Biopsychosocial-Spiritual-Cultural History Description
-Tool that provides information on current/presenting issue, client's past and present physical health, emotional functioning, educational and vocational background, cultural issues, spiritual and religious beliefs, environmental issues, and social functi
Biological Section
-Assesses a client's medical history, developmental history, current medications, substance abuse history, and family history of medical illnesses
-Info should be known about medications taken because side effects can mask or exacerbate psychiatric sympto
Psychological Section
-Assesses a client's present psychiatric illness or symptoms, history of the current psychiatric illness or symptoms, past or current psychological stressors, and mental status
-Exploration of how problem has been treated in past, past or present psychiat
Social Section
-Focuses on client systems and unique client context, and may identify strengths and /or resources available for treatment planning
-Include sexual identity issues. personal history, family of origin history, support system, abuse history, education, lega
Mental Status Examination
-Structured way of observing and describing a client's current state of mind under the domaines of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgement
-Should be document
Appearance
Facial expression, grooming, dress, gait, etc.
Orientation
Awareness of time, place, and events
Speech Pattern
Slurred, pressured, slow, flat tone, calm , Etc
Affect/Mood
Mood as evidenced in both behavior and client statements(sad, jittery, manic, Placid, etc)
Impulsive/Potential for Harm
Impulse control with special attention to potential suicidality and/or harm to others
Judgement/Insight
Ability to predict the consequences of their behavior, to make sensible decisions, to recognize their contributions to their problem
Thought Processes/Reality Testing
Thinking style and ability to know reality, including the difference between stimuli that are coming from inside oneself and those that are coming from outside (statements about delusions, hallucinations, and conclusions about whether or not a client is p
Intellectual Functioning/Memory
Level of intelligence and of recent and remote memory functions
Factors Influencing Experience of Chronic Illness
-Personal characteristics
-Social and family supports
-Culture
-Environment
-Activities
-Personal goals
Biological Factors of Mental Health
-Genes
-Brain structure and functioning
-Must use a systems approach in assessing mental health
Psychological Factors of Mental Health
Personality (relating to others and reacting to the world)
Social Factors of Mental Health
-Socioeconomic situation
-Age
-Gender
-Social networks
-Level of support
-Life events
-Migration
-Culture
Psychosocial Stress
-Results when there is a perceived thereat (real or imagined)
-Ex) threats to social status social esteem, respect, acceptance within a group, self-worth
Causes of Psychosocial Stress
-Upsetting events (natural disaster, divorce, etc.)
-Events from the past
-Often not caused by single event but ongoing problems
Manifestation/Effects of Stress
-High blood pressure, sweating, rapid heart rate, dizziness, feelings of irritability or sadness
-When psychological stress triggers a stress response-body releases group of stress hormones that lead to a burst of energy
-Hormones brought about by stress
Differential Diagnosis
Systematic diagnosis method used to identify the presence of an entity where multiple alternatives are possible
Circulatory System
-Body's transport system
-Made up of group of organs that transport blood throughout body
-Heart pumps blood and the arteries and veins transport it
Digestive System
Made up of organs that break down food into protein, vitamins, minerals, carbohydrates, and fats, which the body needs for energy, growth and repair
Endocrine System
-Group of glands that produce the body's long-distance messengers, or hormones
-Hormones are chemicals that control body functions, such as metabolism, growth, and sexual development
Immune System
-Body's defense system against infections and diseases
-Organs, tissues, cells, and cell products work together to respond to dangerous organisms (viruses or bacteria and substances that mat enter the body from the environment
Lymphatic System
-Defense system for the body
-Filters out organisms that cause disease, produces white blood cells, and generates disease-fighting antibodies.
-Distributes fluids and nutrients in the body and drains excess fluids and protein so that tissues do not swell
Muscular System
-Made up of tissues that work with the skeletal system to control movement of the body.
-Some muscles�like those in arms and legs�are voluntary, meaning that an individual decides when to move them. Other muscles, like the ones in the stomach, heart, inte
Nervous System
-Made up of the brain, spinal cord, and nerves
-Body's control sustem
-Sends, receive, and processes nerve impulses throughout the body
-These nerve impulses tell muscles and organs what to do and how to respond to environment
Reproductive System
-Allows humans to produce children
-Fertilized egg travels from fallopian tube to uterus, where the fetus develops over a period of 9 months
Respiratory System
-Brings air into the body and removes carbon dioxide
-Includes nose, trachea, and lungs
Skeletal System
-Bones, ligaments, and tendons
-Shapes the body and protects organs
-Works with muscular system to help the body move
Urinary System
-Eliminates waste from the body in the from of urine
-The kidneys remove waste from the blood-waste combines with water to form urine
Diagnosis
-Process of identifying problems, with their underlying causes and practical solutions
-Generally obtained after a social worker uses info gained through assessment
-Includes drawing inferences and reaching conclusion based on data available
Comorbid
existing with or at the same time; for instance, having two different illnesses at the same time
Contraindicated
Not recommended or safe to use (a medication or treatment that is contraindicated would not be prescribed because it could have serious consequences)
Delusion
False, fixed belief despite evidence to the contrary (believing something that is not true)
Disorientation
Confusion with regard to person, place, or time
Dissociation
Disturbance or change in the usually integrative functions of memory, identity, perception, or consciousness (often seen in clients with a history of trauma)
Endogenous Depression
Depression caused by a biochemical imbalance rather than a psychosocial stressor or external factors
Exogenous Depression
Depression caused by external events or psychosocial stressors
Folie a Deux
Shared delusion
Hallucinations
Hearing, seeing, smelling, or feeling something that is
not real (auditory most common)
Hypomanic
Elevated, expansive, or irritable mood that is less severe than full-blown manic symptoms (not severe enough to interfere with functioning and not accompanied by psychotic symptoms)
Postmorbid
Subsequent to the onset of an illness
Premorbid
Prior to the onset of an illness
Psychotic
Experiencing delusions of hallucinations
Perspective Used to Understand Sexual Issues
-Systems perspective should be used
-A medical/biological condition that decreases satisfaction or causes dysfunction may heavily impact on psychological and social functioning
-A psychological or social issue can lead to a lack of desire, inability to be
Genogram
-Graphic representation of a family tree that displays the interaction of generations within a family
-Used by social workers to depict a client as part of a larger family system
-Allows user to analyze family, emotional, and social relationships within a
Signs of Marijuana Use
Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss
Signs of Cocaine Use
Dilated pupils, hyperactivity, euphoria, irritability, anxiety, excessive talking followed by depression or excessive sleeping at odd times. may go long periods of time without eating or sleeping, weight loss, dry mouth and nose
Signs of Heroin Use
Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite
Somatization
-Unconscious process by which psychological distress is expressed as physical symptoms
-Somatic symptoms often occur as reactions to stressful situations and are not considered abnormal if they occur sporadically
Persistent Somatization
-Associated with considerable distress and disability
-May lead to over utilization of medical care- including unnecessary medical tests and increased hospitalization rates
Presentations of Somatization
-Having multiple unexplained somatic symptoms
-Exhibiting predominantly illness worry or hypochondriacal beliefs
-Displaying somatization as a manifestation of a variety of mental disorders
Co-occurring Disorders and Conditions
-Present when there are two or more disorders occurring at the same time
-Must be independent and not symptomatology resulting from the other disorder/condition
-Integrated treatment or treatment that considers presence of all disorders or conditions at t
Neurologic and Organic Symptoms
-Caused by disorders that affect part or all of the nervous system or are biologically based
-Symptoms associated with pain, including headache or back pain
-Can include muscle weakness or lack of coordination, abnormal sensations in the skin, and disturb
Organic Brain Syndrome
-Describes physical disorders that impair mental function
-Most common symptoms are confusion, impairment of memory, judgement, and intellectual function, and agitation
-Some disorders that can contribute or organic brain syndrome-alcoholism, alzheimers,
Sexual Dysfunction
-Problems associate with sexual desire or response
-Problems may be caused by psychological factors, physical conditions, or combination of both
-Sexual dysfunction can also be due to childhood sexual abuse, depression, anxiety, stressful life events, and
Symptoms of Trauma
-Anxiety or panic attacks and unable to cope with certain circumstances
-Often believe they cant trust, world is not safe, and they are powerless to change circumstances
-Beliefs about themselves, others, and the world diminish sense of competency
-May di
Traumatization
-When a client experiences neurological distress that does not go away or when one is not able to return to a state of equilibrium
-Can lead to mental, social, emotional, and physical disability
-When trauma or violence occurs during childhood-children ma
Psychotropic Medicaitions
-Affect brain chemicals associated with mood and behavior
-Prescribed to treat a variety of mental health problems and work by changing amounts of important chemicals in brain called neurotransmitters
Antipsychotics
Used for treatment of Schizophrenia and mania
Typical Antipsychotics
Haldol (haloperidol)
Haldol Decanoate (long-acting injectable)
Loxitane (loxapine)
Mellaril (thioridazine)
Moban (molindone)
Navane (thiothixene)
Prolixin (fluphenazine)S
erentil (mesoridazine)
Stelazine (trifluoperazine)
Thorazine (chlorpromazine)
Trilaf
Atypical Antipsychotics
Abilify (aripiprazole)
Clozaril (clozapine)
Geodon (ziprasidone)
Risperdal (risperidone)
Seroquel (quetiapine)
Zyprexa (olanzapine)
Tardive Dyskinesia
-Abnormal, involuntary movements of the tongue, lips, jaw, and face, as well as twitching and snakelike movements of extremities
-May result in taking high doses of antipsychotic medications over a long period of time
Antimanic Agents (Mood Stabilizers)
-Used for treatment of bipolar disorder
-Depakene (valproic acid, divalproex sodium),Depakote sprinkles
-Lamictal (lamotrigine)
-Lithium (lithium carbonate), Eskalith, Lithobid
-Tegretol (carbamazepine), Carbotrol
-Topamax (topiramate)
-There is a small d
Antidepressants
Used for the treatment of Depressive Disorders
Selective Seretonin Reuptake Inhibitors (SSRIs)
-Celexa (citalopram)
-Lexapro (escitalopram)
-Luvox (fluvoxamine)
-Paxil (paroxetine)
-Prozac (fluoxetine)
-Zoloft (sertraline)
Tricylics
-Anafranil (clomipramine)
- Asendin (amoxapine)
-Elavil (amitriptyline)
-Norpramin (desipramine)
-Pamelor (nortriptyline)
-Sinequan (doxepin)
-Surmontil (trimipramine)
-Tofranil (imipramine)
-Vivactil (protriptyline)
Monoamine Oxidase Inhibitors (MAOIs)
-Nardil (phenelzine)
-Parnate (tranylcypromine)
-Dietary restrictions of foods that contain high levels of tyramine (generally food that has been aged).
Other Antidepressants
-Desyrel (trazodone)
-Effexor (venlafaxine)
-Remeron (mirtazapine)
-Serzone (nefazodone)
-Wellbutrin (bupropion)
Antianxiety Drugs
-Used for the treatment of Anxiety Disorders
-Benzodiazepines- primarily used for anxiety disorders
-Ativan (lorazepam)
-Buspar (buspirone)
-Klonopin (clonazepam)
-Valium (diazepam)
-Xanax (alprazolam)
-High abuse potential and dangerous when combined wit
Stimulants
-Used for the treatment of Attention-Deficit/Hyperactivity Disorder
- Adderall (amphetamine, mixed salts)
-Concerta (methylphenidate, long acting)
-Dexedrine (dextroamphetamine)
-Dexedrine Spansules (dextroamphetamine, long acting)
-Metadate (methylphenid
Problem Identification
-Determining the problem targeted for intervention
-Determining issue in exact definable terms, when it occurs, and magnitude
-Often useful to determine what is not the problems
-Should always be considered within person in environment perspective and use
Triangulation
-Using multiple information sources
-Method to have accurate accounts upon which to make assessments and base interventions
Beck Depression Inventory
21 item test, presented in multiple choice format, that assesses the presence and degree of depression in adolescents and adults
Minesota Multiphasic Personality Inventory (MMPI)
An objective vernal inventory designed as a personality test for the assessment of psychopathology consisting of 550 statements, 16 of which are repeated
Myers-Briggs Type Indicator
-Forced-Choice, self-report inventory that attempts to classify individuals along four theoretically independent dimensions
-The first dimension is a general attitude toward the world, either extraverted (E) or introverted (I)
-The second dimension, perce
Rorchach Inkblot Test
Used to assess perceptual reactions and other psychological functioning
Standord-Binet Intelligence Scale
-Designed for the testing of cognitive abilities
-Provides verbal performance, and full scale scores for children and adults
Thematic Apperception Test
-Series of pictures of ambiguous scenes
-Clients are asked to make up stories or fantasies concerning what is happening, has happened, and is going to happen in the scenes, along with a description of their thoughts and feelings
-Provides information on a
Wechler Intelligence Scale
-Measure of a child's intellectual and cognitive ability
-Has four index scaled and a full scale score
Psychological Tests
Instruments used to measure an assortment of mental abilities and characteristics-personality, achievement, intelligence, and neurological functioning
Educational Tests
-Measure cognitive (thinking) abilities and academic achievement
-Provide a profile of strengths and weaknesses that accurately identify areas for academic remediation and insight into the best learning strategies
-Provide details into the learning proces
Social Work Assessment
More comprehensive process that may utilize the results from educational and psychological tests, but can also involve interviewing a client or family, reviewing a client's history, checking existing records, and consulting with previous or concurrent pro
Achievement/Aptitude Tests
Typically use in education, measure how much clients know (have achieved) in a certain subject or subjects, or have ability (aptitude) to learn
Intelligence Tests
Measure intelligence (IQ)
Job/Occupational Tests
Match interests with careers
Personality Tests
Measure basic personality traits/characteristics
Neuropsychological Tests
Assess and measure cognitive functioning
Specialized Clinical Tests
Investigates areas of clinical interest, such as anxiety, depression, Post-traumatic Stress Disorder, etc
Risk Assessment
Examines:
-Frequency, intensity, and duration of suicidal or violent thoughts
-Access to or availability of method(s)
-Ability or inability to control suicidal/violent thoughts
-Ability not to act on thoughts
Factors making a client feel better or worse -
Duty To Warn
When a client is deemed to be a danger to an identifiable third party-this is considered a
"duty to warn" situation
Risk Factors of Suicide (Danger to Self)
-History of previous suicide attempt
-Lack of social supports
-Presence of psychiatric disorder
-Substance abuse
-Family history of suicide
-Exposure to suicidal behavior of others through media or peers
-Losses-relationship, job, financial, social
-Prese
Protective Factors of Suicide
-Effective and appropriate clinical care for mental, physical, and substance use disorders
-East access to a variety of clinical interventions and support
-Restricted access to highly lethal methods
-Family and community support
-Learned coping and stress
Behavioral Warning Signs of Suicide
-Change in eating and sleeping habits
-Drug and alcohol use
-Marked personality change
-Loss of interest in pleasurable activities
-Verbalizes threats to commit suicide or feelings of despair and hopelessness
Risk Factors of Violence (Danger to Others)
-Youth who become violent before age 13
-Drugs, guns, and other risky behaviors
-Involvement with delinquent peers and gang members
Protective Factors of Violence
-Interventions that target change in social context
-Effective and appropriate clinical care for mental, physical, and substance abuse disorders
-Restricted access to highly lethal methods
-Family and community support
-Learned coping and stress reduction
Behavioral Warning Signs of Violence
-Drug and alcohol use
-Marked personality changes
-Angry outbursts
-Preoccupation with killing, war, violence, weapons
-Isolating from others
-Obtaining guns or other lethal methods
Seeking Exceptions
Determining when the problem does not exist or occur (locations, times, contexts)
Scaling the Problem
Identifying the severity of the problem on a scale from 1-10 according to the client
Scaling Motivation
Estimating the degree to which client feels hopeful about resolution
Miracle Question
Having the client determine what would be different if problem did not exist
Assessing Motivation and Resistance
-Important to determine what stage of change a client is in
-Will provide a social worker with appropriate clinical strategies to use to address these issues
-If a client is pushed to fast the therapeutic alliance may break down
When Resistance Occurs in Later Stages of Change
Social worker should reassess the problem and appropriateness of the intervention to ensure that there have not been new developments in a client's life to be considered
Preeconetmplation
-Client is unaware, unable, or unwilling to change
-Greatest resistance and lack of motivation
-Characterized by arguing, interrupting, denial, ignoring the problem, or avoiding talking or thinking about it
-Client may not show up for appointments or agre
Contemplation
-Client is ambivalent or uncertain regarding behavior change-behaviors are unpredictable
-Client may be willing to look at the pros and cons of behavior change but is not committed to working toward it
Strength
The capacity to cope with difficulties, to maintain functioning under stress, to return to equilibrium in the face of significant trauma, to use
external challenges to promote growth, and to be resilient by using social supports
Strengths/Protective Factors
-Areas that can assist clients when they experience challenges
1. Cognitive and appraisal skills
2. Defenses and Coping Mechanisms
3. Temperamental and Dispositional Factors
4. Interpersonal Skills and Supports
5. Other Factors
Cognitive and Appraisal Skills
-Intellectual/cognitive ability
-Creativity and curiosity
-Initiative, perseverance, and patience
-Common sense
-Ability to anticipate problems
-Realistic appraisal of demands and capacities
-Ability to use feedback
Defenses and Coping Mechanisms
-Ability to regulate impulses and affect
-Self-soothing
-Flexible; can handle stressors
Temperamental and Dispositional Factors
-Belief in trustworthiness of others
-Belief in justice
-Self-esteem and self-worth
-Sense of mastery, confidence, and optimism
-Ability to tolerate ambiguity and uncertainty
-Ability to make sense of negative events
-Sense of humor
-Lack of hostility, an
Interpersonal Skills and Supports
-Ability to develop/maintain good relationships
-Ability to confide in others
-Problem-solving skills
-Capacity for empathy
-Presence of an intimate relationship
-Sense of security
Other Factors
-Supportive social institutions, such as church
-Good physical health
-Adequate income
-Supportive family and friends
Ego Strength
-Ability of ego to effectively deal with demands of id, superego, and reality
-Basis for resilience and helps maintain emotional stability by coping with internal and external stress
Indicators of Positive Ego Strength
-Tolerance of pain associated with loss
-Disappointment, shame or guilt
-Forgiveness of others, with feelings of compassion rather than anger
-Persistence and perseverance in the pursuit of goals
-Openness, flexibility, and creativity in learning to adapt
Crisis
-Acute disruption of psychological homeostasis (steady state) in which usual coping mechanisms fail and there exists evidence of distress and functional impairment
-The subjective reaction to a stressful life is a compromised stability and ability to cope
Steps to Crisis Planning
1. Plan and conduct a thorough biopsychosocial and lethality/imminent danger assessment
2. Make psychological contact and rapidly establish the collaborative relationship
3. Identify the major problems, including crisis precipitants
4. Encourage an explor
Objective Data
Facts related to a client's situation
Subjective Data
How facts are perceived by the client through descriptions of his or her feelings, experiences, and perceptions
Evaluation
-Subjective reports of a client in conjunction with objective indicators of progress should be used to determine when goals or objectives have been met and whether new goals or objectives should be set
-Client self-monitoring is a good way to involve a cl
Experimental Research
Most rigorous
Quasi-Experimental Research
-When randomization of subjects or groups is neither practical or feasible
-Uses intervention and comparison groups, but assignment to the groups is nonrandom
Pre-Experimental Research
Intervention groups only-no comparison/control groups-weakest type of study
Single-Subject Research
-Aims to determine whether an intervention has the intended impact on a client-or on many clients who form a group
-The most common single-subject research is pre- and post-test or single-case study (AB) in which there is a comparison of behavior before t
Internal Validity
Extent to which causal inferences can be made about the intervention and the targeted behavior
External Validity
-How generalizable inferences are to general population
-Single-subject research tends to have poor external validity-limiting ability to generalize findings to a wider audience
Qualitative Data
-Collecting information through unstructured interviews, observation, and/or focus groups
-Collected from a single individual at a time or multiple people in group settings
-Very time consuming, so they are confined to smaller samples than usually found i
Quantitative Data
-Collects data through the input of responses to research instruments containing questions (i.e., such as questionnaires)
-Information can be input either by the respondents themselves (e.g., online or mail survey) or social workers can input data (e.g.,
Secondary Data
-Information that has already been collected for other purposes
-Efficient
-Completeness of existing data and reliability may be a concern
Descriptive Statistics
-Basic features of data
-Provide simple summaries about the sample and measures
-Describe what the data shows
Inferential Statistics
-Used to answer research questions or test models or hypotheses
-Conclusions often extend beyond immediate data
-Determine the probability that an observed difference between groups is a dependable one or one that might have happened by chance
Reliability
Concerns the ability to get consistent assessments or data by reducing random errors associated with its collection
Interrater or Interobserver Reliability
Assesses the degree to which different raters/observers give consistent estimates of the same phenomenon
Test-Retest Reliability
Assesses the consistency of a measure from one time to another
Parallel Forms Reliability
Assesses the consistency of the results of two tests constructed in the same way from the same content domain
Internal Consistency Reliability
Assesses the consistency of results across items within a test
Validity
-Degree to which what is being measured actually is what is claimed to be measured.
-Attempts to minimize systematic errors that may yield reliable results but do not actually assess the constructs of
interest
Face Validity
Examines whether the assessments "on their face" measure the constructs
Content Validity
Examines whether all of the relevant content domains are covered
Criterion-Related Validity
Examines whether constructs perform as anticipated in relation to other theoretical constructs
Predictive Validity
Assesses whether constructs predict what they should theoretically be able to predict
Concurrent Validity
Assesses whether constructs distinguish between groups that should be able to be distinguished
Convergent Validity
Assesses the degree to which constructs are similar to (converge on) other constructs to which they should be similar
Discriminant Validity
Assesses the degree to which constructs are different from (diverge away from) other constructs to which they should be dissimilar
Engagement
-Social worker should actively involved w/ client to determine why treatment was sought, what has precipitated desire to change now, parameters of helping relationship, expectations of treatment
-Client involvement is essential in determining what is impo
Assessment
Client is the source of providing essential information upon which to define the problem and solutions, as well as identifying collateral contacts from which gaps in data can be collected
Planning
Client and social worker must develop a common understanding of a client's preferred lifestyle
-Goals are developed from this common understanding in order to provide a direction to help a client move toward this lifestyle
-Specific action plans are devel
Intervention
-Client must be actively involved in mobilizing his or her support network to realize continued progress and sustainable change.
-Client must bring to the attention of a social worker issues that arise which may threaten goal attainment
-Progress, based u
Evaluation
-Subjective reports of a client, in conjunction with objective indicators of progress, should be used to determine when goals or objectives have been met and whether new goals or objectives should be set.
-Client self- monitoring is a good way to involve
Termination
-Client should reflect on what has been achieved and anticipate what supports are in place if problems arise again
-Requires active involvement by both a social worker and client
The Cultural Formulation Interview Guide
-In DSM-5 to help social workers assess cultural factors including clients' perspectives of their symptoms and treatment options
-Includes questions about clients' backgrounds in terms of their culture, race, ethnicity, religion, or geographical origin
-O