioning
6. Members can gain from an organizer's skills in dealing with problems they cannot resolve themselves
Models of Practice/ Community Development
- Derived from economic development
a) Locality Development
b) Social Planning
c) Social Action
d) Social Reform
Locality Development
- Participation of a broad spectrum of people at the local level.

- Those in power need education about community problems
Social Planning
Emphasizes rational study of a community's problem as the basis of determining a solution

- Power elite can be a sponsor or employer
Social Action
- The enemy are those on the community who control community resources
- The problem can only be solved through direct action
- Direct action is the only way to force those in power to relinquish some resources and power
Cooptation
Including the enemy in your group
Social Reform
- Work with other organizations on behalf of the disadvantaged
- develop coalitions of various groups to pressure for change
- By changing laws, workers may be able to overcome community resistance to local problems
Primary Prevention ***
To prevent a problem before its initial onset
Secondary Prevention ***
- To treat symptoms
- To prevent recurrence or exacerbation of an already diagnosed problem or disorder
Tertiary Prevention ***
Reduce duration of problems by reducing negative after-effects
Problem Solving Process ***
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
Collaboration Involves
- Interpersonal communication
- Group process skills
- Empathy- identify and understand the perspective of others

- Empathy is a learned skill and can be improved through practice
The Beginning Phase of Community Intervention
- Problem recognition
- Problem definition
- Information gathering
- Needs assessment
The Middle Phase of Community Intervention
- Goal selection
- Prioritization
- Goal achievement

- Community Decision Instrument (what person or group should make a decision for the community)

- Community members must take primary responsibility in carrying out the community's goal
The Ending Phase of Community Intervention
1. Operation: Involves the implementation of the actual activities decided on in goal selection
- The change activity worker joins in, but does not replace, community effort
- Evaluation issues must be addressed
- worker must initiate thinking about evaluation during the implementation stage because certain activities of an evaluation need to go on simultaneously with implementation
- Recycling: Focuses on channeling the energy developed by one successful community intervention to the next community intervention that is needed

2. Termination: The worker seeks to engage with the client system and works to help that system set up mechanisms for its own continued involvement and development
Discrete
Distinct or separate; limited to single occurrence or action
Continuous
Ongoing or repetitive
What Are Critical Factors in Working With Diverse Populations?
Self-awareness about one's own attitudes, values, and beliefs about cultural differences and a willingness to acknowledge racial/cultural differences

- The SW is responsible for bringing up and addressing issues of cultural difference with the clinet and is also ethically responsible for being a culturally competent clinician by obtaining the appropriate knowledge, skills, and experience
Native American/Alaskan Native Families are Characterized by
Family: Complex family organizations that include relatives without blood ties; strong kinship bonds.

- Groups take preference over individual.
- Husbands and wives show a tendency to communicate more with their gender group than with each other

- Consensual, collateral social relationships

- Respect for elders. Tradition of oral storytelling
Native American/Alaskan Native:

- Sense of time
- Worldview
- Spirituality
- Healing practices
- Sense of Time: Present, relative view of time; Time is viewed as flowing and always with us

- Worldview: Holistic; interconnectedness of mind, body, spirit, and heart

- Spirituality: Fundamental part of life; of all living things; sacredness of all living things; animism

- Use of Traditional and western Healing Practices: Medicine man, shaman, or spiritual leaders are traditional healers
Native American/Alaskan Native:

- Communication
- Reasons for Seeking Help
Communication: Indirectness; being still and quiet; comfortable with silence; value listening; Non-verbal communication

Reasons for Seeking Help:
-Suicide
- Alcoholism
- Family problems
- Conflicts arising from living in two worlds
Native American/Alaskan Native:

- Effective Methods
- Culturally Sensitive, NONDIRECTIVE, COLLABORATIVE APPROACHES

- Use of metaphors, storytelling, paradoxical interventions

- Networking and use of rituals

- Family therapy is consistent with the Indian value of working together to solve problems

- The SW should use active listening skills, increase his/her tolerance for silent pauses, and show patience with slower pace of the interview


Native Americans may avoid eye contact as a show of respect when talking to a higher status person
Hispanic/Latino Clients:
- Common Values and Beliefs
- Religion
- Belief in the innate worth of all individuals and that people are born into their lot in life
- respect for dignity of self and others
- Respect for elders
- Respect for authority

- Mostly Roman Catholic
- Emphasis on spiritual values
Hispanic/Latino Clients:
- Family
- Family Structure
- Extended family system
- Incorporate godparents and informally adopted children
- Commitment to family
- Family unity, welfare and honor are important
- Emphasis on group rather than individual

- Family structure is patriarchal
- Male has greater power and authority
- High value on male characteristics (Machismo)
- Traditional gender roles
- Married women legally keep maiden name
- Family descent traced through a person's second to last name
Hispanic/Latino Clients:
- Personalism
- Most important reason to seek help
Personalism: Personalized way of relating that imparts self worth.
- Display varied emotional expressiveness depending on the language being spoke
- When speaking Spanish, may be more expansive, friendly, playful
- When speaking English, may be more businesslike, rational, and guarded.

- Reasons for seeking help:
- A wish to improve their life circumstances
- Culture shock
- Conflicting cultural values
Hispanic/Latino Clients:
- Effective Approaches
- Elicit, listen, and validate the cultural journey they are experiencing
- Help them build bridges between the old and new worlds

- Short term treatment is more effective than long-term, insight oriented interventions
Asian/Pacific Islander Families:
- Beliefs
- Family structure
- Influenced by Confucian and Buddhist philosophies
- Family Structure:
- Strictly prescribed roles and rules of behavior and conduct
- Adhering to rules reflects on the family
- Patriarchical system in which wife has very low status and is subservient to her father, husband, and oldest son
- Filial piety, obligation to parents, and respect for elders
- Shame, shaming, loss of face and obligation to others are mechanisms for reinforcing cultural norms
- Great emphasis placed on family, friends, ethnic community, work, and education
Asian/Pacific Islander Families:
- Communication
- Common presenting problems
- communication is often indirect in orde to avoid direct confrontation
- People talk around a point or read between teh lines
- Reserved emotional expressiveness and demonstration of affection
- Usually seek help from the family or cultural community
- Emotional problems are expressed through physical/somatic complaints
- regard professional as person who has expert advice to solve a problem

- Common Presenting Problems:
- Family conflict
- Among refugees: PTSD and Dissociative problems are common
Asian/Pacific Islander Families:
- Effective approaches
- Problem-focused, goal-oriented and symptom relieving approaches

- Psychoeducational approach is congruent with Asian values

- Use of indigenous social supports and resources

- In family therapy, encouraging parents and children to communicate openly may conflict with traditional values; children may be perceived as talking back

**- Asian patients may respond to psychotropic drugs differently than Caucasian patients. They typically require lower dosages of medication and may experience more severe side effects from the same doses given to other patients
- Start Asian patients on half the normally prescribed dosage
African Americans:
- Healthy Cultural Paranoia
When a person perceives persons and social systems different from their own, as a threat until proven differently.
African Americans:
- Effective Approaches
- Ethnically sensitive
- Time-limited
- Problem-focused
- Child-focused
- Family therapy

- Use last name of client until client gives permission for less formality
Native American Children Being Placed in Foster Care or Adopted
A SW must contact the administrative office of the child's tribe.

- The Indian Child Welfare Act of 1978 gives jurisdiction to tribal authorities in these cases
Social Worker/Client Relationship
1. A positive relationship is an important tool of helping. SW's must create a warm, accepting, trustworthy and dependable relationship with clients

2. The SW must convey a sense of self-respect for the client's individuality as well as his/her right and capacity for self-determination and for fully being involved in the helping process from beginning to end

3. Empathic Understanding involves being nonjudgmental, accepting, and genuine

4. The most consistent factor associated with positive outcome of a helping relationship is a positive relationship between clinical and client (but other factors such as the clinician's competence and motivation and involvement of client also influence the outcome)
What is the Core of the Helping Process?
- The relationship between the helper and the person being helped

- Mutual acceptance and trust

- If the person feels judged, he/she will not speak freely

- Interaction

- Verbal communication

- Nonverbal behavior
- Both the helper and the person being helped have objectives. Clarification and definition of these objectives often become important parts of the helping process

- The receiver of the help has the most power in the end because his/her subsequent actions determine whether the advise is really followed or the behavior is changed
Barriers to Receiving Help
- It is hard to admit that one has difficulties, even to oneself

- The receiver of help may only be looking for sympathy, support and/or empathy, rather than searching for a new way to solve his/her difficulties

- The thought of depending on or receiving help from another individual seems to violate something within self
Difficulties in Giving Help
- Helpers easily fall into a telling role without finding out whether their advise is appropriate to the abilities, the fears, the powers of the person(s) being helped or their circumstances

- Frequently, the helper is insensitive to the other person's resistance
Requirements of the Helping Situation
- There must be trust

- The helping situation is a joint exploration

- There must be listening on both sides

- The helper must accept what is said in a non-judgmental manner
Multiple Uses of Empathic Communication
- Establishing rapport with clients

- Start where the client is

- Accurately assessing client's problems

- Responding to the client's nonverbal messages

- Facilitating confrontation by blending confrontation with empathic responses

- Using empathic responses to defuse anger and to modify strong emotions that represent obstacles to progress

- Can use empathic responses to facilitate group process

- An empathic response is the least likely of all interventions to cause harm to a patient
What should a SW do when an ethical dilemma arises?
- The SW should first consult the Code of Ethics
What is the Primary Mission of the SW Profession?
To enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty
What is the SW Profession's Focus?
Individual well-being in a social context and the well-being of society
What are Values?
A belief system
What are Ethics?
Standard of conduct
What are the Code of Ethics?
Guide to the everyday professional conduct of Social Workers
The Core Values of Social Work
1. Service

2. Social Justice

3. Dignity and Worth of the person

4. Importance of Human Relationships

5. Integrity

6. Competence
Service (Core Value)
SW's primary goal is to help people in need and to address social problems
Social Justice (Core Value)
SW's challenge social injustice
Dignity and Worth of the Person (Core Value)
SW's respect the inherent dignity and worth of the person
Importance of Human Relationship (Core Value)
SW's recognize the central importance of human relationships
Integrity (Core Value)
SW's behave in a trustworthy manner
Competence (Core Value)
SW's practice within their areas of competence and develop and enhance their professional expertise
Ethical Responsibilities to Clients
1. Primary commitment to clients and responsibility to promote the well-being of clients

2. Promote clients' right to self determination

3. Informed consent
- And clear/understandable language

4. Competence
- And cultural competence

5. Conflicts of Interest:
- Avoid situations interfering with impartial judgment
- No dual relationships!

6. Privacy and Confidentiality

7. Access to Records

8. No sexual relationships

9. Payment for services

10. Termination of services
Privacy and Confidentiality (Ethics)
- Only solicit information necessary fro providing services

- May disclose confidential information when you have a valid consent from client or a person legally authorized to consent

- No disclosure to third-party payers unless clients have authorized such disclosure

- When court of law requires disclosure without a client's consent and such disclosure could cause harm to the client, SW's should request that the court withdraw or limit the order as narrowly as possible and/or maintain the records under seal

- Privilege belongs to the client, but if the client sues you, you are no longer obligated to maintain confidentiality
Exceptions to Confidentiality
To prevent foreseeable, or imminent harm to a client or other identifiable person

- Tarasoff decision

- Child sexual abuse

- Elder abuse
Payment for Services (Ethics)
Ensure that they are fair and reasonable, with consideration given to client's ability to pay
Termination of Services (Ethics)
- When services are no longer needed or when they no longer serve the client's needs or interests

- Avoid abandoning clients still in need of services

- May terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, client not in imminent danger to self or others, addressed and discussed with client

- When making a referral, it is critical that you refer to a competent clinician
Sexual Relationships (Ethics)
No sexual activities with:
- Current clients
- Client's relatives
- Former Clients

- No clinical services to Individuals with whom worker has had a prior sexual relationship
Ethical Responsibilities to Colleagues
1. Treat with respect
2. Respect confidential info shared
3. Participate in interdisciplinary collaboration
4. Referral for Services (When specialized knowledge or expertise is needed)
- Prohibited from receiving payment for a referral
5. No sexual relationships with superiors
- Avoid sexual relationships with colleagues of there is a potential for conflict of interest
6. No sexual harassment
7. Take steps when colleague is impaired by consulting with the employee first. Then if that is unsuccessful take appropriate action through channels established by the employer, agency, NASW, and other regulatory bodies.
8. Report incompetence of colleagues through appropriate channels if consulting with colleague is unsuccessful
9. Discourage, expose, prevent, expose, and correct unethical conduct of colleagues
Whistle Blowing
Entails taking action through appropriate channels:
1. Colleague
2. Supervisor
3. Agency administrator
4. Professional organization
5. Licensing/Regulatory boards
Ethical Responsibilities in Practice Settings
1. Supervision, Consultation, Training:
- Within area of expertise
- Evaluate performance in fair and respectable manner
- Client's routinely informed when services are provided by a student
- No dual or multiple relationships
- Set clear, appropiate, culturally sensitive boundaries

2. Client Records:
- Accurate, timely, protect clients' Privacy
- Store records for reasonable future access
Ethical Responsibilities as Professionals
- Accept responsibility within areas of competence

- Not practice or condone discrimination

- Not allow personal problems to interfere with client's best interests

- Make clear distinctions between statements and action as a private individual and as as representative of the SW profession

- Claim only relevant credentials and affiliations

- No uninvited solicitation of potential clients who are vulnerable to undue influence
Ethical Responsibilities to the Social Work Profession
- Integrity

- Evaluation and research - obtain voluntary and written informed consent from participants without any implied or actual deprivation or penalty for refusal to participate; when necessary, obtain consent from proxy; inform participants of right to withdraw at any time without penalty

- Assure anonymity
Ethical responsibilities to Broader Society
- Promote general welfare of society

- Facilitate informed participation by the public in shaping social policies

- Engage in social and political action

- Promote conditions that encourage respect for diversity of cultures and social diversity

- Act to prevent and eliminate discrimination
Confidentiality
An ethical term.

- It is the SW's obligation to the client
Privileged Communication
A legal term

- The client is "holder of the privilege"
Experimental Studies
The investigator manipulates and 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, with any confidence, the possibility that the effect was created by some other factor that is associated (correlated) with the presumed causal factor
Independent Variable
- The cause

- The manipulated variable

- Controlled by the experimenter

- The treatment
Dependent Variable
- Effect, Result, Impact

- Affected by the independent variable

- Outcome of treatment in clinical studies
Single Subject Designs
Allow experimental study of a single individual

- Poor external validity (generalization)
A
Baseline Measure
B
Intervention
Reversal Design (ABA)
Baseline- Treatment- Withdrawal of treatment

- Does dependent variable return to baseline (pre-treatment) level?

***In some cases it would be unethical to withdraw treatment if patient were at risk for harm. Also, in a crisis, you would not delay treatment in order to obtain baseline data.

* The more A's and B's the better
Reliability
Consistency

- Can you get the same answer repeatedly?
Validity
Accuracy

- Are we measuring what we think we're measuring?
External Validity
Can the results be generalized?
Internal Validity
Confidence in Cause → Effect

***Always pick the answer with more AB's
Descriptive Statistics
Describe the data
Inferential Statistics
Generalizations are made

Examples of inferential statistical tests:
- ANOVA
- T-Test
- Chi-Square
Nominal Scale
Classifies objects into categories based on some defined characteristics

Ex: Race, sex, color
Ordinal Scale
Logical ordering of categories

Ex: Arranging students according to height
Interval Scale
- Equal intervals

Differences between various levels of the categories reflect equal differences

Ex: Temperature in degrees Fahrenheit or Centigrade. Zero is just another point on the scale and does not reflect an absolute absence.
Ratio Scale
Zero reflects an absence of the characteristic

Ex: Weight
Random Sampling
Each individual within a population has an equal chance of being selected for the study
Random Assignment
Individuals selected for a study are assigned to experimental or control groups
Mode
Most frequent score
Median
The point below which one half or 50% of the scores lie

- Best measure of central tendency in highly skewed distribution
Mean
Average

- Most strongly affected by extreme scores
Bias in Test Administration
When different experimenters administer the test differently
Null Hypothesis
Statement of no difference or no relationship

- No difference between the control group and experimental group
Statistical Significance
Probability that difference is due to chance

- Typically, P< .05 (Probability less than 5/100 that difference is due to chance)

or

- P <.01
Qualitative Research
- Seeks to be descriptive of actual events as they occur.

- More likely to include observations and/or interviews with people in which they are encouraged to tell stories in their own way.
What's the most appropriate model of research for social work?
Developmental research
Quantitative Research
Singles out specific aspects of reality
Stages of the Research Process
1. Problem Formulation

2. Research Measurement Design

3. Data Analysis
T-test
Test of statistical significance difference between sample means
Chi Square
test of statistical significance that measures the difference between observed frequencies and expected frequencies due to chance.

- Values less than .05 are statistically significant
Random Error
Assessed by instrument reliablity
Three kinds of resource systems
- Informal or natural

- Formal or membership

- Societal
Informal or Natural Resource Systems
Family, friends, neighbors, co-workers
Formal or Membership Resource Systems
Membership organizations or formal associations which promote the interest of their members

Ex: Labor unions, churches, Professional associations, parent-teacher associations, neighborhood associations
Societal Resource Systems
Get established through individual initiative, public activities, and voluntary citizen action

- May be for profit
- Non-profit organizations
Purpose of Social Work
1. Enhance the problem solving and coping capacities of people

2. Link people with systems that provide them with resources

3. Promote the effective and human operation of these systems

4. Contribute to the development and improvement of social policy
Deinstitutionalization
In the 1950's and 60's two things led to Deinstitutionalization:

1. A series of breakthroughs in the pharmacotherapy of mental illness

2. The Community Mental Health Centers Act of 1963. This act gave teeth to the belief that all citizens should be provided mental health care in their won communities and that mentally disabled persons should be treated in the least restrictive environment possible.
Unintended Consequences of the Community Mental Health Centers Act of 1963
It addressed people's need for mental health services without considering the other needs which hospitals had been meeting (ex: housing, companionship, medical care, income)

- Homelessness
- Boarding Homes
- Single Room Occupancy
How did Case Management Emerge?
From the (1977) NIMH Community Support Program (CSP) and several other projects funded by the department of Health, education, and Welfare, which were created to solve deinstitutionalization.
Community Support Program (CSP)
- Value based
- Defines the target population, the essential components, and the guiding principles of a Community Support System (CSS)
- Population defined as adult psychiatric patients with severe and persistent disabilities which interfere with their functioning in such primary aspects of daily living as personal relationships, living arrangements, or employment.
Ten Essential Components of Community Support Systems (CSS)
1. Special outreach

2. Providing assistance in meeting basic needs

3. Crisis services

4. Support for family and friends

5. Training in skills of daily living

6. Assisting in accessing needed services and support

7. Case management in the form of a "single person or team"

8. Assuring timely access to needed assistance

9. Providing opportunities and encouragement for self help activities

10. Coordinating all services to meet the client's goals
Case Management Definition
Involves working with multiple agencies and coordinating services. The concerns are not to duplicate services and to watch for any gaps in services.
Case Management Encompasses
- Assessment

- Planning

- Coordinating

- Facilitating

- Monitoring of Services
Older Americans Act (OAA) 1965
- Provides a variety of programs offering services to the older American

- Established the AoA, the advocacy agency for older Americans

- AoA awards grants to state agencies on aging. The states award these funds to local Area Agencies on Aging (AAA)
Child Abuse Prevention and Treatment Act of 1974
Established the national center on Child Abuse and Neglect

Required states to:
1. Create an agency to investigate allegations of child abuse
2. Create a reporting system
3. Pass a law protecting children from abuse
Family Educational Rights and Privacy Act (FERPA) of 1974 or Buckley Amendment
- Federal law intending to protect the privacy of educational records.

- Applies to schools receiving federal funds

- The school must have written consent from the parent or student to release any information from the student's record except for certain specified reasons.
Indian Child Welfare Act of 1978
Gives American Indian Nations or organizations jurisdiction over child welfare cases that involve a Native American Child

Hierarchical Procedure:
- Verify ethnic and tribal identity of the child
- Allow tribal jurisdiction over case
- If tribe rejects jurisdiction, place child with family member or
- Foster care with Indian parents or in a non-Indian home.
Omnibus Budget Reconciliation Act (OBRA) of 1981
Created the Community Block Grant (CSBG) funds which were passed directly to states for distribution and regulation
Family Support Act of 1988
- Welfare reform act

- Emphasized self-sufficiency

- Intended to reduce barriers to employment so AFDC recipients can replace welfare benefits with employment

- Required states to create a Job Opportunity and Basic Skills Program (JOBS) to provide participants with the skills and education to find and keep a job

- Requires genetic testing in cases where paternity is contested
Family and Medical Leave Act (FMLA) of 1993
- Required covered employers to provide up to 12 weeks of unpaid, job-protected leave to "eligible" employees for certain family and medical reasons.

-Employees are eligible if they worked for a covered employer for at least one year, and if there are 50 employees within 75 miles
Multiethnic Placement Act of 1994 (MEPA) and the 1996 provision on Removal of Barriers to Interethnic Adoption
Passed to increase the adoption rates of children of color and decrease the amount of time they spent in foster care waiting to be adopted
Violence Against Women Act (VAWA) of 1994
Was passed to address on the federal level the seriousness of violence against women.

- Develop and strengthen law enforcement and prosecution strategies

- Developing and strengthening services for women victims of violent crimes

- STOP: Services, Training, Officers, Prosecutors
Public Law 94-142/ Education for Handicapped Children Act
Guarentees a free, appropiate public education emphasizing special education and related services to meet the needs of all handicapped children between the ages of 3 and 21.

- IEP: Individual Educational Program

- Children with IEP's must be educated in the "least restrictive environment"
American's with Disabilities Act (ADA) of 1990
Mandated an end to discrimination on the basis of disability in four areas:

1. Employment
2. Access to public services
3. Access to public and private transportation
4. Telecommunication

- Provides that reasonable accommodations be made
- Provides for legal recourse i the event of an act of discrimination
ADA Disability Definition
- Person with a physical or mental impairment

- Person with a record of having such an impairment

- Persons regarded by an employer as having an impairment, but who in fact, do not have an impairment that limits their activities

- Persons who are not disabled but are related to or associated with disabled persons
Undue Hardship
Employer not required to make accommodation if such accommodation would impose an "undue hardship," which is defined as:

- An action requiring significant difficulty or expense
Diagnostic Related Groups
- Precursor to the current managed care system

- Underlying concept of the DRG classification System was the considering the commonalities between:
1. Patients' medical diagnoses
2. Other clinical variables such as medical treatment, course of treatment, lengths of stay

it would be possible to predict the average length of stay for a patient in a specific diagnostic group as well as determine a fixed rate for treating each DRG.
- The hospital was paid a predetermined amount on a discharge basis regardless of the actual length of stay or cost of treatment.
- This prospective payment system (PPS) provided an incentive ti shorten lengths of stays and contain treatment costs
- For the SW, the shorter lengths of stays meant a greater focus on discharge planning and less time to address the psychosocial issues of patients
Long Term and Hospice Care
Long term care may be required when the disease is no longer in its acute phase, but the individual is unable to return to full, independent living.

- Institutional: Nursing homes, homes for the aged, psychiatric institutions, facilities for children, homes for the handicapped, chronic disease and extended care facilities of hospitals

- Community-based programs
In-home Health Services
Nursing, rehabilitation, and personal care services as offered by visiting nurse associations, privately owned agencies, public agencies, and private individuals.

-*** Medicare will only reimburse for home services if there is a need for skilled nursing care and only if the patient is homebound
Homemaker and Chore Services
Provide house cleaning, meal preparation, shopping, laundry, and other services that the patient cannot do for him or herself. In this way, the individual is able to maintain a considerable degree of independence and remain in his or her own home.
Hospice Care
Service offered to terminally ill patients and their families so that their quality of life can be maintained while the patient remains in his or her own home
Adult Daycare
Provides such services to their clients as recreational and therapeutic groups, vocational training, counseling, and education. The clients therefore secure some of the services of hospitals while still living in the community
Supplemental Security Income (SSI)
- Intended for people in financial need who are 65 or older of who are blind or disabled at any age

- Must be disabled for at least 12 months

- Income determination is made based on financial considerations

- Precludes eligibility for AFDC

- Individuals who qualify for SSI, automatically qualify for Medicaid in Florida

- Administered by the federal Social Security Administration

- each state is responsible for determining medical eligibility of applicants based on established criteria

- Probably most important source of income for homeless mentally ill

- Loss of SSI can also mean loss of other social services such as medicaid and community residence
Social Security Disability (SSD)
- Must meet disability criteria and earned a specific amount of social security coverage before the disability began.

- A person who has never worked is not eligible

- No income limits

- Recipients not automatically eligible for medicaid or food stamps

- Amount of award usually much higher than SSI
Medicaid (Medical Assistance Program)
- Eligibility based on means test

- Provides free medical and hospital care for those too poor or disabled to provide for such care themselves

- Federal-State program financed mostly through federal funds

- Because it is administered by individual states, it is not a nationally uniform program

-AFDC and SSI recipients automatically receive Medicaid

- In some cases, benefits are extended to "Categorically related people": even those covered by medicare and private insurance may be eligible for Medicaid

- Coverage is based on the disability criteria provided by the Social Security Act and depends on income, assets, and medical expenses
Medicaid Will Pay For:
- Hospital coverage (Ex: Emergency room, inpatient services, testing, medications, Doctor's visits)
- Outpatient medical coverage (Ex: testing, Doctor's visits, medication, eyeglasses, prosthetic devices, home health care)
- All doctors not required to accept Medicaid patients
Medicaid Card
- MA cards and ID cards issued monthly

- Need a mailing address and current information on file
Medicare
- Eligibility based on age or disability

- Nationally uniform program

- 65 years of age or over who qualify for Social Security Benefits

- Some very limited categories of clients qualify: End-stage renal failure patients, SSD recipients who have received disability checks for 34 months

- In-hospital portion provides partial payment of all medically necessary inpatient care

- Medical insurance portion helps pay for medically necessary doctor's care, outpatient services, home health care, physical therapy, speech pathology, and many medications and supplies

- Deductible and Co-payment must be met

- Not for homeless mentally ill population because of co-payment and deductibles (on average a Medicare recipient pays about 45% is his/her health care)
Social Security Retirement benefits
- Intended to pay a portion of wages lost through retirement

- Jobs covered by Social Security earns employment credits toward retirement benefits

- Workers earn a max of 4 credits each year

- Amount of benefits is dependent on average earning over an individual's lifetime

- Retirement income may be subject to federal income taxes if the individual's total income exceeds a certain limit
Social Security Survivor's Benefits
Benefits for certain members of a deceased worker's family

- Provides a source of income the widow or widower of a deceased worker; the extent depends on the surviving spouse's age and physical health

- Provides support for unmarried minor children and children who have been disabled before age 22

- One time lump-sum payment available to the surviving spouse or entitled children
Food Stamps
Eligibility based on income, family size, and living arrangements.

- Formula for eligibility based on net income level and is calculated using variables such as family size, expenses for dependent care, and medical expenses

- No requirement for a fixed residence in order to receive food stamps

- Not necessary to be a citizen to receive food stamps, but only certain categories of non-citizens, such as registered migrant workers, are eligible

- Cannot be used for non-food items or takeout food.
Patient Self-Determination Act of 1991
Any hospital with public funding must inform patients of their rights to make decisions regarding their health
Advanced Directives
Legal way of indicating that a person has the legal right to make decisions on his/her behalf about continuation of support measures should they be incapable physically or mentally of making their wants known
The Living Will
- Many individuals have concluded that extraordinary medical measures disallow death with dignity

- A number of these people have communicated their desire that measures not be taken to prolong their lives when there is no reasonable expectation of recovery

- many have expressed their wishes by signing a living will to retain control over what happened at the end of their life, and to alleviate some of the guilt and anxiety on the part of relatives and health professionals who will later determine what type of life-supporting measures are appropiate
Abused Child
One who is under teh age of 18 whose parent or person legally responsible for his/her care:

- Inflicts physical injury by other than accidental means

- Creates or allows to be created a substantial risk of physical injury which would be likely to cause death or serious protracted disfigurement or protracted impairment protracted loss or impairment of the function of any bodily organ

- Committed or allowed to be committed a sex offense against a child

- Allows, permits, or encourages such child to engage in any act described in article 263 of the penal law (Ex: Obscene sexual performance, sexual conduct, prostitution).

- Committed any of the acts described in section 255.5 of the penal law (Ex: Incest)

Abused child can also mean a child residing in a group residential care facility or a child with a handicapping condition who is 18 years or older who is defined as an abused child in residential care
Maltreatment
A child's physical, mental, or emotional condition has been impaired or placed in imminent danger of impairment, by the parent's or legal guardian's failure to exercise a minimum degree of care

A Maltreated Child includes a child:

- Less than 18 years of age defined as a neglected child by the family court act

- Who has had serious physical injury inflicted upon him/her by other than accidental means

- Is 18 years or older, is neglected and resides in one of the special residential care institutions previously listed
Neglect
A child under 18 whose physical, mental, or emotional condition has been impaired or is in imminent danger of becoming impaired as a result of the failure of his/her parents or other person legally responsible for his/her care to exercise a minimum degree of care:

- In supplying the child with adequate food, clothing, shelter, or education, or medical, dental, optometric, or surgical care though financially able to do so

- In providing the child with proper supervision or guardianship, by unreasonably inflicting or allowing to be inflicted harm, or a substantial risk thereof, including the infliction of excessive corporal punishment

- By misusing a drug, drugs, or alcohol to the extent that he or she loses self-control of his.her actions

- By any acts off similarly serious nature requiring the aid of the court

- whom his/her parents or other person legally responsible for the child's care has abandoned

- Poverty or other financial inability to provide for the child is not maltreatment
In NYS an emotionally neglected child is defined in the Family Court as
A state of substantially diminished psychological/intellectual functioning in relation to such factors as failure to thrive,, control of aggression/self-destructive impulses, ability to think and reason, or acting out and misbehavior
In NYS a neglected child in residential care means
A child whose custodian impairs or places in danger of impairment, the child's physical, mental or emotional condition:
- By intentionally administering to the child any prescription drug not ordered
- Failing to adhere to standards
- Failing to conform to state regulations for appropriate custodial conduct
Definition of "Person Legally Responsible"
- Parent
- Guardian
- Foster parent
- Custodian
- Any other person responsible for the child's care at the relevant time

- Custodian may include any person continually or at regular intervals found in the same household as the child when the conduct of such persons causes or contributes to the abuse or neglect of the child
When and How to to Report Abuse
- Immediately by telephone at at ny time of say, seven days a week

- A written report must be filed within 48 hours of the verbal report

- Maintain careful notes, noting things such as dates, times, places, names of individuals involved
Subject of the Report
- Parent
- Guardian
- Custodian
- Any person 18 or older:
* who is legally responsible

Also means:
- Operator of, or:
* Employee or volunteer or a home operated by:
1. An authorized agency
2. The Division for Youth
3. An office of the Department of Mental Hygiene
* and who is allegedly responsible for causing or allowing infliction of injury, abuse, or maltreatment to such child
what if abuse if caused by an individual other than a parent or person legally responsible?
- Enforcement authorities should be contacted directly
Legally sealed unfounded reports may be unsealed when:
- There is another report involving a child names in the prior unfounded report

- Subsequent report involves subject of the unfounded report

- Fatality teams need to prepare a fatality report
Ethnocentrism
When you think your ethnic group is better than another
Stratification
Separation; Structured inequality of entire categories of people who have unequal access to social rewards
Pluralism
A society in which diverse members maintain their own traditions while cooperatively working together
Institutionalized Discrimination
When the practice or policy is discriminatory
Gender Identity/Expression
Different from sexual orientation
PIE System
PIE is a holistic, four factor classification system used by social workers to describe and code social functioning problems with common descriptors. The four factors address problems and strengths under the following headings:

- Social Roles in Relationship to Others

- Social Environment

- Mental Health

- Physical Health
Mental Status Exam
Areas include:

- Appearance
- Manner and approach
- Orientation
- Alertness
- Thought
- Process
- Affect
- Judgment
Culture Bound Syndromes
Diagnosis of a culture
Involuntary Commitment
When the client is a harm to himself or others
Mascot (Family Member Role)
Charming and funny in times of stress
Biofeedback
Behavior training program that teaches how to control certain functions such as heart rate, blood pressure, temperature, and muscular tension

- Used for ADHD, and Panic Disorders
Congruence
- Consistent

- Matching of what you're feeling and saying
SOAP
- Way of organizing case file

- Subjective, Objective, Assessment, Plan
Self-Disclosure
Most therapeutic situations will call for little or no disclosure
Tarasoff vs. Board
- Duty to warn
- Must be imminent threat
- Must have identified victim
Access to Records
- When SW does or is incapacitated
- Treatment of minors
- Unless release of records places client at risk
SW vs. Redson
You don't have to testify against your client
Employee Assistance Programs
Service provided by employers for employees and their families who need help with personal problems such as:

- Family
- Marriage
- Depression
- Finances
- Job
Social Work Planned Change Process
- Engage
- Assess
- Plan
- Intervene
- Evaluate
- Terminate