Monday, December 21, 2015

Information Gathering


Information gathering for assessment and throughout the treatment process to termination is vital and may be done through a variety of means. Effectively trained social workers can ascertain accurate and useful information through the social work hallmark of the biopsychosocial assessment, a psychosocial history, structured Diagnostic and Statistical Manual of Mental Disorders, 4th, ed. (DSM-IV-TR) decision tree or algorithm, psychological testing, collateral data and a variety of non-standardized measurements. An interviewer can use visual and auditory observations for powerful cues and information about what is going on with a client, guiding where additional information or issues may need to be assessed. Olfactory cues may also be relevant to assessment. Additionally, it is often what a client does not say, not just what is said, that is telling information about what is going on with a client or client system.

The correct tool for information gathering will depend on the client and the context of the situation. However, in almost all instances outside of a crisis or disaster/trauma response scenario, it will be appropriate to take a biopsychosocial history and complete a mental status exam. These two elements will provide for a basic picture of the client in their context and allow for educated planning for further assessment or case disposition.

Briefly, the biopsychosocial assessment is a tool that provides the clinician with information on the current or presenting issue or issues, the clients past and present physical health, including developmental milestones, the clients emotional functioning, educational/vocational background, cultural issues, spiritual and religious beliefs, environmental issues and social functioning. Each issue may be reviewed for its relationship or impact with the presenting issue.

The Mental Status Exam (MSE) is a structured approach to attain a comprehensive cross-section of the clients state of mind. Areas specifically explored include speech, thought process, thought content, perception, cognition, judgment, insight, mood and affect, behavior, attitude and appearance. Information is gathered through unstructured observation and direct interaction. Sometimes individuals confuse the MSE with the Mini-Mental Status Exam (MMSE); however, the two instruments are very different psychological tools. The MMSE is a brief neuropsychological tool used for quick assessment and screening of dementia.

These two protocols provide educated guidance for which DSM-IV-TR diagnostic decision tree or algorithm to use. If a formal diagnostic assessment is not the purpose of the interview, such as in disaster response or other crisis oriented intervention, the MSE can guide crucial intervention strategies that may prevent both imminent pitfalls and minimize long-term detrimental effects.

Additional information gathering to supplement client self-report in the primary protocols reviewed may be required. While clients may be forthcoming about their situations, they may have reasons not to be honest, such as fear of being disliked, shame, lack of trust, desire to please the clinician, fears of retribution, distorted thinking, legal concerns and a constellation of issues that may relate to being an involuntary client. Because self-report is flawed, having collateral sources of information can be invaluable. Sources of collateral information may be a significant other, teacher, parent, other family member, spouse, employer, hospital discharge summary, medical records, caseworker or many other sources. Remember, it is vital that permission is received from the client and documented appropriately (release of information, parental permission with release of information).





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Thursday, November 19, 2015

Service Delivery Outline

I.  FORMAL SERVICE DELIVERY SYSTEMS/ ORGANIZATIONS

A.       Public agencies: mandated by law to provide income maintenance or other tangible goods and services
B.       Private Not-for-Profit: non-governmental, operating under specific legal guidelines regarding financial issues
C.       Private/Proprietary Agencies: non-governmental providing social services with profit motive
D.       Self-help Agencies: voluntary or mutual aid groups
E.       Independent Practice: proprietary, clinical and non-clinical activities (consultation, research, workshops)

II. SERVICE DELIVERY

A.       Models
        1.        Social Competency
        2.        Social Change
        3.        Medical/Clinical
        4.        Educational
        5.        Ecological
B.       Steps in Service Delivery
        1.        Engagement
        2.        Assessment
        3.        Planning
        4.        Implementation
        5.        Evaluation
C.       Designs
        1.        Centralization vs. Decentralization
        2.        Single service vs. cluster of services
        3.        Coordinate efforts or operate alone
        4.        Employ professionals, para-professionals, consumers to provide services

III. POLICIES & PROCEDURES

A.       Types of Policy
        1. Social/Family Policy
        2. Regulatory Policy
        3. Redistributive Policy
        4. Definitional Policy
B.       Purpose-Governmental (Federal/State)
        1.        Establish governmental agencies
        2.        Establish income maintenance guidelines
        3.        Establish parameters for services
C.       Purpose-Agency
        1.        Establish operations consistent with fed/state guidelines
        2.        Establish specific service delivery system
        3.        Consistent service delivery
        4.        Client rights, responsibilities and entitlements
D.       Implementation of Organizational Policy and Procedure
        1. Policy Implementation
         a. Secondary Legislation period requiring details about regulations, procedures and guidelines
         b. Impacted by agency limitations and capabilities
E.       Affects Service Delivery
        1.        Agency budget and resources
        2.        Staffing availability
        3.        Agency Capacity
        4.        Political climate

IV. METHODS OF SOCIAL WORK ADVOCACY

A.       Policy Development
B.       Group Advocacy
C.       Individual and Family Advocacy
D.       Message-based
E.       Relationship-based
F.       Media-based

V. INTERDISCIPLINARY COLLABORATION

A.       Multiple disciplines
B.       Holistic approach to complex clients




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Wednesday, October 21, 2015

General Assessment Issues

General Assessment Issues

The basis for any effective social work action is effective assessment of the problem or situation. A solid understanding of assessment issues is important to the success of case work, crisis management, clinical treatment, psycho education, community organizing, new parent support, child protection services, advocacy, policy development and any other issues that may be defined. It is the key to beginning an effective relationship with a client or starting any element of mezzo or macro practice.

The first part of the process in assessment is to determine why the client is present. The psychosocial summary should include a statement about what brought the client to the session, specifically the basis for the assessment. When the reason for the assessment is discovered, it drives who should be present for the initial meeting. For example, if parents call about a problem child, age 7, who is out of control, who should attend the first session? Should the entire family be present or some subset thereof? Further, what is observed in the waiting room prior to the initial session? Is the parent engaged with the child, dismissive, agitated, pacing, on the phone? Which member of the family seems eager to be present? Who seems anxious, angry or scared?

Confidentiality must be addressed prior to the start of assessment. If notes are taken during session, be open with the client about what you are doing, such as saying I need to have some specific information because some things may be hard for me to recall, like dates, names or events. The full parameters of what information can and cannot be kept confidential are important to provide. If insurance is being filed, it is important to make sure the client(s) understand what the insurance company can access and review or what is submitted to the company. If the client is involuntary (i.e. court ordered), make sure the client knows what is expected of them and how confidentiality relates to their status.

Often clients have curiosity about their social worker. After all, the worker is often actively engaged in the clients life and knows extensive information about the client. As a social worker, one must decide how personal questions will be addressed. This should be based on several considerations. One is agency policy. Does the agency have a policy about the disclosure of personal information with clients? Theory often drives how much information is disclosed and the meaning of the question asked by the client. Generally, it is important to understand the meaning of the question to the client. Some clients may ask a personal question because they want to know if the worker has experience in something going on in the clients life. Cultural issues may drive the clients question, perhaps wanting to learn about how a social worker from the dominant culture may relate to a client from a minority background. Other clients have a sincere curiosity about the person who is becoming a part of their life. Some clients have significant boundary issues. Most important is to understand the significance of the clients question and put the clients interests first. This does not suggest the client needs intimate details of a social workers life, but interpersonal sharing can begin healthy role-modeling for the client. If the worker is uncomfortable sharing any personal information, the worker must negotiate that, as well. The worker can still set the tone for a positive relationship by setting a boundary that does not include sharing personal information by responding honestly, such as I am not comfortable sharing about my personal life with you, but I want to understand what that question means to you or if you feel I can help without answering personal questions.

The timeframe for assessment may very across settings. Requirements present in a governmental agency may be different than in a non-profit agency setting or an independent practitioners office. An inpatient unit may require assessment to go very quickly because the turn-around time for the client is fast, while a residential program may allow for assessment to be done over two or three sessions, resulting in a more in-depth assessment. The payer (i.e. insurance, private, self-pay) often dictates the limits or flexibility allowed in the assessment process.





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Monday, September 14, 2015

Diagnostic interviewing techniques


Questioning: 
o Client asked direct questions in areas determined by interviewer
o Questioning may be open or closed.
Open= unlimited answer options
Closed= Yes, No, or one word questions

Reflection: 
o Restate the clients cognitive or emotional material
o Demonstrate empathic understanding
o Rogerian Client-Centered Therapists rely heavily on reflection
o Overuse is counterproductive - important areas are left unaddressed

Restatement (Paraphrasing): 
o Rephrase what client says.
o Demonstrates active listening.
o Reflection is type of intervention, clarifies and joins themes.

Clarification: 
o Accompanied by utilizing other techniques such as questioning, paraphrasing, restating
o Shows understanding of client in the interview
o If done from a not knowing stance, should not invoke defensive response.

Confrontation: 
o May be used to call client out on discrepancies
o Is often used with substance abusers in order to break denial and/or rigid defenses
o This may increase anxiety and avoidance but is necessary and can be constructive.

Self-disclosure 
o The sharing of personal experiences by the therapist to the client relative to the session with the purpose of helping.
o Intended to facilitate client disclosure.
o Should be used minimally
o Must be careful not to cross boundaries.

Silence: 
o While this may occur unintentionally there are many benefits if used correctly.
o Provides both client and therapist time to process what is being understood.
o Timing is essential
o Promotes introspection

Exploration: 
o Therapist test the limits of what client is willing to process.
o May be used to determine clients level of insight.

Reframing (Cognitive reframing): 
o This allows for a different perspective
o Used to challenge negative self concepts and harmful thinking patterns.
o The purpose is to lead to behavioral change.





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Monday, September 7, 2015

Reference materials regarding medication side effects and classification



AllPsych Online
http://allpsych.com/meds.html

⋄ One of the largest psychology websites on the Internet.
⋄ Holds over 920 individual, cross referenced, web pages and an estimated 3000 pages of printed material.
⋄ It is referenced by over 100 colleges and universities in ten countries.
⋄ It provides:
        o Drug name
        o How they work
        o What they treat
        o Possible side effects


SEDBASE
http://library.dialog.com/bluesheets/html/bl0070.html

⋄ This is a full text database that critically analyzes the published drug side effect literature on drugs currently in use.
⋄ Drug class chapters are prepared by recognized authorities who critically assess published literature each year.
⋄ The goal of the database is to document every drug known to have a side effect reported in the literature.
⋄ It is organized by drug class chapters and does not contain any speculative or unsubstantiated statements.
⋄ Some of the specific areas covered include:
        o adverse drug reactions
        o drug interactions
        o drug toxicity
        o special risk situations
        o pharmacological or patient-dependent factors associated with the occurrence of side effects.





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