ASWB: Notes on Assessment and Intervention Planning

Focus of social work assessment
The different approaches to social work have different aims for assessment. Different focuses that social work assessment can have are as follows:
Intrapsychic dynamics, strengths, and problems
Interpersonal dynamics, strengths, and problems
Environmental strengths and problems
The interaction and intersection of intrapsychic, interpersonal, and environmental factors.

Psychosocial approach
Assessment in the Psychosocial approach to Social Work practice:

- Outlines client's presenting problem and client's resources for addressing it.

- Determines if there is an appropriate match between presenting problem and available services.

- Begins in first interview and continues throughout treatment.

Components include:
Dynamic: Determining how different characteristics of client and client's important relationships interact to influence his/her total functioning.
Etiological: Determining the causative factors that produced the presenting problem and that influence the client's previous attempts to deal with it.
Clinical: articulation of the client's functioning (i.e., mental status, coping strategies/style, if pertinent a clinical diagnosis).

Problem-Solving approach
Assessment in the Problem-Solving approach to Social Work practice is as follows:- Focus first on identifying the problem and the aspects of the person/environment that can be involved in problem solving.- Assess motivation, capacity, and opportunity (MCO) of the client to resolve the problem.- Include a statement of the problem (objective facts and subjective responses to them), precipitating factors, and prior efforts to resolve it.- A combined activity of worker and client.
Crisis Intervention
The assessment process in the Crisis Intervention approach is concerned with the following:
Exploring the stress producing event/situation, the individual's response to it, and responses to past crises.
Characteristic signs, phases, patterns of adaptation and maladaptation to crisis (i.e. PTSD)
Because of need for quick action, highly focused assessment that emphasizes current state of functioning, internal and environmental supports and deficits.

Cognitive Therapy practice approach
The following issues should be listed during the assessment process in the Cognitive Therapy practice approach:
List the client's cognitive distortions (e.g., catastrophizing, minimizing, negative predictions, mind-reading, overgeneralization, personalization).
List the client's negative automatic thoughts and dysfunctional beliefs.

Task-Centered practice approach
The following are part of the process of assessment in the Task-Centered practice approach:
Examination and clarification of problems are primary. The problem must be one that concerns the client and is amenable to treatment.
The worker and client create a rationale for resolution of the problem and note potential treatment benefits.

Systems Theory practice approach
During the assessment in the Systems Theory practice approach:
Problems do not belong to the individual, but instead belong to the interaction of the behaviors or social conditions that create disequilibrium.

Family Systems theory approach
The assessment and treatment planning in the Family Systems theory approach to practice is explained as follows:

Assessment:
Acknowledgement of dysfunction in the family system.
Family hierarchy: Who is in charge? Who has responsibility? Who has authority? Who has power?
Evaluation of boundaries (around subsystems, between family and larger environment)—are they permeable or impermeable? Flexible or rigid?
How does the symptom function in the family system?

Treatment planning:
Worker creates a mutually satisfactory contract with the family to establish service boundaries.
Bowenian family therapy's goal is differentiation of the individual from the strong influence of the family.

Narrative therapy practice approach
The assessment and treatment planning in the Narrative therapy practice approach is explained as follows:
Assessment
Mapping how the problem influences the client's life and relationships—how does the problem affect the client(s)?
Mapping the influence of the person/family in the life of the problem—Clients start to see themselves as authors or co-authors of their own stories.

Treatment planning
Together worker and client establish clear goals for their work.
Worker and client divide out and work on small, specific, limited goals.
The approach avoids a medical (disease) model that seeks explanations for problems or ascribes pathology to the family system.

This therapy builds on strengths and abilities of families and individuals rather than seeking weaknesses and deficits.
Assessment and treatment planning when treating children
Assessment seeks to understand the child's inner feelings and conflicts, the parent-child interaction, the family dynamics and interactions, and practical difficulties and environmental problems. Assessment will be sensitive to multi-problem families and will be culturally competent.

Treatment planning:
Build on strengths, focus on areas where functioning is problematic (individual difficulties, family dysfunction, environmentally-generated crises).
Support adaptive behavior
Set realistic goals and emphasize the issues that directly affect the care of the child.
Clarify the projected length of time of treatment; ongoing reevaluation.
Build relationship through management of concrete problems.

Assessment and treatment planning in Geriatric Social Work
Assessment is concerned with:
Presenting problem and client's resources for resolving it
When adult children involved, intergenerational dynamics/resources, relevance and impact of family history on present functioning
Presence and effect of chronic illness and physical/cognitive limitations

Home safety
Medications, their influence on functioning, and negative side effects
Need for supportive services or institutional care
ADLs (activities of daily living—e.g., bathing, dressing, etc.) and IADLs (instrumental activities of daily living—e.g., cooking, driving)

Treatment planning is concerned with:
Interventions, solutions that offer choice and support the older adult's highest level of functioning
Promoting independence by planning home modifications through home-safety assessment and planning for assistive devices through assessing physical/cognitive limitations

Trauma-Based social work practice
The assessment for Trauma-Based social work practice is as follows:
Assessment for PTSD: evaluate the nature of the trauma; the strengths and limitations that pre-date the trauma; the impact of trauma on the client's emotional life, self-esteem, and functioning; if client remains at risk evaluate need for self-protective measures.
Assessment for domestic violence: evaluate if client is still at risk and if practical protective measures are required. Legal reporting not required for adult-adult domestic violence, however, if children are at risk as witnesses or victims the worker must make a report to child protective services.

Clinical Practice
The assessment process in Clinical Practice is as follows:
Determine the presenting problem
Determine if there is a match between the problem and available services.
Ongoing data collection and reassessment to enhance understanding of client's problems.
Worker's role is to ask questions and ask for elaboration and description, observe client's behavior/affect, and organize data to create a meaningful psychosocial or diagnostic assessment.
Sources of data other than client include interviews with family members; home visits; contacts with teachers, clergy, doctors, social agencies, and friends.
Clinical diagnosis—a product of the worker's understanding of the client's problems based on the data collected. It categorizes the client's functioning. Also includes relevant medical illnesses or physical conditions and their influence on client's emotional life/functioning.

DSM
The DSM-5 is a manual which provides a common language and standard criteria for the classification of mental disorders. It is also a classification system with periodic revisions. It includes comprehensive descriptions of the symptoms and manifestations of mental disorders and associated information such as prevalence. It does not discuss causation (etiology). The DSM offers specific criteria for clinicians to diagnose disorders.   The DSM also takes cultural context, cultural belief systems, and cultural differences between client/worker into account and includes Culture-Bound Syndromes.  The DSM also presents a Defensive Functioning Scale, which assesses the client's defenses or coping patterns at time of the evaluation and just preceding it.

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
Disruptive, impulse-control, and conduct disorders
Substance-related and addictive disorders
Neurocognitive disorders
Personality disorders
Paraphilic disorders
Other mental disorders
Medication-induced movement disorders

Other conditions that may be a focus of clinical attention

 

Neurodevelopmental disorders
Intellectual disability
Intellectual disabilities are neurodevelopmental disorders that include a cognitive capacity deficit and an adaptive functioning deficit. The onset of an intellectual disability must be during the developmental years. The severity of the disability ranges are mild, moderate, severe, and profound. The severity is determined by the client's adaptive functioning level, rather than the client's cognitive capacity. The DSM-5 has changed the wording of 'mental retardation' to intellectual disability to align more closely with other medical, educational, and advocacy groups.

Communication disorders
The DSM-5 includes the category communication disorders. The subcategories include language disorder, speech sound disorder, chldhood-onset fluency disorder (stuttering), and social communications disorder. With the change from DSM-IV to DSM-5, many conditions that previously fell under pervasive developmental disorders will now meet the criteria for communication disorders. Because autism spectrum disorder has a social and communication deficits as part of its defining characteristics, it is important to note that communication disorders should not be diagnosed when there are repetitive behaviors or narrowed interests or activities.

Autism spectrum disorder
Autism spectrum disorder (ASD) has two components in its diagnosis:  delays or abnormal functioning in social interaction/language for social communication and restricted repetitive behaviors, interests, and activities. Both of these pieces will be present in the ASD diagnosis. Severity levels are: Level 1 (requires support), Level 2 (requiring substantial support), and Level 3 (requiring very substantial support).  Of note, ASD now encompasses four disorders that were previously separate under DSM-IV autistic disorder, Asperger's disorder, childhood integrative disorder, and pervasive developmental disorder. Patients with ASD associated with other known conditions, environmental factors should have the diagnosis written

- autism spectrum disorder associated with (name of condition, such as Rett Syndrome).

Attention-deficit/hyperactivity disorder (ADHD)
Characterized by two symptom domains, inattentiveness and or/hyperactivity and impulsivity. Requires symptoms persisting for at least six months, and symptoms not motivated by anger or wish to displease or spite others.

Inattentiveness symptoms (must have 6 for diagnosis for children)

- Forgetful in everyday activity- Easily distracted (often)- Makes careless mistakes and doesn't give attention to detail- Difficulty focusing attention- Does not appear to listen, even when directly spoken to- Starts tasks but does not follow through- Frequently loses essential items- Finds organizing difficult- Avoids activities that require prolonged mental exertion

Impulsivity/Hyperactivity (must have 6 for diagnosis for children)

- Frequently gets out of chair- Runs/climbs at inappropriate times- Frequently talks more than peers- Often moves hands and feet, or shifts position in seat- Frequently interrupts others- Frequently has difficulty waiting on turn- Frequently unable to enjoy leisure activities silently- Frequently 'on the go' and seen by others as restless- Often finishes other's sentences before they can

Motor disorders
Motor disorders are a type of neurodevelopmental disorder. Motor disorders can be classified as developmental coordination disorders, stereotypic movement disorders, and tic disorders.  Tic disorders are further classified as Tourette's disorder, persistent motor or vocal tic disorder and provisional tic disorder.  Tic disorders are characterized by rapid, recurrent, stereotyped motor movements or vocalizations.  Those with Tourette's disorder typically have multiple motor tics and one or more vocal tics.  Those with chronic motor or vocal tic disorder have either motor or vocal tics.

Psychotic disorders
Psychotic disorders are characterized by psychotic symptoms during an active phase (delusions, hallucinations, disorganized speech, thought disorder) and/or negative symptoms such as flat affect, alogia, or avolition. Psychotic disorders are also characterized by decline from a previous level of functioning in work, social relations, and/or self care. There must be a continuous illness for at least six months with at least one month of an active phase of psychotic symptoms. Onset is typically in adolescence or young adulthood.

Schizophrenia spectrum and other psychotic disorders
The schizophrenia spectrum and other psychotic disorders classification includes:- delusional disorder- brief psychotic disorder- schizophreniform disorder- schizophrenia- schizoaffective disorder- substance/medication-induced psychotic disorder- psychotic disorder due to another medical condition- catatonia

Schizophrenia

Criteria A:
Schizophrenia criteria includes- the client must have at least 2 of the following symptoms:- Hallucinations (known as a core positive symptom)- Delusions (known as a core positive symptom)- Disorganized speech (known as a core positive symptom)- Severely disorganized or catatonic behavior- Negative Symptoms (such as avolition or diminished expression)
For diagnosis the client must have at least one of the 3 core positive symptoms listed above.
Criteria B: Client's level of functioning is significantly below level prior to onset.
Criteria C: If the patient has not had successful treatment there are continual signs of schizophrenia for more than six months
Criteria D: Depressive disorder, bipolar disorder, and schizoaffective disorder have been ruled out.
Criteria E: The symptoms cannot be attributed to another medical condition or a substance.
Criteria F: If the patient has had a communication disorder or Autism since childhood, a diagnosis of schizophrenia is only made it the patient has hallucinations or delusions.

Schizoaffective disorder
Criteria A: The client must have at least 2 of the following symptoms:- Hallucinations (known as a core positive symptom)- Delusions (known as a core positive symptom)- Disorganized speech (known as a core positive symptom)- Severely disorganized or catatonic behavior- Negative Symptoms (such as avolition or diminished expression)
For diagnosis the client must have at least one of the 3 core positive symptoms listed above.
The client will experience the above symptoms during a continuous period of illness during which there will also be a significant manic or depressive mood episode.
Criteria B: Client experiences hallucinations or delusions for at least two weeks during illness that do not occur during a significant depressive or manic mood episode.
Criteria C: The client experiences significant depressive or manic mood symptoms for most of the time of the illness.
Criteria D: The symptoms cannot be attributed to another medical condition or a substance.

Schizophreniform disorder
Criteria A: The client must have at least 2 of the following symptoms:- Hallucinations (known as a core positive symptom)- Delusions (known as a core positive symptom)- Disorganized speech (known as a core positive symptom)- Severely disorganized or catatonic behavior- Negative Symptoms (such as avolition or diminished expression)
For diagnosis the client must have at least one of the 3 core positive symptoms listed above.
Criteria B: an illness of at least one month but less than six months duration
Criteria C: Depressive disorder, bipolar disorder, and schizoaffective disorder have been ruled out.
Criteria D: The symptoms cannot be attributed to another medical condition or a substance.

Delusional disorder
These disorders are typified by the presence of a persistent delusion. Delusion may be persecutory type, jealous type, erotomanic type (that someone is in love with delusional person), somatic type (that one has physical defect or disease), grandiose type, or mixed.

Delusional Disorder:
Criteria A: The client experiences at least one delusion for at least one month or longer.
Criteria B: The client does not meet criteria for schizophrenia.
Criteria C: Functioning is not significantly impaired, and behavior except dealing specifically with delusion is not bizarre.
Criteria D: Any manic or depressive episodes are brief.
Criteria E: The symptoms cannot be attributed to another medical condition or a substance.
It should be specified if the delusions are bizarre. Severity is rated by the quantitative assessment measure 'Clinician-Rated Dimensions of Psychosis Symptom Severity'.

Brief psychotic disorder
A delusion that has sudden onset and lasts less than one month.
Brief psychotic disorder is a classification of the schizophrenia spectrum and other psychotic disorders.
Criteria A: At least one of the follow symptoms: Delusions, hallucinations, disorganized speech, or catatonic behavior.
Criteria B: The symptoms last more than one day but less than one month. The client does eventually return to baseline functioning.
Criteria C: The disorder cannot be attributed to another psychotic or depressive disorder.

Treatment for schizophrenic and psychotic disorders
Treatment of schizophrenic and other psychotic disorders is as follows:
Antipsychotic medication. This must be consistently administered and monitored for response and side effects.
Individual psychotherapy. Supportive, little anxiety inducement, seeks to contain psychotic symptoms, focuses on realistic goals to maintain highest level of functioning. Goal is to aid coping and self-acceptance.
Family therapy. Education and support for family members.
Group therapy. To help develop social skills, to begin or sustain relationships. Should be practical and supportive.
Milieu Therapy. Hospital/institutional treatment entailing therapeutic combination of staff, program, social structure, respite, and expectations of reasonable behavior.
Social Network Intervention/Case Management. Help with housing, income, social support, educational/vocational opportunities, and medical care.
Self-Help Groups. Support and education for client and family members.

Depressive disorders
Types of depressive disorders:

- Major depressive disorder

- Persistent depressive disorder

- Pre-menstrual dysmorphic disorder

- Disruptive mood dysregulation disorder

- Substance/medication induced depressive disorder

- Depressive disorder due to another medical condition

- Other specified depressive disorder

- Unspecified depressive disorder

Major depressive disorder
Criteria A: The client experiences 5 or more of the following symptoms during 2 consecutive weeks. These symptoms are associated with a change in the client's normal functioning. (Note: Of the presenting symptoms, either depressed mood or loss of ability to feel pleasure must be included to make this diagnosis).

Depressed mood
Loss of ability to feel pleasure or have interest in normal activities
Decreased aptitude for thinking
Thoughts of death
Fatigue (daily)
Inappropriate guilt/worthlessness
Observable motor agitation or psychomotor retardation
Weight change of more than or less than 5% in one month.
Hypersomnia or Insomnia (almost daily)

Criteria B: The episode causes distress or social/functional impairment.
Criteria C: The symptoms cannot be attributed to a substance or another condition/disease.
Criteria D: The episode does not meet the criteria for schizophrenia spectrum or other psychotic disorder.
Criteria E: The client does not meet criteria for manic episode or a hypomanic episode.
Persistent depressive disorder (dysthymia)
Criteria A: For at least two years the client experiences for most of a day, more days than they don't experience it, a depressed mood.
Criteria B: The client experiences 2 or more of the following when depressed: low self-esteem, decreased appetite or overeating, a feeling of hopelessness, fatigue, difficulty concentrating, insomnia or hypersomnia.
Criteria C: During the episode the client has not had relief from symptoms for longer than 2 months at once.
Criteria D: The client may have met the criteria for a major depressive disorder.
Criteria E: The client does not meet criteria for cyclothymic disorder, manic episode or hypomanic episode.
Criteria F: The episode does not meet the criteria for schizophrenia spectrum or other psychotic disorder.
Criteria G: The symptoms cannot be attributed to a substance.
Criteria H: The symptoms cause distress or impairment socially or functionally.

Bipolar and related disorders

Bipolar I disorder
Criteria A: The client must meet the criteria (listed below) for at least one manic episode. The manic episode is usually either proceeded or followed by an episode of major depression or hypomania.
Criteria B: The episode cannot be explained by schizophrenia spectrum and other psychotic disorders criteria.

Manic Episode Criteria:
Criteria A: An episode of significantly elevated, demonstrative, or irritable mood. There is significant goal-directed behaviors, activities, and an increase in the amount of energy the patient normally has. These symptoms are present for most of the day and last at least one week.
Criteria B: During the period described in criteria A, the patient will experience 3 of the following symptoms (if the client presents with only an irritable mood 4 of the following symptoms need to be present for diagnosis:

● less need for sleep

● excessive talking

● inflated self-esteem

● easily distracted

● flight of ideas

● engages in activities that have negative consequences

● engages in either goal directed activity or purposeless activity

Criteria C: The episode causes significant impairment socially.
Criteria D: The symptoms cannot be attributed to a substance.

Bipolar II disorder
Bipolar II Disorder Criteria:
Criteria A: The client has had one or more major depressive episodes and one or more hypomanic episodes.
Criteria B: The client has never experienced a manic episode.
Criteria C: The episode doesn't meet criteria for schizophrenia spectrum or other psychotic disorder.
Criteria D: The depressive episodes or alterations between the two moods cause significant impairment socially or functionally.

Hypomania Criteria:
Criteria A: An episode of significantly elevated, demonstrative, or irritable mood. There is significant goal-directed behaviors, activities, and an increase in the amount of energy the patient normally has. These symptoms are present for most of the day and last at least 4 days.
Criteria B: During the period described in criteria A, the patient will experience 3 of the following symptoms (if the client presents with only an irritable mood 4 of the following symptoms need to be present for diagnosis:

● less need for sleep

● excessive talking

● inflated self-esteem

● easily distracted

● flight of ideas

● engages in activities that have negative consequences

● engages in either goal directed activity or purposeless activity

Criteria C: The episode causes a change in the functioning of the individual.

Criteria D: The episode causes changes noticeable by others.

Criteria E: The episode does not cause social impairments.

Criteria F: The symptoms cannot be attributed to a substance.

Cyclothymic disorder
Cyclothymic disorder is characterized by chronic, fluctuating mood with many hypomanic and depressive symptoms, however, not as severe as either bipolar I or bipolar II.
Criteria A: The client experiences a considerable number of hypomania symptoms without meeting all the criteria for hypomanic epsidodes and depressive symptoms that do not meet the criteria for major depressive episode for two years or more (can be for one year or more in <18 y/o).
Criteria B. During the above time period, the client exhibits the symptoms more than half of the time and the client is never symptom free more than two months at a time.
Criteria C: The client has not met the criteria for manic, hypomanic, or major depressive episodes.
Criteria D: The episode doesn't meet criteria for schizophrenia spectrum or other psychotic disorder.
Criteria E: The symptoms cannot be attributed to a substance.
Criteria F: The episodes cause significant impairment socially or functionally.

Treatment for bipolar and depressive disorders
Antidepressants for major depressive disorder and dysthymia. Anti-psychotics if accompanied by psychotic features. Mood stabilizers if bipolar I, bipolar II, or cyclothymia. Consistent administration and monitoring for effectiveness and side effects required.

Interpersonal/psychodynamic therapy.
Behavioral therapy
Cognitive therapy
Group psychotherapy
Self-help groups

Anxiety disorders
The following are the different types of anxiety disorders:

- Panic disorder - recurrent brief but intense fear in the form of panic attacks with physiological or psychological symptoms.

- Specific Phobia - fear of specific situations or objects

- Generalized anxiety disorder - chronic psychological and cognitive symptoms of distress, excessive worry lasting at least 6 months of duration.- Separation anxiety disorder - excessive anxiety related to being separated from someone the client is attached to

- Selective mutism - unable to speak in social settings (when it would seem appropriate) though normally able to speak

- Social anxiety disorder - anxiety about social situations

- Agoraphobia - anxiety of being outside of the home or in open places

Treatment of anxiety disorders:
Short-acting anti-anxiety medications for episodic symptoms (panic attacks) and antidepressants for longer term use (ex. phobias)
Psychotherapy such as supportive therapy, cognitive-behavioral therapy (systematic desensitization), DBT (Dialectical Behavioral Therapy), EMDR for

Group therapy
Inpatient hospitalization (when a threat to self or others)

Obsessive-compulsive and related disorders
Criteria A: The client exhibits obsessions, compulsions, or both.
Obsession- continuous, repetitive thoughts, compulsions, or things imagined that are unwanted and cause distress. The client will try to suppress thoughts, ignore them, or do a compulsive behavior.
Compulsion- recurrent behavior or thought the client feels obliged to perform after an obsession to decrease anxiety, however, the compulsion is usually not connected in an understandable way to an observer.
Criteria B: The obsessions/compulsions take at least one hour per day and cause distress.
Criteria C: The behavior is not caused by a substance.
Criteria D: The behavior could not better be explained by a different  mental disorder.
Note if the criteria is met with good insight (client realizes OCD beliefs are not true), poor insight (client thinks the OCD beliefs are true), or absent insight (client is delusional, truly believing OCD beliefs are true). Note if the client has ever had tic disorder.

Other Obsessive-Compulsive and related disorders include:
Body dysmorphic disorder
Hoarding disorder
Trichotillomania (hair-pulling disorder)
Excoriation (skin-picking disorder)

Trauma- and stressor-related disorders
Reactive attachment disorder - child rarely seeks or responds to comfort when upset, usually due to neglect of emotional needs by caregiver (e.g. foster and institutionalized children)
Disinhibited social engagement disorder - child has decreased hesitations regarding interacting with unfamiliar adults. Does not question leaving normal caregiver to go off with a stranger.
Posttraumatic stress disorder - persistently re-experiencing a severe trauma for more than one month. Individual exhibits arousal-anxiety symptoms, and avoidance of things associated with the trauma or numbness.
Acute stress disorder - anxiety and dissociative symptoms develop within one month of experiencing a trauma.
Adjustment disorder - the client has behavior/emotional changes occurring within 3 months of a stressor. These changes cause distress for the client and are disproportional to the actual stressor.

Sleep-wake disorders
Insomnia disorders - Difficulty falling asleep, staying asleep, or early rising without being able to go back to sleep.
Hypersomnolence disorder - sleepiness despite getting at least 7 hours with difficulty feeling awake when suddenly awoke, lapses of sleep in the day, feeling unrested after long periods of sleep.
Narcolepsy - uncontrollable lapses into sleep, occurring at least three times each week for at least 3 months.
Obstructive sleep apnea hypopnea - Breathing related sleep disorder with obstructive apneas or hypopneas.
Central sleep apnea - Breathing related sleep disorder with central apnea.
Sleep-related hypoventilation - Breathing related sleep disorder with evidence of decreased respiratory rate and increased CO^2 level.
Circadian rhythm sleep-wake disorder - sleep wake disorder with the primary cause being a mismatch between the circadian rhythm and the sleep required by the person
Non-rapid eye movement sleep arousal disorder - awakening during the first third of the night associated w/ sleep walking/sleep terrors.
Nightmare disorder - Recurring distressing dreams that are well remembered and cause distress.
Rapid eye movement sleep behavior disorder - arousal during REM sleep associated with motor movements and vocalizing.
Restless legs syndrome - the need to move the legs due to uncomfortable sensations, usually relieved by activity.

Somatoform disorders
All somatoform disorders are marked by multiple physical/somatic symptoms that cannot be explained medically. Symptoms impair social or work functioning and cause distress.

- Somatic symptom disorder - Somatic symptoms (including pain) that are persistent and distressing about which feelings regarding these symptoms take up an extremely large amount of time and energy.- Illness anxiety disorder - Preoccupation with getting or currently having an illness

- Factitious disorder - Falsely presenting oneself or someone else as ill, even when there are no obvious gains in doing so.

- Conversion disorder (functional neurological symptom disorder)

- Motor or perceptual symptoms suggesting physical disorder, but actually reflect emotional conflicts.

- Psycological factors affecting other medical conditions - the client has a medical condition that is adversely affected by psychological behavior.

Treatment of somatoform disorders:
No definitive treatment, but goal is early diagnosis in order to circumvent unnecessary medical/surgical intervention.
Attempt to move attention from symptoms to problems of living.
Supportive Therapy to help individual cope with symptoms.
Long-term relationship with single physician.
No medication.

Dissociative disorders
These are all characterized by a disturbance in the normally integrative functions of identity, memory, consciousness, or environmental perception.

- Dissociative identity disorder (previously multiple personality disorder)

- Two or more personalities exist within one person. Each personality is dominant at a particular time.

- Dissociative amnesia - Inability to recall important personal data, more than forgetfulness. Is not due to organic causes and comes on suddenly.

- Depersonalization/derealization disorder

- Feeling detached from one's mental processes or body, as if one is an observer.
Treatment is primarily done via psychotherapy, with the goals of working through unconscious conflict or recovering traumatic memories, and integrating feeling states with memories or events.

Feeding and eating disorders
Types of feeding and eating disorders:

- Pica- Rumination disorder

- Anorexia nervosa- Avoidant/restrictive food intake disorder- Bulimia nervosa- Binge eating disorder

Anorexia
Criteria A: Extreme restriction of food, lower than requirements, leading to low body weight.
Criteria B: An irrational fear of gaining weight or behaviors that prevent weight gain, though at low weight.
Criteria C: Distorted body image or a lack of acknowledgement of gravit of current weight.

Bulimia nervosa
Criteria A: Cyclical periods of binge eating:
1. Discretely consuming an amount of food that is larger than most individuals would eat eat in the same time period and situation.
2. The client feels a lack of control over the eating.
Criteria B: Characterized by binge eating followed by purging via self-induced vomiting/laxatives/fasting/vigorous exercise in order to prevent weight gain.
Criteria C: At least one binge eating episodes per week for three months.
Criteria D: It is marked by a persistent over-concern with body shape and weight.
Criteria E: The eating and compensatory behaviors do not only occur during periods of anorexia nervosa.
Pica
Persistent eating of non-food substances such as paint, hair, sand, cloth, pebbles, etc. Those with pica do not show an aversion to food.
Rumination disorder
Regurgitation and re-chewing of food
 

Avoidant/restrictive food intake disorder
Criteria A: A disruption in eating evidence by not meeting nutritional needs and failure to gain expected weight or weight loss, nutritional deficiency, requires nutritional supplementation, or interpersonal interference.
Criteria B: This disruption is not due to lack of food or culture.
Criteria C: There does not appear to be a problem with the clients's body perception.
Criteria D: The disturbance can't be explained by another medical condition.

Treatment for eating disorders:
Psychopharmacology
Individual therapy
Family therapy
Medical supervision to monitor weight, vital signs, and blood values
Hospitalization when necessary for close behavioral and medical supervision

Elimination disorders
Encopresis is the involuntary fecal soiling in children who have already been toilet trained.
Enuresis is the repeated voiding of urine during the day or night in bedding or clothes. It occurs in those old enough to be expected to exercise bladder control.
Encopresis and enuresis make up the two major categories of elimination disorders.

Personality disorders
Personality disorders are characterized by a long-term and inflexible pattern of maladaptive personality traits. These traits cause subjective distress and/or significant impairment in social or work functioning. These disorders are believed to operate as coping and defensive mechanisms due to ego deficits and early developmental problems.
Criteria A: Long-term pattern of maladaptive personality traits and behaviors that do not align with the client's culture. These traits and behaviors will be found in at least two areas:

Impulse Control
Inappropriate emotional intesity or responses
Inappropriately interpreting people, events, and self

Inappropriate social functioning
Criteria B: The traits and behaviors are inflexible and exist despite changing social situations.
Criteria C: The traits and behaviors cause distress and impair functioning.
Criteria D: Onset was adolescence or early adulthood and has been enduring.
Criteria E: The behaviors and tratis are not due to another mental disorder.
Criteria F: The behaviors and traits are not due to a substance.
Cluster A personality disorders

- Paranoid personality disorder: pervasive and inappropriate interpretation of others' actions as threatening or demeaning. Does not cause psychotic symptoms.

- Schizoid personality disorder: lack of concern for social relationships and a restricted range of emotional experience and expression. Incapacity to form intimate social relationships/experience affection for others, and lack of caring about others' responses.

- Schizotypal personality disorder: characterized by deficits in interpersonal connectedness; peculiarities in various thought, perception, speech and behavior patterns (i.e. magical thinking, ideas of reference, recurrent illusions).
Cluster B personality disorders- Antisocial personality disorder: a history of chronic irresponsible and antisocial behavior, beginning in childhood or adolescence. Violations of others' rights and occupational failure over several years. Early lying/stealing can lead to acting out sexual behavior, drinking, drugs, and later failure at work and home and adult violations of social norms.

- Borderline personality disorder: instability in relationships, mood, and self-image. Unpredictable and impulsive acting-out, which can be self-destructive. Strong mood shifts from normal state to rage. Chronic fear of being alone, dread of feeling emptiness. May have short-lived paranoid or dissociative symptoms.

- Histrionic personality disorder: excessive emotionality and attention seeking. Constant seeking of reassurance, approval, or praise. Overly dramatic and intense behavior.

- Narcissistic personality disorder: grandiose sense of self-importance, fantasies of unlimited success, chronic exhibitionism, difficulty dealing with criticism, indifference to others. Relationship difficulties—feeling entitled, taking advantage of/exploiting others, polarizing others by idealizing or devaluing.

Cluster C personality disorders-

Avoidant personality disorder: characterized by social discomfort, fear of criticism, timidity, extreme sensitivity to possibility of social rejection, fear of social relationships, desire for closeness but withdrawing socially, low self-esteem.

- Dependent personality disorder: characterized by a persistent pattern of dependent and submissive behavior, a lack of self-confidence, and an inability to function independently.

- Obsessive-compulsive personality disorder: characterized by a persistent pattern of perfectionism and inflexibility. Limited ability to demonstrate positive emotions. Perfectionism and an over-concern for trivial detail. Demand others comply. Preoccupation with work; tight with money.

Treatment
Treatment of personality disorders:
Intervention's purpose is to alleviate symptoms, decrease social/emotional disability, or deal with interpersonal/societal need for symptom management.
Psychotherapy is used to promote recognition of the client's covert dependence and unexpressed fearfulness.
Worker should place importance on awareness of countertransference issues because of treatment-resistant behaviors, among others, such as mistrust of the worker, lack of boundaries, and lack of recognition of the worker as a person.
Psychopharmacology is not generally used.

Disruptive, impulse-control, and conduct disorders
The components of the disruptive, impulse-control, and conduct disorders classification are:- Oppositional defiant disorder- Intermittent explosive disorder- Conduct disorder- Pyromania- Kleptomania
Pattern of negative, hostile, and defiant behavior, and vindictiveness however, with less serious violations of the basic rights of others that characterize conduct disorders. Behavior is motivated by interpersonal reactivity or resentful power struggle with adults.
 

Conduct disorder
Criteria A: Persistent pattern of behavior in which significant age-appropriate rules or societal norms are ignored, and others' rights and property are violated (theft, deceitfulness); aggression to people and animals and destruction of property are common.
Criteria B: The patterns of behavior cause academic, social or other impairments.
Criteria C: The behaviors couldn't better be classified as antisocial personality disorder.

Major and minor neurocognitive disorders
Delirium
Criteria A: A disturbance in consciousness or attention.
Criteria B: Develops over a short period of time, and fluctuates throughout the day
Criteria C: There are also changes in cognition.
Criteria D: Not better explained by another condition.
Criteria E: Is caused by a medical condition or is substance related.

Major and minor neurocognitive disorders (NCD) which may be due to:

- Alzheimer's disease- Frontotemporal lobar degeneration- Lewy body disease- vascular disease- traumatic brain injury- substance/medication use- HIV Infection

- prion Disease

- Parkinson's disease

- Huntington's disease

- another medical condition

- multiple etiologies

Criteria A: A change in cognitive ability from baseline. This information can be determined by the client, a well-informed significant other, family member, or caretaker, or it can be determined by neuropsychology testing.
Criteria B: For a major neurocognitive disorder, the cognitive change interferes with ADLs and independence. For a minor neurocognitive disorder, the cognitive change doesn't interfere with normal ADLS and independence, if accommodations are used.
Criteria C: The cognitive change cannot be defined as delirium only.
Criteria D: The cognitive change is not better described as another mental disorder.

Psychopharmacological drugs
Psychopharmacological drugs used for schizophrenia and psychotic symptoms
Old antipsychotics:
Haldol (haloperidol)
Thorazine (chlorpromazine)
Mellaril (thioridazine)
Stelazine (trifluoperazine)
Prolixin (fluphenazine)
Navane (thiothixene)
Clozaril (clozapine)

Newer or atypical antipsychotics:
Clozaril
Risperdal
Seroquel
Zyprexa (olanzapine)
Abilify

A major drawback and potential side effect for the older antipsychotics (which are effective) is Tardive Dyskinesia. TD is irreversible and causes involuntary movements of the face, tongue, mouth, or jaw. Other possible side effects for the older antipsychotics include Parkinson-like tremor or muscle rigidity; these are reversible and can be counteracted with Cogentin.
Among the newer antipsychotics, Clozaril requires frequent blood testing due to the risk of agranulocytosis, a blood disorder that decreases white blood cells and increases the risk of infection. Though some atypical antipsychotics have much less risk of TD, they are very expensive and can cause weight gain, affect blood sugar, and affect the lipid profile.

Typical drugs for bipolar disorder
Bipolar disorder is treated with mood stabilizers:
Lithium
Tegretol
Depakote
Lamictal

Mood stabilizers can cause weight gain. Regular blood work is necessary to monitor for therapeutic drug levels and for potential side effects. Lithium can cause kidney or thyroid problems, and Tegretol and Depakote can cause problems with liver function.

Treatment of unipolar depression
The following drugs are used for the treatment of unipolar depression:
SSRIs (Selective Serotonin Reuptake Inhibitors):
Prozac
Zoloft
Paxil
Luvox
Celexa
Lexapr- 

Atypical Antidepressants:
Effexor
Wellbutrin
Cymbalta

Tricyclic Antidepressants:
Imipramine
Amitriptyline
Elavil

MAO Inhibitors:
Nardil
Parnate
Marplan

SSRIs have fewer side effects than other antidepressants and one cannot overdose on SSRIs alone. SSRIs take several weeks to be effective, are expensive, can cause a loss of libido, and can lose effectiveness after years of usage. In a few individuals, SSRIs can cause agitation, suicidal ideation, or manic symptoms (in which case the prescriber should discontinue).
Of the atypical antidepressants, Wellbutrin does not cause libido loss and is sometimes prescribed in combination with an SSRI to counter sexual side effects or to increase the positive antidepressant effect of the SSRI. Cymbalta is recommended for depression linked with somatic complaints.
Tricyclic antidepressants can cause side effects such as dry mouth. These are no longer in common usage due to cardiac monitoring issues.
MAO Inhibitors are not in common usage as they require a special diet to be safe.

Drugs used for anxiety
Drugs used for anxiety are Benzodiazepines:
Ativan (lorazapam)
Xanax
Klonopin
Valium

Benzodiazepines are effective, short acting, and quickly relieve anxiety. They should be used for as short a time as possible and in conjunction with appropriate therapeutic intervention because of their addiction potential.  In the elderly, long term-use of these drugs can cause psychotic symptoms that can be reversed by discontinuing their usage.

Typical drugs used for attention disorders
Typical drugs used for attention disorders are as follows:
Amphetamine-like:

- Ritalin (short acting)
- Long-Acting Ritalin
- Concerta
- Adderall (short acting)
- Adderall XR (long acting)
These relieve symptoms quickly and individuals can take them on selected days or part-days if desired. These have potential for abuse, can suppress appetite and cause weight loss, and can cause edgy feelings like too much caffeine. Can cause increased heart rate.
 
Non-Amphetamine like:

Strattera
These are less appetite suppressing; weight loss is less of a problem. Takes 2-4 weeks to be effective and must be taken every day. Must be monitored for a rarely occurring liver problem. This drug has no abuse potential.
Substance related disorders and their treatment
Substance related disorders may be caused by abusing a drug, by medication side-effects, or by exposure to a toxin.
Substance intoxication or withdrawal—the behavioral, psychological, and physiological symptoms due to effects of the substance. It will vary depending on type of substance.
Substance related disorders includes the following classes: caffiene; hallucinogens; alcohol; cannabis; stimulants; tobacco; inhalants; opioids; other; and sedatives, hypnotics and anxiolytics. The severity of the particular substance use disorder can be determined by the presence of the number of symptoms.
Also present may be substance induced delirium, dementia, psychosis, mood disorders, anxiety disorder, sexual dysfunction, or sleep dysfunction.
Treatment should focus first on the substance. Treatment options include outpatient or inpatient; residential or day care; group, individual, and/or family counseling; methadone maintenance (for opiates); detoxification; self-help groups; or a combination of therapies and medication.
Substance-related and addictive disorders now include gambling disorder, as evidence shows that the behaviors of gambling trigger simliar reward systems as drugs.

Substance use and misuse
The following are possible injuries or illnesses that often result from the use of substances:
Physical damage
Brain damage
Organic failure
Fetal damage when used by pregnant women
Birth of drug exposed babies who require intensive therapy throughout childhood
Altering of brain chemistry/permanent brain damage
Effects on dopamine in brain, which directly effects mood

Indications of possible misuse of narcotics are as follows:
Scars (tracks) caused by injections
Constricted pupils
Loss of appetite
Sniffles
Watery eyes
Cough
Nausea
Lethargy
Drowsiness
Nodding
Syringes, bent spoons, needles, etc.
Weight loss or anorexia

Depressants
The possible effects of depressants are as follows:
Sensory alteration, reduction in anxiety, intoxication
In small amounts, can cause relaxed muscles and calmness
In larger amounts—slurred speech, impaired judgment, loss of motor coordination
In very large doses—respiratory depression, coma, death
Newborn babies of abusers may exhibit dependence, withdrawal symptoms, behavioral problems, and birth defects.

The following are symptoms of overdose of depressants:
Shallow respiration
Clammy skin
Dilated pupils
Weak and rapid pulse
Coma
Death

Indications of possible misuse of depressants are:
Behavior similar to alcohol intoxication (without the odor of alcohol)
Staggering, stumbling, lack of coordination
Slurred speech
Falling asleep while at work
Difficulty concentrating
Dilated pupils

Stimulants
The symptoms of overdose of stimulants are:
Agitated behavior
Increase in body temperature
Hallucinations
Convulsions
Possible death

The following are the indications of possible misuse of stimulants:
Excessive activity, talkativeness, irritability, argumentativeness, nervousness.
Increased blood pressure or pulse rate, dilated pupils
Long periods without sleeping or eating
Euphoria

Hallucinogens
The symptoms of overdose of hallucinogens are:
Longer, more intense episodes
Psychosis
Coma
Death

The following are indications of possible misuse of hallucinogens:
Extreme changes in behavior and mood
Sitting/reclining in a trance-like state
Individual may appear fearful
Chills, irregular breathing, sweating, trembling hands
Changes in sensitivity to light, hearing, touch, smell, and time
Increased blood pressure, heart rate, blood sugar

Cannabis
The symptoms of overdose of cannabis are:
Fatigue
Lack of coordination
Paranoia

Some indications of possible misuse of cannabis are as follows:
Animated behavior and loud talking, followed by sleepiness.
Dilated pupils
Bloodshot eyes
Distortions in perception
Hallucinations
Distortions in depth and time perception
Loss of coordination

Alcohol
Some symptoms of overdose of alcohol use are:
Staggering
Odor of alcohol on breath
Loss of coordination
Dilated pupils
Slurred speech
Coma
Respiratory failure
Nerve damage
Liver damage
Fetal alcohol syndrome (in babies born to alcohol abusers)

The following are some indications of possible misuse of alcohol:
Confusion
Disorientation
Loss of motor control
Convulsions
Shock
Shallow respiration
Involuntary defecation
Drowsiness
Respiratory depression
Possible death

Steroids
Symptoms of overdose of steroids are:
Rapid gains in weight and muscle
Extremely aggressive behavior
Severe skin rashes
Impotence, reduced sexual drive
In female users, development of irreversible masculine traits

The following are indications of possible misuse of steroids:
Increased aggressiveness
Increased combativeness
Jaundice
Purple or red spots on body
Unexplained darkness of skin
Unpleasant and persistent breath odor
Swelling of feet, lower legs

Substance use disorder terms
 
Tolerance—needing clearly increasing amounts of the substance to achieve desired effect; or clearly diminished effect with continued use of the same amount of the substance
Withdrawal—typical withdrawal syndrome for the substance; or the same or a similar substance is taken to relieve/avoid withdrawal symptoms

Remission
The type of remission is based on whether any of the criteria for abuse/dependence have been met and over what time frame:
Early Remission: After the criteria for a substance use disorder have been met, none of those criteria are fulfilled (except for the criteria for craving) for at least three months but not more than 1 year.
Sustained Remission: After the criteria for a substance use disorder have been met, none of those criteria are fulfilled (except for the criteria for craving) for 1 year or longer.
If the client is in remission in a controlled environment, this should be specified.
Maintenance Therapy - a replacement medication that can be taken to avoid withdrawal symptoms. The client could still be considered in remission from a substance use disorder if while using maintanance therapy, they do no meet any criteria for that substance use disorder except for craving. For tobacco use disorder this would include using nicotine replacement systems. For opioid use disorder this could include medications such as methadone.

Clinical disorders found with substance use disorders
The following clinical disorders are commonly found in clients with substance use disorders:
Conduct disorders, particularly the aggressive subtype
Depression
Bipolar disorder
Schizophrenia
Anxiety disorders
Eating disorders
Pathological gambling
Antisocial personality disorder
PTSD
Other personality disorders

Medical problems related to substance use
Some medical problems that may be directly related to substance use are:
Cardiac problems (acute cocaine intoxication)
Respiratory depression and coma (severe opioid overdose and alcohol abuse)
Hepatic cirrhosis (prolonged heavy drinking)
Malnutrition (from poor self-care)
Physical trauma (risk-taking behavior)
HIV infection (risk-taking behavior)

Conditions associated with those who administer substances by injection:
Bacterial infections
HIV
Hepatitis

Pharmacologic treatment
Pharmacologic treatments for clients with substance use disorders are used in the following ways:
To treat intoxication and withdrawal.
To decrease reinforcing effects of abused substances.
To discourage the use of substances by causing unpleasant consequences through a drug-drug interaction or by pairing substance use with an unpleasant drug-induced condition.
Agonist substitution therapy (i.e. methadone).
Medications to treat clinical conditions.

Treatment plan
The components of a treatment plan for a client with a substance use disorder are:
A strategy to achieve abstinence or to reduce the effects or use of substances.
Efforts to increase ongoing compliance with the treatment program, prevent relapse, and enhance functioning.
Clinical management.
If necessary, additional treatments for clients with associated conditions.

Management of alcohol intoxication and withdrawal
The management of alcohol intoxication and withdrawal in clients being treated for alcohol use disorders is as follows:
Clients who are acutely intoxicated need to be monitored and kept in a safe environment.
Within 4-12 hours after stopping or reducing alcohol use symptoms of alcohol withdrawal typically begin. These symptoms peak during the second day of abstinence, and settle within 4-5 days.
There can be serious complications of alcohol withdrawal including seizures, hallucinations, and delirium.
For clients with moderate to severe withdrawal, treatment includes medical attention to reduce the physical effects of withdrawal.

Treatment for cocaine use
The following is the recommended treatment setting for most clients with cocaine use disorders:
Intensive outpatient treatment (meetings more than twice/wk).
Variety of treatment modalities used simultaneously.
Focus of treatment is the maintenance of abstinence.

Management of cocaine intoxication and withdrawal
The management of cocaine intoxication and withdrawal in clients being treated for substance use disorders is as follows:
Intoxication (by cocaine) can cause hypertension, tachycardia, seizures, and paranoid delusions. Usually only supportive care is required, but some acutely agitated clients may benefit from sedation.
After stopping cocaine use, craving and depression are common.

Opioid use disorders
Pharmacological treatments
Clients who have a history of at least one year of dependence on opioids, maintenance on methadone or LAAM (l-a-acetylmethadol or levomethadyl acetate) can be appropriate.
One goal of treatment is to achieve a stable maintenance dose.

Abstinence
The goal of abstinence for those being treated for opioid use disorders is explained as follows:- Some clients will be able to attain abstinence from all opioid drugs.- Some clients will require long-term maintenance with opioid agonists (methadone or LAAM).- Abstinence can never be achieved for some clients. In these cases the goal of treatment is reduction in morbidity and mortality through reducing the effects of opioid use.
Strategies to treat withdrawal
Effective strategies in the treatment of opioid withdrawal include:
Methadone substitution with gradual tapering.
Abrupt cessation of opioids, with medications to suppress symptoms of withdrawal.
Because the concurrent use of or withdrawal from other substances can complicate the treatment of opioid withdrawal, monitoring for the presence of other substances is imperative.

Clinical influences on treatment
Clinical aspects that may influence treatment of opioid use disorders are:
Mental illness. Many clients who are opioid-dependent also have mental illnesses that must be identified and treated alongside the substance use disorders.
Injection. Using opioids by injection is linked with a high risk of medical complications such as bacterial endocarditis, hepatitis, HIV infection, and tuberculosis.
Treating pregnant women with opioid use disorders is complicated by the increased risks to the fetus and the urgency of minimizing the intake of opioids. These risks include low birth weight, prematurity, neonatal abstinence syndrome, stillbirth, and sudden infant death syndrome.

Group work
The interventive skills the worker will use in the beginning work phase of a group are summarized below:
Worker must tune into the needs and concerns of the members. Member cues may be subtle and difficult to detect.
Seeking members' commitment to participate through engagement with members.
Worker must continually asses:

- members' needs/concerns
- any ambivalence/resistance to work
- group processes
- emerging group structures
- individual patterns of interaction

Facilitate the group's work.

The interventive skills the worker will use in the middle phase of group work are summarized as follows:
Being able to judge when work is being avoided.
Being able to reach for opposites, ambiguities, and what is happening in the group when good and bad feelings are expressed.
Supporting different ways in which members help each other.
Being able to partialize larger problems into more manageable parts.
Being able to generalize and find connections between small pieces of group expression and experience.
Being able to facilitate purposeful communication that is invested with feelings.
Identifying and communicating the need to work and recognizing when work is being accomplished by the group.

The intervention and development stages of the worker in work with groups are summarized below:

- Power and control stage—consists of limit setting, clarification, use of the program

- Intimacy stage—consists of handling transference, rivalries, degree of uncovering

- Differentiation stages—consist of clarification of differential and cohesive processes, group autonomy

- Separation—consists of a focus on evaluation, handling ambivalence, incorporating new resources

Community organization practice
The following are the tasks/goals of community organization practice:
Change public or private priorities in order to give attention to problems of inequality and social injustice.
Promote legislative change or public funding allocation.
Influence public opinions of social issues and problems.
Improve community agencies/institutions in order to satisfy needs of the community better.
Develop new ways to address community problems.
Develop new services and coordinate existing ones.
Improve community access to services.
Set up new programs and services in response to new or changing needs.
Develop the capacity of grassroots citizen groups to solve community problems and make claims on public resources for under-served communities.
Seek justice for oppressed minorities.

The following are factors are used in determining which type of tactics will be used in community organization practice:
The degree of differences or commonality in the goals between the community group and the target system.
The relative power of the target system and the community group.
The relationship of the community group to the target system.

Collaborative tactics in community organization practice include problem solving, joint action, education, and mild persuasion. Requires a perceived consensus in goals, power equality, relatively close relationships, and cooperation/sharing.
Campaign tactics in community organization practice include hard persuasion, political maneuvering, bargaining/negotiation, and mild coercion. Requires perceived differences in goals, inequality in power, and intermediate relationships.
Contest tactics in community organization practice include public conflict and pressure.
Requires public conflict, disagreement concerning goals, uncertain power, distant or hostile relationships.