COMPONENTS OF 

 DISCHARGE PLANNING

1. History/Assessment

2. Treatment Provided

3. Follow-up Needed

STEPS IN THE PROBLEM-SOLVING PROCESS

1. Engagement

2. Assessment

3. Planning

4. Intervention

5. Evaluation

6. Termination

ENGAGEMENT phase (1st session w/ client) includes

• Finding out why client is there
• Why client is seeking services now
• Explaining the role of the SW/what to expect in tx
• Listening to client explain situation
• Explaining limits of confidentiality

Maslow's hierarchy of needs

(which are listed in priority order, starting with base of pyramid)

1. Physiological,
2. safety,
3. social (love & belonging),
4. esteem,
5. self-actualization
   
   (1st 4 are "D needs"/deficiency needs; last/top one = growth needs or "B needs"/being needs)

• Client w/ acute medical prob(needs 1st) a medical eval;
• DV victim = address medical & safety issues;
• Refugee = address shelter, food, income & clothing BEFORE working on fulfilling higher levels

1. Physiological

2. Safety

3. Social

4. Esteem

Physiological needs

Necessary to maintain life:

food, water, oxygen, feasible body temperature

Safety needs

To FEEL safe from harm, danger, or threat of destruction. (include safety AND a degree of predictability)

Social needs

Friendship, intimacy, affection & love

(from co-workers, family, friends, romantic partners)

ESTEEM needs

A stable, firmly based level of self-respect

and respect from others

Self-actualization needs

(the one category of "growth" needs in Maslow's hierarchy)

• To be oneself
• An ongoing process that involves developing one's potential.
• Makes true objectivity possible: permits dealing w/ the world as it is, rather than as one NEEDS it to be.
• You're free to really do what you want to do; everything is right (peak experience), so you're in a position to find your true calling.
  Only 1% of population consistently operates at this level. 

Erik ERIKSON's theory of personality development 

Looks at how people socialize & how this affects their sense of self & development of personality throughout the life course.   

identified 8 stages of social development, each w/ an identity crisis that yields 2 possible outcomes (ABC vs XYZ). Successful completion of each stage=> health personality/successful interactions with others. Stages NOT completed successfully during the original time period CAN be resolved at a later time of life.

Developing social competencies enhances MH, success in work, & ability to achieve life tasks.

ERIKSON'S 8 stages of development

• birth to 1: trust vs. mistrust
• age 1 to 3: autonomy vs. shame/doubt
• age 3 to 6: initiative vs. guilt
• 6 to puberty: industry vs. inferiority
• adolescence: identity vs. role confusion
• young adulthood: intimacy vs. isolation
• middle adulthood: generativity vs. stagnation
• older adults: ego integrity vs. despair

Infancy (birth to age 1)

Erikson's 1st of 8 stages of development

 trust vs. mistrust 

Based on consistency of caregiver(s)

Success = ability to feel secure even when threatened (vs inability to trust, fear, anxiety, insecurities)

Age 1 to 3 

Erikson's 2nd stage of development

 autonomy vs. shame & doubt

Kids assert independence; walk away from Mom, pick which toy to play with, make choices re food, clothes etc. 

If encouraged/supported, kid gains confidence/security in ability to survive out in the world.

Too much criticism/control can lead to kid doubting ability to survive & can make them overly dependent on others.

Ages 3 to 6

Erikson's 3rd stage of development

Initiative vs. guilt (think Elliot W)

Kids assert themselves more often; start to plan activities, make up games, initiate play with others. 

Success = a sense of initiative & feeling of security to lead others/make decisions.

If no opportunities to do this, kids feel guilty/a nuisance to others & will remain followers (lack self-initiative)

Age 6 to puberty 

Erikson's 4th stage of development

Industry vs. Inferiority

 Kids start developing a sense of pride in their accomplishments, completed projects & achievements. Reinforcement/encouragement of this=> feeling industrious & confident. If their efforts are restricted, kids start to feel inferior, doubt their abilities and fail to reach their potential. 

Identity vs. role confusion

in ADOLESCENCE - Erikson's 5th stage of development

Transition from childhood to adulthood; kids become more independent and think about future life choices, explore possibilities & on the basis of that exploration, begin to form own identities. If their sense of who they are is hindered, they can become confused about themselves & their role in the world.  

Intimacy vs. Isolation

Erikson's 6th stage of development: Young Adulthood.

 People begin to share themselves more intimately with others & explore long-term committed relationships outside their families. 

Success can = comfortable relationships that include a sense of commitment, safety & care.

Avoiding intimacy & fearing commitment can lead to isolation, loneliness, sometimes depression.

Generativity vs Stagnation

Middle adulthood - Erikson's 7th stage of development

If individuals fail to achieve this stage's objectives (raising children, productivity at work, involvement in community activities/organizations) they may become stagnant and feel unproductive.

Ego Integrity vs. Despair

Older adulthood/senior citizens - 

Erikson's 8th & last stage of development

If happy with the progression of their lives & their achievements=> sense of ego integrity

self-perception of being unproductive/failing to accomplish life goals => dissatisfaction with life/despair/possibly depression & hopelessness

Six levels of cognition

1. Knowledge: rote memorization, recognition, or recall of facts
2. Comprehension understanding what the facts mean
3. Application - correct use of the facts, rules or ideas
4. Analysis - breaking down info into component parts
5. Synthesis  - combination of facts, ideas or info to make a new whole
6. Evaluation - judging or forming an opinion about the info or situation

EXAM LINGO

Refer can mean "inform client about" (vs send client away to another agy) 

Confront could mean calling attention to something (not necessarily in a negative way) and 

Contract could refer to a treatment plan (or agreement between client & SW), as opposed to a safety plan.

mnemonic for 1st/NEXT-type case vignettes

FAREAFI

Feelings acknowledged

Assess

Refer

Educate

Advocate

Facilitate

Intervene

mnemonic for BEST/MOST-type 

case vignettes

AASPIRINS

Acknowledge client pain

Assess

Start where the client is

Protect life (of client & community)

Intoxicated - do not treat; refer

Rule out medical issue

Informed consent

Non-judgmental stance

Support patient self-dermination

three DOMAINS of development

1.  Cognitive - mental skills - knowledge

   ---

2. Affective -growth in feelings or emotional areas (attitude or self)

   ---

3. Psychomotor - manual or physical skills

Piaget's theory of 

cognitive development

4 stages of cognitive development - how humans gradually come to acquire knowledge. Kids learn through interaction with environment & with each other.

EQUIFINALITY 
(family systems theory)

Idea that families, which are goal-oriented, can reach the same goals through different routes.

Stages of change

1   Precontemplation (denial/ignoring)

2   Contemplation (ambivalence)

3   Preparation (maybe experiment w/ small changes)

4   Action - movement toward the goal

5   maintenance - sustained behavior

6   relapse

SOAP note

Method of documentation in medical records: 

Subjective findings

Objective findings

Assessment - combination of those

Plan

Erikson stages

1) trust vs mistrust (1st year of life)

2) autonomy vs shame/doubt (age 1 to 3)

3) initiative vs guilt (3 to 6)

4) industry vs inferiority (6 to puberty)

5) identity vs role confusion - adolescence

6) intimacy vs isolation - young adulthood

7) generativity vs stagnation - middle adulthood

8) ego integrity vs despair - old age 

Hierarchies 
(in family systems theory)

A concept that describes how families organize themselves into smaller subsystems that make up the larger family system. When lines get crossed (members/tasks of different subsystems are blurred), family difficulties result. 

(i.e., when a child gets involved in marital issues)

Family systems theory - basic assumptions

* A health family has flexibility, consistent structure, and effective exchange of information

* Family = an interactional system whose component parts have constantly shifting boundaries + varying degrees of resistance to change

Negative feedback loops

Patterns of interaction that help families achieve homeostasis/sense of balance; negative feedback loops maintain stability or consistency while minimizing change. 

(vs. positive feedback loops, which facilitate change or movement either toward growth or toward dissolution)

Agnosia

vs

Aphasia

vs 

Ataxia

Agnosia = difficulty recognizing familiar objects

Aphasia = difficulty with language

Ataxia = difficulty  with motor skills

Components of a sexual history

Partners: number, gender, risk factors, length of relationships

Practices: risk behaviors, vaginal/anal/oral, satisfaction with, desire/arousal/orgasm

Protection from/hx of STDs

Birth control/reproductive history

Antipsychotics

(used for schizophrenia & mania)

typical

Haldol (haloperidol)

Loxitane (loxipane)

Mellaril (thioridazine)

Moban, Navane, Prolixin, Serentil, Stelazine

Thorazine (chlopromazine)

Trilafon

less typical:

Abilify, clozapine, Geodon, risperidone, Seroquel, Zyprexa

Tardive dyskinesia

Side effect from long-term, high-dosage use of antipsychotic meds.

Abnormal involuntary movements of tongue, lips, jaw, face; twitching and snakelike movement of extremities

(+ occasionally of the trunk)

Mood stabilizers

(aka amtimanic agents)

Used for bipolar disorder:

Depakene (valproic acide, divalproex sodium)

Depakote sprinkles

Lamictal/lamotrigine

Lithium, Eskalith, Lithobid

Tegretol (carbamazepine), Carbotrol

Topamax (topiramate)

Precautions with lithium 

*Narrow therapeutic index (small difference between therapeutic level and toxic level) requires regular checks of  blood levels of lithium

* Periodic checks of thyroid and kidney function

Antidepressants

SSRIs: Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft

Tricyclics: Anafranil (clomipramine), Asendin, Elavil, Norpramin, Pamelor, Sinequan (doxepin), Surmontil, Tofranil, Vivactil

MAOs  Nardil (phenalzine) and Parnate (tranylcypromine)

Others: Desyrel (trazodone), Effexor, Remeron, Zerzone, Wellbutrin

Antianxiety drugs

Benzodiazapines (mainly used for treating anxiety, but also effective in treating several other things)

Ativan (lorazepam)

Buspar

Klonopin

Valium
Xanax

Stimulants used for ADHD

Adderall (amphetamine, mixed salts)

Concerta (methylphenidate)

Dexedrine (dextroamphetamine)

Metadate (methylphenidate)

Ritalin

ASSESSMENT TOOLS

(besides Meyers Briggs)

Beck Depression Inventory (teens & adults, 21 mult.ch ?s)

Minnesota Multiphasic Personality Inventory (for psychopathology) (550 statements with 16 repeats)

Stanford-Binet Intelligence Scale-cognitive abilities, kids/adults; Wechsler Intelligence Scale - kids only

Widely used projective tests

Rohrschach Inkblot - tests perceptions, etc.

Thematic Apperception Test (TAT) - clients describe past/present/future for series of pics of ambiguous scenes, along with thoughts & feelings. Tests perception & imagination to understand clt's needs, motivations, conflicts (both conscious & not)

Freud's 3 levels of awareness

-the conscious - contains what you're paying attention to at a given time

-the preconscious - all the info outside of a client's attention but readily available if needed

- the unconscious - contains thoughts, feelings, desires, memories of which client has no awareness that that influence day-to-day life