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Social Work 1010 > Zastrow Ch. 5-6 > Flashcards

Zastrow Ch. 5-6 Flashcards

1
Q

U.S. Census Definition of Family

A

Group of two or more persons related by blood, marriage, or adoption.

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2
Q

U.S. Census Family definition does not include some who consider themselves to be a family:

A

Husband/Wife with foster children.
Lesbian couple with children from previous relationship.
Man and woman cohabiting without marriage.

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3
Q

Broader definition of Family

A

A kinship system of all relatives living together or recognized as a social unit. Definition can include unmarried, gay/lesbian, foster families, other units that feel like a family.

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4
Q

Extended Family

A

A number of relatives living together; parents, children, grandparents, great-grandparents, aunts, uncles, in-laws, and cousins.

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5
Q

Predominant Family Pattern of Pre-Industrial Societies

A

Extended family - members all share various agricultural, domestic, and other duties.

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6
Q

Nuclear Family

A

Married couple and children living together.,

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7
Q

Predominant Family Pattern in Industrialized Societies

A

Nuclear family - smaller size and geographic ‘mobility’ make it more adaptable to changing conditions (need to relocate for employment.)

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8
Q

Third Family Form in U.S.

A

Single parent families are emerging. Unmarried people adopting children, unmarried women giving birth, married couple divorcing with one parent assuming custody.

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9
Q

Single Parent Family Prevalence in U.S.

A

About 29% of all families in U.S. are single parent families.

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10
Q

Preindustrial Extended Family Facts

A
  1. Nearly self-sufficient. What was consumed was produced on the farm.
  2. Required tasks on small farms meant the extended family was functional; there were the right number of members to carry out tasks.
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11
Q

Monolithic Code Cultural Beliefs - Preindustrial American Society (Cuber, John, and Thompson)

A

One pattern of behavior permitted.

  1. Adults expected to be married. Women in teens or early 20s.
  2. Marriage permanent. Divorce rare highly disapproved of.
  3. Individuals expected to place welfare of family above individual preferences. (Choice of mate to benefit family, not personal preference.)
  4. Sexual relations restricted to marriage. (Double standard for women and men.)
  5. Married couples expected to have children. Children economic assets and religious obligations.
  6. Parents expected to care for children, regardless of costs. Children to obey parents. Children to care for parents in old age or disability.
  7. Father - head of family and made decisions. Women left homes and moved to husband’s home. Male children valued more highly because they remained at home after adulthood.
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12
Q

Industrial Revolution Impact

A

Families began to lose economic/productive function.
Fewer people were needed to fill essential roles.
Smaller families more functional because of mobility to full employment opportunities.

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13
Q

Individualism (Shift after Industrial Revolution)

A

Belief that desires of inidividual should take precedence over those of the family. *** Choice of mate became based on personal preference.

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14
Q

Children after Industrial Revolution

A

Became a liability rather than asset. Had to be fed, clothed, and sheltered, without increasing family income.
Parents began having fewer children as a result.

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15
Q

Change in Function of American Family - 1

1938 Sociologist William Ogburn

A

Economic - productive function lost. Financial resources now acquired outside home.

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16
Q

Change in Function of American Family - 2

1938 Sociologist William Ogburn

A

Protective function lost. Protective function now met by police departments, hospitals, insurance companies, nursing homes.

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17
Q

Change in Function of American Family - 3

1938 Sociologist William Ogburn

A

Educational function sharply reduced. Schools, daycares, Head Start programs replaced much of educational function.

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18
Q

Change in Function of American Family - 4

1938 Sociologist William Ogburn

A

Family less likely to be center for religious activity.

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19
Q

Change in Function of American Family - 5

1938 Sociologist William Ogburn

A

Recreational function reduced. Family members seek recreation outside of home.

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20
Q

Change in Function of American Family - 6

1938 Sociologist William Ogburn

A

Status recognition sharply reduced. Individuals receive recognition for achievements in organizations outside of family.

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21
Q

Change in Function of American Family - 7

1938 Sociologist William Ogburn

A

Family has retained affectional function. Members receive social and emotional gratification from the family.

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22
Q

Post Industrial Revolution - Changes for Women

A

Right to Vote
Questioning sexual double standard of morality
Women in workforce
Increased sexual relations outside of marriage (men and women)

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23
Q
  1. Function of Family - Replacement of Population
A

Societies have defined rights and responsibilities of reproductive partners in family unit.

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24
Q
  1. Function of Family - Care of the Young
A

Family is primary institution for rearing children.

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25
Q
  1. Function of Family - Socialization of New Members
A

To become productive members of society, children must be socialized into the culture. Family plays major role in socialization process.

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26
Q
  1. Function of Family - Regulation of Sexual Behavior
A

Unregulated sexual behavior would result in clashes between individuals and jealousy, as well as large numbers of births outside of marriage - children for whom no father could be held responsible.

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27
Q
  1. Function of Family - Source of Affection
A

Spitz has demonstrated that humans need affection, emotional support, and positive recognition. (Approval, smiles, encouragement, and reinforcement for accomplishments.) Without affection and recognition, emotional, intellectual, physical, and social growth is stunted.

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28
Q

American Society - Romantic Love

A

Higher value that most societies - glories of romantic love portrayed in TV, books, movies, etc.
Reality is that the romantic ideal rarely happens.
*** 1/2 marriage end in divorce. Rate has been gradually increasing.

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29
Q

Difficulties of Divorce

A

Less likely to perform well at job during divorce - more likely to be fired.
Divorced people have shorter life expectancy.
Suicide rates are higher for divorced men than married men.

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30
Q

Rising Divorce Rate

A

Doesn’t necessarily mean more marriages are failing; possibly simply means that more marriages are dissolving rather than continuing unhappily.

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31
Q

Romantic Love vs. Rational Love

A

If love does not grow into rational love, marriage is likelty to fail.

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32
Q

Possible Reason for Divorce Rate - Women’s Status

A

Many men still prefer traditional marriage with husband dominant and wife subordinate.

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33
Q

Working Women Outside Home

A

Over 70% of women with children under 18 work outside home.

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34
Q

Possible Reason for Divorce Rate - Individualism

A

Individualism - belief that people should actualize themselves, be happy, develop interests and capacities to the fullest, and fulfill own needs and desires. Those interests should take precedence over needs of family.

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35
Q

Reason for Divorce Rate - Functions of Marriage/Traditional Family Reduced

A

Collapse of a marriage used to mean severe economic/survival difficulty for both parties.
Now, people lose less by divorce than they did historically.

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36
Q

Divorce Laws

A

In the past, divorce laws made dissolve of marriage almost impossible. One spouse petitioned court for divorce. Had to document that other spouse was guilty of some offense like adultery, desertion, cruel or inhuman treatment.
Modern divorce laws are “no-fault” and allow divorce rapidly by stating marriage has irreparably broken down.

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37
Q

Costs of Divorce Paid by Society

A

Subsidized housing, public sector make-work jobs, and payments to lawyers involved in collecting support for women and children.
When fathers are unwilling/unable to provide adequate support, mothers and children qualify for TANF.

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38
Q

Custody Battles

A

Can last up to two years. Emotionally damaging for all parties.
Richard Neely says that children under 14 should be in custody of primary caretaker parent:
1. prepares food. 2. changes diapers, dresses child. 3. takes child to school, church, etc. 4. makes appts. with Dr., etc. 5. interacts with child’s friends, school, other adults engaged in activities involving child.

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39
Q

Empty Shell Marriage - Devitalized Relationship

A

Husband and wife lack excitement or real interest in each other or marriage. Boredom and apathy. Serious arguments rare.

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40
Q

Empty Shell Marriage - Conflict Habituated Relationship

A

Husband and wife frequently quarrel in private or public. May put up facade of being compatible. Characterized by considerable conflict, tension, bitterness.

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41
Q

Empty Shell Marriage - Passive Congenial Relationship

A

Both partners unhappy but content with lives. Partners may have interests in common but generally insignificant. Spouses contribute little to one another’s real satisfactions. Little overt conflict.

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42
Q

Empty Shell Marriages (Children)

A

Children from these relationships are usually starved for love and reluctant to have friends visit.

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43
Q

Marriage Counselors use a Problem-Solving Approach

A

A) Problems are identified.
B) Alternative solutions are generated.
C) Merits and shortcomings of alternative solutions are evaluated.
D) Clients choose one or more alternatives to implement.
E) Extent to which problems are resolved is later assessed.
***Because spouses “own” their problems, they become the primary problem solvers.

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44
Q

Premarital Counseling Services

A

Designed for couples considering marriage to assess whether marriage is in best interest, and to prepare for realities of marriage.

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45
Q

Parents Without Partners (PWP)

A

Social group and organization that helps divorced people, unwed mothers, and stepparents.

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46
Q

Divorce Mediation

A

Helps divorcing spouses to resolve as amicably as possible, issues like dividing personal property, deciding custody, child support, and alimony arrangements.

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47
Q

Relationship Workshops and Encounter Couple Groups

A

Designed to help those who are dating or married to improve relationships by sharing concerns and improving communication.

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48
Q

Eight Categories of Elder Abuse

A
  1. Physical Abuse
  2. Psychological Abuse
  3. Financial Abuse
  4. Neglect
  5. Sexual Abuse
  6. Self-Neglect
  7. Abandonment
  8. Violating Personal Rights
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49
Q

Violence in Families - Changes in 1960s

A

Prior to 1960s, family was sacred institution and private domain.
In response to growing national concern, all states adopted child abuse and neglect reporting laws. Such laws are case-finding device.

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50
Q

Family Fights / Spouse Abuse

A

Single largest category of calls to police are family fights.
Husbands abused with same frequency of wives.
More than 10% of murder victims are killed by spouses.
Injuries from woman battering are more common than rape, mugging or car accidents.
Several studies found that many believe it’s appropriate for a husband to hit his wife every now and then.

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51
Q

Shelter Homes

A

Give abused women opportunity to flee.
Help with counseling, finding jobs, legal services, and “safety planning.”
Programs also in place for husbands - anger management, group therapy, etc.

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52
Q

Child Abuse and Neglect includes:

A

Physical Abuse.
Malnourishment, lack of proper shelter, poor clothing, poor sleeping arrangements, or supervision.
Denial of medical care.
Failure to attend school regularly.
Exploitation, overwork.
Exposure to unwholesome or demoralizing circumstances.
Sexual abuse.
Less frequent: emotional abuse and neglect/denial of experiences to allow child to feel loved, wanted, secure.

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53
Q

Battered Child Syndrome

A

George C. Curtis - abused children may “become tomorrow’s murderers and perpetrators of other crimes of violence.” Children who are have a high probability of becoming abusive parents.

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54
Q

Child Abuse Risk Factors

A

Parents with limited education and few employment skills.
Non-white, mother headed, single parent families.
Family discord due to limited financial resources.
Mothers are more likely to abuse than fathers.
More than 2/3 of abused children are allowed to stay in home by protective services.

55
Q

Parents who Abuse their children:

A
  1. Parents were abused or lacked love/stable relationships.
  2. More common in lower classes, but more random than neglect.
  3. One child is frequently singled out. (Slow, delinquent, resemblance to disliked spouse, frequent crying, hyperactivity, or more demanding of parents.)
  4. Some cases, child contributes by placing greater than normal burdens on parents.
  5. Some cases, families need scapegoat for disturbed family balance.
  6. Abusive parents - absence of guilt, social isolation, high overall aggression.
  7. Environmental stress factors.
  8. Belief in strict discipline and view misbehavior as deliberate disobedience.
  9. Some cases, alcohol or drug abuse is a contributor.
56
Q

Parents who Neglect their children:

A
  1. Financial deprivation - lower classes.
  2. High percentage - 60% - are one parent families headed by female.
  3. Frequently have atypically large number of children.
  4. Fair number of neglectful mothers below normal intellectually.
  5. Physically and emotionally exhausted, health problems, socially withdrawn, isolated, frustrated, lack hope. These things lead to indifference toward children.
  6. Tend to have been emotionally deprived during childhood.
  7. Have intrapsychic distress but less emotionally disturbed than abusive parents.
57
Q

Parens Patraie

A

Concept that state is ultimately responsible to parent all children. When natural parents neglect, abuse or exploit, state has legal right and responsibility to intervene.

58
Q

Mary Ellen - America - 1875

A

Colonial times, children were personal property. Concerned neighbors were unaware of any community options to protect Mary Ellen - appealed to Prevention of Cruelty to Animals. Brought to court’s attention and placed with another family. Following her case, Society for Prevention of Cruelty to Children formed in New York.

59
Q

Protective Services had two focuses from the start:

A

Law enforcement approach - emphasized punishment for abusive or neglectful parents.
Rehabilitative approach - emphasized importance of helping parents and keeping family together.

60
Q

Title XX to Social Security Act in 1975

Child Abuse Prevention and Treatment Act - 1974

A

Protective services mandatory for each state. Federal reimbursement for most costs.

Provides direct assistance to states to help them develop child abuse and neglect programs.

61
Q

Protective Services Agencies:

A
  • View court action as a means of protecting the child rather than prosecuting the parents.
  • Social workers try to get objective and accurate description of situation - specific, relevant information is important to determine whether child is in danger and for potential future court case.
  • Social workers must be tactful and empathetic to help children as well as parents.
  • One of few social services that are involuntary.
62
Q

Removing children from home:

A

Parental consent first sought. If denied, court petition is filed. Judge must protect rights of parents and child.
If child is placed in emergency foster home, court hearing must be held within 24 hours.

63
Q

Effectiveness of Protective Services:

A

Even modest success may have been more than could have been expected initially. Scarce resources, disturbed families, involuntary clients, resistive to change seems to guarantee likelihood of limited success.

64
Q

Multidisciplinary Teams (MDTs)

A

Formed with variety of agencies to collaborate on child abuse and neglect cases. Each brings roles and obligations to the team, but all have common goal. Typically includes social services, medical, criminal justice, mental health, educators, community members.

65
Q

Child Advocacy Centers (CACs)

A

Serve as “one stop shop” for children and families, child protective services, and other involved agencies. Provide appropriate and friendly environment with expert interviewers and access to video and audio technology. Neutral facility where professionals can conduct joint investigative interviews regarding abuse or neglect.
- Advantages - quality services, cost savings, collaboration, and improved accountability.

66
Q

Parents Anonymous (PA)

A

Established in 1970 in California by mother who could not find resources to help her stop abusing her children. Support group for abusive parents with chapters across country. Effective and beneficial.

67
Q

Family Group Conferencing

A

Originated in New Zealand.

  1. Family is defined to include extended family.
  2. Family is given opportunity to prepare plan to help child.
  3. Professionals involved must agree unless it will put child at risk.
68
Q

Child Molestation

A

Sexual abuse of child by adult.
Central feature is that the act is designed for erotic gratification of older, more powerful person.
- 1 in 3 girls, 1 in 6 boys experience sexual abuse.
-More than 90% of molesters are male.
- Men socialized to see sex as acts rather than relationship.
- Men socialized to be aggressive and believe sex partners should be smaller and younger than themselves.
- Women more frequently caregivers and more attuned to children’s emotional needs.

69
Q

Two Categories of Child Molesters

A

Fixated - molester’s primary sex object choice is children - pedophiles. Generally interested in male children.

Regressed - usual sex partner adults, but regresses to children when under stress. Generally seek female children. Most incest perpetrators are regressed.

70
Q

Incest

A

Sexual relations between blood relatives. Father daughter most commonly REPORTED. Brother/sister actually most common.

Many view sexual behavior as ultimate ego validation. Most child molesters intend no harm; psychologically needy people who use children in battle for emotional survival.

71
Q

Births Outside of Marriage

A

Women between 15 and 24 are 40% of total population, yet account for 70% of births outside of marriage.

More than a million teens become pregnant each year. About 60% give birth.

2/5 of women who give birth to first child not married.

4/5 teen marriages end in divorce.

90% decide to keep child rather than place it for adoption.

70% of african american babies are born to single women.

Teen females are 25% of childbearing population but account for 45% of births.

Teen birth rates have fallen but are still higher than other industrialized nations.

72
Q

Sex Information and Education Council of the United States (SIECUS)

A

Goals of Sex Education:

  1. Information. Accurate information about sexuality, reproduction, anatomy, STDs, etc.
  2. Attitudes, values, and Insights. Provide young people opportunity to question explore and assess sexual attitudes.
  3. Relationships and Interpersonal Skills. Help young people develop interpersonal skills, including communication, decision making, assertiveness, etc.
  4. Responsibility. Help young people exercise responsibility regarding sexual choices.
73
Q

Welfare Reform Act and Teen Mothers

A

States can provide payments to unmarried teen mothers only if:
She is under 18 and living at home or in adult supervised environment.
Attends school once child is 12 weeks old.

74
Q

Single Parent Services

A
  1. Alternatives counseling - abortion, adoption, keeping child, terminating parental rights, foster placement.
  2. Physical and Mental Childbirth Preparation - drug and alcohol effects on embryo, prenatal counseling.
  3. Counseling on Legal Issues - paternity action, termination of parental rights, adoption procedures.
  4. Counseling on Interpersonal Relationships
  5. Alternative Living Arrangements
  6. Alleged-Father Counseling
  7. Family Planning Counseling
  8. Educational and Employment Counseling
  9. Self-Development Counseling
  10. Financial and Money Management Counseling
  11. Child Care
  12. Child Development Counseling
75
Q

Problem Solving Approach

A
  1. Define Problems
  2. Identify Alternatives.
  3. Make pro/con list for each alternative
  4. Evaluate alternatives
  5. Select one or more alternatives
  6. Implement and later evaluate alternatives that are chosen.
76
Q

Foster Care

A

Goal to protect children, rehabilitate parents, and generally return children to parents as soon as feasible.

If parents do not relinquish parental rights, children may be raised in series of foster homes resulting in considerable emotional trauma.

77
Q

Rape

A

More than 90K cases reported annually.
Most common reason for not reporting is feeling somehow that they contributed to rape’s occurrence.

Primarily an aggressive act, secondarily sexual act.

78
Q

Three Categories of Rapists

A

Anger Rapist - uses act to discharge anger. Brutal and uses more force than needed.
Power Rapist - wants to posess victim, not harm her. Acts out of underlying feelings of inadequacy and wants to control victim.
Sadistic Rapist - Eroticizes aggression - aggressive force creates arousal in him. Gratified by victim’s torment and pain.

79
Q

Adoption and Safe Families Act (AFSA) of 1997

A
  • Safety of children is paramount.
  • Foster care is temporary setting.
  • Permanency planning should begin immediately when child enters foster care.
  • Child Welfare System must focus on results and accountability.
  • Innovative approaches are needed to achieve goals of safety, permanency and well being.

Children who are in in foster care for 15 out of 22 months must have termination of parental rights and be moved toward adoption.

80
Q

Rape Trauma

A

Acute - several weeks. Anger, fear, humiliation, anxiety, desire for revenge. Most common - fear and self-blame.
Long Term Reorganization - variety of major disruptions, Avoidance of environments similar to where rape occurred. Difficulty at job and difficulty maintaining employment. Sometimes move and change phone numbers.

81
Q

Albert Ellis - To understand why offenses occur with emotionally disturbed:

A

What was offender thinking at time of offense?

a) Why bizarre actions occurred
b) What may have prevented them from happening
c) What services needed to prevent future occurrences.
* Primary determinant of actions is our thoughts.*

82
Q

Isolation and the Behavioral / Emotional Disturbed

A

Isolation prevents people from being able to reality check thoughts and ideas.

83
Q

Emotional / Behavioral Statistics

A

1 in 5 Americans (18 and older) has some form of emotional or behavioral disturbance in any given year.

More than 6 million people annually receive mental health care in U.S.

84
Q

Mental Illness - Labeling

A

“Amazingly, we act as if the label accurately describes the person, and we then relate to that person as if the label were correct and all-encompassing.”

85
Q

Medical Model (Emotional / Behavioral)

A

Emotional and behavioral problems are mental illness, comparable to physical illness.
Developed in response to historical notion that emotionally disturbed were possessed and often beaten, locked up, or killed.
Model often questioned because professionals frequently disagree on diagnoses.

86
Q

Interactional Model

A

Thomas Szaz - 1950s
Mental Illness a myth. Model focuses on processes of every day social interaction and effects of labeling on people.
People DO have emotional problems, but not mystical mental illnesses.

87
Q

Interactional Model - Types of Emotional/Behavioral Disorders (Thomas Szaz)

A
  1. Personal Disabilities. (anxiety, depression, fears, inadequacy.) Also called ‘Unwanted Emotions.’
  2. Antisocial Acts. (bizarre homicides, etc. homosexuality was in this category until 1974.)
  3. Deterioration of the Brain with Associated Personality Changes. (Alzheimer’s, Chronic Alcoholism, General Paresis, Brain Damage) - under this approach, these are considered diseases of the brain and not the mind
88
Q

Adverse Effects of Medical Labeling

A

People believe they have a ‘disease’ with no cure.
Gives people an excuse for not taking responsibility for actions.
People idle away time waiting for a cure to be discovered rather than making efforts to improve.
People can lose legal rights with such labels, become stigmatized.

89
Q

Cooley’s Looking Glass Self

A

We develop our self concept based on how other people react to us.
For those labeled mentally ill, they begin to “play that role.”

90
Q

Interactional Approach – Mental Illness Myth

Thomas Szaz

A

People labeled mentally ill because they 1) have intense unwanted emotion. 2) engaged in dysfunctional or deviant behavior.
Labeling does not tell how emotions/behaviors originated or how to treat them.

91
Q

Thomas Scheff - Sociological Theory

A
  • Labeling is most important determinant of people’s displaying a chronic mental illness.
  • Despite research, determinants of chronic mental disorders largely unknown.

** Major determinants are not inside a person but in social processes. (Scheff)

92
Q

Difficulty for Mental Health Personnel

A

Better to judge well person as ill than ill person as well.

1) Diagnosis of illness = minimal damage to person’s status and reputation.
2) Unless illness is treated it will become worse.

Both theories above are extremely questionable. Approach should be (Scheff) when in doubt, do NOT label a person as mentally ill.

93
Q

Homeless and Emotional / Behavioral Problems

A

1 to 3 million homeless in America.
Estimated that 20% - 30% have serious/chronic mental illness.
A result of deinstitutionalization 60 years ago.
Goal was to humanely and conveniently treat individuals in communities, but that has not been fulfilled.

94
Q

Civil Rights

A

Most jurisdictions - people cannot be involuntarily confined unless they’ve committed an illegal act or are a threat to themselves or others.
People cannot be involuntarily confined unless they have actually committed an illegal act.

95
Q

Patients and Right to Refuse Treatment

A

One of the greatest fears of people committed against their will is that they will be given drugs / treatments that rob them of consciousness and free will.

Most states now require informed consent.

Some provisions that overrule right in certain circumstances. (Only in cases where patient is unable to make decisions.)

96
Q

Plea of Innocent by Reason of Insanity

A

Argument for eliminating insanity plea is that people are using it to literally get away with murder.

3 States (Montana, Idaho, and Utah) have abolished insanity plea, but people are often found incompetent to stand trial and end up in same hospitals.

97
Q

Psychotropic Drugs

A
  • Tranquilizers, Antipsychotic Drugs, Antidepressants.
  • Discovered in 1954.
  • Credited with decreasing number of patients in state hospitals from 550K (1955) to 100K (today).
  • Do NOT cure, but are useful in relieving anxiety, depression, and tension.
  • Many urge patients to undergo counseling or therapy in addition to drugs to resolve underlying issues.
98
Q

Managed Health Care

A

Generic term used to describe a variety of methods of delivering and financing health care services designed to contain the costs of service delivery while maintaining a defined level of quality of care.

99
Q

HMO (Health Maintenance Organization)

A

Type of managed care system - 2 functions:
1. Establishing policies and procedures to regulate benefits, payments, and providers.
2. Employing gatekeepers to review and authorize services.
Restrictions:
- limiting number of visits.
- increasing use of medication as primary treatment
- restricting number of days for inpatient care
- limiting number of dollars per patient per year or per lifetime
- increasing deductibles and copayments

100
Q

Evidence Based Practice (EBP)

A
  • Basing practice on the best available evidence.
  • Broader concept than just evidence informed interventions. Using clinical expertise and client’s values/preferences to decide which intervention to use.
  • More accurate to describe as “evidence informed practice.”
  • EBP considers all the evidence available and uses it to inform one’s choice of intervention, consistent with professional competence and client preferences.
101
Q

Managed Care and Evidence Based Practice

A

Advocates suggest only interventions w/ demonstrated effectiveness should be supported financially.

Pressure from managed care for professionals to prove treatments and outcomes.

Empirically Supported Treatments (EST) are promoted by managed care.

102
Q

Social Work and Evidence Based Practice

A

Approach tends to focus on symptoms and ignore other issues/concerns. Goes against the person in environment approach.

103
Q

EBP disadvantages

A

Tends to avoid individualizing clients. Attempts to treat problem, rather than building therapeutic relationship.

104
Q

Therapeutic Alliance

A

Identified as the key to successful outcomes for clients.

105
Q

Managed Care and Ethical Dilemmas

A
  • Promoting well being of client can conflict with HMO’s focus on saving money.
  • Increased EBP reduces clients to symptoms rather than respecting individual.
  • Clients rights to privacy violated because of contractual agreements with HMO.
  • Social workers avoid abandoning a client - HMOs limit number of visits.
106
Q

Additional Managed Care Issues

A
  • To what degree does EBP work for or against best interests of client?
  • How is quality of care? Who defines it?
  • Provisions for access to care for high risk?
  • Complex issues surrounding confidentiality.
  • Streamlining care and keeping costs down may lead to treating symptoms and not causes.
  • Leads to a system where workers who see more people are rewarded, those who see less are punished.
  • Coverage limits create heavy burden for those who need expensive treatment.
  • Self Determination – some cases, client may be denied therapy based on unwillingness to take medication.
107
Q

History of Treatment for Emotionally Disturbed

A
  • Prior to 19th century, people were confined to “almshouses” with harsh conditions.
  • 19th century, France, England, and U.S. began taking a more humanitarian approach. Improved surroundings and residents treated with respect and dignity. Not widely adopted - expense.
  • 1908 Clifford Beers “A Mind that Found Itself” and subsequent mental health associations formed under Beers’ leadership.
  • 1900-1920, Freud and Psychoanalysis. Mental illnesses from early traumatic experiences, internal psychological conflicts, etc. Freud’s influence paved way for more humanitarian approach.
  • 1950s, psychoanalysis showed little improvement and began to be rejected.
  • Since 1950s, approaches include behavior modification, rational therapy, reality therapy, transactional analysis, family therapy, feminist intervention, and client-centered therapy.
108
Q

Deinstitutionalization

A

1950s - when deinstitutionalization began.

Mental hospitals do not cure patients, but actually further perpetuate disturbed behavior long term.

Resulted in significant expansion of services to meet needs of disturbed in home communities.

109
Q

Community Mental Health Centers

A

Federal Government - Community Mental Health Centers Act of 1963. Provided for transferring of majority of mentally ill to home communities from state hospitals.

Emphasis on Local Care.
Additional emphases:
- early diagnosis, treatment and return to community.
- centers near and accessible to populations
- comprehensive care 5 components (inpatient, outpatient, partial hospitalization, emergency, and consultation/education.)

110
Q

Social Work and Mental Health

A

Social workers first employed in mental health in 1906 to take histories of patients at Manhattan State Hospital, NYC.

Shift in emphasis from treating individual to treating the family.

111
Q

NASW Registered Clinical Social Worker Requirements

A
  • Masters or Doctoral Degree from accredited school.
  • 2 years or 3000 hours postgraduate supervised clinical experience.
  • Active membership in Academy of Certified Social Workers (ACSW) or state license exam.
112
Q

Counseling definition

A

Broad term covering family, individual, and group therapy.

Skilled counselor has knowledge of interviewing principles and comprehensive and specific treatment approaches.

Skill is transferrable - training in counseling and not in specialized counseling areas.

113
Q

Social Work Most Important Skill

A

Capacity to counsel effectively.

114
Q

Three Phases to Counseling

A
  1. Building Relationship
  2. Exploring Problems in Depth
  3. Exploring Alternative Solutions

Phases/stages overlap.

115
Q

Counseling - Building a Relationship

A
  1. Establish nonthreatening atmosphere.
  2. “Sell” yourself as a knowledgeable, understanding person who may be able to help and wants to try.
  3. Be calm. Don’t laugh or express even subtle shock.
  4. Be generally nonjudgmental and nonmoralistic. Respect counselee’s values. Let counselee choose course of action.
  5. View counselee as an equal.
  6. Use “shared vocabulary.”
  7. Tone of voice should convey message of empathy, understanding and care about client’s feelings.
  8. Keep confidentiality.
  9. When counseling relative or friend, emotional involvement may cause arguments. Drop subject immediately and tactfully.
116
Q

Counseling - Exploring a Problem in Depth

A
  1. Take time to explore client’s views on topics (unwed teen mother - abortion, adoption, etc.)
  2. Examine extent of problem, duration, causes, counselee’s feelings about problem, and capacities and strengths counselee has to cope.
  3. When problem is identified, subproblems may surface. Explore all subproblems.
  4. Multiproblem situation - ask counselee which one is most pressing to them. Success in solving subproblem will increase counselee’s confidence in counselor and relationship.
  5. Convey empathy, not sympathy.
  6. “Trust your Gut” Continually strive to place yourself in client’s situation, with client’s values and pressures.
  7. When client touches on important area of concern, encourage further communication by:
    • nonverbally showing interest.
    • pausing. gives client time to think and motivates to continue conversation.
    • Using neutral probes. “Could you tell me more about it?” “Why do you feel that way?”
    • Summarize what client is saying. “You made comments about this. It sounds like you are unhappy about this.”
    • Reflecting feelings. “You seem to be depressed about that.”
  8. Approach issues tactfully. Tact is essential quality in counseling. (Example: “I am wondering if personal appearance may be reason for job dismissals.”
    * It is important to confront clients about ineffective actions that negatively affect them.
  9. When pointing out limitation of client, mention and compliment assets.
  10. Watch for nonverbal cues to identify sensitive subjects. Fidgeting, changed tone of voice, etc.
  11. Be honest. Counselor should always point out shortcomings in counselee’s best interest.
  12. Listen ATTENTIVELY. Try to hear their words, not from your own perspective, but from theirs.
117
Q

Counseling - Exploring Alternative Solutions

A
  1. Begin by asking “Have you thought about how to resolve this?” Merits, shortcomings, and consequences of alternative (of either client’s or counselor’s suggestion) should be examined.
  2. Counselee has right to self determination. Counselor chooses alternative - negative outcome, client blames counselor. Positive outcome, client becomes dependent on counselor for decision making.
    Say, “Have you thought about…?” instead of “I think you should…”
  3. Counseling is done WITH counselee, not TO or FOR the counselee.
  4. Right to self determination should be removed only if selected course of action will likely hurt counselee or others.
  5. Attempt to form explicit, realistic “contracts” with counselees. Define tasks, responsible parties, and deadlines.
  6. If contract isn’t met, do not punish but don’t accept excuses. Ask, “Do you still wish to try to fulfill your commitment?” If yes, set another deadline.
  7. Biggest single factor of counselee’s success is motivation to carry out essential tasks.
  8. Increase motivation by clarifying what will be gained from meeting commitments.
  9. If counselee lacks confidence or experience, role-play tasks.
118
Q

Contemporary and Comprehensive Counseling Approaches

A 
Psychoanalysis
Rational Therapy
Client Centered Therapy
Adlerian Psychotherapy
Behavior Modification
Gestalt Therapy
Reality Therapy
Transactional Analysis
Neurolinguistic Programming
Encounter Approaches
119
Q

Counseling Approaches - Theoretical Material

A
  1. Personality Theory, or how normal psychosocial development occurs.
  2. Behavior Pathology, or how emotional/behavior problems arise.
  3. Therapy, or how to change unwanted emotions and dysfunctional behaviors.
120
Q

Rational Therapy - Albert Ellis and Maxie Maultsby

A 
Erroneously believed by many that emotions are and actions are determined by our experiences. 
ALL feelings and actions occur by: 
1. Event
2. Self-Talk
3. Emotions
4. Actions
121
Q

Importance of Self-Talk (Rational Therapy)

A

Self-talk determines how we feel and act. Changing self talk means we can change how we feel and act. We have power to think rationally and change ALL of our unwanted emotions and ineffective actions.

Repeated occurrences of an event means self talk and emotional reactions become nearly automatic.

122
Q

Changing Unwanted Emotions

A
  1. Meaningful Activity - dwelling on irritations = unwanted emotions. Meaningful enjoyable activity makes a healthy distraction. Make “Escape List” of activities. (Note: if something can be done to change event, it should be!)
  2. Changing Self-Talk - Rational Self Analysis (RSA) - 1977. RSA has 6 parts
    a. State facts or events.
    b. Self-talk. Write all thoughts about (a).
    c. Emotional consequences. Write simple statements of gut reactions stemming from self-talk in (b).
    d (a). “Camera Check” of (a). “If I had a video camera to prove facts, would (a) state facts or include slants/opinions?” Written ONLY after A through C are complete.
    d (b). Read each (b) emotion and determine if it is rational or irrational thinking. For irrational self talk statements, write an alternative, rational statement.
    e. Write new emotions for future (a) situations. New emotions will follow new self-talk statements.
123
Q

Irrational Self Talk Statements:

A
  1. Not based in objective reality.
  2. Hampers you in protecting your life.
  3. Hampers you in achieving short and long term goals.
  4. Causes significant trouble between you and others.
  5. Leads you to feel emotions you do not want to feel.
124
Q

Rational Self Analysis

A

Maultsby.

Rational self-challenges will work only if clients actively PRACTICE using rational self challenges they develop.

125
Q

Changing Distressing Events

A

Some cases, constructive action can be taken to change distressing event. Ex. Man loses job - finds new job and thus changes distressing event.

126
Q

Counseling vs. Therapy/Psychotherapy (Defined)

A

Counseling: Professional guidance of individuals, families, or groups to assist in coping with life challenges using problem solving, identifying alternatives, articulating goals, and providing needed information.

Therapy: Therapeutic treatment, especially of bodily, emotional, or behavioral disorders.

Psychotherapy: Treatment of emotional or behavioral disorders or of related bodily ills by professional therapists - clinical social workers, psychologists, psychiatrists. *Licensed.

127
Q

Counseling vs. Psychotherapy

A

Focus of counseling is likely specific problems or changes in life adjustment. Psychotherapy focus on restructuring of personality or self.

Psychotherapists likely to work with more disturbed clients over longer period of time.

Counseling is educational modality. Psychotherapy is emotional, understanding, restorative modality.

Counseling = Problem solving. Helps individuals use full coping potential.

Psychotherapy = Deeper psychological/mental health issues. Some type of personality change.

LCSW can diagnose clients using Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)

128
Q

Counseling’s 2 Main Issues

A
  1. Changing unwanted emotions of clients.

2. Changing dysfunctional behaviors of clients.

129
Q

Source of Unwanted Emotions

A

Negative and irrational thinking.

130
Q

Source of Dysfunctional Behaviors

A

Negative and irrational thinking.

131
Q

When is Counseling / Therapy therapeutic?

A

ONLY when it inspires client to change his or her negative and irrational thinking in a positive and rational direction.

132
Q

Date Rape:

A

22% of female college students have been victimized by forced intercourse on a date.

Date rape seems to result from belief by man that if he spends money on her, she “owes” him sexual rewards.

When victim views herself as in love with perpetrator, tendency to see rape as within acceptable behavior.

133
Q

Rape - Media Portrayals

A

After beating up rival, spanking woman in front of townspeople and dragging her home, the man gains compliance and cooperation.

“Real Men” obtain power, status, sexual gratification by violating women.

Social Work 1010 (3 decks)

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