Assessment Methods and Techniques Flashcards
What factors & processes are used in Problem Formulation?
- Problem identification concerns determining the problem targeted for intervention
○ Often difficult to isolate the issue that, when addressed, will result in a change in the symptomology of a client/client system- Have to determine the issue in exact, defineable terms, when it occurs, and its magnitude
- In macro practice, SW will often need to get consensus from the group around what the nature of the problem is
- Often useful to determine what the problem is not
- Should always be considered in PIE & with strengths
When should a SW gather collateral & what are the benefits?
- Collateral is often still necessary - family, friends, other agencies, physicians etc. as informants
○ Often used when credibility & validity of information obtained from the client/others is questionable
○ Credibility of informants must be assessed as well, data from neutral parties is more likely to be valid
○ Info from collateral informants that matches info from client increases validity of data
***** NEED INFORMED consent before contacting collateral sources
What does the Beck Depression Inventory (BDI) assess?
21-item test, MC, assesses presence and degree of depression in adolescents & adults
What does the Minnesota Multiphasic Personality Inventory (MMPI) assess?
Objective verbal inventory designed as a personality test for the assessment of psychopathology, consisting of 550 statements, 16 of which are repeated
What does the Myers-Briggs Type Indicator assess?
○ Forced-choice, self-report inventory that attempts to classify individuals along 4 theretically independent dimensions
§ General attitude towards the world: Extraverted or Introverted
§ Perception: Sensation or Intuition (N)
§ Processing: Thinking or Feeling
Judging or Perceiving
What does the Rorschach Inkblot Test assess?
Responses to inkblots to assess perceptual reactions and other psychological functioning (projective test)
What does the Stanford-Binet Intelligence Scale assess?
Tests cognitive abilities - verbal, performance, and full scare scores
What does the Thematic Apperception Test assess?
○ Projective
○ Series of pictures and ambiguous scenes - make up stories/fantasis around what has/will/going to happen in each scene & thoughts/feelings
» Understanding thoughts/feelings/emotions/conflicts both conscious and unconscious
What does the Wechsler Intelligence Scale assess?
Measures children’s intellectual & cognitive ability - 4 index scales & a full scale score
What can psychological tests bring to Assessments?
○ Measure mental abilities & characteristics - personality, achievement, intelligence, neurological functioning
○ Questionnaires, written, verbal, pictorial
- Can be scales, surveys, screens, checklists, assessments, measures, inventories etc.
What can educational tests bring to Assessments?
○ Measure cognitive abilities & academic achievement
○ Profile of strengths and weaknesses that accurately identify areas for academic remediation and insight into best learning strategies
○ Documentation for legal purposes of establishing disabilities
- Often comes after a period of struggle, distress, and different efforts
What other kinds of tests can be utilized in assessment?
○ Achievement/Aptitude Tests - education or ability to learn
○ IQ Tests
○ Job/Occupational Tests
○ Personality Tests
○ Neuropsychological tests - cognitive functioning
- Specialized clinical tests - areas of clinical interest - anxiety, depression, PTSD etc.
Which communication concepts/styles are ineffective?
○ Should/Ought can be judgemental/moralizing and can have opposite effect
○ Offering advice/solutions prematurely before thorough problem exploration can cause resistance
○ Using logical arguments, lecturing, or arguing may result in a power struggle
○ Judging, criticizing, blaming are detrimental to client & relationship
○ Using professional jargon and defining client in terms of their diagnosis can impact self-view
○ Providing premature reassurance without a genuine basis is often for the SW’s own benefit. Have to explore feelings no matter how painful they are
○ Ill-timed or frequent interruptions disrupt the process
○ Excessive social rather than therapeutic interactions is counterproductive
- Must provide structure and direction to the process instead of being passive or inactive
What are the 10 critical communication concepts?
- Acceptance
- Cognitive Dissonance
- Context
- Double Bind
- Echolalia
- Information
- Information Processing
- Information Processing Block
- Metacommunication
- Nonverbal Communication
Define Cognitive Dissonance
- Arises when someone has to pick between 2 contradictory beliefs
- Most often when 2 options are equally attractive
> 3 ways to reduce: reduce the importance of conflicting beliefs, acquire new beliefs that change the balance, remove conflicting attitude/behaviour
Define Double Bind
Offering two contradictory messages and prohibiting the recipient from noticing the contradiction
What are the 2 different types of communication content?
Manifest & Latent
What is Manifest communication?
concrete words or terms contained in a communication
- relying only on manifest content to understand client experiences/problems may not result in full understanding
What is Latent Communication?
not visible, underlying meaning of words/terms
Define Congruence (in communication)
matching of awareness and experience with communication
- Client needs to be able to express themselves and for their communication to be reflective of their feelings - Essential for the vitality of a relationship and to facilitate true helping in the problem solving process
What is a good tool for assessing & enhancing communication skills?
Role Playing - allows to see if there is congruence between nonverbal & verbal communication
What does a Risk Assessment achieve?
- Assessing risks of clients to themselves and others
- No indicators that definitively predict whether a client will act on their feelings to hurt themselves
- Must review ALL assessment data to determine appropriate level of care/plan
- No indicators that definitively predict whether a client will act on their feelings to hurt themselves
What does a Risk Assessment include?
> MUST include:
○ Risk & protective factors
○ Behavioural warning signs
> MAY include:
○ Frequency, intensity & duration of suicidal/violent thoughts
○ Access to/availability of method(s)
○ Ability/inability to control suicidal/violent thoughts
○ Ability not to act on thoughts
○ Factors making the client feel better or worse
○ Consequences of actions
○ Deterrents to acting on thoughts
○ Whether client has been using substances to cope
Measures a client requires to maintain safety
When must a SW notify others of risk?
- When a client is seen to be a danger to themselves or others, involuntary treatment may be sought
- If a client is deemed a danger to an identifiable 3rd party a SW should consider this a “duty to warn” (Tarasoff decision)
What are some client strengths that are often overlooked?
- Facing problems by seeking help rather than avoiding
- Taking risks by sharing problems with SW
- Perseverance
- Being resourceful
- Meeting family & financial obligations
- Seeking to understand actions of others
- Functioning in stressful situations
- Considering alternative courses of action
How can a SW identify strengths?
- Seeking exceptions - when the problem doesn’t exist/occur (locations, times, contexts)
- Scaling the problem - severity from 1-10
- Scaling motivation - estimating degree to which client feels hopeful about resolution etc
- Miracle Question - what would be different if the problem didn’t exist
What are some strengths often found in community?
- Organizations
- People
- Partnerships
- Facilities
- Funding
- Policies
- Regulations
- Culture
How can a SW identify community strengths?
- Can look at experiences of other communities that have experienced similar problems - their strengths to see if similar ones can be mobilized
- Must have an understanding of gaps/needs in the community
- Collaboration & community building are essential for addressing community challenges
- Must have an understanding of gaps/needs in the community
- Can look at experiences of other communities that have experienced similar problems - their strengths to see if similar ones can be mobilized
What are some forms of data collection used in community?
- Interviews
- Observation
- Surveys
- Observation
What are some indicators of Resistance?
○ Limiting amount of info communication to SW
○ Silence, minimal talking in sessions
○ Small talk about irrelevant topics
○ Intellectual talk - technical/abstract terms or asking questions not related to issues
○ Discounting, censoring, editing thoughts when asked about them by SW
○ False promising
○ Flatting a SW to attempt to “soften” them to not be pushed to act
○ Not keeping appointments
- Payment delays/refusals
What is key to determine about resistance?
> Essential to determine the extent to which this resistance or inabilities are caused by the client, the SW, or the conditions present
- May be resistant due to guilt/shame may not be ready to recognize/address feelings and behaviours being brought up - May be frightened of change/benefitting from problems somehow - SW may not be ready due to lack of rapport, unclear expectations/role - Can be external - change in client living situation, physical health problems, lack of social support, financial problems
Methods to Assess
○ Motivation & Resistance exist along a continuum of readiness - clients can’t move at a faster pace than they are ready for
○ Lack of motivation often found in precontemplation and contemplation (Transtheoretical model)
○ Can be motivational challenges in preparation, action, and maintenance as well but these are more easily addressed
- SW can reassess problem & appropriateness of intervention to ensure there have been no new developments that need to be considered
Define Precontemplation & its concepts
unaware, unable or unwilling to change
- Greatest resistance and lack of motivation - Can be characterized by arguing, interrupting, denial, ignoring the problem, avoiding thinking/talking about it - May not even show up to appointments - Best methods are to establish rapport, acknowledging, resistance or ambivalence, keeping conversation informal, try to engage, and recognize thoughts, feelings, fears, and concerns
Define Contemplation & its concepts
ambivalent or uncertain regarding behaviour change – behaviours are unpredictable
- May be looking at pros/cons of behaviour change but not committed to working towards it - Best methods are to emphasize client's free choice and responsibility, discuss pros&cons of change and discuss how change can assist in achieving life goals - Fear can be reduced by giving ex. Of change & clarifying what change is and is not
What is important to keep in mind when assessing communication skills?
- Assessing communication skills allows for determining effective methods of gathering information & ensuring clients understand information presented to them
- Trauma informed - how trauma may impact communication styles and patterns
- Also cultural and should be viewed within the contexts of client’s backgrounds and experiences
- Silence also a form of communication
- Communication with clients who are activated/upset/angry - how word choice/tones can be upsetting to clients based on ethnic backgrounds, part experiences
What is important to keep in mind when assessing coping abilities?
- Can learn a lot about client’s difficulties by determining how clients have attempted to cope with their problems in the past
- Also give clues about levels of stress and functioning
- Some rely on avoidance - immersing themselves in work, withdrawing or using substances
- Some are aggressive or act out
- Others become dependent and rely on family members/friends to manage difficulties for them
- If they are no longer able to manage - important to find out what changed – why now?
What questions can be useful in assessing coping abilities? Extent to which clients…
○ Turn to work/other activities to take their mind off things
○ Get upset & let their emotions out
○ Get advice from others about what to do
○ Concentrate on doing something about their problems
○ Put their trust in higher powers
○ Laugh about their situations
○ Discuss feelings with others
○ Use substances to make themselves feel better
○ Pretend their problems don’t exist
- Seek others who have similar experiences
Define Strength
the capacity to cope with difficulties, to maintain functioning under stress, to return to equilibrium in the face of significant trauma, use external challenges to promote growth, and be resilient by using social supports
What are the 5 indicators/categories of strengths?
- Cognitive & Appraisal Skills
- Defenses & Coping Mechanisms
- Temperamental & Dispositional Factors
- Interpersonal Skills & Supports
- Other factors
What strengths fall under Cognitive & Appraisal Skills
- Intellectual/cognitive ability
- Creativity/curiosity
- Initiative, perseverance, patience
- Common sense
- Ability to anticipate problems
- Realistic appraisal of demands & capacities
- Ability to use feedback
What strengths fall under Defenses & Coping Mechanisms
- Ability to regulate impulses & affect
- Self-soothing
- Flexible, can handle stressors
What strengths fall under Temperamental & Dispositional Factors
- Belief in trustworthiness of others
- Belief in justice
- Self esteem and self worth
- Sense of mastery, confidence, optimism
- Ability to tolerate ambiguity & uncertainty
- Ability to make sense of negative events
- Sense of humour
- Lack of hostility, anger, anxiety
- Optimistic & open
- Ability to grieve
- Lack of helplessness
- Responsibility for decisions
- Sense of direction, mission, purpose
What strengths fall under interpersonal skills & support?
- 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
What are the other strengths?
- Supportive social institutions, such as church
- Good physical health
- Adequate income
- Supportive family & friends
Define Ego Strength
ability of the ego to effectively deal with the demands of the id, superego, and reality
- A basis for resilience, helps maintain emotional stability by coping with internal and external stress
What are some indicators of Positive Ego Strength?
- Tolerance of pain associated with loss
- Disappointment
- Shame or guilt
- Forgiveness of others
- Feelings of compassion rather than anger
- Persistence and perseverance in the pursuit of goals
- Openness, flexibility, and creativity in learning to adapt
- Less likely to have psychiatric crises
- Acknowledging feelings - grief, insecurity, loneliness, anxiety
- Not getting overwhelmed by moods
- Pushing forward after loss, not being paralyzed by self-pity or resentment
- Using painful events to strengthen themselves
- Knowing that painful feelings will eventually fade
- Empathizing with others without trying to reduce or eliminate their pain
- Being self-disciplined and fighting addictive urges
- Taking responsibility for actions
- Holding themselves accountable
- Not blaming others
- Accepting themselves with their limitations
- Setting firm limits even if it means disappointing others/risking rejection
- Avoiding people who drain them physically/emotionally
Define Trauma & its effects
response that a client has to an extremely negative event
- A normal reaction but effects can be so severe that they interfere with a client's ability to live life - Clients may have anxiety or panic attacks and be unable to cope in certain circumstances - Must address underlying emotional impacts of the trauma in order for clients to make behavioural changes - Often believe they cannot trust, the world is not safe, and that they are powerless to change their circumstances - Diminish their competencies - see themselves as 'damaged' - Can display intense emotions toward others or emotionally retreat and isolating
What are the impacts of trauma on self image?
- Anxiety
- Denial
- Agitation
- Irritability or rage
- Flashbacks or intrusive memories
- Feeling disconnected from the world
- Unrest in certain situations
- Being “shut down”
- Being very passive
- Feeling depression
- Guilt/Shame/Self-Blame
- Unusual fears
- Impatience
- Having a hard time concentrating
- Wanting to hurt oneself
- Being unable to trust anyone
- Feeling unlikeable
- Feeling unsafe
How does trauma manifest physically?
- Insomnia or fatigue
- Using harmful substances
- Keeping to oneself
- Overworking
- Lethargy
- Eating problems
- Substance use
- Needing to do certain things over and over
- Always having to have things a certain way
- Doing strange or risky things
What are the placement options based on assessed level of care?
- Continuum of intensity depending on the level of crisis
- Should be able to transfer between levels of care as needed
- Intervention Services
- Outpatient
- Hospitalization
- Residential/Inpatient
» Goal is to be least restrictive while still meeting needs and ensuring health & safety
- Should be able to transfer between levels of care as needed
What are the effects of Addiction and Substance Misuse?
- BPSSC impacts of substance abuse/dependents - wide array of physical effects other than those that are expected
- Excitement ‘high’ of cocaine followed by a crash in mood & desire for more cocaine to alleviate this
- Marijuana & Alcohol interfere with motor control
- Hallucinogens may bring flashbacks
- Sudden abstinence can result in withdrawal
- Tolerance develops with continued use- Also impacts mental health - can cause irrational behaviour, violence, lapses in memory
- Chronic use can result in long-lasting brain changes which can lead to paranoia, depression, aggression and hallucinations
- Overdose a constant risk
- Can disrupt family life and destroy relationships with focus on acquiring and use substances, can also create patterns of codependency
- Can result in accidental injury, disability, legal involvement, loss of income/employment
- May seek out those who engage in similar behaviour and create new dangerous relationships
Define Codependency
when a person out of love or fear of consequences, inadvertently enables a client to continue using substances by covering up, supplying $ or denying the problem
Indicators of Addiction & Substance Misuse
- Causing problems at work/home/school/relationships
- Neglecting responsibilities
- Dangerous behaviour (driving, using dirty needles, unprotected sex, binging/purging despite medical conditions)
- Causing financial/legal trouble
- Problems in relationships - fights, loss of friends
- Creating tolerance - more needed to produce same effect
- Out of control - causing feeling of powerlessness
- Life consuming - resulting in abandoning activities that used to be enjoyed
- Resulting in psychological issues
What are signs of marijuana use?
Glassy red eyes, loud talking, inappropriate laughter, sleepiness, loss of interest, motivation, weight gain/loss
What are signs of cocaine use?
Dilated pupils, hyperactivity, euphoria, irritability, anxiety, excessive talking followed by depression/excessive sleeping at odd times, long periods of time without eating/sleeping, weight loss, dry mouth & nose
What are signs of heroin use?
Constricted pupils, no response of pupils to light, needle marks, sleeping at unusual times, sweating, vomiting, coughing, sniffling, twitching, loss of appetite
What are the characteristics of co-occurring disorders & conditions
- Can be substance & mental health
- To be co-occurring it must be independent and not symptomatology resulting from the other disorder/condition
- Don’t have to match in severity/degree of impairment - one can be severe and the other mild and can change over time
- Compared to those with one disorder, often require longer treatment, have more crises, progress more gradually in treatment
- Integrated treatment associated with lower costs and better outcomes
What updates were included in the DSM-5
- DSM-5 deleted a separate section for “Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence” and now lists these in other chapters
- DSM 5 replaces the Not Otherwise Specified (NOS) categories with 2 options: Other Specified Disorder and Unspecified Disorder
- OSD allows SW to specify why the criteria for a specific disorder is not met
- UD allows SW to forgo specification
- Discarded the multiaxal system of diagnosis (formerly Axis I, II, & III) and combines the first 3 into one axis with all mental/other medical diagnoses
- Avis IV replaced with significant psychosocial and contextual features
Dropped Axis V
- DSM 5 replaces the Not Otherwise Specified (NOS) categories with 2 options: Other Specified Disorder and Unspecified Disorder
What are the 22 Categories of Disorders?
- Neurodevelopmental Disorders
- Schizophrenia Spectrum and Other Psychotic Disorders
- Bipolar and Related Disorders
- Depressive Disorders
- Anxiety Disorders
- Obsessive-Compulsive and Related Disorders
- Trauma- and Stressor-Related Disorders
- Dissociative Disorders
- Somatic Symptom and Related Disorders
- Feeding and Eating Disorders
- Elimination Disorders
- Sleep–Wake Disorders
- Sexual Dysfunctions
- Gender Dysphoria (Now its own category)
- Disruptive, Impulse-Control, and Conduct Disorders
- Substance-Related and Addictive Disorders
- Neurocognitive Disorders
- Personality Disorders
- Paraphilic Disorders
- Other Mental Disorders
- Medication-Induced Movement Disorders and Other Adverse Effects of Medication
22. Other Conditions That May Be a Focus of Clinical Attention
What are the indicators of Behavioural Dysfunction?
- “Normal” and “Abnormal” depend on the person, place, situation and are largely shaped by social standards
- Definitions of normal change with societal standards and norms
- When people don’t conform to normal they are often labelled negatively - sick, disabled which can lead to marginalization or stigmatization
- Most comprehensive attempt to distinguish normal from abnormal is the DSM
- Shows how normality has changed through history and often involves value judgements
Define Somatization & its concepts
unconscious process by which psychological distress is expressed as physical symptoms
- Often reactions to stress and not abnormal if they occur sporadically - Persistent somatization is associated with considerable distress and disability - Can lead to overutilization of medical care - Not all are motivated by an unconscious wish to adopt the sick role (like those with Factitious Disorder)
Is Malingering considered a mental illness?
NO. In the DSM-5 receives a V code as one of the conditions that may be a focus of clinical attention
Define Malingering & its concepts
falsely or grossly exaggerating physical or psychological problems
- Motivation is usually external - avoiding work, obtaining reward, avoiding legal action etc. - Can also be an adaptive response such an inmate with mental illness trying to obtain scarce resources - Varies from some symptoms being falsified to all being falsified or exaggerated - Prolonged direct observation can reveal malingering because it is difficult for a client to maintain consistency with false/exaggerated claims over an extended period - Clues can be reports of rare or improbable symptoms, discrepancies between claimed distress and objective findings
What are the 3 kinds of malingering?
Pure Malingering: feigning a nonexistent disorder
Partial Malingering: consciously exaggerating real symptoms
False imputation: ascribing real symptoms to a cause a client knows is unrelated to the symptoms
What are psychotropic medications & what are they used for?
- Psychotropic medications affect brain chemicals associated with mood and behaviour
- Prescribed to treat a variety of mental health problems - change amounts of important neurotransmitters
- Usually prescribed by psychiatrists
- Can be used to treat Schizophrenia, BPD but often combined with other supports - social, lifestyle changes, other treatments etc.
What are antipsychotics used to treat?
- Used for the treatment of Schizophrenia and mania
- Some available in injectable forms & useful for those noncompliant with oral meds
Define Tardive Dyskinesia & why does it happen?
abnormal involuntary movements of tongue, lips, jaw, face and twitching/snake like movement in extremities and occasionally trunk
- May result from high doses of antipsychotics over long period of time - May persist after discontinuation - Should be closely monitored and at low doses if possible
What are typical antipsychotics?
§ Haldol (haloperidol) § Haldol Decanoate (long-acting injectable) § Loxitane (loxapine) § Mellaril (thioridazine) § Moban (molindone) § Navane (thiothixene) § Prolixin (fluphenazine) § Serentil (mesoridazine) § Stelazine (trifluoperazine) § Thorazine (chlorpromazine) Trilafon (perphenazine)
What are Atypical Antipsychotics?
§ Abilify (aripiprazole) § Clozaril (clozapine) -- increased risk of agranulocytosis, requires blood monitoring § Geodon (ziprasidone) § Risperdal (risperidone) § Seroquel (quetiapine) Zyprexa (olanzapine)
What are antimanic agents (Mood Stabilizers) used to treat? + Some examples
- Used to treat Bipolar Disorder
- Small difference between toxic & therapeutic levels (narrow therapeutic index)
- Needs periodic checks of blood levels of lithium, thyroid & kidney function as lithium affects these
§ Depakene (valproic acid, divalproex sodium), Depakote sprinkles
§ Lamictal (lamotrigine)
§ Lithium (lithium carbonate), Eskalith, Lithobid
§ Tegretol (carbamazepine), Carbotrol
Topamax (topiramate)
What are Antidepressants used to treat?
- Treating depressive disorders
Dietary restrictions of foods that contain high levels of tyramine (food that has been aged) - beer, ale, wine, cheese, smoked/pickled fish, beef/chicken liver, summer sausage, fava beans, yeast vitamin supplements
What are examples of SSRI’s?
§ Celexa (citalopram) § Lexapro (escitalopram) § Luvox (fluvoxamine) § Paxil (paroxetine) § Prozac (fluoxetine) Zoloft (sertraline)
What are examples of tricyclics?
§ Anafranil (clomipramine) § Asendin (amoxapine) § Elavil (amitriptyline) § Norpramin (desipramine) § Pamelor (nortriptyline) § Sinequan (doxepin) § Surmontil (trimipramine) § Tofranil (imipramine) Vivactil (protriptyline)
What are examples of Monoamine Oxidase Inhibitors (MAOIs)?
§ Nardil (phenelzine)
Parnate (tranylcypromine)
What are Antianxiety drugs used for? + examples
- Treatment of anxiety disorders
- High abuse potential, can be dangerous when combined with alcohol or illicit substances – critical to look for signs of impaired motor/other functioning
Benzodiazepines: class of drugs primarily for treating anxiety but also effective with other disorders
§ Ativan (lorazepam)
§ Buspar (buspirone)
§ Klonopin (clonazepam)
§ Valium (diazepam)
Xanax (alprazolam)
What are Stimulants used to treat? + examples
- Used for treatment of ADD/ADHD
§ Adderall (amphetamine, mixed salts)
§ Concerta (methylphenidate, long acting)
§ Dexedrine (dextroamphetamine)
§ Dexedrine Spansules (dextroamphetamine, long acting)
§ Metadate (methylphenidate, long acting)
Ritalin (methylphenidate)
What are some Common prescription meds & their uses
- Vast majority of Americans take at least one, half take two or more
- Advair Diskus: asthma and COPD
- Crestor: lipid-lowering agent taken orally
- Cymbalta: SSNRI oral
- Diovan: heart disease/failure
- Hydrocodone/Acetaminophen: most popular painkiller - moderate to severe pain through CNS and stops coughing. Can be habit forming over time
- Levothyroxine sodium: hypothyroidism & thyroid cancer
- Lantus: sterile solution of insulin glargine for diabetes - injection
- Lisinopril: BP med - block chemicals that trigger tightening of blood vessels, heart failure
- Lyrica: seizures and treat nerve pain and fibrmyalgia
- Metoprolol: high BP, reduce heart attack risk, heart failure/pain
- Nexium: gastroesophageal reflux (GERD), excessive stomach acid
- Simvastatin: high cholesterol with diet changes, can prevent heart attacks & strokes
- Synthroid: hypothyroidism - synthetic
- Ventolin: inhalers for asthma
Vyvanse: hyperactivity and impulse control