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Mental Health in Social Work A Casebook on Diagnosis
and Strengths Based Assessment Dsm 5 Update
Jacqueline Corcoran Digital Instant Download
Author(s): Jacqueline Corcoran; Joseph M. Walsh
ISBN(s): 9780205991037, 0205991033
Edition: Paperback
File Details: PDF, 6.73 MB
Year: 2014
Language: english
CSWE’s Core Competencies and Practice Behavior Examples in this Text
Competency Chapter
Professional Identity
Practice Behavior Examples…
Serve as representatives of the profession, its mission, and its core values 3
Know the profession’s history
Commit themselves to the profession’s enhancement and to their own professional conduct
and growth
Advocate for client access to the services of social work
Practice personal reflection and self-correction to assure continual professional development
Attend to professional roles and boundaries 12
Demonstrate professional demeanor in behavior, appearance, and communication
Engage in career-long learning
Use supervision and consultation
Ethical Practice
Practice Behavior Examples…
Obligation to conduct themselves ethically and engage in ethical decision-making
Know about the value base of the profession, its ethical standards, and relevant law
Recognize and manage personal values in a way that allows professional values to guide 11
practice
Make ethical decisions by applying standards of the National Association of Social Workers’ 12
Code of Ethics and, as applicable, of the International Federation of Social Workers/International
Association of Schools of Social Work Ethics in Social Work, Statement of Principles
Tolerate ambiguity in resolving ethical conflicts
Apply strategies of ethical reasoning to arrive at principled decisions 5
Critical Thinking
Practice Behavior Examples…
Know about the principles of logic, scientific inquiry, and reasoned discernment
Use critical thinking augmented by creativity and curiosity
Requires the synthesis and communication of relevant information
Distinguish, appraise, and integrate multiple sources of knowledge, including research-based 4, 8, 9, 10
knowledge, and practice wisdom
Analyze models of assessment, prevention, intervention, and evaluation 1
Demonstrate effective oral and written communication in working with individuals, families, 6
groups, organizations, communities, and colleagues
Adapted with the permission of Council on Social Work Education
CSWE’s Core Competencies and Practice Behavior Examples in this Text
Competency Chapter
Diversity in Practice
Practice Behavior Examples…
Understand how diversity characterizes and shapes the human experience and is critical to the 2
formation of identity
Understand the dimensions of diversity as the intersectionality of multiple factors including age, 6
class, color, culture, disability, ethnicity, gender, gender identity and expression, immigration
status, political ideology, race, religion, sex, and sexual orientation
Appreciate that, as a consequence of difference, a person’s life experiences may include 8
oppression, poverty, marginalization, and alienation as well as privilege, power, and acclaim
Recognize the extent to which a culture’s structures and values may oppress, marginalize, 1, 5, 7
alienate, or create or enhance privilege and power
Gain sufficient self-awareness to eliminate the influence of personal biases and values in working
with diverse groups
Recognize and communicate their understanding of the importance of difference in shaping life 7, 10
experiences
View themselves as learners and engage those with whom they work as informants
Human Rights & Justice
Practice Behavior Examples…
Understand that each person, regardless of position in society, has basic human rights, such as
freedom, safety, privacy, an adequate standard of living, health care, and education
Recognize the global interconnections of oppression and are knowledgeable about theories of
justice and strategies to promote human and civil rights
Incorporates social justice practices in organizations, institutions, and society to ensure that 5
these basic human rights are distributed equitably and without prejudice
Understand the forms and mechanisms of oppression and discrimination 2
Advocate for human rights and social and economic justice
Engage in practices that advance social and economic justice
Research-Based Practice
Practice Behavior Examples…
Use practice experience to inform research, employ evidence-based interventions, evaluate their 1, 4
own practice, and use research findings to improve practice, policy, and social service delivery
Comprehend quantitative and qualitative research and understand scientific and ethical
approaches to building knowledge
Use practice experience to inform scientific inquiry
Use research evidence to inform practice 9
CSWE’s Core Competencies and Practice Behavior Examples in this Text
Competency Chapter
Human Behavior
Practice Behavior Examples…
Know about human behavior across the life course; the range of social systems in which people
live; and the ways social systems promote or deter people in maintaining or achieving health
and well-being
Apply theories and knowledge from the liberal arts to understand biological, social, cultural, 2
psychological, and spiritual development
Utilize conceptual frameworks to guide the processes of assessment, intervention, and 4, 8, 11,13
evaluation
Critique and apply knowledge to understand person and environment. 4, 7, 13
Policy Practice
Practice Behavior Examples…
Understand that policy affects service delivery and they actively engage in policy practice
Know the history and current structures of social policies and services; the role of policy in
service delivery; and the role of practice in policy development
Analyze, formulate, and advocate for policies that advance social well-being 7, 9
Collaborate with colleagues and clients for effective policy action 8
Practice Contexts
Practice Behavior Examples…
Keep informed, resourceful, and proactive in responding to evolving organizational,
community, and societal contexts at all levels of practice
Recognize that the context of practice is dynamic, and use knowledge and skill to respond
proactively
Continuously discover, appraise, and attend to changing locales, populations, scientific and 9, 11
technological developments, and emerging societal trends to provide relevant services
Provide leadership in promoting sustainable changes in service delivery and practice to improve 10
the quality of social services
CSWE’s Core Competencies and Practice Behavior Examples in this Text
Competency Chapter
Engage, Assess Intervene, Evaluate
Practice Behavior Examples…
Identify, analyze, and implement evidence-based interventions designed to achieve client goals
Use research and technological advances
Evaluate program outcomes and practice effectiveness
Develop, analyze, advocate, and provide leadership for policies and services
Promote social and economic justice
A) ENGAGEMENT 3
Substantively and effectively prepare for action with individuals, families, groups, organizations,
and communities
Use empathy and other interpersonal skills 13
Develop a mutually agreed-on focus of work and desired outcomes
B) ASSESSMENT 3
Collect, organize, and interpret client data
Assess client strengths and limitations 2, 12
Develop mutually agreed-on intervention goals and objectives 5
Select appropriate intervention strategies
C) INTERVENTION
Initiate actions to achieve organizational goals
Implement prevention interventions that enhance client capacities 12
Help clients resolve problems
Negotiate, mediate, and advocate for clients 5
Facilitate transitions and endings
D) EVALUATION 3, 6
Critically analyze, monitor, and evaluate interventions
Second Edition
DSM-5 update
Mental Health
in Social Work
A Casebook on Diagnosis and Strengths-
Based Assessment
Jacqueline Corcoran
Virginia Commonwealth University
Joseph Walsh
Virginia Commonwealth University
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Library of Congress Cataloging-in-Publication Data
Corcoran, Jacqueline.
Mental health in social work : a casebook on diagnosis and strengths based assessment /
Jacqueline Corcoran, Virginia Commonwealth University, Joseph Walsh, Virginia Commonwealth
University. — Updated second edition.
pages cm
Includes bibliographical references and index.
ISBN-13: 978-0-205-99103-7 (alk. paper)
ISBN-10: 0-205-99103-3 (alk. paper)
1. Community mental health services—Case studies. 2. Psychiatric social work—Case
studies. 3. Medical social work—Case studies. I. Walsh, Joseph (Joseph F.) II. Title.
RA790.6.C64 2015
362.2’2—dc23
2013038117
10 9 8 7 6 5 4 3 2 1
ISBN-10: 0-205-99103-3
ISBN-13: 978-0-205-99103-7
Contents
Preface xii
Part One: Assessment
1. Diagnosis and the Social Work Profession 1
The DSM Classification System 3
Mental Status Examination 4
Rationale for the Diagnosis 5
Limitations of the Dsm 6
2. Biopsychosocial Risk and Resilience and Strengths Assessment 8
Definitions and Description 8
Individual Factors 9
Biological Mechanisms 9
Psychological Mechanisms 11
Social Mechanisms 12
Family 12
Neighborhood 14
Social Support Networks 15
Societal Conditions 15
The Health and Mental Health Care System 16
Poverty 17
Ethnicity 17
Guidelines for Eliciting and Enhancing Client Strengths 18
Conclusion 22
Part Two: Neurodevelopmental Disorders
3. Autism Spectrum Disorder 23
Prevalence and Comorbidity 24
Assessment 24
Biopsychosocial Risk and Resilience Influences 28
vii
viii Contents
Onset 28
The Course of Autism Spectrum Disorder 30
Interventions 31
Special Education 31
Family Education, Support, and Involvement 32
Behavioral Management 32
Medication 32
Social Skills Training 33
Complementary and Alternative Treatments 33
Interventions for Adolescents and Adults 33
Critical Perspective 34
4. Neurodevelopmental Disorders 39
Prevalence and Comorbidity 40
Assessing ADHD 40
Biopsychosocial Risk and Resilience Influences 43
Onset 43
Course and Recovery 45
Intervention 46
Psychosocial Intervention 46
Medication 47
Critique 47
Critical Perspective 48
Part Three: Schizophrenia Spectrum and Other
Psychotic Disorders
5. Schizophrenia 52
Prevalence and Comorbidity 52
Assessment 53
Biopsychosocial Risk and Resilience Influences 56
Onset 56
Biological Influences 56
Course and Recovery 58
Intervention 59
Medications 59
Psychosocial Interventions 60
Critical Perspective 64
Contents ix
Part Four: Bipolar and Related Disorders
6. Bipolar and Related Disorders 68
Prevalence and Comorbidity 69
Assessment of Bipolar Disorder 71
Biopsychosocial Risk and Resilience Influences 72
Onset 72
Course and Recovery 73
Intervention 76
Medications 76
Psychosocial Interventions 78
Critical Perspective 79
Part Five: Depressive Disorders
7. Depressive Disorders 85
Prevalence and Comorbidity of Depression 85
Assessment 86
Biopsychosocial Risk and Resilience Influences 89
Onset 89
Course and Recovery 90
Intervention 91
Psychotherapy 92
Medication 93
Critical Perspective 96
Part Six: The Anxiety, Obsessive-Compulsive, and Trauma
and Stressor-Related Disorders
8. The Anxiety, Obsessive-Compulsive, and Trauma and Stressor-Related
Disorders 100
Prevalence and Comorbidity 102
Assessment of the Anxiety Disorders 102
Assessment Concerns Specific to PTSD 103
Biopsychosocial Risk and Resilience Influences 105
Onset 105
Course and Recovery 107
Intervention 108
Psychosocial Interventions 108
Medication 110
Critical Perspective 110
x Contents
Part Seven: Feeding and Eating Disorders
9. Eating Disorders 114
Prevalence and Comorbidity 115
Assessment 116
Biopsychosocial Risk and Resilience Influences 118
Onset 118
Course and Recovery 121
Intervention 123
Treatment Settings 123
Psychosocial Interventions 123
Medication 125
Critical Perspective 125
Part Eight: Disruptive, Impulse Control, and Conduct
Disorders
10. Oppositional Defiant Disorder and Conduct Disorder 130
Prevalence and Comorbidity 130
Assessment of Odd and CD 130
Biopsychosocial Risk and Resilience Influences 133
Onset 133
Course and Recovery 135
Interventions for Odd and CD 135
Psychosocial Interventions 135
Medication 136
Critical Perspective 137
Part Nine: Substance-Related and Addictive Disorders
11. Substance-Related and Addictive Disorders 142
Prevalence and Comorbidity 142
Assessment 143
Biopsychosocial Risk and Resilience Influences 147
Onset 147
Course and Recovery 149
Intervention 150
Psychosocial Treatments 151
Pharmacologic Interventions 153
Critical Perspective 155
Contents xi
Part Ten: Neurocognitive Disorders
12. Alzheimer’s Disease 159
Prevalence and Comorbidity 160
Assessment Guidelines 160
Biopsychosocial Risk and Resilience Influences 162
Onset 162
Course and Recovery 163
Intervention 165
Goals 165
Psychosocial Interventions 165
Nutritional Interventions 167
Medications 167
Interventions for Caregivers 168
Critical Perspective 168
Part Eleven: Personality Disorders
13. Borderline Personality Disorder 174
Characteristics of Personality Disorders 175
Borderline Personality Disorder 176
Prevalence and Comorbidity 176
Assessment 177
Biopsychosocial Risk and Resilience Influences 179
Onset 179
Course and Recovery 181
Intervention 183
Psychosocial Interventions 183
Medications 185
Critical Perspective 186
Appendix: Case Workbook 191
Index 268
Preface
Mental Health in Social Work: A Casebook on Diagnosis and Strengths-Based Assessment is a
graduate-level textbook that will help students and professionals learn to understand clients
holistically as they proceed with the assessment and intervention process. A major purpose
of Mental Health in Social Work is to familiarize readers with the American Psychiatric
Association’s Diagnostic and Statistical Manual (DSM) classification of mental disorders.
The primary reasons that social workers need to become conversant with the DSM are
the following: (1) to offer clients appropriate referrals and treatment; (2) to c ommunicate
effectively with other mental health professions; and (3) to be eligible for third-party
reimbursement.
The learning in Mental Health in Social Work primarily occurs through a case study
method; students are asked to respond to case illustrations that are presented in each
chapter. Cases (two to three in each chapter) have been selected to represent the diversity
of people with whom social workers intervene. Answers to the questions posed about each
case are provided in an instructor’s manual and should be discussed in class and/or through
feedback on case study assignments. Note that in order to complete the diagnosis in each
case, readers will have to use the DSM-5.
While gaining competence in DSM diagnosis, the reader is also taught to maintain a
critical perspective on the various DSM diagnoses and the medical model as promulgated
through the DSM. The field of social work has a focus not just on the individual, but on
the person within an environmental context, and concerns itself with strengths as well
as problems. Additionally, social work has a traditional commitment to oppressed and
vulnerable populations. Because the DSM is limited in these areas, Mental Health in
Social Work includes the biopsychosocial risk and resilience perspective, which takes into
account both risks and strengths at the individual and environmental levels. Each c hapter
then explores the relevant risk and protective influences for each disorder, highlighting
some of the particular risks for special populations, including children, women, the elderly,
minorities, people with disabilities, gay and lesbian individuals, and those from low socio-
economic strata. Students are asked to complete risk and resilience assessments for the case
studies presented.
Another emphasis in Mental Health in Social Work is evidence-based treatment, a
recent movement in social work and various other health and mental health disciplines.
The meaning of evidence-based practice can be debated (Norcross, Beutler, & Levant,
2006), but has been generally defined as the prioritization of research evidence when
social workers consider how to best help clients. However, client preferences and avail-
able resources must also be part of the process of clinical judgment in addition to research
studies (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). In considering the
hierarchy of evidence, whenever possible we rely on systematic reviews and meta-analyses,
which are considered “first-line evidence” (Petticrew & Roberts, 2006). These systematic
reviews aim to comprehensively locate and synthesize the treatment outcome literature in
a particular area. If the review lends itself to combining the results of primary studies in a
quantitative way, then it is referred to as meta-analysis (Petticrew & Roberts, 2006).
From these reviews of the literature, Mental Health in Social Work presents treatment
guidelines for each disorder covered in the book, and through the case studies, students
will learn how to form evidence-based treatment plans. At the same time, in keeping with
xii
Preface xiii
the importance of the environmental context, interventions address the broad nature of
the concerns that people bring to social work professionals. For instance, if socioeconomic
problems, such as lack of health insurance and unemployment, are part of the client’s pre-
senting problems, then intervention will appropriately address these concerns, as they are
critical to a person’s well-being and healthy functioning.
The Council on Social Work Education has implemented educational policy and accred-
itation standards that involve competencies and the practice behaviors associated with them
that social workers are to learn. As a result, Mental Health in Social Work has become part of
the Advancing Core Competencies series. The following table demonstrates how the competen-
cies and practice behaviors are an integral part of this book. Additionally, each chapter includes
critical thinking questions that exemplify the competences and practice behaviors.
In summary, this book takes a case study approach, with students applying evidence-
based information on mental disorders to build their social work competency in terms of
assessment and treatment of mental illness.
Social Work Competencies Addressed in Casebook Exercises
Competency Practice behaviors Casebook application
Competency 2.1.1— P.B. 2.1.1a: Readily identify The social work perspective is balanced with the
Identify as a profes- as social work professionals biomedical perspective of DSM with the risk and
sional social worker P.B. 2.1.1c: Manage resilience biopsychosocial assessment. An overall
and conduct oneself assessment interviews with critique of DSM is offered in chapter 1 and for
accordingly clients, using the person- each DSM disorder.
in-environment perspective
Competency 2.1.4— P.B. 2.1.4a: Research A chart for each mental disorder with a discussion
Engage diversity and and apply epidemiologi- of socially diverse populations.
difference in practice cal knowledge of diverse
populations and their
mental/behavioral disorders
P.B. 2.1.4.Fa: Recognize the A critique of the DSM and its association with our
extent to which a culture’s culture’s power structures is presented in chapter 1.
structures and values may
Directions for each case study include Critical
oppress, marginalize,
Perspective: Formulate a critique of the diagnosis
alienate, or create or
as it relates to the case example. Questions
enhance privilege and power
to consider include the following: Does this
diagnosis represent a valid mental disorder from
the social work perspective? How does oppres-
sion, discrimination, and trauma play out in
the development of the disorder? Your critique
should be based on the values of the social work
profession (which are incongruent in some ways
with the medical model) and the validity of the
specific diagnostic criteria applied to this case
(i.e., is this diagnosis significantly different from
other possible diagnoses?).
Competency P.B. 2.1.3c: Identify and Directions for each case study include
2.1.3—Apply critical articulate clients’ strengths Biopsychosocial Risk and Resilience Assessment:
thinking to inform and vulnerabilities as part of Formulate a risk and resilience assessment, both
and communicate the assessment for the onset of the disorder and for the course of
professional the disorder, including the strengths that you see
judgments for this individual and the techniques you would
use to elicit them.
xiv Preface
Competency Practice behaviors Casebook application
Competency 2.1.5— P.B. 2.1.5a: Use knowledge Directions for each case study include Critical
Advance human of the effects of oppression, Perspective: Formulate a critique of the diagnosis
rights and social and discrimination, and trauma as it relates to the case example. Questions to
economic justice on development of clients’ consider include the following: Does this diag-
mental/emotional/behav- nosis represent a valid mental disorder from the
ioral disorders social work perspective? How does oppression,
discrimination, and trauma play out in the devel-
opment of the disorder? Your critique should be
based on the values of the social work profession
(which are incongruent in some ways with the
medical model) and the validity of the specific
diagnostic criteria applied to this case (i.e., is this
diagnosis significantly different from other pos-
sible diagnoses?).
Competency P.B. 2.1.6a: Use research Evidence-based assessment and practice guide-
2.1.6—Engage in knowledge to inform clinical lines are presented based on the latest research
research-informed assessment/diagnosis for each disorder.
practice
Competency 2.1.7— P.B. 2.1.7a: Synthesize and The latest research on etiological factors associ-
Apply knowledge differentially apply biologi- ated with mental disorders in general (chapter 2)
of human behav- cal, developmental, social, and for each mental disorder is presented.
ior and the social and other theories of etiol-
environment ogy associated with specific
mental, emotional, and
behavioral disorders
P.B. 2.1.7b: Use a Directions for each case study include Diagnosis:
biopsychosocial-spiritual Prepare the following: a diagnosis, the rationale
perspective and diagnostic for the diagnosis, and additional information you
classification system to for- would have wanted to know in order to make a
mulate differential diagnoses more accurate diagnosis.
P.B. 2.1.7.Fa: Utilize Strengths-based assessment techniques, solution-
conceptual frameworks focused therapy, and motivational interviewing
to guide the processes of are covered in chapter 2. Theories of evidence-
assessment, intervention, based intervention are covered for each mental
and evaluation. disorder.
P.B 2.1.7b: Critique and Directions for each case study include
apply knowledge to Biopsychosocial Risk and Resilience Assessment:
understand person and Formulate a risk and resilience assessment, both
environment for the onset of the disorder and for the course of
the disorder, including the strengths that you see
for this individual and the techniques you would
use to elicit them.
Competency 2.1.3— P.B. 2.1.3.a: Distinguish, Directions for each case study include Goal
Apply critical thinking appraise, and integrate Setting and Treatment Planning: Given your risk
to inform and com- multiple sources of and resilience assessments of the individual, your
municate professional knowledge, including knowledge of the disorder, and evidence-based
judgments research-based knowledge, practice guidelines, formulate goals and a pos-
P.B. 2.1.3.b: Analyze and practice wisdom (S) sible treatment plan for this individual.
models of assess-
ment, prevention,
intervention, and
evaluation (S)
Preface xv
Competency Practice behaviors Casebook application
Competency P.B. 2.10.d: Collect, Directions for each case study include Diagnosis:
2.1.10—Assess organize, and interpret Given the case information, prepare the
with individuals, data (P) following: a diagnosis, the rationale for the
families, groups, diagnosis, and additional information you would
organizations, and have wanted to know in order to make a more
communities accurate diagnosis.
P.B. 2.10.e: Assess client Directions for each case study include
strengths and limitations (P) Biopsychosocial Risk and Resilience Assessment:
Formulate a risk and resilience assessment, both
for the onset of the disorder and for the course of
the disorder, including the strengths that you see
for this individual and the techniques you would
use to elicit them.
P.B. 2.10.g: Select Directions for each case study include Goal
appropriate intervention Setting and Treatment Planning: Given your risk
strategies (P) and resilience assessments of the individual, your
knowledge of the disorder, and evidence-based
practice guidelines, formulate goals and a pos-
sible treatment plan for this individual.
Acknowledgments
The case studies that make up this book are based on our clinical practice and the
contributions of our students and other professionals. As the application of assessment
competencies is a core element of this book, we are truly grateful to the following students
who offered case contributions: Susan Bienvenu, Treva Bower, Lindsay Doles, Martha Dunn,
Gidget Fields, Lisa Genser, Carolynn Ghiloni, Christine Gigena, Dana Gilmore, Kristine
Kluck, Elizabeth Lincoln, Pamela McDonald, Jodee Mellerio, Cynthia Ormes, Kristi Payne,
Constance Ritter, Zoe Rizzuto, Heather Roberts, Anne Ross, Amelia Schor, Tina Shafer,
Rebecca Sorensen, Megan Vogel, Raquelle Ward, and Dallas Williams. We are also indebted
to the following social work professionals: Kim Giancaspro, Kris McAleavey, and Adina
Shapiro. Most of all, we want to thank Shane Fagan for tirelessly reading over case studies
and offering her valued clinical opinions.
We thank the reviewers for their suggestions: Chrystal Baranti, California State
University; Laura Boisen, Augsberg College; Daphne S. Cain, Louisiana State University;
Rebecca T. Davis, Rutgers University; and Judith H. Rosenberg, Central Connecticut State
University.
As always, thanks to Patrick Corcoran for his diligent and conscientious proofreading,
helping us to prepare the best book we can put forward.
This text is available in a variety of formats—digital and print. To learn more about our
programs, pricing options, and customization, visit www.pearsonhighered.com.
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Chapter 1
Diagnosis and the Social Work
Profession
Henry Williams, a 59-year-old African American, was in the hospital after undergoing surgery for
removal of a brain tumor. His past medical history included seizures, insulin-dependent diabetes
mellitus, and pancreatitis (an inflammation of the pancreas that causes intense pain in the upper
abdomen). Currently, Mr. Williams was taking several medications, including Dilantin (used to
treat epilepsy), insulin, and steroids (to decrease swelling around his tumor).
About six days after the surgery, Mr. Williams woke up in the middle of the night and
was very loud in “casting the demons out,” as he called it. The nurse tried to calm him, but
Mr. Williams was so incensed that he picked up a small monitoring machine next to his bed and
threw it at her. Security officers and the on-duty physician assistant were called to calm the patient.
The next morning, the neurosurgery team requested a psychiatric exam, but because it
was a Friday Mr. Williams was not examined until the following Monday. His family visited over
the weekend, and he repeatedly became agitated, even accusing his wife of cheating on him.
He was upset and emotional during those visits, and it took him a while to calm down after his
family left.
On Sunday night, Mr. Williams got up at midnight and threatened his roommate.
Mr. Williams yelled that his roommate was cheating on him with his wife and they were plotting
to kill him. Because his roommate feared for his safety, he was moved to another room, while
the nurse tried to calm Mr. Williams.
When the psychiatric team, accompanied by the social work intern, finally examined
Mr. Williams, he said he felt great but was hearing voices, most prominently that of his pastor.
He reported that he saw demons at night and was attempting to fight them off. He also stated
that he thought someone wanted to kill him to benefit from his life insurance policy. In addition,
Mr. Williams told the psychiatrist that his wife had not come to visit him for some days (this was
not true; she had been there twice over the weekend) but that his son had been at his bedside
in the morning and that he had enjoyed the visit.
Mr. Williams’s wife heard about the incident with the roommate and said she would not
take Mr. Williams home because she was afraid of him. She told the social work intern that
Mr. Williams had behaved similarly in the past. She would sometimes wake up in the middle of
the night and find him standing next to the bed or leaning over her body, staring at her. When
she confronted her husband, he would pass it off as a joke, saying he was making sure she was
really in bed and had not gone out. (They had separate bedrooms.) She also told the intern that
although she had never cheated on her husband, he had had an affair several years ago. After
she found out, they went to marriage counseling together, but the marriage had been “rocky”
ever since.
1
2 Part One: Assessment
T
he case described is one in which the client, Mr. Williams, appears to have a men-
tal disorder. Almost half of all Americans (46.4%) meet the criteria for a mental,
emotional, or behavioral disorder sometime during their lives (Kessler, Berglund
et al., 2005). The various disorders are catalogued and described in the Diagnostic and
Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric
Association (APA). The DSM is the standard resource for clinical diagnosis in the United
States. The first edition of the DSM was published in 1952, and the manual has undergone
many revisions during the last 60 years. The latest version is DSM-5, published in May 2013.
The definition of mental disorder in DSM-5 (APA, 2013) is a “syndrome character-
ized by clinically significant disturbance in an individual’s cognition, emotion regulation,
or behavior that reflects a dysfunction in the psychological, biological, or developmen-
tal processes underlying mental functioning” (p. 20). Such a disorder usually represents
significant distress in social or occupational functioning. The DSM represents a medical
perspective, only one of many possible perspectives on human behavior. The medical defi-
nition focuses on underlying disturbances within the person and is sometimes referred to
as the disease model of abnormality. This model implies that the abnormal person must
experience changes within the self (rather than create environmental change) in order to be
considered “normal” again.
In its desire to promote the “objectivity” of its manual, the APA does not recognize the
notion of mental illness as a social construction. A social construction is any belief system
in a culture that is accepted as factual or objective by many of its members, when in fact
the belief system is constructed by influential members of that society (Farone, 2003). The
medical profession holds great influence in Western society, so when mental health diagno-
ses are presented as scientifically based disorders, many people accept them as such. Social
constructionism asserts that many “accepted” facts in a society are in fact ideas that reflect
the values of the times in which they emerge.
The foregoing information may explain why the DSM classification system does
not fully represent the knowledge base or values of the social work profession, which
emphasizes a transactional, person-in-situation perspective on human functioning. Still,
the DSM is extensively used by social workers, for many positive reasons. Worldwide,
the medical profession is preeminent in setting standards for mental health practice, and
social workers are extensively employed in mental health settings, where clinical diagno-
sis is considered necessary for selecting appropriate interventions. In fact, social workers
account for more than half of the mental health workforce in the United States (Whitaker,
2009). Competent use of the DSM is beneficial to social workers (and clients) for the
following reasons:
• Social workers are employed in a variety of settings, not just mental health agencies
and facilities, where they meet people who are vulnerable to mental health d isorders
because of poverty, minority status, and other social factors. No matter what
their setting, social workers should be able to recognize the symptoms of possible
disorders in their clients and appropriately refer them for treatment services.
• The diagnostic system provides the partial basis of a comprehensive bio-psycho-
social assessment.
• An accurate diagnosis facilitates the development of a suitable intervention plan
(although many interventions are available for persons with the same diagnosis).
• The diagnostic categories enable social workers to help clients, and possibly also
their families, learn about the nature of the client’s problems. Although stigma is
often attached to the assignment of a diagnostic label, many people take a certain
comfort in learning that their painful experiences can be encapsulated in a diagno-
sis that is shared by others. It validates their experience and offers hope that their
problems can be treated.
Diagnosis and the Social Work Profession 3
• Use of the DSM allows practitioners from various disciplines to converse in a
common language about clients.
• The DSM perspective is incorporated into professional training programs offered
by a variety of human service professions and portions of state social worker
licensing examinations.
• Insurance companies usually require a formal DSM diagnosis for client
reimbursement.
For these many reasons, social workers need to gain competence in DSM diagnosis,
and enabling them to do so is a major purpose of this book. To that end, each chapter cov-
ers a particular mental disorder and is illustrated with two to three case studies on which
readers can practice their skills and knowledge. Cases have been selected to represent the
diversity of people with whom social workers intervene. The disorders chosen for this book
are those that social workers may see in their employment or field settings and that have
sufficient research information behind them. For instance, reactive attachment disorder is
not included, even though child clients may carry this diagnosis, because there has been
relatively little research on the disorder itself, despite the fact that data have been gathered
throughout the years on attachment theory and attachment styles.
We now turn to an overview of the DSM classification system, using the case that
opened the chapter as an illustration. We will later describe some of the tensions involved
in DSM diagnosis as practiced by social workers and discuss how this book will help
develop social workers’ skills in ways that will overcome some of the limitations of the DSM
approach to clinical practice.
The DSM Classification System
Following is a description of the DSM classification system of mental disorders, along with
some general guidelines for its use (APA, 2013).
Beginning with the problem that is most responsible for the current evaluation, the
mental disorder is recorded. Most major diagnoses also contain subtypes or specifiers
(e.g., “mild,” “moderate,” and “severe”) for added diagnostic clarity. When uncertain if a
diagnosis is correct, the social worker should use the “provisional” qualifier, which means
he or she may need additional time or information to be confident about the choice. It is
important to recognize that more than one diagnosis can be used for a client, and medical
diagnoses should also be included if they are significant to the client’s overall condition.
Social workers cannot make medical diagnoses, of course, but they can be included if they
are noted in a client’s history or the client reports their existence. Further, if a person no
longer meets criteria for a disorder that may be relevant to his or her current condition, the
qualifier “past history” can be used, although this would not be the primary diagnosis. For
example, if a woman seeks help for depression while she is pregnant, it may be important
to note if she had an eating disorder history. Social and environmental problems that are
a focus of clinical attention may also be included as part of the diagnosis. A chapter in the
DSM titled “Other Conditions That May Be a Focus of Clinical Attention” includes a list of
conditions (popularly known as V-codes) that are not considered formal diagnoses but can
be used for that descriptive purpose.
Following is a list of “hierarchical principles” that can help the practitioner decide
which diagnoses to use in situations where several might be considered:
• “Disorders due to a general medical condition” and “substance-induced disorders,”
which include not only substances people consume but also medications they are
prescribed, preempt a diagnosis of any other disorder that could produce the same
symptoms.
4 Part One: Assessment
• The fewer diagnoses that account for the symptoms, the better. This is the rule of
“parsimony.” Practitioners need to understand the “power of the diagnostic label,”
in its negative as well as positive aspects, and use diagnostic labels judiciously. For
example, posttraumatic stress disorder (PTSD) and reactive attachment disorder
are sometimes diagnosed simultaneously in children. Although they share some
presentation, when they are used together, the diagnostic picture becomes impre-
cise and does not lead to a coherent treatment plan.
• When a more pervasive disorder has essential or associated symptoms that are
the defining symptoms of a less pervasive disorder, the more pervasive d isorder
is diagnosed if its criteria are met. For example, if symptoms of both “autism
spectrum disorder” and “specific communication disorder” are present, the social
worker should use the former diagnosis, because its range of criteria overlaps with
the latter one (see chapter 3 for case examples).
The principles outlined earlier are, of course, applied only after a comprehensive client
a ssessment is carried out. Each chapter in this book includes assessment principles relevant
to specific disorders, but here we present some general guidelines for the assessment of a
client’s mental, emotional, and behavioral functioning.
Mental Status Examination
A Mental Status Examination (MSE) is a process by which a social worker or other human
services professional systematically examines the quality of a client’s mental functioning.
Ten areas of functioning are considered individually. The results of the examination are
combined with information derived from a client’s social history to produce clinical
impressions of the client, including a DSM diagnosis. An MSE can typically be completed
in 15 minutes or less. One commonly used format for an MSE evaluates the following areas
of client functioning (Daniel & Gurczynski, 2003):
• Appearance. The person’s overall appearance in the context of his or her cultural
group. These features are significant because poor personal hygiene or grooming may
reflect a physical inability to care for one’s physical self or a loss of interest in doing so.
• Movement and behavior. The person’s manner of walking, posture, coordination,
eye contact, and facial expressions. Problems with walking or coordination may
reflect a disorder of the central nervous system.
• Affect. This refers to a person’s outwardly observable emotional reactions and may
include either a lack of emotional response or an overreaction to an event.
• Mood. The underlying emotional tone of the person’s answers.
• Speech. The volume of the person’s voice, the rate or speed of speech, the length of
answers to questions, and the appropriateness and clarity of the answers.
• Thought content. Any indications in the client’s words or behaviors of hallucina-
tions, delusions, obsessions, symptoms of dissociation, or thoughts of suicide.
• Thought process. The logical connections between thoughts and their relevance to
the conversation. Irrelevant detail, repeated words and phrases, interrupted thinking,
and illogical connections between thoughts may be signs of a thought disorder.
• Cognition. The act or condition of knowing. The social worker assesses the per-
son’s orientation with regard to time, place, and personal identity; long- and short-
term memory; ability to perform simple arithmetic (counting backward by threes
or sevens); general intellectual level or fund of knowledge (identifying the last five
presidents, or similar questions); ability to think abstractly (explaining a proverb);
ability to name specified objects and read or write complete sentences; ability to
understand and perform a task (showing the examiner how to comb one’s hair or
Diagnosis and the Social Work Profession 5
throw a ball); ability to draw a simple map or copy a design or geometrical figure;
ability to distinguish between right and left.
• Judgment. The social worker asks the person what he or she would do about a
commonsense problem, such as running out of a prescription medication.
• Insight. A person’s ability to recognize a problem and understand its nature and
severity.
Abnormal results for an MSE include any evidence of brain damage or thought dis-
orders, a mood or affect that is clearly inappropriate to its context, thoughts of suicide,
disturbed speech patterns, dissociative symptoms, and delusions or hallucinations.
Directions: Now that you have read a description of the diagnostic system,
h ierarchical principles, and an MSE, can you work out a diagnosis for Henry
Williams before reading ahead?
Diagnosis
Diagnosis of Mr. Williams
292.12 Medication-induced psychotic disorder, with onset during intoxication,
severe
F19.959 without use disorder
250.01 Insulin-dependent diabetes mellitus
225.2 Meningioma (cerebral)
345.10 Seizure disorder
577.1 Pancreatitis
V61.10 Relational distress with spouse
Rationale for the Diagnosis
Medication (steroid)–induced psychotic disorder was diagnosed because Mr. Williams’s
symptoms began a few days after he started to take the medication. Steroids can affect the
limbic system, causing aggression and emotional outbursts. Although this diagnosis would
have to be made by medical personnel, the social worker should be aware that the symp-
toms of apparent mental disorders may result from a medical condition or from medication
used to treat the condition. A diagnosis of psychotic disorder due to a medical condition
was excluded because Mr. Williams did not show symptoms before or immediately after
the craniotomy was performed. They developed six days after the surgery.
The “with onset during intoxication” specifier was used because the symptoms devel-
oped after Mr. Williams began taking the medication, rather than after he terminated it
(which would be a withdrawal state). The “severe” specifier indicates that the symptoms
(delusions and hallucinations) are dramatic, present, and severe. (The delusions may have
Another Random Scribd Document
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Mathematics - Course Outline
Fall 2022 - Laboratory
Prepared by: Prof. Davis
Date: August 12, 2025
Unit 1: Practical applications and examples
Learning Objective 1: Experimental procedures and results
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Case studies and real-world applications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 3: Assessment criteria and rubrics
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Learning outcomes and objectives
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 5: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Problem-solving strategies and techniques
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 6: Interdisciplinary approaches
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 7: Diagram/Chart/Graph]
Note: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 8: Fundamental concepts and principles
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Study tips and learning strategies
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 10: Diagram/Chart/Graph]
Module 2: Critical analysis and evaluation
Practice Problem 10: Theoretical framework and methodology
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 11: Study tips and learning strategies
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Research findings and conclusions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 13: Diagram/Chart/Graph]
Definition: Learning outcomes and objectives
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Interdisciplinary approaches
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Practical applications and examples
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 16: Diagram/Chart/Graph]
Example 16: Comparative analysis and synthesis
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 17: Diagram/Chart/Graph]
Definition: Comparative analysis and synthesis
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Critical analysis and evaluation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 19: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Abstract 3: Case studies and real-world applications
Important: Research findings and conclusions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 21: Diagram/Chart/Graph]
Example 21: Assessment criteria and rubrics
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 22: Diagram/Chart/Graph]
Remember: Statistical analysis and interpretation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 23: Diagram/Chart/Graph]
Note: Assessment criteria and rubrics
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Assessment criteria and rubrics
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 25: Learning outcomes and objectives
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 26: Experimental procedures and results
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 27: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Experimental procedures and results
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice 4: Experimental procedures and results
Key Concept: Key terms and definitions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Learning outcomes and objectives
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Statistical analysis and interpretation
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 33: Diagram/Chart/Graph]
Practice Problem 33: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Learning outcomes and objectives
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Comparative analysis and synthesis
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Interdisciplinary approaches
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 38: Case studies and real-world applications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Part 5: Current trends and future directions
Remember: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 41: Historical development and evolution
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Interdisciplinary approaches
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Ethical considerations and implications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 46: Diagram/Chart/Graph]
Practice Problem 46: Literature review and discussion
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Statistical analysis and interpretation
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Theoretical framework and methodology
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice 6: Ethical considerations and implications
Practice Problem 50: Assessment criteria and rubrics
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 51: Historical development and evolution
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 53: Assessment criteria and rubrics
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 54: Ethical considerations and implications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Case studies and real-world applications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 56: Diagram/Chart/Graph]
Definition: Literature review and discussion
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Current trends and future directions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 58: Practical applications and examples
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Research findings and conclusions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Module 7: Historical development and evolution
Note: Experimental procedures and results
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 61: Experimental procedures and results
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Study tips and learning strategies
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Study tips and learning strategies
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Case studies and real-world applications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Theoretical framework and methodology
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Case studies and real-world applications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Best practices and recommendations
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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