Most writers agree that the foundation of the group is
A) ?the leader's skill in teaching members about group pro-cess
B) ?the motivation of members to work hard
C) ?the degree of enthusiasm of the group leader
D) ?trust
D
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Which of the following best illustrates the source of the research problems for researchers
at the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) described in Research in Practice 4.1?
a. Personal interest. b. Prior research. c. Policy implementation. d. Conceptual development
In the case of Impacting the Staff System in a Residential Setting, the combination of overlapping boundaries and underdeveloped communication resulted in areas of conflict with limited opportunities for resolution
a. True b. False Indicate whether the statement is true or false
What was the history of Daybreak and what services did the agency offer?
As an employee of a private, nonprofit HIV/AIDS clinic in a rural North Carolina community, Linda Summerfield’s job was to provide direct services to people with HIV/AIDS as well as to connect them with resources. Aware of their needs, she also respected their need for confidentiality and anonymity in an area where issues surrounding HIV/AIDS were highly charged and prejudice was common. In 1999, Linda was also eager to help six men in her caseload who were struggling with uncertainty, loneliness, and isolation. Aware of their shared needs, she believed in the healing power of group work for such clients. Although initially reluctant, the six men agreed to “meet” via telephone and, despite their apprehension and some technical difficulties, after five weeks all agreed that the experience was helpful. But when meeting via telephone became unworkable, Linda faced decisions over whether and how or where to persuade the men to continue meeting.
Are there psychosocial stressors that might be contributing to Donald’s symptom development?
DSM Diagnosis F25.1 Schizoaffective disorder, depressive type, multiple episodes, currently in acute episode Rationale The diagnosis of schizoaffective disorder, depressed type was made because Donald’s illness meets the criteria for schizophrenia and major depressive episodes. He shows the characteristic symptoms of schizophrenia in that he experiences the following during a one-month period: Delusions (people are ridiculing him and reading his mind, the day treatment program is “evil,” fathers are “perverted, he is possessed by the devil and by not eating, he could starve them away), hallucinations (a presence is touching him, voices), disorganized speech (frequent derailment), disorganized behavior (sitting outside in cold weather with light clothing, sleeping in the back yard), and negative symptoms (namely affective flattening). Donald’s social and occupational functioning is disturbed in that he is currently unable to work, continue his college education, or socialize. He has been experiencing symptoms for three years. He experiences delusions and hallucinations for periods of at least two weeks in the absence of mood symptoms, but he also has prolonged depressive episodes during the majority of his illness. Donald has a history of depression going back to age 13. Episodes lasting several weeks have continued since he experienced his first bout of psychosis at age 20. During these periods he will sleep at least 12 to 14 hours and has difficulty waking. He eats less, is more withdrawn and isolative, and is less active than at other times. The specifier “multiple episodes, currently in acute episode” was selected to reflect the fact that Donald has fluctuating symptoms of his disorder over time, but at the present time his psychotic symptoms are prominent. Additional Information Needed The pattern of Donald’s illness seems to fit schizoaffective disorder without question. However, it would be helpful to know the true pattern of his psychotic and depressive symptoms. It was not clear how long the depressive episodes last, or how long the psychotic symptoms had been present when he had his first depressive episode after the psychosis. It is not certain, however, that this information would change the diagnosis. It would certainly create a clearer picture of the pattern that is typical for Donald’s illness. If the depressive episodes decrease over time, whether in number or in length of the episode, the diagnosis would have to be reevaluated to determine if a diagnosis of schizophrenia would be more appropriate. Risk and Resilience Assessment Donald’s risk for the onset of the schizoaffective disorder may include the biological vulnerability present in his family. Although there is no clear familial history of schizophrenia, there seems to be a history of mental illness. Donald’s age (early 20’s) and gender also present risk. In addition, he was born in February, which puts one at a higher risk for the disorder. Protective mechanisms for the onset of Donald’s illness include the fact that he suffered no major traumatic event or brain injury and that he has a relatively high socioeconomic status and a stable, functional family. His mother also had a normal pregnancy and delivery. The main risk influence for the course of the disorder includes repeated relapses, with some residual symptoms between episodes. Protective mechanisms include Donald’s ability to maintain some insight. Therefore, the social worker, doctor, and his family members can talk with Donald about treatment options when he is most receptive. Other protective influences involve the fact that he received the early interventions of medication and day treatment. He is currently compliant with his medication and if that continues, it will be another protective factor for the course of his illness. One of the most critical protective factors in this case is Donald’s family’s supportiveness and their involvement in his care. Finally, he has access to quality treatment in the community where he lives and his family has the means to pay for it. What questions can help to assess for additional strengths in Donald 1. What behaviors does Donald currently demonstrate that are functional or adaptive? Where, when, and with whom does he demonstrate these qualities? 2. Donald has attempted to live on his own on several occasions. While he was not successful in this regard, what positive survival skills account for his persistence at these times? 3. Does Donald express any realistic personal goals that might be used to motivate him for goal setting? 4. Donald demonstrated some vocational capacities in his adolescence. How might these be tapped as a means of developing vocational goals? 5. There are times when Donald’s behavior seems more socially appropriate than others, and when his symptoms are less evident. In what situations do these behaviors appear to be most prominent? 6. What personal aspirations or desires for social interaction account for Donald’s several attempts to “succeed” at the day treatment program? 7. Donald cares deeply about children. Even though the behaviors related to his caring have been inappropriate, is there a way to tap into his empathy toward a constructive end? Intervention Plan Since Donald is opposed to a hospital setting for a revamping of his medications, other options need to be explored. One option is that at his day treatment program, a doctor can observe his behaviors daily, monitor his medications, and gradually adjust them as needed. Another option in the community is a 16-bed short-term residential facility in which clients are closely monitored and receive transportation to appointments, referrals to necessary agencies, meals, recreational groups, individual therapy, group therapy, and medication management. The facility has a psychiatrist and a nurse practitioner. These professionals can help the client through a medication transition in a gradual manner. As part of Donald’s intervention, his parents could attend a family psychoeducational group that can provide them with support from others, education about schizoaffective disorder, treatment strategies, ways to manage their son’s behavior, and coping skills for themselves. Participation in such a group may help Donald avoid relapse and also help them gain needed support and knowledge about living with a son with the disorder. Critical Perspective Schizoaffective disorder is a psychotic disorder although it has some similarities to bipolar disorder with psychotic features, which is a mood disorder. It appears in this case the diagnosis could be accurately made due to the clarity of symptoms, but social workers must always take care to differentiate between the two disorders, because their treatments are quite different.