Fall 2023 SOWK 486w Week 08: Assessments

Assessments gathering information and formulating it into a coherent picture of the client and his or her circumstances Jacob Campbell, Ph.D. LICSW Heritage University Fall 2023 SOWK 486w

Diagnostic Assessments Screening Tools Agenda DSM-5 Documentation Mini-Mental Status Exams Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Mid-Term Feedback Please Submit Tonight or Tomorrow (I Believe) Completed 3 To be Completed 19 Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

The Multidimensionality of Assessment Complex Interplay Complex Social Institutions Person’s Functioning (Hepworth et al., 2017) Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Priorities in Assessment Initial Three Questions that Need to Be Assessed • What does the client see as his or her primary concerns or goals? • What (if any) current or impending legal mandates must the client and social worker consider? • What (if any) potentially serious health or safety concerns might require the social worker’s and client’s attention? (Hepworth et al., 2022) Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Ethical Considerations Regarding Clinical Work • Who gives diagnoses? • Students roles in understanding clinical practice Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Using the DSM The Major Reasons • Common language • Billing • Research Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Problems With the DSM (Graybeal, 2001; Shackle, 1985) • Not strengths based • Possible loss of personal freedom • Lifelong labeling • Variance of diagnoses among professionals Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

DSM Sections Each Diagnosis Includes • Diagnostic criteria • Development and course • Subtypes/speci ers • Risk and prognostic factors • Recording procedures • Speci c culture, gender, and age features • Diagnostic features • Associated features supporting diagnosis • Prevalence • Functional consequences of the speci c diagnosis • Di erential diagnosis • Comorbidity (American Psychiatric Association, 2013) Heritage University fi fi fi ff Jacob Campbell, Ph.d. LICSW Fall 2023 SOWK 486w

Emphasizing Strengths in Assessments Give pre-eminence to the client’s understanding of the facts Discover what the client wants Assess personal and environmental strengths on multiple levels (Cowger, 1994) Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Framework for Strengths in Assessment Strengths or Resources Environmental Factors (family, community) Individual or Personal Factors De cit, Obstacle, or Challenges fi Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w (Saleebey, 2009)

How Observant Are You? Do The Test. (2008). Test your Awareness: Do the test [Video]. YouTube. https://youtu.be/ Ahg6qcgoay4 Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Conditions Surrounding Troubling Behaviors Reinforcement Social Physiological When Troubling Behavior Consequences Jacob Campbell, Ph.d. LICSW Heritage University Duration Fall 2023 SOWK 486w Where

In Assessments Information provided by the client • Background sheets or other intake forms the clients complete • Interviews with clients Social workers personal experiences with the client • Direct observation of clients’ nonverbal behavior • Direct observation of interactions between partners, family members, and group members • Client self-monitoring Collateral information Tests or assessment instruments • Personal experiences of the social worker based on direct client interactions What are the advantages and limitations of each of the sources of information for assessment? What sources are typically used in their eld settings? What other information sources would be useful? Why are useful sources not used? Jacob Campbell, Ph.d. LICSW Heritage University fi 􀅵 Sources of Information Fall 2023 SOWK 486w (Hepworth, et al., 2022)

Where Would You Get Information Assessing Various Populations a middle-aged man with a history of job losses a 17-year-old who is seeking custody of younger siblings a child acting out in the classroom Jacob Campbell, Ph.d. LICSW an elderly woman whose competence is in question Heritage University Fall 2023 SOWK 486w

How do we manage stress? BBC. (2010). Managing stress Brainsmart - BBC [Video]. YouTube. https://youtu.be/ hnpQrMqDoqE Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Perceived Stress Scale For each question choose from the following alternatives: 0 - never 1 - almost never 2 - sometimes 3 - fairly often 4 - very often 1. In the last month, how often have you been upset because of something that happened unexpectedly? 2. In the last month, how often have you felt that you were unable to control the important things in your life? 3. In the last month, how often have you felt nervous and stressed? 4. In the last month, how often have you felt con dent about your ability to handle your personal problems? 5. In the last month, how often have you felt that things were going your way? 6. In the last month, how often have you found that you could not cope with all the things that you had to do? 7. In the last month, how often have you been able to control irritations in your life? 8. In the last month, how often have you felt that you were on top of things? 9. In the last month, how often have you been angered because of things that happened that were outside of your control? 10. In the last month, how often have you felt di culties were piling up so high that you could not overcome them? (Cohen et al., 1983) fi Heritage University ffi Jacob Campbell, Ph.d. LICSW Fall 2023 SOWK 486w

Perceived Stress Scale (Cohen et al., 1983) Scoring Yourself

1. Reverse your scores for questions 4, 5, 7, and 8. On these 4 questions, change the scores like this: 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0. 2. Add up your scores for each item to get a total. Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low stress. Scores ranging from 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress. The Perceived Stress Scale is interesting and important because your perception of what is happening in your life is most important. Consider the idea that two individuals could have the exact same events and experiences in their lives for the past month. Depending on their perception, total score could put one of those individuals in the low stress category and the total score could put the second person in the high stress category Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

PHQ-9 Patient Depression Questionnaire Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/ j.1525-1497.2001.016009606.x Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Generalized Anxiety Disorder 7-item (GAD-7) scale Over the last 2 weeks, how often have you been bothered by the following problems? Not at all sure Several days Over half the days Nearly every day

1. Feeling nervous, anxious, or on edge 0 1 2 3
2. Not being able to stop or control worrying 0 1 2 3
3. Worrying too much about different things 0 1 2 3
4. Trouble relaxing 0 1 2 3
5. Being so restless that it’s hard to sit still 0 1 2 3
6. Becoming easily annoyed or irritable 0 1 2 3
7. Feeling afraid as if something awful might happen 0 1 2 3 Add the score for each column

Total Score (add your column scores) = If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? GAD-7 Assessing Generalized Anxiety Disorder Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/ archinte.166.10.1092 Not difficult at all __________ Somewhat difficult _________ Very difficult _____________ Extremely difficult _________ Source: Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097. Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

DIVISION OF BEHVIORAL HEALTH AND RECOVERY (DBHR) DBHR Target Data Elements Gain Short Screening Setup ADMINISTRATION TIME GAIN-SS STAFF IDENTIFICATION DATE AGENCY NUMBER SECTION I CLIENT IDENTIFICATION 1. LAST NAME 5. GENDER Male 2. FIRST NAME 6. DATE OF BIRTH 3. MIDDLE NAME 7. SOCIAL SECURITY NUMBER Female 4. OTHER LAST NAME 8. WASHINGTON DRIVER’S LICENSE OR ID NUMBER 9. WHICH RACE/ETHNICITY GROUP WOULD YOU IDENTIFY YOURSELF WITH (CHECK A MAXIMUM OF FOUR THAT APPLY) Asian Indian Black/African American Cambodian Chinese Filipino Guamanian Hawaiian (Native) Japanese Korean Laotian Internalizing, Externalizing, and Substance Use Disorders Middle Eastern Native American Other Asian Other Pacific Islander Other Race Refused to Answer Samoan Thai Vietnamese White/European American Non – Federal Tribe Tribal Code (No. 1) Tribal Code (No. 2) 10. SPANISH/HISPANIC/LATINO (CHECK ONE) Dennis, M. L., Chan, Y.-F., & Funk, R. R. (2006). Development and validation of the GAIN short screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions, 15(s1), 80-91. https://doi.org/ 10.1080/10550490601006055 Cuban Mexican, Mexican American, Chicano Not Spanish/Hispanic/Latino Other Spanish/Hispanic/Latino Puerto Rican Refused to Answer Global Appraisal of Individual Needs-Short Screener (GAIN-SS) The following questions are about common psychological, behavioral or personal problems. These problems are considered significant when you have them for two or more weeks, when they keep coming back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go on. Please answer the questions Yes or No. Mental Health Internalizing Behaviors (IDScr 1): During the past 12 months, have you had significant problems a. with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future? b. with sleep trouble, such as bad dreams, sleeping restlessly or falling sleep during the day? c. with feeling very anxious, nervous, tense, scared, panicked or like something bad was going to happen? d. when something reminded you of the past, you became very distressed and upset? e. with thinking about ending your life or committing suicide? Each yes answer is “1” point IDS Sub-scale Score (0 to 5) Heritage University No No No Yes Yes No No Mental Health Externalizing Behaviors (EDScr 2): During the past 12 months, did you do the following things two or more times? a. b. c. d. e. Lie or con to get things you wanted or to avoid having to do something? Have a hard time paying attention at school, work or home? Have a hard time listening to instructions at school, work or home? Been a bully or threatened other people? Start fights with other people? Each yes answer is “1” point EDS Sub-scale Score (0 to 5) Yes Yes Yes Yes Yes No No No No No Yes Yes No No Yes No Yes No Yes No Substance Abuse Screen (SDScr 3): During the past 12 months, did….. a. you use alcohol or drugs weekly? b. you spend a lot of time either getting alcohol or drugs, using alcohol or drugs, or feeling the effects of alcohol or drugs (high, sick)? c. you keep using alcohol or drugs even though it was causing social problems, leading to fights, or getting you into trouble with other people? d. your use of alcohol or drugs cause you to give up, reduce or have problems at important activities at work, school, home or social events? e. you have withdrawal problems from alcohol or drugs like shaking hands, throwing up, having trouble sitting still or sleeping, or use any alcohol or drugs to stop being sick or avoid withdrawal problems? Each yes answer is “1” point SDS Sub-scale Score (0 to 5) DSHS 14-479 (REV. 10/2010) Jacob Campbell, Ph.d. LICSW Yes Yes Yes Fall 2023 SOWK 486w

Examples of Screener Forms Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Problem Assessment concentrate on Identifying the presenting problem Jacob Campbell, Ph.d. LICSW Uncovering the sources of this problem Heritage University Engaging the client in planning Fall 2023 SOWK 486w

Systems of Interaction What do you Assess • The family • The social network • Public institutions • Personal service providers • The faith community (Hepworth et al., 2022) Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Determining Needs Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Determining Needs Common Client Wants and Needs • To have less family con ict • To overcome depression • To feel valued by one’s spouse or partner • To have more friends • To be self-supporting • To gain more self-con dence • To have more freedom • To be included in decision-making • To get discharged from an institution • To make a di cult decision • To master fear or anxiety • To control one’s temper • To cope with children more e ectively (Hepworth et al., 2022) Heritage University ff fl fi ffi Jacob Campbell, Ph.d. LICSW Fall 2023 SOWK 486w

Students are to develop a 5-10 minute short presentation teaching your peers about assessing the chosen area. • Assessing biophysical Functioning (pp. 168-172) • Assessing Cognitive/Perceptual Functioning (pp. 172-176) Coming Next Week • Assessing A ective Functioning (pp. 176-180) • Assessing Behavioral Functioning (pp. 180-182) • Assessing Environmental System (pp. 182-186) Group Discussion (Hepworth et al., 2022) Jacob Campbell, Ph.d. LICSW ff 􀅵 In Class Teach Back Activity Heritage University Fall 2023 SOWK 486w Provide Info

How I Write My Notes A Look Into the Madness Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Mental Status Exam The General Components • General appearance • Intelligence • Behavior • Reality testing • Thought process and content • Suicidal or homicidal ideation • A ect • Judgment • Impulse control • Insight • Cognitive functioning ff Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

General Appearance Use of mobility device Posture and gait Build Meticulous Self-neglect Grooming Garish Skillfully applied Outstanding features Disabilities Physical characteristics Important physical features Immaculate Fashionable Dress Unconventional Jacob Campbell, Ph.d. LICSW Heritage University Appearance Fall 2023 SOWK 486w

General Appearance Passive Sullen Ingratiating Guarded Hostility Seductive Attitude and Interpersonal Style Uncooperative Demanding Jacob Campbell, Ph.d. LICSW Manipulative Heritage University Playful Inappropriate boundaries Contemptuous Withdrawn Fall 2023 SOWK 486w

General Appearance Flat Liable Bland Facial expression Awkward Motor hyperactivity Motor retardations Mannerism Posturing Tics and twitches Tension Severe akathisia Rigid Agitated Behavior and Psychomotor activity Hyperactive Combative Jacob Campbell, Ph.d. LICSW Heritage University Tardive dyskinesia Seated quietly Fall 2023 SOWK 486w

General Appearance Impoverished Pressured Perseveration Dysarthria Neologisms Speech and Language Monotonous Emotional Stereotypy Aphasia Global aphasia Jacob Campbell, Ph.d. LICSW Heritage University Accented Wernike’s aphasia Broca’s aphasia Fall 2023 SOWK 486w

Emotions Full range of a ect A ect Broad Constricted Congruent with mood Appropriate Flat Anhedonic Emotional withdrawal Blunted Labile Euphoric Expansive Mood Middle insomnia Initial insomnia Hypersomnia ff ff Jacob Campbell, Ph.d. LICSW Anxious Clients description Terminal insomnia Sleep Euthymic Heritage University Fall 2023 SOWK 486w

Cognitive Functioning Lethargy Attention and concentration Oriented Times Four Orientation and level of consciousness Coma Stupor Obtundation Anterograde amnesia Transient global amnesia Amnesia Retrograde amnesia Memory Registration Retention Retrieval Short term memory Jacob Campbell, Ph.d. LICSW Heritage University Head Injuries Long term memory Fall 2023 SOWK 486w

Cognitive Functioning Memory Testing Ability to Abstract and Generalize Information Intelligence Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Somatic delusions Nihilistic delusions Thought Content Delusions Bizarre behavior Grandiose delusions Delusional guilt Ideas of inference Thought content Magical thinking Thoughts and Perception Ideas of reference Distortions Though broadcasting Suspiciousness Paranoid delusions Thought withdrawal Thought insertion Illusions Hallucinations Disordered Perceptions Dearealization Depersonalization Jacob Campbell, Ph.d. LICSW Heritage University Fall 2023 SOWK 486w

Thoughts and Perception Loose association Perseverative Racing thoughts Conceptual disorganization Neologism Overvalued Thought Process Distractable Goal directed Spontaneous Incoherent Circumstantial Jacob Campbell, Ph.d. LICSW Heritage University Tangentiality Clang association Illogical Flight of ideas blocking Impoverished Fall 2023 SOWK 486w

Somatic preoccupations Phobias Preoccupations Obsessions Compulsions Suicidality, Homicidality, Impulse control Jacob Campbell, Ph.d. LICSW Heritage University Thoughts and Perception Insight and Judgment Fall 2023 SOWK 486w