Part IV (20)

1. You are called to evaluate a 64-year-old male with chronic obstructive pulmonary disease. He lives in an assisted living facility, and was brought to the emergency room by his daughter. She had taken him to lunch, and became distressed when he refused to return to the facility. He states he wants to live in his motor home, as he resents the loss of privacy at the facility. His daughter confirms he owns a working, fully self-contained motor home (i.e., stove, shower, refrigerator, etc). He has adequate funds. He plans to park the motor home in a nearby Kampgrounds of America (KOA) campground, where all utilities can be hooked up. He can have food and other supplies delivered. However, it is November and it is unseasonably cold. The doctor confirms that the patient is prone to pneumonia, and the daughter states "he will die if he doesn't return to the facility." The patient refuses to consider any other living situation. In this situation, the social worker should:

a. Call the police and have them take the patient back to the facility.
b. Call adult protective services for further intervention.
c. Allow the patient to move into his motor home.
d. Place the patient on an involuntary hold for suicidal behavior. 

2. You have just had your first session with a 24-year-old college student. She is seeing you following the break-up of a two-year relationship, which occurred without warning about six weeks prior to this visit. As she explained it, "He met someone else and just moved on." She has been having trouble sleeping and concentrating on her studies since that time. Today she presents as dysphoric and tearful, but is affectively expressive and responsive to humor and other interactive stimuli. The university she attends is a considerable distance from her family and friends, leaving her with limited support during this difficult time. The most appropriate diagnosis would be:

a. Primary insomnia.
b. Major depression.
c. Adjustment disorder with depressed mood.
d. Acute stress disorder. 

3. You are hired by a private practice therapist who operates a court-supervised violent offender treatment program. One of your responsibilities is to screen new client referrals, to ensure that only low-risk, first-time offenders are accepted into the program. In this process, you are to have each client sign a treatment consent form, which also includes a detailed consent for release of information. You note that instead of the usual time and target limits, the form allows information to be released at any time to "any law enforcement agency," "any spouse, ex-spouse, or significant other," "any welfare or abuse protection agency," etc. You ask about the ethics of having clients sign this form, and you are told, "It's a hassle to try and get specific information releases, and the safety of the public is at stake. Use the form." Your BEST response is to:

a. Use the form as directed.
b. Refuse to use the form.
c. Call your licensing board and discuss the form.
d. Call law enforcement and discuss the form. 

4. In statistical research, a "Type I Error" (also called an "alpha error," or a "false positive") refers to:

a. Failing to reject the null hypothesis when the null hypothesis is false.
b. A failure to randomize research participants, thereby potentially introducing bias.
c. Rejecting the null hypothesis when the null hypothesis is true.
d. Assuming a normal statistical distribution when it is skewed. 

5. Identify the missing step in Albert R. Roberts seven-stage crisis intervention model: 1) assess lethality; 2) establish rapport; 3) __________; 4) deal with feelings; 5) explore alternatives; 6) develop an action plan; 7) follow-up. The third step is:

a. Evaluate resources.
b. Identify problems.
c. Environmental control.
d. Collateral contacts. 

6. Self-Psychology, as postulated by Heinz Kohut, acknowledges that personality is partly formed by social structure. A cohesive self is achieved by incorporating the perceptions and functions of healthy significant others and objects into an internalized self structure through a process called:

a. Empathic mirroring.
b. Rapprochement.
c. Differentiation.
d. Transmuting internalization. 

7. An early cognitive theorist, who worked directly with Freud, established a theoretical orientation that differed from Freud's in three key features: 1) an individual's personality is best perceived as a whole, rather than as having hierarchical segments or parts; 2) social relationships drive behavior more than sexual motivations; and 3) current beliefs and thoughts play a far greater role in human behavior than is suggested via psychoanalytic theory, which is based largely in the unconscious and in past experiences and beliefs. The name of this theorist is:

a. Lawrence Kohlberg.
b. Anna Freud.
c. Albert Ellis.
d. Alfred Adler. 

8. In working with a client, you become aware that she persistently behaves in ways to please or gain the approval of others. While this is not always problematic, you discover that she is obsessed with wearing the "right" clothes, living in the "right" neighborhood, and marrying the "right" person. At present, her finances are in a shambles as she tries desperately to "keep up with the Joneses," and her romantic life is suffering, as she only pursues relations that she believes others think are optimum, rather than judging relationships on more personally relevant values, such as her feelings for them, baseline compatibility, etc. Utilizing Kohlberg's Theory of Moral Development, specify the Level and Stage of moral development that applies to this individual:

a. Conventional Level, Stage 3.
b. Pre-conventional Level, Stage 1.
c. Post-conventional Level, Stage 6.
d. Conventional Level, Stage 4.

9. You have been contacted by a couple to assist them with issues of marital discord. They have been married about six months. The wife presents as vulnerable, tearful, and anxious, and the husband presents as angry and overwhelmed. The wife openly claims that "he has never loved me," and expresses anger that he married her without "the proper feelings." The husband responds that he has "done everything possible" to "prove" his love (to the point of near bankruptcy and jeopardizing his employment with frequent absences), but nothing is sufficient. During the interview, you discover that she has had many short-term relationships in the past, that she has a history of suicide gestures and "fits of rage." Further, she frequently demands a divorce and then begs him to stay, is routinely physically assaultive, etc. The most likely diagnosis is:

a. Intermittent explosive disorder.
b. Histrionic personality disorder.
c. Paranoid personality disorder.
d. Borderline personality disorder. 

10. All but one of the following are National Association of Social Workers (NASW) standards for cultural competence:

a. Social workers should endeavor to seek out, employ, and retain employees who provide diversity in the profession.
b. Social workers shall endeavor to resources and services in the native language of those they serve, including the use of translated materials and interpreters.
c. Social workers should develop the skills to work with clients in culturally competent ways, and with respect for diversity.
d. Social workers should work with diverse clients only if they have had specific training in that client's unique cultural background. 

11. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used to diagnosis mental disorders. It also allows for the entry of related factors through a multi-axial coding approach. Name the proper axis (in the corresponding order) for entry of each of the following: a) the Global Assessment of Functioning; b) relevant physical disorders; c) personality disorders and mental retardation; d) relevant psychosocial factors; and e) clinical disorders:

a. Axis I; Axis III; Axis II; Axis IV; and Axis V.
b. Axis V; Axis III; Axis II; Axis IV; and Axis I.
c. Axis II; Axis IV; Axis III; Axis V; and Axis I.
d. Axis IV; Axis III; Axis II; Axis V; and Axis I. 

12. You are seeing a 16-year-old youth who has, for the past year, been losing his temper frequently, is regularly argumentative with adults, often refuses to follow direct requests, is easily annoyed, and routinely uses blaming to escape responsibility. Approximately four months ago he was caught in a single episode of shoplifting. The most appropriate diagnosis for this youth is:

a. Oppositional defiant disorder.
b. Conduct disorder.
c. Impulse-control disorder.
d. Disruptive behavior disorder, not otherwise specified. 

13. Encopresis is defined as:

a. The voluntary or involuntary passage of stool in an inappropriate place by a child over the age of four.
b. The voluntary or involuntary passage of stool in an inappropriate place by a competent adult.
c. Deliberate fecal incontinence only in a child over age four.
d. Involuntary fecal incontinence only in a developmentally delayed adult. 

14. The following criteria are all used to distinguish substance abuse from substance dependence except:

a. Symptoms of substance abuse are usually less severe than those of dependence.
b. The problematic effects of abuse are usually limited to family, finances, employment, and legal issues (e.g., driving under the influence), while dependence also involves significant physiological problems.
c. Substance abuse typically involves narcotics, while dependence typically involves non-narcotic drugs.
d. Abuse is typically limited to recreational use, while dependence involves the need for increasing doses for the desired effect and withdrawal symptoms of not used regularly. 

15. Name the four classic diagnostic "A's" of schizophrenia:

a. Awareness, ambivalence, autism, and associations.
b. Agitation, awareness, associations, and autism.
c. Affect, anxiety, ambivalence, and awareness.
d. Affect, associations, ambivalence, and autism. 

16. You are called to see a young black man in his mid-twenties. Two adult sisters brought him for an urgent appointment. The young man is clean, neatly dressed in slacks, dress shoes, and a tweed sport coat. He is also calm, relaxed, and without any signs of agitation. The two sisters, however, appear disheveled, frazzled, and almost histrionic. They blurt out the he "has problems" and urge you to talk with him. Privately, he tells you that he is fine. Later, however, the ladies tell you he left home abruptly and traveled cross-country with no destination. He didn't sleep for three days (with them pursuing him), was spending money excessively and writing checks he couldn't cover. He ended up in a nationally famous amusement park at 3:00 a.m. (having scaled a fence), sitting on an empty roller coaster "waiting for the ride to start." When confronted, he admits all of this, but says he's now rested, and doing better. The most likely diagnosis would be:

a. Brief psychotic disorder.
b. Bipolar I, single manic episode, in full remission.
c. Bipolar I, single hypomanic episode, in full remission.
d. Cyclothymic disorder. 

17. A therapeutic approach that views the client from a social context, that sees behavior as derived from unconscious drives and motivations, that views disorders and dysfunction as emerging from internal conflicts and anxiety, and that seeks to facilitate the conscious awareness of previously repressed information is called a:

a. Cognitive approach.
b. Psychoanalytic approach.
c. Gestalt approach.
d. Behavior approach. 

18. The concepts of "pre-affiliation" (becoming acquainted), "power and control" (setting the roles), "intimacy" (developing cohesion), "differentiation" (independent opinion expression), and "separation" (moving to closure and termination) are all stages in:

a. The lifecycle of a therapeutic relationship.
b. General relationship cycles.
c. Group development.
d. Team cohesion. 

19. When a client seems overwhelmed or uncertain how to share further, it can help to break down the concerns at hand into smaller, more manageable parts. This communication technique is known as:

a. Fragmentation.
b. Sequestration.
c. Downsizing.
d. Partialization. 

20. "Single system" research designs involve observing one client or system only (n=1) before, during, and after an intervention. Because of their flexibility and capacity to measure change over time, single system designs are frequently used by practitioners to evaluate:

a. Their practice.
b. Difficult clients.
c. Conformation to policy.
d. Regulation adherence. 

ANSWERS 

1 - C: Allow the patient to move into his motor home.

The patient has a plan sufficient to meet his needs for food, clothing, and shelter. He has the legal right to choose where he wishes to live, even if others are not comfortable with his choice. Calling the police will not help, as they cannot force him to return to the facility. Adult protective services may have a subsequent role, if the patient begins to exhibit marked self-neglect or cognitive changes, but they cannot force the patient either. Finally, the patient is not eligible for an involuntary hold, as he is not placing himself or others in danger based upon a diagnosable mental illness, intoxication, or other substance abuse. Careful collateral planning, however, will be important (ensuring the daughter visits and checks in on him, etc) to try and maximize his potential for success. After coping with the hardships of independent living, he may willingly return to assisted living.

2 - C: Adjustment disorder with depressed mood.

Criteria for this disorder includes a time-limited nature, usually beginning within three months of the stressful event, and lessening within six months-either with removal of the stressor or through new adaptation skills. Adjustment disorder is a "sub-threshold disorder," allowing for early classification of a temporary condition when the clinical picture remains vague. While the patient does have insomnia, it arises from the stressful loss and not as an independent condition. Many of the essential criteria for a major depression are absent (weight loss, psychomotor agitation, blunted affect, etc), although without successful treatment this condition could emerge. The diagnosis of acute stress disorder is not appropriate as the precipitating event did not involve threatened or actual serious injury or death.

3 - B: Refuse to use the form.

No client or client population is beneath the ethical standards of the field. An appropriate information release form stipulates a limited period of time beyond which the form expires, the specific kind of information to be released, the specific purpose for which the information is to be provided, and a specific individual or entity to whom/which the information will be provided. While obtaining an information release is indeed a "hassle" it is the ethical standard of care in the field, and deviation from it can open a practitioner to legal liability. The fact that a given client, or client population, may be unaware of this does not excuse the therapist from using an ethically appropriate form in keeping with expected standards of care. Any limitations to confidentiality-such as mandatory reporting if a client expresses intent to commit a crime or harm another-belong on a treatment consent form, rather than on an information release form.

4 - C: Rejecting the null hypothesis when the null hypothesis is true.

A failure to randomize research participants will potentially introduce bias, and may provide grounds upon which to invalidate a study, but it is not a type I error. Assuming a normal statistical distribution when it is skewed will violate the assumptions necessary to apply a proper statistical model to the analysis of data.

5 - B: "Identify problems" is the third step in the Roberts crisis intervention model.

6 - D: Transmuting internalization.

Empathic mirroring is the process by which the mother demonstrates ("reflects") care and understanding of the child, in turn helping the child to develop a self-identity. Rapprochement is a term from object relations theory, indicating the need for an infant to seek independence while still retaining security. Differentiation is a substage in object relations theory, where an infant begins to look at the outside world, as opposed to the inward focus common to infants younger than five months of age.

7 - D: Alfred Adler.

Adlerian theory also includes a biological view, largely absent in Psychoanalytic Theory, recognizing that hormonal changes, physical illness, chemical imbalances, and neurological disorders can dramatically influence capacity and behavior. It is important to note, however, that Alder still locates false beliefs, irrational thoughts, and misconceptions in the unconscious mind.

8 - A: Conventional Level, Stage 3.

The Theory of Moral Development was created by Lawrence Kohlberg, to extend and enhance Jean Piaget's theory. Overall, Kohlberg felt that the process of moral development was more complex and extended than that put forth by Piaget.

9 - D: Borderline personality disorder.

Individuals with this diagnosis will exhibit: frantic efforts to avoid real or imagined abandonment; unstable and intense interpersonal relationships (especially extremes of idealization and devaluation); an unstable sense of self; extreme impulsivity (e.g., spending, sex, drug use, reckless driving, binge eating, etc); recurring suicidal behavior (gestures or threats, or self-mutilating behavior); affective instability due to reactivity of mood; chronic feelings of emptiness; intense anger (e.g., frequent displays of temper, recurrent physical fights); transient, stress-related paranoid ideation; or severe dissociative symptoms. However, as with all Axis II disorders, this diagnosis cannot properly be made during a first contact, but must be substantiated over a course of clinical contacts sufficient to compel the diagnosis to be made (DSM-IV).

10 - D:

Although it is ideal for social workers to receive specific training regarding each of the individual minority populations they typically serve, they should still ensure that someone from an unfamiliar background receives needed services even where no staff with special training in that background is available.

11 - B: Axis V; Axis III; Axis II; Axis IV; and Axis I.

Clinicians should assess clients on all five axes to ensure a thorough evaluation.

12 - A: Oppositional Defiant Disorder.

Disruptive Behavior Disorder, not otherwise specified (NOS) is an umbrella term for behavior disturbances that lack sufficient clarity for the assignment of a more specific diagnosis. Impulse-Control Disorder is only appropriate when a behavior is compulsive in nature. While anger may be a part of that picture, it tends to be an overreaction to a provocation; other relevant compulsions include gambling, skin-picking, kleptomania, etc. The hallmark of Conduct Disorder is deliberate cruelty, and wanton disregard for others rights and property. This client lacks any pervasive and long-standing evidence in this regard.

13 - A: The voluntary or involuntary passage of stool in an inappropriate place by a child over the age of four (i.e., past toilet training).

This is a frequently misused term. It is most frequently applied to children and developmentally delayed adults. Adults with psychosis may warrant use of the term, although the term "fecal incontinence" is more commonly used for adults. A British literature review found only one use of the term in an adult that was not either psychotic or mentally retarded-a 1932 case of a 36-year-old diagnosed with "infantile neurosis." The most typical etiology is stool impaction (constipation) compromising sphincter control and allowing leakage into the underclothing. However, emotional disorders, anxiety, or oppositional defiant disorder can sometimes underlie the behavior. Incidence of the condition drops steadily after age six.

14 - C: Substance abuse typically involves narcotics, while dependence typically involves non-narcotic drugs.

In general, narcotics are more addictive than non-narcotic substances. Even relatively "benign" substances of abuse, such as marijuana, can produce dependence if used often enough, and mounting clinical and preclinical evidence suggests that a marijuana withdrawal syndrome also exists (however, it is not yet in the DSM). Common treatment medications include: Antabuse (disulfiram; for alcohol abuse); ReVia (naltrexone; for alcohol and narcotics); and Trexan (naltrexone; for alcohol and opioid dependence).

15 - D: Affect, associations, ambivalence, and autism.

In 1911, Eugen Bleuler coined the term schizophrenia, and defined it using his now-classic four "As:" Affect (blunted emotional response to stimuli); associations (loosening, disordered thought patterns), ambivalence (an inability to make decisions due to poor information integration and processing), and autism (a preoccupation with the self and one's thoughts). Common medications for treatment: Clorazil (clozapine), Haldol (haloperidol), Loxitane (loxapine), Mellaril (thioridazine), Prolixin (fluphenazine), Risperdal (risperidone), Stelazine (trifluoperazine), Thorazine (chlorpromazine), and Zyprexa (olanzapine).

16 - B: Bipolar I, single manic episode, in full remission.

There is no evidence of frank psychosis, thus brief psychotic disorder can be ruled out. Hypomania does not appear appropriate, as the client's behavior would likely have resulted in hospitalization had anyone been able to evaluate him during his period of mania. Cyclothymic disorder does not appear appropriate, as the client's conduct exceeded the threshold severity for hypomania, and no information is provided regarding depressive symptoms (though he may well have them). Finally, the Bipolar I, single manic episode is identified to be in full remission, as the client's manic symptoms appear to have completely resolved.

17 - B: Psychoanalytic approach.

This approach is built upon the concepts and theory of Sigmund Freud and others who have followed him. The approach is also sometimes called a "psychodynamic" approach.

18 - C: Group development.

During these stages, the social worker needs to: 1) facilitate familiarity and elicit participation; 2) clarify roles; 3) develop group cohesion; 4) support individual differences; and 5) foster independence. The use of a "Sociogram" (a chart or diagram depicting group member relationships) can aid the social worker in revealing, monitoring, and intervening (if necessary) in group member interactions and bonding.

19 - D: Partialization.

For example, "Well, if we take these things one at a time, maybe we can start with..."

20 - A: Their practice.

The evaluation process involves: 1) problem identification (called the "target" of the research); 2) operationalization (selecting indices that represent the problem that can be measured; 3) determining the "phase" (the time over which measurement will occur), including a "baseline phase" (without intervention) and an "intervention phase." This may also include a "time series design," where data is collected at discrete intervals over the course of the study.

Reference : http://www.socialworkexamzone.com/aswb-masters-practice-answers.htm