SOCW 310 Exam 2 (Ch 8-9 and 12)

Question 1

(I WRITTEN ASSESSMENTS)
Social workers approach assessment with…

Answer 1

A culturally humble approach
rooted in anti-oppressive practice

Familiarity with effects of
oppression, racism, and trauma

An understanding of one’s own
positionally

A proactive effort to understand
their clients’ cultural experiences
and implications
1. Remember your purpose and audience. These can help you decide what should be included and maintain that focus.
2. Be precise and accurate. It is impor-tant that any data you include be accurate.
Document your sources of information and specify the basis for any conclusions and the crite-ria on which a decision was based
Present essential information in a coherent
manner.
3. Avoid the use of labels, subjective terminology, and jargon.

Question 2

(I WRITTEN ASSESSMENTS)
What is assessment?

Answer 2

PRODUCT:
A written product that results from the process of understanding the client; provides a synthesis of the case.

“A complex working hypothesis”

Comprehensive (biopsychosocial-spiritual) orBrief (mental status, suicide risk).

Depends on the role of the social worker, the setting where they work, and the needs of the client.

PROCESS:
The social worker is constantly gathering information, analyzing it, and synthesizing it to understand client needs and strengths.

Assessment happens from beginning to the end of the relationship.

Question 3

(II CULTURAL COMPETENCY IN ASSESSMENT)
How social workers consider diverse backgrounds during assessment=

Answer 3

GOODNESS OF FIT: the degree of which the clients experiences fit into the culture in which they are situated
-ecological systems perspective
-cultural humility
-cultural genogram
-The social work value of competence demands that social workers have the knowledge, skills, and val-ues to practice effectively with a wide array of potential clients. This includes being familiar with the history and the effects of oppression, racism, and trauma. You should also examine your own positionality and understand how your race, gender, education, and role as a social worker give you opportunities and power that your client may lack.

Question 4

(II CULTURAL COMPETENCY IN ASSESSMENT)
Considering assessment through a cultural lens:

Answer 4

If you don’t ask, you don’t know!

If a community-based culture, consider including wider circle of people in assessment process

Consider implications of historical trauma, systems of oppression, and racism in how your client is presenting for care

Question 5

(III ASSESSMENT METHODS AND SOURCES)
Primary sources of information:

Answer 5

-info provided by client
●C7 Background sheets or other intake forms the clients complete
●Interviews with clients (e.g., explanation, his-tory, and views about the problem, significant contributing events)
-interviews help in establishing a trust-ing relationship and acquiring the information needed for assessment. It is important to respect clients’ feelings and reports, to use empathy to convey understanding, to probe for depth, and to check with the client to ensure that your understanding is accurate.
●Client self-monitoring (e.g., keeping a journal of anxious thoughts)

-collateral info
(e.g., relatives, friends, physi-cians, teachers, employers, and other professionals)
-Social workers must exercise discretion when decid-ing that such information is needed and in obtaining it. Clients can assist in this effort by suggesting which col-lateral contacts might provide useful information. Their written consent (through agency release of information forms) is required prior to contacting these sources.

-test or assessment instruments
-To avoid the danger of misusing these tools, social workers should thoroughly understand any instru-ments they are using or recommending and seek con-sultation in the interpretation of test administered by other professionals. It is vital to ensure the chosen tool is suitable for the demographics of your specific client
-in some cases social workers can administer assessment tools. For example, the Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001) and the Beck Depression Inventory (BDI-II; Beck et al., 1996) have well-established validity and reliability, can be effectively administered and scored by clinicians from a variety of professions, and can assist practitioners in evaluating the seriousness of a client’s condition.

-the sw experiences with the client
●Direct observation of clients’ nonverbal behavior
-adds information about emotional states and reactions such as anger, hurt, embarrassment, and fear. The social worker must be attentive to nonverbal cues such as tone of voice, tears, clenched fists, vocal tremors, quivering hands, a tightened jaw, pursed lips, variations of expression, and gestures and link these behaviors to the topic or the theme during which they arise. The social worker may share these observations in the moment
-Direct observation of interactions between part-ners, family members, and group members
-reciprocal interactions=the interactions between a person and their external world; the person acts upon and responds to the world, and those actions affect the external world’s reactions (and vice versa).
●Personal experiences of the social worker based on direct client interactions

Question 6

(I) Initial assessment prioritize:

Answer 6

• What does the client see as their
  primary concerns or goals?
• What (if any) current or impending
  legal mandates must the client
  and social worker consider?
• What (if any) potentially serious
  health or safety concerns might
  require the social worker’s
  attention?

Question 7

(V BEHAVIORAL ASSESSMENT)
Sites of problematic behaviors:

Answer 7

-Determining where the presenting problem occurs can assist you in identifying patterns that warrant further exploration and in pinpointing factors associated with the behavior in question.

Question 8

(V) Temporal contexts of presenting problem/antecedents and consequences:

Answer 8

-Events that precede problematic behavior are referred to as antecedents. Antecedents often give valuable clues about the behavior of one participant that may provoke or offend another participant, thereby trig-gering a negative reaction, followed by a counter negative reaction, thus setting the reciprocal interaction in motion. In addition to finding out about the circumstances preced-ing troubling episodes, it is important to learn about the consequences or outcomes associated with problematic behaviors. These results may shed light on factors that perpetuate or reinforce the client’s difficulties.

Question 9

Assessing strengths

Answer 9

1. How have you been coping with your presenting problem?
2. What resources or supports have you been using?
3. What qualities do you have that have enabled you to keep going in the face of such difficulty and stress?

ROPES:
-resources focuses on your client’s personal resources and strengths as well as those embedded in their family, social environment, and community.
-options emphasizes the choices your client has and focuses on the present by looking at acces-sible resources and available resources that have not yet been leveraged.
-possibilities helps your client creatively imagine their future and think about possible options they have not yet tried. -exceptions asks the client about moments when the problem does not happen or is different and how the client has survived and endured their dif-ficult circumstances.
-solutions helps the client think of creating solutions by asking them about what is currently working, what their successes have been, and what they are doing that they will continue to do

Question 10

(IV DAILY LIVING AND LIFE TRANSITIONS)
Developmental transitions

Answer 10

●Work, school, career choices
● Health impairment
● Parenthood
● Geographic moves and migrations
● Retirement
● Separation or divorce
● Single parenthood
● Death of a spouse or partner
● Military deployments
● Marriage or partnership commitment

Question 11

(VI SUPPORT SYSTEMS IN CLIENT ASSESSMENT)
Informal support systems

Answer 11

An essential part of understanding indi-viduals involves understanding the sys-tems with which they interact. This can include
-formal systems such as schools, medical clinics, mentors, or home health aides, and natural or
-informal systems such as neighbors, family, or friends.
These sys-tems are also important parts of problem and strengths assessments. Formal support systems may be part of the problem (the school that cannot provide adequate edu-cational resources to help a child with disabilities or the child welfare service plan that is too demanding for the client to manage along with part-time work and adequate child care). Natural support systems may also be part of the problem configuration (the family member whose criticism fuels a client’s despair or the peer network that encourages theft and drug use). On the flip side, formal and informal networks can be part of coping and client strengths

Question 12

(IV) ADL’s

Answer 12

-Comprehensive, competent assessments for geriatric clients also involve items that go beyond the typical multidimensional assessment. For example, functional assessments would address the client’s ability to perform various tasks, typically activities of daily living (ADLs)—those things required for independent living such as dressing, hygiene, feeding, and mobility.

Question 13

(IX RISK ASSESSMENT)
Maltreatment risk factors

Answer 13

-Physical injuries: Burns, bruises, cuts, or broken bones for which there is no satisfactory or credible explanation; injuries to the head and face
● Lack of physical care: Malnourishment, hygiene, unmet medical or dental needs
-Unusual behaviors: Sudden behavioral changes, withdrawal, aggression, sexualized behavior, self-harm, fearful behavior at the mention of or in the presence of caregiver
●Financial irregularities: For the older client, missing money or valuables, unpaid bills, coerced spending

Question 14

(V) Behavioral theory

Answer 14

-behavioral theo-ries focus on identifying and altering the antecedents and consequences that cause and maintain problematic behavior. As such, an assessment rooted in behav-ioral theory would focus on the conditions surrounding troubling behaviors, the conditions that reinforce the behavior, and the consequences and secondary gains that might result

Question 15

(II) Implicit bias

Answer 15

Introspection-Acknowledge existence and learn about your own biases
Mindfulness-Practice mindfulness to decrease use of implicit biases during stressful moments
Perspective-Taking Engage in activities to understand the perspective of different groups of people
Learn-to Slow Down Stop, think, and reflect before, during, and after interactions with stereotyped groups
Individuation-Use individual characteristics vs group stereotypes
Check-Your Messaging Welcome and embrace diversity; don’t be “colorblind”
Institutionalize-Fairness Work to counter biases in your organizations
Take-Two This is a lifelong work

Question 16

(VII COMPREHENSIVE CLIENT ASSESSMENT AREAS)
Biophysical functioning

Answer 16

Biophysical functioning encompasses physical character-istics, health factors, and genetic factors, as well as the use and abuse of drugs and alcohol.

Physical Characteristics and Presenting Factors:
* Physical appearance: build, dental health, posture, facial
features, gait, any physical anomalies
* Dress and grooming
* Tremors, tics, rigidity

Physical Health:
* Determine if client is under medical care and being treated for medical problems
* Examine family history of pertinent health diagnoses

Alc/Drug Use Signs:
* Risky behavior
* Preoccupation with drinking
* Affect work/school
* Decrease in normal capabilities
* Poor physical appearance
* Use of sunglasses
* Wearing long sleeves
* Associating with known users
* Involvement in illegal/dangerous
activities

Mental Health Status Exam:
Reality testing provides insight on a person’s mental health. Strong functioning on this dimension means meeting the following criteria: 1. Being properly oriented to time, place, person, and situation
2. Reaching appropriate conclusions about cause-and-effect relationships
3. Perceiving external events and discerning the intentions of others with reasonable accuracy
4. Differentiating one’s own thoughts and feelings from those of others

• Identifying information
• History of Presenting Problem
• Developmental History
• Current Work and/or School
• Medical History
• Mental Health & Substance Use History
• Legal Considerations
• A Mental Status Exam
• A Case Formulation

Question 17

(VII) Developmental assessment components

Answer 17

Developmental Assessment: timeline of development from infancy through current including: pregnancy, L/D, infancy, developmental milestones, family dynamics, interests, life transitions, problems, history of the problem, school history, etc.

Question 18

(IX) Social support system

Answer 18

missing, affirming, harmful
-Social systems across the various ecological levels of your client’s life constitute the second item on the list of needed resources. Social support systems fill a vari-ety of needs to improve quality of life.

Question 19

(I) Components of comprehensive assessment

Answer 19

A comprehensive assessment of the individual considers a variety of elements, including biophysical, cognitive/perceptual, affective (emotional), and behavioral factors and examines the ways that these interact and affect inter-actions with people and institutions in the individual’s environment

Question 20

(VIII MENTAL HEALTH AND COGNITIVE ASSESSMENT)
Judgment

Answer 20

Judgment is the ability to accurately identify the conse-quences of a given action

Question 21

(VIII) Cognitive disonance

Answer 21

may result when people discover inconsistencies among their beliefs and behav-iors.

Question 22

(VIII) Major nuerocognitive disorder

Answer 22

Major neurocognitive disorder (NCD) is characterized by “evidence of significant cognitive decline from previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition”

Treatment of individuals with these diagnoses is special-ized and varied but may include use of medication as well as vocational, residential, and case management services. Understanding the features of these and other cognitive or thought disorders can assist you in better understanding clients, in planning appropriate treatment, and in considering how your role on cases meshes with that of other service providers

Question 23

(VIII) Affect assessment

Answer 23

People often seek help because they are experiencing strong emotions, or they feel that their emotions are out of control. Some individuals, for example, are emotion-ally volatile and engage in aggressive behavior while in the heat of anger. Others are emotionally unstable, strug-gling to stay afloat in a turbulent sea of feelings. Some people become emotionally distraught as the result of stress associated with the death of a loved one, divorce, severe disappointment, or another blow to self-esteem.

Question 24

(VIII) emotional functioning

Answer 24

-What are the client’s emotional reactions to the problem(s)? It is impor-tant to explore and assess these reactions for three major reasons. First, people often gain relief simply by express-ing troubling emotions. Common reactions to problem situations are worry, agitation, resentment, hurt, fear, and feeling overwhelmed, helpless, or hopeless. Being able to express painful emotions in the presence of an understand-ing and concerned person is a source of great comfort.
-People vary widely in the degree of con-trol they exercise over their emotions, ranging from emotional constriction to emotional excesses. Individuals who are experiencing emotional constriction may appear unexpressive and withholding in relationships.
-A person with emotional excesses, on the other hand, may have “a short fuse,” losing control and reacting intensely to even mild provocations.

Appropriateness of Affect:
Healthy functioning involves spontane-ously experiencing and expressing emotion congruent with the context and the material being discussed. However, labeling affect as appropriate is subjective and may be impacted by your own background and your clients’ circumstances. Practicing with humil-ity and an anti-oppressive lens means accounting for historic and structural factors in assessing the way that people express themselves. Suspicion, discomfort, or irritation may be entirely appropriate affect for a first session with a stranger (social worker) whose inten-tions are unknown, but power is clear.

Question 25

(VIII) Signs of mania

Answer 25

The dominant feature of bipolar disorder is the presence of manic episodes (mania) with intervening periods of depression. Among the symptoms of mania are “a distinct period of abnor-mally and persistently elevated, expansive or irritable mood” (American Psychiatric Association, 2013a, p. 124) and at least three of the following:

●inflated self-esteem or grandiosity
● Decreased need for sleep
● More talkative than usual or pressure to keep talking
● Flight of ideas or subjective experience that thoughts are racing-flight of ideas, in which the client’s response seems to “take off” based on a par-ticular word or thought, unrelated to logical progression or the original point of the communication. These dif-ficulties in coherence may be indicative of head injury, mania, or thought disorders such as schizophrenia.
●Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
●Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purpose-less non-goal-directed activity)
Excessive involvement in pleasurable activities with a high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions, or unwise business investments

-Full-blown manic episodes require that symptoms be suffi-ciently severe to cause marked impairment in job performance or relationships or to necessitate hospitalization to protect patients or others from harm.

Question 26

(IX) Predictive factors of aggression

Answer 26

The most consistently predictive of these factors is past violent behavior or criminal behavior. Additional risk factors include early age of first criminal offense, substance abuse, gender (violence by men generally exceeds that by women), and psychopathy. several dynamic risk fac-tors such as impulsiveness, anger, psychosis, inter-personal problems, and antisocial attitudes that may impact violence, but no predictive conclusions can yet be drawn (Andrade, 2009). For youth violence, there are a variety of risk factors, including prior history of violence, early initiation of violence, school achieve-ment problems, abuse, maltreatment and neglect, substance use problems, impulsivity, negative peer relationships, and community crime and violence

Question 27

(IX) Motivation levels

Answer 27

People who do not believe that they can influence their environments may demonstrate a kind of learned helplessness, a passive resignation that their lives are out of their hands. Others may be at dif-ferent phases in their readiness to change. Involuntary clients my express less motivation to change given that they are being forced into treatment. For example, if a someone does not see their drinking as problematic but has been coerced into attending treatment by their family, motivation to change may be low. Asking clients about their goals and what changes they would like to make is a good way to start assessing motivation.

Question 28

(X SPIRITUALITY AND RELIGION)
the difference

Answer 28

-Spirituality reflects the “human search for tran-scendence, meaning and connectedness beyond the self”
-religion refers to a “more formal embodi-ment of spirituality into relatively specific belief systems, organizations and structures”

Question 29

(X) role in assessment

Answer 29

A spiritual assessment-may help the social worker better understand the client’s belief system and resources. While spirituality is almost always a part of religion, individuals may consider themselves to be spiritual without prescribing to religious doctrines or belonging to a specific reli-gious group.

Question 30

(XI GOAL DEVELOPMENT PROCESS)
Client driven goal setting

Answer 30

Client-driven goals are more likely to reflect client strengths, be sensitive to their experience of trauma, and more likely to empower cli-ents rather than marginalize or oppress them.
-goals are the most effective if client centered
-Motivational Congruence: satisfies mandates of requirements, but also meets long term goals prioritized by clients.
1. What is the mandate? Ask clients to explain in their own words
and share their views.
2. What is the rationale?
3. What options are available to fulfill the mandate?
-Your goal is to find common ground: may involve bridging a gap or
negotiating.

Question 31

SMART goals

Answer 31

S-specific
M-measurable
A-achievable
R-realistic
T-time oriented

EX: OG goal
 Client will improve their
mental health

SMART goal
 Over the next six months,
client will attend weekly
counseling with aim to reduce
experience of depression as
measured by PHQ9

Question 32

Long-term goals

Answer 32

Frame people’s ambitions within their identities and values

In Social Work Practice, can take up to a year to accomplish

In general when you think of long term goals for yourself, 3-5 years or even longer can be the time frame.

Can fail to motivate people in the short-term because they seem
overwhelming.

Question 33

Short-term goals

Answer 33

Are often “partialized” version of a long-term goal.

Possess 1+ parts of the SMART goals
framework

Help to make progress towards the long term goal.

Question 34

(XI) Approach vs avoidance goals

Answer 34

 Approach goals identify a positive end state, emphasizing growth and change
“To gain the freedom to make my own decisions about my schedule and how I care for my baby”

 Avoidance goals identify a future state to be avoided or minimized
“To get staff to stop telling me what to do.”

Question 35

(XI) Performance vs learning goals

Answer 35

 Performance goals define a final outcome
“Bettina will have saved enough money to move into her own apartment by her 19th birthday”

 Learning goals emphasize a process and the acquisition of knowledge and skills that people can use to achieve short and long term goals.
“Bettina will know about the benefits and disadvantages of bank savings, bank loans, and credit cards.”

Question 36

(XI) Empowerment vs compliance/conformity vs risk-resilience

Answer 36

 Empowerment oriented goals are framed toward self-determination and
agency.
“Parent will identify role models for expressing masculinity without violence.”

 Compliance and conformity goals are responsive to the requirements of
larger social systems and authority figures.
“Parent will maintain a clean, safe home environment for their children.”

 Risk-Resilience goals identifies changes in risk and protectives processes
that are likely to alleviate presenting problems.
“Youth will avoid after school contact with peers who are actively using drugs.”

Question 37

(XI) Working with minors

Answer 37

-You should still be actively including
minors in decision making process
about their goals!

-give choices

-take input seriously

Question 38

(XII GOAL IMPLEMENTATION)
Baseline measures

Answer 38

Measurements taken before implementing change-oriented interventions are termed baseline measures because they provide a baseline against which measures of progress can be compared.

Question 39

(I) Components of comprehensive assessment

Answer 39

Therefore, a comprehensive assess-ment should use the ecological perspective introduced in Chapter 2 to address individual functioning while also considering the larger social context (e.g., family, work/ school, social conditions, racism, oppression, cultural factors) that impact the client.

A comprehensive assessment of the individual considers a variety of elements, including biophysical, cognitive/perceptual, affective (emotional), and behavioral factors and examines the ways that these interact and affect inter-actions with people and institutions in the individual’s environment

Question 40

(I) Purpose of assessment

Answer 40

A written assessment summarizes the client’s presenting problem(s); current functioning including mood, affect, and cognition; treat-ment goals; social, medical, and mental health history; sources of strength and adversity; possible resources; and factors contributing to the problem. Because assessments must constantly be updated and revised, it is helpful to think of an assessment as a complex working hypothesis based on the most current data available.

Typically, an initial social work assessment, con-ducted with new clients over the first one or two ses-sions, takes the form of a biopsychosocial assessment and is global in nature. The purpose of initial assessments is to paint a comprehensive picture of the client and their presenting problem and strengths.

Question 41

(XIII PROFESSIONAL SKILLS)
Strengths based perspective

Answer 41

As noted in Chapter 2, the strengths perspective counters the focus on pathol-ogy and highlights the importance of attending to clients’ strengths, including available supports, coping mechanisms, and problem-solving abilities. Social work-ers should infuse their assessments with the strengths-based perspective and ask questions such as:
1. How have you been coping with your presenting problem?
2. What resources or supports have you been using?
3. What qualities do you have that have enabled you to keep going in the face of such difficulty and stress?

Question 42

(VII) Developmental assessment components

Answer 42

A developmental assessment may be particularly relevant for understanding the child’s history and current situation. With this type of assessment, a parent or other caregiver provides information about the circumstances of the child’s delivery, birth, and infancy; achievement of developmental milestones (e.g., language, motor development); family description and atmosphere (e.g., ages of family members, who lives in the home, finan-cial situation, family relationship dynamics); interests (e.g., hobbies, friends); significant life transitions (e.g., separations from caregivers, loss of loved ones to death); presenting problem including history of the problem; and school history (Jordan & Hickerson, 2003; Konrad, 2019; Levy & Frank, 2011). This information helps form impressions about the child’s experiences and life events, especially as they may relate to their current functioning.

Question 43

(VIII) cognitive theory

Answer 43

Cognitive theory holds that thought patterns fuel psycho-logical problems

Question 44

(XII) Involuntary clients

Answer 44

In general, intervention goals for involuntary clients should be consistent with the mandates that brought them into the service system in the first place. However, this can be a significant challenge for involuntary clients who disagree with the referring authority or who resent the loss of freedom and control represented by the imposition of treatment man-dates.

Question 45

(XI) goal specificity

Answer 45

Goal specificity is usually conceptualized in one or more of four dimensions: behavioral description, time, person, place. Often, goal specificity can be enhanced by simply asking clients to provide elaborated behav-ioral descriptions of metaphors and ambiguous words or phrases,

Question 46

(XIII) priority goal setting

Answer 46

The purpose of identifying high-priority goals is to ensure that beginning change efforts are directed toward the goals of utmost importance to clients. Depending on the nature of the goals, the client’s devel-opmental stage, the resources available to the client, and the time required, settling on no more than three goals is advisable for most clients. In cases with multiple mandated goals, you can help the client to prioritize so that they are more manageable, emphasizing those that have a greater consequence.