Wednesday, August 15, 2012

License Exam: Multi-axial Diagnosis

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MULTIAXIAL DIAGNOSIS

In the DSM-IV-TR system, an individual is diagnosed on five different domains, or "axes." In a single axis system, an individual would be diagnosed in just one domain (for example, a clinical disorder, such as major depressive disorder, would be assigned). This, however, conveys very limited information on what can be a very complex clinical picture. The multi-axial system in DSM-IV-TR was developed in part in order to capture more of the complexity surrounding psychiatric conditions. In the DSM-IV-TR, each axis can convey important information about both the symptoms experienced by the individual and the context surrounding those symptoms.

Axis I: Clinical Disorders

Major psychiatric disorders are diagnosed on Axis I. When you think of a "psychiatric diagnosis," these are the kinds of disorders that probably come to mind. For example, major depressive disorder andposttraumatic stress disorder are diagnosed on Axis I. Disorders of learning, such as reading or arithmetic disorders, and developmental disabilities, such asautistic disorder, are also diagnosed on Axis I. Axis I tends to be reserved for major disorders that are thought to be somewhat episodic (i.e., they typically have a clear onset and periods of remission or recovery). But, this is not true of all Axis I disorders (e.g., autistic disorder is not an episodic condition).

Axis II: Personality Disorders or Mental Retardation

Axis II also includes some conditions that we might consider "psychiatric disorders," but these are thought to be longer-standing conditions that are typically present before age 18. The personality disorders are longstanding, pervasive patterns of thinking and behavior that usually appear before the age of 18 but are typically diagnosed after 18 (when the personality is considered more fully formed). These disorders are not thought of as episodic; they are considered stable and chronic (although there is some recent research suggesting otherwise). Mental retardation (or MR) is also a long-standing condition (it must be present before the age of 18) that is stable over time. MR refers to significantly below average intellectual functioning combined with deficits in adaptive behavior. One rationale for the diagnosis of personality disorders and MR on Axis II is that these are chronic conditions that should be separated from Axis I conditions in order to allow them to be highlighted, since they convey important additional diagnostic information. There is some controversy, however, about whether personality disorders are truly qualitatively different than Axis I clinical disorders, and whether they should remain on Axis II.

Axis III: Medical or Physical Conditions

Axis III is reserved for medical or physical conditions that may affect or be affected by mental health issues. For example, if someone has cancer, and their illness and treatment are affecting their mental health, that would be important information to be conveyed in the diagnosis. So, the cancer diagnosis would be included on Axis III. Alternatively, someone might have a medical condition that is impacted by their mental health. For example, someone with diabetes might not comply with their medical treatment regimen if they have a psychiatric disorder that causes impulsive or erratic behavior. Diagnosing the medical illness on Axis III might alert a clinician of a potential problem.


Axis IV: Contributing Environmental or Psychosocial Factors

Often, a psychiatric diagnosis happens in the context of major environmental or social stressors. For example, job loss, divorce, financial problems, or homelessness may contribute to the development or maintenance of a mental health condition (alternatively, a psychiatric disorder can contribute to the development of these stressors). These important contextual factors are coded on Axis IV.

Axis V: Global Assessment of Functioning

The last axis, Axis V, is reserved for the global assessment of functioning, or GAF. The GAF is a number between 0 and 100 which is meant to indicate level of functioning, or a person's ability to engage in adaptive daily living. Lower scores indicate lower functioning, with a score of zero indicating that a person is incapable or maintaining their own safety or basic hygiene, or is an imminent threat to the safety or welfare of others. Scores near 100 indicate superior functioning.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revision.Washington, DC, Author, 2000.
Bernstein, DP, Iscan, C, Maser, J, Board of Directors, Association for Research in Personality Disorder, & Board of Directors, International Society for the Study of Personality Disorders. "Opinions of personality disorder experts regarding the DSM-IV Personality Disorders classification system." Journal of Personality Disorders, 21:536-551, 2007.

Monday, August 13, 2012

License Exam: Differential Diagnosis Decision Trees


DSM Decision Trees for Differential Diagnosis

The purpose of these decision trees is to aid the clinician in understanding the organization and hierarchical structure of the DSM-IV Classification. Each decision tree starts with a set of clinical features. When one of these features is a prominent part of the presenting clinical picture, the clinician can follow the series of questions to rule in or rule out various disorders. Note that the questions are only approximations of the diagnostic criteria and are not meant to replace them.

The Psychotic Disorders decision tree is the only one that contains disorders that are mutually exclusive (i.e., only one disorder from that section can be diagnosed in a given individual for a particular episode). For the other decision trees, it is important to refer to the individual criteria sets to determine when more than one diagnosis may apply.

Contents

I. Differential Diagnosis of Mental Disorders Due to a General Medical Condition

II. Differential Diagnosis of Substance-Induced Disorders

III. Differential Diagnosis of Psychotic Disorders

IV. Differential Diagnosis of Mood Disorders

V. Differential Diagnosis of Anxiety Disorders

VI. Differential Diagnosis of Somatoform Disorders

Monday, August 6, 2012

License Exam: Community Practice

Community Practice

SWOT Analysis from Community Toolbox

Friday, August 3, 2012

License Exam resource: Wikipedia Psychology Portal


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Wednesday, August 1, 2012

NASW Social Work Code of Ethics (English and Spanish)

Code of Ethics (English and Spanish)


Preamble

The primary mission of the social work profession is to enhance human well­being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. A historic and defining feature of social work is the profession’s focus on individual well­being in a social context and the well­being of society. Fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living.
Social workers promote social justice and social change with and on behalf of clients. “Clients” is used inclusively to refer to individuals, families, groups, organizations, and communities. Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice. These activities may be in the form of direct practice, community organizing, supervision, consultation administration, advocacy, social and political action, policy development and implementation, education, and research and evaluation. Social workers seek to enhance the capacity of people to address their own needs. Social workers also seek to promote the responsiveness of organizations, communities, and other social institutions to individuals’ needs and social problems.
The mission of the social work profession is rooted in a set of core values. These core values, embraced by social workers throughout the profession’s history, are the foundation of social work’s unique purpose and perspective:
  • service
  • social justice
  • dignity and worth of the person
  • importance of human relationships
  • integrity
  • competence.
This constellation of core values reflects what is unique to the social work profession. Core values, and the principles that flow from them, must be balanced within the context and complexity of the human experience.


Ethical Principles

The following broad ethical principles are based on social work’s core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. These principles set forth ideals to which all social workers should aspire.

Value: Service

Ethical Principle: Social workers’ primary goal is to help people in need and to address social problems. 
Social workers elevate service to others above self­interest. Social workers draw on their knowledge, values, and skills to help people in need and to address social problems. Social workers are encouraged to volunteer some portion of their professional skills with no expectation of significant financial return (pro bono service).

Value: Social Justice

Ethical Principle: Social workers challenge social injustice. 
Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers’ social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. These activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people.

Value: Dignity and Worth of the Person

Ethical Principle: Social workers respect the inherent dignity and worth of the person. 
Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. Social workers promote clients’ socially responsible self­determination. Social workers seek to enhance clients’ capacity and opportunity to change and to address their own needs. Social workers are cognizant of their dual responsibility to clients and to the broader society. They seek to resolve conflicts between clients’ interests and the broader society’s interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession.

Value: Importance of Human Relationships

Ethical Principle: Social workers recognize the central importance of human relationships. 
Social workers understand that relationships between and among people are an important vehicle for change. Social workers engage people as partners in the helping process. Social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well­being of individuals, families, social groups, organizations, and communities.

Value: Integrity

Ethical Principle: Social workers behave in a trustworthy manner. 
Social workers are continually aware of the profession’s mission, values, ethical principles, and ethical standards and practice in a manner consistent with them. Social workers act honestly and responsibly and promote ethical practices on the part of the organizations with which they are affiliated.

Value: Competence

Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional expertise. 
Social workers continually strive to increase their professional knowledge and skills and to apply them in practice. Social workers should aspire to contribute to the knowledge base of the profession.


Purpose of the NASW Code of Ethics

Professional ethics are at the core of social work. The profession has an obligation to articulate its basic values, ethical principles, and ethical standards. The NASW Code of Ethics sets forth these values, principles, and standards to guide social workers’ conduct. The Code is relevant to all social workers and social work students, regardless of their professional functions, the settings in which they work, or the populations they serve.
The NASW Code of Ethics serves six purposes:
  1. The Code identifies core values on which social work’s mission is based.
  2. The Code summarizes broad ethical principles that reflect the profession’s core values and establishes a set of specific ethical standards that should be used to guide social work practice. 
  3. The Code is designed to help social workers identify relevant considerations when professional obligations conflict or ethical uncertainties arise. 
  4. The Code provides ethical standards to which the general public can hold the social work profession accountable. 
  5. The Code socializes practitioners new to the field to social work’s mission, values, ethical principles, and ethical standards. 
  6. The Code articulates standards that the social work profession itself can use to assess whether social workers have engaged in unethical conduct. NASW has formal procedures to adjudicate ethics complaints filed against its members.* In subscribing to this Code, social workers are required to cooperate in its implementation, participate in NASW adjudication proceedings, and abide by any NASW disciplinary rulings or sanctions based on it.
The Code offers a set of values, principles, and standards to guide decision making and conduct when ethical issues arise. It does not provide a set of rules that prescribe how social workers should act in all situations. Specific applications of theCode must take into account the context in which it is being considered and the possibility of conflicts among the Code‘svalues, principles, and standards. Ethical responsibilities flow from all human relationships, from the personal and familial to the social and professional.

Further, the NASW Code of Ethics does not specify which values, principles, and standards are most important and ought to outweigh others in instances when they conflict. Reasonable differences of opinion can and do exist among social workers with respect to the ways in which values, ethical principles, and ethical standards should be rank ordered when they conflict. Ethical decision making in a given situation must apply the informed judgment of the individual social worker and should also consider how the issues would be judged in a peer review process where the ethical standards of the profession would be applied.

Ethical decision making is a process. There are many instances in social work where simple answers are not available to resolve complex ethical issues. Social workers should take into consideration all the values, principles, and standards in this Code that are relevant to any situation in which ethical judgment is warranted. Social workers’ decisions and actions should be consistent with the spirit as well as the letter of this Code.

In addition to this Code, there are many other sources of information about ethical thinking that may be useful. Social workers should consider ethical theory and principles generally, social work theory and research, laws, regulations, agency policies, and other relevant codes of ethics, recognizing that among codes of ethics social workers should consider theNASW Code of Ethics as their primary source. Social workers also should be aware of the impact on ethical decision making of their clients’ and their own personal values and cultural and religious beliefs and practices. They should be aware of any conflicts between personal and professional values and deal with them responsibly. For additional guidance social workers should consult the relevant literature on professional ethics and ethical decision making and seek appropriate consultation when faced with ethical dilemmas. This may involve consultation with an agency­based or social work organization’s ethics committee, a regulatory body, knowledgeable colleagues, supervisors, or legal counsel.

Instances may arise when social workers’ ethical obligations conflict with agency policies or relevant laws or regulations. When such con­flicts occur, social workers must make a responsible effort to resolve the conflict in a manner that is consistent with the values, principles, and standards expressed in this Code. If a reasonable resolution of the conflict does not appear possible, social workers should seek proper consultation before making a decision.

The NASW Code of Ethics is to be used by NASW and by individuals, agencies, organizations, and bodies (such as licensing and regulatory boards, professional liability insurance providers, courts of law, agency boards of directors, government agencies, and other professional groups) that choose to adopt it or use it as a frame of reference. Violation of standards in this Code does not automatically imply legal liability or violation of the law. Such determination can only be made in the context of legal and judicial proceedings. Alleged violations of the Code would be subject to a peer review process. Such processes are generally separate from legal or administrative procedures and insulated from legal review or proceedings to allow the profession to counsel and discipline its own members.

A code of ethics cannot guarantee ethical behavior. Moreover, a code of ethics cannot resolve all ethical issues or disputes or capture the richness and complexity involved in striving to make responsible choices within a moral community. Rather, a code of ethics sets forth values, ethical principles, and ethical standards to which professionals aspire and by which their actions can be judged. Social workers’ ethical behavior should result from their personal commitment to engage in ethical practice. The NASW Code of Ethics reflects the commitment of all social workers to uphold the profession’s values and to act ethically. Principles and standards must be applied by individuals of good character who discern moral questions and, in good faith, seek to make reliable ethical judgments.

Monday, July 23, 2012

License Exam: The Social Work Intervention Model / Problem-Solving Method

View each question in light of how you would approach work with a client, as a process of social work, and in time-order.  In other words, what do you do FIRST when you are assisting a client?  What happens NEXT in the process?

 

ENGAGE > COLLECT INFO > ASSESS  > SET GOALS / PLAN TREATMENT > EVALUATE > TERMINATE

1. Engage the client.  Develop rapport and cultivate the professional/therapeutic relationship.

2. Collect information from the client, relevant to the challenges that brought her to seek services

3. Assess the client’s needs with this information (may include diagnosis in some social work roles)

4. Set goals for and plan treatment, always putting the client’s needs first, as well as her choices about challenges to address and the methods used.  Keep in the forefront of your mind that every client is a worthy person with the right to self-determination.

5. Evaluate the work done, including process, methods, outcomes, and progress made

6. Terminate the relationship with the client in a manner that supports her continuing human needs.

 

Another perspective on the social work process stresses the importance of aiding clients as they address their own challenges, whereby social workers use the least-invasive methods and intervene only after assisting in other ways:.

1. Feelings

2. Assess

3. Refer

4. Educate

5. Advocate

6. Facilitate

7. Intervene

Tuesday, June 19, 2012

NPR Audio: Coping With College And Mental Illness

Entering College (with Autism, ADHD, and Depression)

 An Autistic Student's Journey To College : NPR

On Morning Edition, a great story about managing in college when one is diagnosed with mental health issues.  In this story, a student entering college talks about registering with Disability Services on-campus when he's dealt with several long-term illnesses from a young age.  He mentions planning to register with the office, even though he doesn't feel as if he needs services now -- he wants them to know that he comes with diagnoses and that now at the school.

It's smart to register because you get to learn about possible services that can be of immense help and you also have a contact to guide you through the process, who can also step in if   They talk about making the transition from home to school and necessary steps they need to take to make his experience successful.

Many students either don't know they have a mental/behavioral health disorder, or are in the dark about how to get help or the fact that they deserve support int he form of accommodations.  However, the Americans with Disabilities Act (ADA) ensures that a wide variety of accommodations are available for people with all types of disabilities (or, rather, different abilities from the majority) that help everyone to exist on more level playing field, and, in effect, increasing social justice in our culture.

Too often, work flow proceeds in a traditional way that no one questions because they have no trouble following those practices.  It's always been (done) that way?  But, discerning critical thinkers realize that these are just as socially created as "work" is itself.  There are a million different ways to do most tasks and to be productive.  Using the resources offered by the ADA is a way of celebrating the rights of all people, even those in the majority as far as abilities go.