A brief synopsis of the most significant findings of an evaluation is contained in the:
A) ?Executive summary
B) ?Literature review section
C) ?Introduction section
D) ?All of the above
A
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Title VII of the Civil Rights Act of 1964 established the ___________ to enforce laws against discrimination
A) Department of Labor B) Civil Rights Commission C) Equal Employment Opportunity Commission D) Department of Health and Human Services
A physician in a ____________________ practice would have patients pay a flat fee each year for services. The physician would then be available to the patient via email, cell phone, and a guarantee of appointments within 24 hours of scheduling.
a. Homeopathic medicine b. Naturopathic medicine c. Concierge medicine d. Personalized medicine
Do Kenda’s presenting problems result from patterns of interaction with others?
Diagnosis 296.33 Major Depression, Recurrent, Severe, Without Psychotic Features 301.83 Borderline Personality Disorder, Principal Diagnosis Rationale Kenda meets the following criteria for major depression: For periods of two weeks or more she feels depressed most of the day as indicated by her self-report and the observations of others; even though she is active she is uninterested in most activities other than her volunteer work; she experiences chronic insomnia, feels fatigued much of the day, has problems with concentration, feels hopeless about her future, and has recurrent self-destructive ideation. These symptoms are not related to the use of a substance or to some medical condition, and the symptoms cause her distress in all areas of social functioning. Further, these episodes are recurrent, appearing to surface with regularity, although she also experiences brief periods of remission from her feelings of self-destruction and hopelessness. The client also meets the criteria for Borderline Personality Disorder. This is specified as the principal diagnosis because it is the more pervasive diagnostic issue, and her depressive episodes are related to her maladaptive personality patterns. Kenda struggles with abandonment issues every day of her life. She has a pattern of unstable relationships and tends to devalue others rather than idealize them. Her identity disturbance is seen in her low self-esteem and negative sense of self. In her adolescence she engaged in dangerous driving and now she is self-damaging in her tendencies to routinely smash her hand into walls. She is chronically suicidal, has pervasive feelings of emptiness, and is affectively unstable, (and tries to keep busy as a way of avoiding those feelings). She clearly meets seven of the nine criteria for the personality disorder. Additional Information Required Kenda’s family and interpersonal history is complex, and due to her feelings of isolation and depression she is not willing or able to share many details of her history and symptoms. It is also possible that some of her symptoms could be related to medical conditions. Thyroid deficiencies, for example, are associated in some studies with mood lability, although no such conditions have been discovered in Kenda’s recent physical exams (during her psychiatric hospitalizations). Thus, Kenda provides a good example of a client who requires an ongoing assessment of biological, psychological, and social functioning in order to understand the full nature of her many symptoms. Risk and Resilience Assessment Onset Kenda presents with a variety of risk influences for borderline personality disorder. One that we cannot be sure of is a possible temperamental predisposition to mood lability. The client has a history of severe trauma, given her years of sexual abuse by her father. There seems to have been a great deal of emotional neglect and family conflict as well with the parents’ statements echoing the client’s notion that she was not provided with a supportive living environment. The absence of supportive friends in childhood also put her at risk. On the positive side, Kenda seems to have good physical health, and she did mention that there were several relatives to whom she felt close. She also lived in a lower-middle class neighborhood but did not have to deal with material deprivation to a significant degree. Course Kenda may or may not respond well to intervention and eventually overcome her personality disorder. Of concern, however, is that she has had a poor response to medications. The presence of another disorder (major depression) puts her at risk for ongoing problems with personality functioning. The fact that her present relationships are not solid (from the client’s perspective) can perpetuate her assumption that people cannot be trusted. Further, her history of employment problems (except for her EMT work) indicates serious trouble with maintaining structure. On the protective side, Kenda is intelligent, has career goals, and has some motivation to get her life back on course. Her living situation is stable for now and she does have some friends. What techniques could be used to elicit additional strengths? 1. Inquire about the resilient qualities Kenda has shown to survive, despite the abuse and the pain she’s suffered. 2. Attempt to build Kenda’s self-confidence by asking about exceptions to her negative self-evaluations – that is, when she feels better about herself, and the circumstances of those episodes. 3. Ask Kenda about the times she has been able to manage periods of self-doubt, anger, sadness, and loneliness. Where has she been, and with whom (if anyone) and what did she do that seemed helpful? 4. Ask Kenda about any people she has known, but not necessarily been close to, who were pleasant and good to her. How does she account for this? (Look for any cognitive distortions in her replies.) 5. Ask Kenda about what the future will look like once her current problems are solved. Any goals she has; or any desired future scenarios that are relatively problem-free for her. What would be some steps she could take to move in that direction? Treatment Kenda has made a tentative connection with the social worker and may be ready to engage in a sustained intervention program. The social worker will need to carefully develop their relationship in light of the client’s tendency to engage in splitting behaviors (seeing others as “all bad” when disappointed in them). The social worker will need to balance support and demand behaviors (insuring that the client assumes responsibility for her actions) as they work toward Kenda’s goals of a more stable temperament, better social and interpersonal skills, and consistency in her activities surrounding work and her desire to attend nursing school. To plan ahead for probable crisis situations, the social worker will help Kenda articulate her existing support systems on which she can rely, and also inform the nearby emergency services unit of Kenda’s clinical situation so that she can call or drive there when she is feeling self-destructive. The social worker also needs to clarify with the client her policy regarding phone calls. The social worker will provide Kenda with individual counseling to improve her coping and assertiveness skills (as she is quite passive in her general demeanor). There are no Dialectical Behavior Therapy groups available in this agency, but the social worker will utilize a DBT treatment manual and use that in her individual work. The social worker will teach Kenda coping skills in the areas of mood regulation, tolerating distress, interpersonal effectiveness, and correct maladaptive cognitions. If the client responds well to these interventions, the social worker may eventually refer her to an Interpersonal Therapy group that exists at another agency in her area where Kenda can test out her new cognitions and feelings about others. She will be further helped to develop appropriate interpersonal boundaries, maintain better self-control, and generalize her new learning and experiences. Kenda has not responded to antidepressant medications in the past but such an evaluation will be an important part of this intervention plan. She will be linked with an agency physician and the social worker will monitor her responses to any medications that are prescribed. She will be also referred to an incest survivors group located in the area as a means of addressing her issues in a supportive, affirming environment. Finally, Kenda will be referred to an area clubhouse program where she can develop a variety of social and vocational skills in an informal atmosphere. Family intervention will not be included in the treatment plan because the client is alienated from her family and does not wish to work toward reunification at this time. The social worker may also link Kenda with educational resources if she decides to pursue her desire to become a nurse. Critical Perspective Kenda’s presentation provides a good example of the interaction of two disorders and how that complicates the assessment and intervention process. The symptoms of major depression and BPD overlap to some extent. Major depression can be recurrent and chronic, even when treated, and present challenges to the person throughout the life course, although not always continuously. Borderline personality disorder, as a personality disorder, is assumed to be chronic in nature, although the symptoms can and often do remit over time. When working with a client who has BPD, then, the practitioner may also be monitoring and treating the symptoms of other disorders, such as anxiety and depression. The range of symptoms of BPD, and the varying levels of severity which the person may experience, makes it difficult to select particular interventions that can be assured of being helpful.
The helper therapy principle generally is operative in treatment groups as members at times interchange roles and become the helper for someone else.
Answer the following statement true (T) or false (F)