The parental subsystem functions include:
a. Discipline, guidance, nurturing, and access
b. Discipline, punishment, nurturing, and access
c. Discipline, guidance, teaching, and nurturing
d. Discipline, nurturing, child-care, and guidance
a. Discipline, guidance, nurturing, and access
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The law changes to reflect current values and knowledge
Indicate whether the statement is true or false
Research shows that child welfare agencies that use risk assessment as a "quick
fix" for major systemic problems are far more likely to be successful in implementation of risk and safety assessment programs because any form of risk assessment will enhance safety programs. a. True b. False
Zeke has just learned that he will be released from prison before he serves his full sentence; however, he will remain under court supervision for a stipulated period of time. Zeke has most likely been ______.
A. assigned to community service B. given probation C. cleared of all charges D. granted parole
Is there evidence of a premorbid personality disorder in this client?
DSM Diagnosis F20.9 Schizophrenia, Continuous F60.1 Schizoid Personality Disorder (Premorbid) Rationale Regarding the diagnosis of schizophrenia, Anna exhibits abnormal patterns of thought and behavior that have persisted for well more than six months. It is not clear whether she is having delusions or hallucinations right now, because she is not sharing much of her thinking. However, it appears that she is distracted by, and preoccupied with, thoughts unrelated to here-and-now circumstances, so we may assume the presence of auditory hallucinations or delusions. Further, her behavior is clearly disorganized, as she is unable to care for herself. She does not bathe or wash her clothes and has no evident sense of the effects these actions have on others (such as the secretaries who objected to her behavior). Therefore, she meets the criteria for two of the active symptoms of schizophrenia. What is equally striking about the client is her affective impairment, or her negative symptoms. Her affect is continuously flat; she is socially isolated, non-communicative, and passive in her orientation to those around her. She rarely asserts what she wants or how she is feeling. Finally, Anna’s social functioning is poor, and seems to have declined from the higher level of her early college years. Her functioning is currently so marginal that it does not appear that she could carry out any of those activities. The specifier “continuous” was added, as it appears from the history that Anna’s active psychotic symptoms are always present and have been for more than six months. A diagnosis of schizoid personality disorder can be made as a premorbid condition based on the symptoms summarized in the first section. At present the client does not experience medical problems. The client’s gross lack of personal hygiene does place her at risk for a variety of physical illnesses, for which the social worker should stay alert through observation and referrals for physical examinations. Risk and Resilience Assessment Onset Anna appears to have a genetic loading for schizophrenia, since her mother also has a psychotic disorder. The specific biological factors are not known, and cannot be directly investigated, but they may involve a disorder in her limbic system, enlargement of certain brain ventricles, and abnormal levels of certain neurotransmitters. There is no evidence of early trauma, but it is possible that Anna’s risk could have been complicated by birth complications or prenatal viral exposure. Regarding psychological factors, it is possible that the household in which Anna grew up was not a nurturing one, given the reports of erratic and unpredictable behavior of her mother. This may have activated Anna’s biological sensitivity to the disorder. There are a variety of traumatic events along the lines of parental neglect and family tension that could have been present in her household. Finally, Ann’s poor level of social skills indicates that she would have difficulty making transitions into adulthood. Regarding protective factors, Anna’s environment was materially comfortable and there is no evidence that she experienced physical trauma that may have contributed to constitutional weakness. Regarding the course of her disorder, Anna faces certain risk influences. She experienced a gradual onset of schizophrenia, demonstrated marginal premorbid social functioning, does not experience her psychotic symptoms as strange, and shows prominent negative symptoms. She lives in a large urban area and continues to experience high levels of family tension with her father’s disapproval and her stepmother’s lack of support. She has poor social skills and has experienced deterioration in her intellectual capacity. Regarding protective factors, Anna is part of a family system that could potentially become more supportive. Further, she has some independent living skills, to the extent that she has been living in a condominium with her sister. What questions can help to assess for further strengths in Anna: 1. Despite Anna’s limitations, does she demonstrate any personal qualities that are functional or adaptive? Where, when, and with whom does she demonstrate these qualities? 2. Does Anna express any personal goals that might be used to motivate her for change? 3. What talents did Anna demonstrate in her childhood and adolescence? Does she ever utilize these talents now, or indicate a desire to do so? 4. In what kind of environments (both housing and social) does Anna seem to best manage her activities of daily living? What characteristics of those settings seem to be appealing to her? 5. When does Anna seem most comfortable with other persons? In what situations is she most verbal? Is Anna capable of developing relationships in which she seems trusting? Intervention Plan There are many services from which Anna might benefit with regard to the remission of both the positive and negative symptoms of schizophrenia, and her acquisition of social and vocational skills. Still, the social worker needs to be cautious in developing an initial treatment plan. Like many persons with schizophrenia, Anna is reluctant to participate in an extensive intervention process at the outset because she seems to be easily overwhelmed. She may also be reluctant to trust others because she is not comfortable in relationships. It will initially be important to engage Anna in a relationship of trust, and then later she may take the initiative to participate in other interventions. What follows here is a summary of interventions that could be utilized now and others that might eventually be used with the client. Anna may well benefit from taking antipsychotic medications, given the severity of her symptoms. The social worker can schedule Anna to meet with the physician in the coming week so that he may at least talk with her about the possible benefits of medication. Family education and support will be important if the client’s father (and perhaps step-mother) would be obliging. Mr. Yannucci appears to have little awareness of schizophrenia and its treatment. He has suffered greatly as he has tried to help his daughter, but he does not know how to do so, given her condition. This service may be provided individually or in a group setting. Anna’s parents could learn about her disorder, available interventions, and behavior management strategies; and find support for the burden that they experience. The remaining goals could be provided by a case manager or though an assertive community treatment team. Clubhouse involvement would be a helpful way for the client to add structure to her life, improve her activities of daily living skills (budgeting, laundry, home care) and improve her social skills. Anna might learn to cook and engage in modest work activities. Vocational assessment and rehabilitation could assess Anna’s skills and potential for work, and place her in programs where her skills could be developed. Through referrals for recreational activities the client might be able to expand her range of daily activities. For example, since she enjoys walking, she might be helped to get a membership at a health club. Linkages with entitlement services could help Anna insure that she was receiving benefits such as social security disability money and health insurance. Her father has been providing her with such assistance, but he might like to assume less responsibility for this aspect of his care, if possible. Critical Perspective The DSM’s reliance on behavior observation in making diagnoses presents a problem with Anna’s presentation. She is withdrawn, passive, and marginally communicative, which makes it difficult to assess with certainty if she is experiencing the active symptoms of schizophrenia (hallucinations and delusions). Her presentation also demonstrates the necessity of relying on historical data (from her father and the referring hospital) in diagnosis. If the social worker was limited to the client’s current presentation, many other diagnoses (including cognitive, medical, and substance abuse) would need to be considered more seriously.