Section B 11/30/06

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Clinical Practice: _____ seeks to alleviate the internalized negative effects of environmental factors such as stress from health, vocatioinal, family, and interpersonal problems
Social Workers help: ___ individuals, couples, and families to modify attitudes, feelings and coping behaviors that interfere with optimal social functioning.
Clinical Practice is conducted in: agencies or private practice settings.
Different theorists differentiate clinical practice from other practice by: its goal of helping individuals change, facilitating personal adjustment, treating emotional disorders and mental illness or enhancing intrapsychic or interpersonal functioning.
Like all social work practice, assessment is psychosocial: focused on the person in environment with the goal of enhancing social functioning.
Psychosocial focuses on: Intrapsychic and interpersonal change
Psychosocial is based on: Psychoanalytic theory, ego psychology, role and systems theory.
Problem solving: to solve discrete problems, based on psychosocial and functional approaches.
Behavior Modification is used for: symptom reduction of problem behaviors and learning alternative positive behaviors.
Cognitive Therapy is used for: symptom reduction of negative thoughts, distorted thinking, and dysfunctional beliefs.
Crisis Intervention used for: brief treatment of reactions to crisis situations and reestablich the client's equilbrium
Family Therapy is used for: treat the whole family system and sees the individual symptom bearer as indicative of a problem in the family as a whole.
Group Therapy is used for: A practice model in which group members can help and be helped by others with similar problems, get validation for thier own experiences, and test new social identities and roles.
Narrative Therapy is used for: Uses the storeis that people tell about their lives as revealing how they structure perceptions of their experiences. Therapist co-constructs alternative, more affirming storeies with client.
Ecological or Life Model: Focuses on Life transitions, environmental pressures, and the maladaptive fit between individual and family or the larger environment. Focuses on the interaction and interdependance of people and environments.
Task Centered is used for: focuses on accomplishing tasks to reinforce self esteem and reestablish usual capacity for coping
Assumptions and Knowledge base.: Individual growth, development, and behavior result from complex interaction of psychological and environmental factors
Individual growth, development and behaviors: are a result from complex interaction of psychological and environmental factors
Theories of personality development: systems theroy, clinical diagnosis:DSM IV-TR, Sociocultural factors
sociocultural factors: are significant influence, including ethnicity, immigration status, occupation, race, gender, sexual orientation, and socioeconomic class
Methodology: Problem Assessment, Planning for Change, Determining the intervention locus, Evaluating change in order to
Problem Assessment: Assessment is done to evaluate the client's strengths, to appraise the client system's strength and weakesses and to identify supports or constraints that may influence change possiblities.
Planning for change: Identify specific treatment goals, select appropriate change strategies
Determining the intervention locus.: Behavioral, Affective, Cognitive
Determining the intervention locus: Behavioral--Modify actions
Affective --Modify feelings
Cognitive -- Modify thoughts or thought patterns.
Evaluating change in order to: a: Assess progress in achieving treatment goals
b: Assess effectiveness of treatment interventions
c: Determine areas still needing work.
Beginning Stage of Clinical Practice: Begining Stage---Assessment
2. Match between presenting problem and available services, contracting wiht resistant clients
Assessment / Match between presenting problem and available services: Clinical dagnosis. Diagnosis is a product of the worker's understanding of the client's problems based on the data collected. This process is possible because of te client's willingness to discuss problems and the worker's interest and skill in understandign and interpreting. Worker notes symptoms characteristic of known clincial and personality disorders. This is an attempt to define or classify the basic manner in which the client functions and to understand the areas in which the client dysfunctional. Clinical diagnosis categorizes the client's functioning. Diagnosis also includes relvant medical illnesses or physical conditions and their influence onthe client's emotional life and functioning.
Stages of Clinical Practice/ Beginning Stages: 1.Assessment
2.Establishing a positive therapeutic relationship
3. Contracting or goal setting
Establishing a positive therapeutic relationship: Needs of the client: Hope and courage to engage in the change process motivation to change, trust in the worker's interest and skill to help to be dealt with as an individual rather than a case, personality type or category to express self to be accepted as a person of worth, to make ones own choices and to change at ones own pace.
Contracting or setting: Not limited to an intial working agreement, but part of the total socail work process
Contracting or goal setting: Flexibility. To guard against rigidity, includes provisions for renegotiation by mutual consent.
Contracting with resistant clients: Limitations. Difficult to contract with involuntary clients who do not acknowledge or recognize problems or who see the worker as marginal or unhelpful and with very severely disturbed or mentally retarded clients. Useful to openly acknowledge the difficulty for both worker and client inherent in mandatory treatmetn and to negotiate a contract.
Beginning Stage: 1. Assessment
2. Establishing a positive 3. therapeutic relationship
Contracting or goal setting
Middle Stage: 1. Confrontation 2. Clarification 3. Intrepretation 4. Partialization 5. Unversalization 6. Ventilation 7. Catharsis
Special Considerations in Treatment: Counter Transference. The therapist's unconscious distorted perceptions and responses to the client based on emotional conflicts regarding a significant person from social workers' past. Worker needs to understand counteransference reactions, be aware of thier presence and consequences, and use supervisory help or therapy to understand them and not impose them on the client.
Ending Stage: 1. Use of termination phase of treatment 2.Factors that affect the client's ending 3. The client's dynfunctional responses to ending 4. The worker's role
Use of the termination phase of treatment: Evaluate treatment and the treatment relationship. What treatment goals were met? What was effective withi the treatment that facilitated growth? What did not work effectively? What facilitated meeting treatment goals from the client's resources outside treatment and which may continue as resurces beyond termination?
Factors that affect the client's ending: Is termination with one worker part of a transfer plan to begin with a new worker? In this case, the evaluation phase of work should be used to formulate ideas about the focus and goals for the next treatment relationship.
The client's dysfunctional responses to ending: Defensive reactions. Client may deny or devalue the work and the worker to deny feelings about losing something of value. The client may act out feelings of tension, anxiety, depression through self-defeating behaviors, e.g. lateness, explosiveness, premature ending.
The worker's role: Present the possibility of future contact at times of difficulty. Review the client's' internal and environmental resources that can be drawn on before deciding to reenter treatment.
Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR): Does not discuss etiology
Diagnostic0 and Statistical Manual of Mental Disorders (DSM IV-TR): Is descriptive, delineating the clinical features of disorders and offering specific diagnostic criteria for the use of clincians.
Multaxial evaluation AXIS I: Clinical Disorders, e.g. Schizophrenia, Delusional Disorder, Mood Disorder, and other conditions that may be a focus of clinical attention. A person may have more than one Axis I diagnosis.
Multaxial evaluation AXIS II: Personality Disorders or Mental Retardation. A person may have more than one Axis II diagnosis
Multaxial evaluation AXIS III: Physical Disorders and Conditions. These are medical diagnosis, or that have either directly cause or somewhat contribute to an Axis I diagnosis, or that have important treatment implications, or that influence the choice of psychotropic medication
Multaxial evaluation AXIS IV.: Psychosocial and environmental problems that affect diagnosis, treatment and prognosis. The problem can be events (death in the family) and may include lack of family or community supports or resources. The problems can be pecipitants or consequences of pathology.
Multaxial evaluation AXIS V,: Global Assessment of Functioning (GAF). A numerical designation reflectingcurrent functioning and/ or the highest level of functioning in the past year by considering the person's psychological, social, and occupational functioning.
Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) Cultural Assessment: Evaluation of the impact of cultural context, cultural belief systems, and cultural differences between client and interviewer in assessing illness behavior. Includes Culture Bound Syndromes.
Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) Defensive Functioning Scale: An assessment of the client's defenses or coping patterns at the time of the evaluation and the period preceeding it.
Axis I: Disorders usually first diagnosed in Infancy, Childhood, or Adolescence
Characteristics of Childhood Disorders inDSM IV-TR: Mental Retardation is an Axis II diagnosis and is found in this outline under Axis II.
Learning Disorders for Reading, Mathematics, or Written Expression.: These diagnoses are determined through the use of individualy administred, standardized test when the child scores substantially below expectations for age, grade level, or intellectual level.
Motor skills Disorder: Developmental Coordination Disorders. Motor coordination is substantially below or markedly delayed for the child's age and measured intelligence.
Communciation Disorders: Phonological (articulation) or stuttering disorders.
Pervasive Developmental Disorders: A spectrum of disorders taht are characterized by qualitative impairment in reciprocal social interaction, impairment in communication skills, and stereotyped behavior, interests, and activities.
Pervasive Developmental Disorders / Autistic Disorder: Onset before three years of delays or abnormal functioning in social interaction, language for soical communication and or symbolic or imaginative play. Non verbal communication is not used or understood spontaneously. There is a restricted or stereotyped repertoire of activities and intersts, and a lack of peer relationships or reciprocal interpersonal sharing
Pervasive Developmental Disorders / Rett's Disorder: Normal development until five months, followed by severe deterioration of head growth and hand skills, and later loss of social interaction, language development and psychomotor capacity.
Pervasive Developmental Disorders / Childhood Disintegrative disorder: At least two years of normal development, followed by deterioration of language skills and social interaction, and onset of sterotyped behaviors and interestrs.
Pervasive Developmental Disorders / Asperger's Disorder: Social impairment and restricted behaviors and interests, but with normal language and cognitive development.
Attention Deficit and Disruptive Behavior Disorders / Attention Deficit Hyperactivity Disorder (ADHD): Inattentive and or hyperactive, impulsive types. Symptoms persist for at least six months and include difficulty staying focused being easily distracted, fidgeting acting "driven." Symptoms are not motivated by anger or the wish to displease or spite others. Treatment by medication and or Behavior Modification.
Attention Deficit and Disruptive Behavior Disorders / Conduct Disorder: Persistent pattern of behavior in which other's rights and property are violated and significant age - appropriate rules or societal norms are ignored: agrresion and destruction of property are common.
Attention Deficit and Disruptive Behavior Disorders / Oppositinal Defiant Disorder: Pattern of negative, hostile, and defiant behavior with less serious vioatons of the basic rights of others that characterize Conduct Disorder. Behavior is motivated by interpersonal ractivity or a resntful puower struggle with adults.
Feeding and Eating Disorders of Infancy or Early Childhood / Pica: Persistent eating of nonnutritive substance such as paint hair, sand, clth, pebbles, without aversion to food.
Feeding and Eating Disorders of Infancy or Early Childhood / Rumination Disorder: Regurgitation and rechewing of food.
Tic Disorders: Characterized by rapid recurrent steroptyped motor movements or vocalizations.
Tic Disorders / Tourette's Disorder: Multiple motor tics and one or more vocal tics
Tic Disorders / Chronic Motor or Vocal Tic Disorder: Either motor or vocal tics
Tic Disorders / Transient Tic Disorder: Like Tourette's but less severe and symptoms end within 12 months.
Elimination Disorders / Encopresis: Repeated passage of feces in inappropriate places
Tic Disorders/ Enuresis: Repeated voiding of urine during day or night in bedding or clothes after continence would be expected.
Other Disorders of Infancy, Childhood and Adolescence / Separation Anxiety Disorder: Excessive distress wehn separated from major attachment figure(s): sleep refusal unless near that person.
Other Disorders of Infancy, Childhood and Adolescence / Reactive Attachment Disorder: A lack of attachment or indiscriminate, superficial attachments.
Other Disorders of Infancy, Childhood and Adolescence / Selective Mutism: Not Speaking in specific social situations though having the ability to communicate.
Other Disorders of Infancy, Childhood and Adolescence / Stereotype / Movement Disorder: Repetitive, driven motor behavior e.g. hand waving picking, head banging, rocking.
Delrium, Dementia, Amnestic, and other Cognitive Disorders.//Delrium: Disturbance in consciousness or cognition that develops over a short period of time and is due to a medical conditon or substance induced.
Delrium, Dementia, Amnestic, and other Cognitive Disorders.// Dementia: Memory impairment, multiple cognitive deficits. Includes Alzheimer's (gradual onset woth progessive deterioration) Vascular Dementia, Dementia due to HIV disease, Parkinson's or toher medical conditions.
Delirium, Dementia, Amnestic, and other Cognitive Disorders // Amnestic Disorder: Memory impairment without other cognitive impairments. May be subastance induced, e.g. Lorsakoff's Syndrome (alcohol).
Delirium, Dementia, Amnestic, and other Cognitive Disorders //: Mental Disorders due to General Medical Contion. Delirium, Dementia or Amnestic Disorder, psychosis, mood disorder, sexual dysfunction, sleep disorder or personality change due to medical conditions, e.g. epilepsy, tumors, head trauma
Substance Related Disorders: May be caused by abusing a drug, by side effects of a medication, or by toxin exposure
Substance Related Disorders// Substance Dependence: Maladaptive pattern of drug use with increased tolerance, withdrawal symptoms, compulsive use or behavior problems.
Substance Related Disorders// Substance Abuse.: Social role, legal, or medical problems due to drug use
Substance Related Disorders// Substance Intoxication or Withdrawl: Behavioral, psychological, and physiological symptoms due to effects of the substance; will vary depending on type of substance, e.g. hallucinations, insomnia, stupor, agitation.
Substance Related Disorders//: Treatment options includeoutpatient or inpatient: residential or day car; group, individual, and or family counseling; methadone maintenance (for opiates); detoxification; self helpl groups; combination of therapies and medicaiton.
Schizophrenic and Other Psychotic Disorders.: Also characterized by deterioration from a previous level of functioning (in work wocial relations,self care). Durations: Continuouis illness for at least six months with at least one month of an active phase of psychotic symptoms. Onset is often in adolescence or young adulthood. Medical or substance causing psychosis should be evaluated and diagnosed separately.
Schizophrenia / Catatonic Type: Stupor, negativism, rigidity, mutism
Schizophrenia/ Disorganized Type: Incoherence, flat or grosslyinappropriate affect
Disorganized Type / Paranoid Type: Delusions or frequent auditory hallucinations often persecutory or grandiose
Paranoid Type / Undifferentiated Type: prominent delusions, hallucinations, incoherence or grossly disorganized behavior
Undifferentiated Type / Residual type: absence of prominent psychotic features
Schizophrenic and Other Psychotic Disorders / Schizophrenia: Treatment: medicaiton and ego supportive therapy aimed at containing psychotic symptoms and maintaining the person's highest level of functioning.
Schizophrenic and Other Psychotic Disorders / Schizophreniform Disorder: Illness of less than six months duration; also a greater likelihood of an acute onset preceded by turmoil / high stress; a range of prognoses and characterized by the absence of blunted or flat affect. Treatment is similar to Schizophrenia
Schizophrenic and Other Psychotic Disorders / Schizoaffective Disorder: Psychotic symptoms of Schizophrenia concurrent with the presence of either a Major Depressive Episode, a Manic Episode, or a Mixed Episode. treatment is the same as for Schizophrenia
Schizophrenic and Other Psychotic Disorders / Delusional Disorders: Caracterized by the presence of a persistent delusion. Hallucinations are either absent or not prominent.
Schizophrenic and Other Psychotic Disorders / Delusional Disorders / Persecutory Type: Delusion that one is being malevolently treated
Schizophrenic and Other Psychotic Disorders / Delusional Disorders / Jealous Type: that one's sexual partner is unfathful
Schizophrenic and Other Psychotic Disorders / Delusional Disorders / Erotomanic Type: That someone is in love with the delusion person
Schizophrenic and Other Psychotic Disorders / Delusional Disorders/ Somatic Type: that one has some physical defect or disease
Schizophrenic and Other Psychotic Disorders / Delusional Disorders/ Grandiose Type: that one has a great but unrecognized talent, has made a great discovery, or is a prominent person or close to a prominent person
Schizophrenic and Other Psychotic Disorders / Delusional Disorders/ Brief Psychotic Disorder: Usually sudden onset and duration of less than one month.
Schizophrenic and Other Psychotic Disorders / Delusional Disorders/ Shared Psychotic Disorder: A dulusion is held with another person in a close relationship.
Treatment of Schizophrenic and Other Psychotic Disorders /Psychopharmacology: Antipsychotic medication with consisten administration and monitoring for response and side effects. e.g. Tardive Dyskinesia-involuntary movement of the mouth tongue, jaw, facialgrimacing
Treatment of Schizophrenic and Other Psychotic Disorders / Individual Psychotherapy: Supportive in nature, little anxiety inducement, contain psychotic symptoms, and focus on realistic goals to maintain highest level of functioning. The goal is to facilitate coping and self acceptance.
Treatment of Schizophrenic and Other Psychotic Disorders / Family Therapy: Provide education and support to family members
Treatment of Schizophrenic and Other Psychotic Disorders / gROUP Therapy: Practical, supportive, helps develop social skills to begin or sustain relationships.
Treatment of Schizophrenic and Other Psychotic Disorders / Milieu Therapy: Often hospital /nstitutional treatment involving a therapeutic combination of staff, program, social structrue, respite, and expectations of resonable behavior
Treatment of Schizophrenic and Other Psychotic Disorders / Social Network Intervention / Case Management: Help with housing, income, social cntacts, educational and vocational oportunities, medical care, or other resources
Treatment of Schizophrenic and Other Psychotic Disorders / Self help groups: For support and education to the client and family members
Treatment of Schizophrenic and Other Psychotic Disorders / Differential Diagnosis // Paranoid Personality Disorder: There may be paranoid ideation or pathological jealousy, but there are no delusions or hallucinations.
Treatment of Schizophrenic and Other Psychotic Disorders / Differential Diagnosis: Illnesses that may have less severe or transient psychotic features include Major Depressive Disorder, Bipolar Disorder or Personality Disorder, such as Schizotyal Personality Disorder
Treatment of Schizophrenic and Other Psychotic Disorders / Differential Diagnosis / Course: Varies from chronic to remission within a few months.
Mood Disorders: Impact is psychological distress and impaired role functioning. Culture may affect presentation; e.g. more somatic symptoms among Asian Clients.
Mood Disorders / Major Depressive Disorder: Vegetative or classic symptoms: significant weight loss or gain insomia or sleeping too much, motor agitation or low energy. Feeling sad or empty, worthless, difficulty concentrating or making decisions. general loss of pleasure and interest. Recurrent thoughts of death or sucide. At least two weeks duration
Mood Disorders / Dysthymic Disorder: Similar symptoms to Major Depressive Disorder, but less severe and more chronic, at least two years.
Mood Disorders / Bipolar I Disorder: Formerly called Manic Depression. One or more Manic Episodes characterized by persisteent abnormally elevated or irritable mood, pressured speech, grandiosity, sleeplessness, and / or excessive pleasurable, high-risk activity.
Mood Disorders / Bipolar II Disorder: Major Depressive Episodes with at least one Hypomanic Episode (Manic symptoms at a less severe intensity)
Mood Disorders / Cyclothymic Disorder: Chronic fluctuating mood with many hypomanic and many depressive symptoms, but not as severe as in either Bipolar I or Bipolar II
Mood Disorders / Treatment of Mood Disorders / Psychopharmacology: Behavioral Therapy
Cognitive Therapy
Group Psychotherapy
Self help groups
Mood Disorders / Treatment of Mood Disorders /: Interpersonal / Psychodynamic Therapy

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