Case vignettes PTSD case study. Please see instructions attached! CSWE’s Core Competencies and Practice Behavior Examples in this text Professional Identi

Case vignettes

PTSD case study. Please see instructions attached!

CSWE’s Core Competencies and Practice Behavior Examples in this text

Professional Identity

Practice Behavior Examples…

Serve as representatives of the profession, its mission, and its core values 3

Know the profession’s history

Commit themselves to the profession’s enhancement and to their own professional conduct
and growth

Advocate for client access to the services of social work

Practice personal reflection and self-correction to assure continual professional development

Attend to professional roles and boundaries 12

Demonstrate professional demeanor in behavior, appearance, and communication

Engage in career-long learning

Use supervision and consultation

Ethical Practice

Practice Behavior Examples…

Obligation to conduct themselves ethically and engage in ethical decision-making

Know about the value base of the profession, its ethical standards, and relevant law

Recognize and manage personal values in a way that allows professional values to guide
practice

11

Make ethical decisions by applying standards of the National Association of Social Workers’
Code of Ethics and, as applicable, of the International Federation of Social Workers/International
Association of Schools of Social Work Ethics in Social Work, Statement of Principles

12

Tolerate ambiguity in resolving ethical conflicts

Apply strategies of ethical reasoning to arrive at principled decisions 5

Critical Thinking

Practice Behavior Examples…

Know about the principles of logic, scientific inquiry, and reasoned discernment

Use critical thinking augmented by creativity and curiosity

Requires the synthesis and communication of relevant information

Distinguish, appraise, and integrate multiple sources of knowledge, including research-based
knowledge, and practice wisdom

4, 8, 9, 10

Analyze models of assessment, prevention, intervention, and evaluation 1

Demonstrate effective oral and written communication in working with individuals, families,
groups, organizations, communities, and colleagues

6

Competency Chapter

Adapted with the permission of Council on Social Work Education

CSWE’s Core Competencies and Practice Behavior Examples in this text

Competency Chapter

Diversity in Practice

Practice Behavior Examples…

Understand how diversity characterizes and shapes the human experience and is critical to the
formation of identity

2

Understand the dimensions of diversity as the intersectionality of multiple factors including age,
class, color, culture, disability, ethnicity, gender, gender identity and expression, immigration
status, political ideology, race, religion, sex, and sexual orientation

6

Appreciate that, as a consequence of difference, a person’s life experiences may include
oppression, poverty, marginalization, and alienation as well as privilege, power, and acclaim

8

Recognize the extent to which a culture’s structures and values may oppress, marginalize,
alienate, or create or enhance privilege and power

1, 5, 7

Gain sufficient self-awareness to eliminate the influence of personal biases and values in working
with diverse groups

Recognize and communicate their understanding of the importance of difference in shaping life
experiences

7, 10

View themselves as learners and engage those with whom they work as informants

Human Rights & Justice

Practice Behavior Examples…

Understand that each person, regardless of position in society, has basic human rights, such as
freedom, safety, privacy, an adequate standard of living, health care, and education

Recognize the global interconnections of oppression and are knowledgeable about theories of
justice and strategies to promote human and civil rights

Incorporates social justice practices in organizations, institutions, and society to ensure that
these basic human rights are distributed equitably and without prejudice

5

Understand the forms and mechanisms of oppression and discrimination 2

Advocate for human rights and social and economic justice

Engage in practices that advance social and economic justice

Research-Based Practice

Practice Behavior Examples…

Use practice experience to inform research, employ evidence-based interventions, evaluate their
own practice, and use research findings to improve practice, policy, and social service delivery

1, 4

Comprehend quantitative and qualitative research and understand scientific and ethical
approaches to building knowledge

Use practice experience to inform scientific inquiry

Use research evidence to inform practice 9

CSWE’s Core Competencies and Practice Behavior Examples in this text

Human Behavior

Practice Behavior Examples…

Know about human behavior across the life course; the range of social systems in which people
live; and the ways social systems promote or deter people in maintaining or achieving health
and well-being

Apply theories and knowledge from the liberal arts to understand biological, social, cultural,
psychological, and spiritual development

2

Utilize conceptual frameworks to guide the processes of assessment, intervention, and
evaluation

4, 8, 11,13

Critique and apply knowledge to understand person and environment. 4, 7, 13

Policy Practice

Practice Behavior Examples…

Understand that policy affects service delivery and they actively engage in policy practice

Know the history and current structures of social policies and services; the role of policy in
service delivery; and the role of practice in policy development

Analyze, formulate, and advocate for policies that advance social well-being 7, 9

Collaborate with colleagues and clients for effective policy action 8

Practice Contexts

Practice Behavior Examples…

Keep informed, resourceful, and proactive in responding to evolving organizational,
community, and societal contexts at all levels of practice

Recognize that the context of practice is dynamic, and use knowledge and skill to respond
proactively

Continuously discover, appraise, and attend to changing locales, populations, scientific and
technological developments, and emerging societal trends to provide relevant services

9, 11

Provide leadership in promoting sustainable changes in service delivery and practice to improve
the quality of social services

10

Competency Chapter

CSWE’s Core Competencies and Practice Behavior Examples in this text

Engage, Assess Intervene, Evaluate

Practice Behavior Examples…

Identify, analyze, and implement evidence-based interventions designed to achieve client goals

Use research and technological advances

Evaluate program outcomes and practice effectiveness

Develop, analyze, advocate, and provide leadership for policies and services

Promote social and economic justice

A) ENGAGEMENT

Substantively and effectively prepare for action with individuals, families, groups, organizations,
and communities

3

Use empathy and other interpersonal skills 13

Develop a mutually agreed-on focus of work and desired outcomes

B) ASSESSMENT

Collect, organize, and interpret client data

3

Assess client strengths and limitations 2, 12

Develop mutually agreed-on intervention goals and objectives 5

Select appropriate intervention strategies

C) INTERVENTION

Initiate actions to achieve organizational goals

Implement prevention interventions that enhance client capacities 12

Help clients resolve problems

Negotiate, mediate, and advocate for clients 5

Facilitate transitions and endings

D) EVALUATION

Critically analyze, monitor, and evaluate interventions

3, 6

Competency Chapter

Mental Health
in Social Work

A Casebook on Diagnosis and Strengths-
Based Assessment

Jacqueline Corcoran
Virginia Commonwealth University

Joseph Walsh
Virginia Commonwealth University

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S e c o n d E d i t i o n

DSM-5 update

Credits and acknowledgments borrowed from other sources and reproduced, with permission, in
this textbook appear on appropriate page within text.

Copyright © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Printed in the
United States of America. This publication is protected by Copyright and permission should be
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Library of Congress Cataloging-in-Publication Data
Corcoran, Jacqueline.
Mental health in social work : a casebook on diagnosis and strengths based assessment /
Jacqueline Corcoran, Virginia Commonwealth University, Joseph Walsh, Virginia Commonwealth
University. — Updated second edition.
pages cm
Includes bibliographical references and index.
ISBN-13: 978-0-205-99103-7 (alk. paper)
ISBN-10: 0-205-99103-3 (alk. paper)
1. Community mental health services—Case studies. 2. Psychiatric social work—Case
studies. 3. Medical social work—Case studies. I. Walsh, Joseph (Joseph F.) II. Title.
RA790.6.C64 2015
362.2’2—dc23

2013038117

10 9 8 7 6 5 4 3 2 1

ISBN-10: 0-205-99103-3
ISBN-13: 978-0-205-99103-7

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Contents

Preface xii

Part OnE: aSSESSmEnt

1. Diagnosis and the Social Work Profession 1
The DSM Classification System 3
Mental Status Examination 4

Rationale for the Diagnosis 5
Limitations of the DSM 6

2. Biopsychosocial risk and resilience and Strengths assessment 8
Definitions and Description 8
Individual Factors 9

Biological Mechanisms 9
Psychological Mechanisms 11

Social Mechanisms 12
Family 12
Neighborhood 14
Social Support Networks 15

Societal Conditions 15
The Health and Mental Health Care System 16
Poverty 17
Ethnicity 17

Guidelines for Eliciting and Enhancing Client Strengths 18
Conclusion 22

Part tWO: nEurODEvElOPmEntal DiSOrDErS

3. autism Spectrum Disorder 23
Prevalence and Comorbidity 24
Assessment 24
Biopsychosocial Risk and Resilience Influences 28

vii

viii Contents

Onset 28
The Course of Autism Spectrum Disorder 30

Interventions 31
Special Education 31
Family Education, Support, and Involvement 32
Behavioral Management 32
Medication 32
Social Skills Training 33
Complementary and Alternative Treatments 33
Interventions for Adolescents and Adults 33

Critical Perspective 34

4. neurodevelopmental Disorders 39
Prevalence and Comorbidity 40
Assessing ADHD 40
Biopsychosocial Risk and Resilience Influences 43

Onset 43
Course and Recovery 45

Intervention 46
Psychosocial Intervention 46
Medication 47

Critique 47
Critical Perspective 48

Part thrEE: SChizOPhrEnia SPECtrum anD OthEr
PSyChOtiC DiSOrDErS

5. Schizophrenia 52
Prevalence and Comorbidity 52
Assessment 53
Biopsychosocial Risk and Resilience Influences 56

Onset 56
Biological Influences 56
Course and Recovery 58

Intervention 59
Medications 59
Psychosocial Interventions 60

Critical Perspective 64

ix Contents

Part FOur: BiPOlar anD rElatED DiSOrDErS

6. Bipolar and related Disorders 68
Prevalence and Comorbidity 69
Assessment of Bipolar Disorder 71
Biopsychosocial Risk and Resilience Influences 72

Onset 72
Course and Recovery 73

Intervention 76
Medications 76
Psychosocial Interventions 78

Critical Perspective 79

Part FivE: DEPrESSivE DiSOrDErS

7. Depressive Disorders 85
Prevalence and Comorbidity of Depression 85
Assessment 86
Biopsychosocial Risk and Resilience Influences 89

Onset 89
Course and Recovery 90

Intervention 91
Psychotherapy 92
Medication 93

Critical Perspective 96

Part Six: thE anxiEty, OBSESSivE-COmPulSivE, anD trauma
anD StrESSOr-rElatED DiSOrDErS

8. the anxiety, Obsessive-Compulsive, and trauma and Stressor-related
Disorders 100

Prevalence and Comorbidity 102
Assessment of the Anxiety Disorders 102

Assessment Concerns Specific to PTSD 103
Biopsychosocial Risk and Resilience Influences 105

Onset 105
Course and Recovery 107

Intervention 108
Psychosocial Interventions 108
Medication 110

Critical Perspective 110

x Contents

Part SEvEn: FEEDing anD Eating DiSOrDErS

9. Eating Disorders 114
Prevalence and Comorbidity 115
Assessment 116
Biopsychosocial Risk and Resilience Influences 118

Onset 118
Course and Recovery 121

Intervention 123
Treatment Settings 123
Psychosocial Interventions 123
Medication 125

Critical Perspective 125

Part Eight: DiSruPtivE, imPulSE COntrOl, anD COnDuCt
DiSOrDErS

10. Oppositional Defiant Disorder and Conduct Disorder 130
Prevalence and Comorbidity 130
Assessment of Odd and CD 130
Biopsychosocial Risk and Resilience Influences 133

Onset 133
Course and Recovery 135

Interventions for Odd and CD 135
Psychosocial Interventions 135
Medication 136

Critical Perspective 137

Part ninE: SuBStanCE-rElatED anD aDDiCtivE DiSOrDErS

11. Substance-related and addictive Disorders 142
Prevalence and Comorbidity 142
Assessment 143
Biopsychosocial Risk and Resilience Influences 147

Onset 147
Course and Recovery 149

Intervention 150
Psychosocial Treatments 151
Pharmacologic Interventions 153

Critical Perspective 155

xi Contents

Part tEn: nEurOCOgnitivE DiSOrDErS

12. alzheimer’s Disease 159
Prevalence and Comorbidity 160
Assessment Guidelines 160
Biopsychosocial Risk and Resilience Influences 162

Onset 162
Course and Recovery 163

Intervention 165
Goals 165
Psychosocial Interventions 165
Nutritional Interventions 167
Medications 167
Interventions for Caregivers 168

Critical Perspective 168

Part ElEvEn: PErSOnality DiSOrDErS

13. Borderline Personality Disorder 174
Characteristics of Personality Disorders 175
Borderline Personality Disorder 176
Prevalence and Comorbidity 176
Assessment 177
Biopsychosocial Risk and Resilience Influences 179

Onset 179
Course and Recovery 181

Intervention 183
Psychosocial Interventions 183
Medications 185

Critical Perspective 186

Appendix: Case Workbook 191
Index 268

xii

Preface

Mental Health in Social Work: A Casebook on Diagnosis and Strengths-Based Assessment is a
graduate-level textbook that will help students and professionals learn to understand clients
holistically as they proceed with the assessment and intervention process. A major purpose
of Mental Health in Social Work is to familiarize readers with the American Psychiatric
Association’s Diagnostic and Statistical Manual (DSM) classification of mental disorders.
The primary reasons that social workers need to become conversant with the DSM are
the following: (1) to offer clients appropriate referrals and treatment; (2) to communicate
effectively with other mental health professions; and (3) to be eligible for third-party
reimbursement.

The learning in Mental Health in Social Work primarily occurs through a case study
method; students are asked to respond to case illustrations that are presented in each
chapter. Cases (two to three in each chapter) have been selected to represent the diversity
of people with whom social workers intervene. Answers to the questions posed about each
case are provided in an instructor’s manual and should be discussed in class and/or through
feedback on case study assignments. Note that in order to complete the diagnosis in each
case, readers will have to use the DSM-5.

While gaining competence in DSM diagnosis, the reader is also taught to maintain a
critical perspective on the various DSM diagnoses and the medical model as promulgated
through the DSM. The field of social work has a focus not just on the individual, but on
the person within an environmental context, and concerns itself with strengths as well
as problems. Additionally, social work has a traditional commitment to oppressed and
vulnerable populations. Because the DSM is limited in these areas, Mental Health in
Social Work includes the biopsychosocial risk and resilience perspective, which takes into
account both risks and strengths at the individual and environmental levels. Each chapter
then explores the relevant risk and protective influences for each disorder, highlighting
some of the particular risks for special populations, including children, women, the elderly,
minorities, people with disabilities, gay and lesbian individuals, and those from low socio-
economic strata. Students are asked to complete risk and resilience assessments for the case
studies presented.

Another emphasis in Mental Health in Social Work is evidence-based treatment, a
recent movement in social work and various other health and mental health disciplines.
The meaning of evidence-based practice can be debated (Norcross, Beutler, & Levant,
2006), but has been generally defined as the prioritization of research evidence when
social workers consider how to best help clients. However, client preferences and avail-
able resources must also be part of the process of clinical judgment in addition to research
studies (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). In considering the
hierarchy of evidence, whenever possible we rely on systematic reviews and meta-analyses,
which are considered “first-line evidence” (Petticrew & Roberts, 2006). These systematic
reviews aim to comprehensively locate and synthesize the treatment outcome literature in
a particular area. If the review lends itself to combining the results of primary studies in a
quantitative way, then it is referred to as meta-analysis (Petticrew & Roberts, 2006).

From these reviews of the literature, Mental Health in Social Work presents treatment
guidelines for each disorder covered in the book, and through the case studies, students
will learn how to form evidence-based treatment plans. At the same time, in keeping with

xiii Preface

the importance of the environmental context, interventions address the broad nature of
the concerns that people bring to social work professionals. For instance, if socioeconomic
problems, such as lack of health insurance and unemployment, are part of the client’s pre-
senting problems, then intervention will appropriately address these concerns, as they are
critical to a person’s well-being and healthy functioning.

The Council on Social Work Education has implemented educational policy and accred-
itation standards that involve competencies and the practice behaviors associated with them
that social workers are to learn. As a result, Mental Health in Social Work has become part of
the Advancing Core Competencies series. The following table demonstrates how the competen-
cies and practice behaviors are an integral part of this book. Additionally, each chapter includes
critical thinking questions that exemplify the competences and practice behaviors.

In summary, this book takes a case study approach, with students applying evidence-
based information on mental disorders to build their social work competency in terms of
assessment and treatment of mental illness.

Social Work Competencies Addressed in Casebook Exercises
Competency Practice behaviors Casebook application

Competency 2.1.1—
Identify as a profes-
sional social worker
and conduct oneself
accordingly

P.B. 2.1.1a: Readily identify
as social work professionals
P.B. 2.1.1c: Manage
assessment interviews with
clients, using the person-
in-environment perspective

The social work perspective is balanced with the
biomedical perspective of DSM with the risk and
resilience biopsychosocial assessment. An overall
critique of DSM is offered in chapter 1 and for
each DSM disorder.

Competency 2.1.4—
Engage diversity and
difference in practice

P.B. 2.1.4a: Research
and apply epidemiologi-
cal knowledge of diverse
populations and their
mental/behavioral disorders

A chart for each mental disorder with a discussion
of socially diverse populations.

P.B. 2.1.4.Fa: Recognize the
extent to which a culture’s
structures and values may
oppress, marginalize,
alienate, or create or
enhance privilege and power

A critique of the DSM and its association with our
culture’s power structures is presented in chapter 1.

Directions for each case study include Critical
Perspective: Formulate a critique of the diagnosis
as it relates to the case example. Questions
to consider include the following: Does this
diagnosis represent a valid mental disorder from
the social work perspective? How does oppres-
sion, discrimination, and trauma play out in
the development of the disorder? Your critique
should be based on the values of the social work
profession (which are incongruent in some ways
with the medical model) and the validity of the
specific diagnostic criteria applied to this case
(i.e., is this diagnosis significantly different from
other possible diagnoses?).

Competency
2.1.3—Apply critical
thinking to inform
and communicate
professional
judgments

P.B. 2.1.3c: Identify and
articulate clients’ strengths
and vulnerabilities as part of
the assessment

Directions for each case study include
Biopsychosocial Risk and Resilience Assessment:
Formulate a risk and resilience assessment, both
for the onset of the disorder and for the course of
the disorder, including the strengths that you see
for this individual and the techniques you would
use to elicit them.

xiv Preface

Competency Practice behaviors Casebook application

Competency 2.1.5—
Advance human
rights and social and
economic justice

P.B. 2.1.5a: Use knowledge
of the effects of oppression,
discrimination, and trauma
on development of clients’
mental/emotional/behav-
ioral disorders

Directions for each case study include Critical
Perspective: Formulate a critique of the diagnosis
as it relates to the case example. Questions to
consider include the following: Does this diag-
nosis represent a valid mental disorder from the
social work perspective? How does oppression,
discrimination, and trauma play out in the devel-
opment of the disorder? Your critique should be
based on the values of the social work profession
(which are incongruent in some ways with the
medical model) and the validity of the specific
diagnostic criteria applied to this case (i.e., is this
diagnosis significantly different from other pos-
sible diagnoses?).

Competency
2.1.6—Engage in
research-informed
practice

P.B. 2.1.6a: Use research
knowledge to inform clinical
assessment/diagnosis

Evidence-based assessment and practice guide-
lines are presented based on the latest research
for each disorder.

Competency 2.1.7—
Apply knowledge
of human behav-
ior and the social
environment

P.B. 2.1.7a: Synthesize and
differentially apply biologi-
cal, developmental, social,
and other theories of etiol-
ogy associated with specific
mental, emotional, and
behavioral disorders

The latest research on etiological factors associ-
ated with mental disorders in general (chapter 2)
and for each mental disorder is presented.

P.B. 2.1.7b: Use a
biopsychosocial-spiritual
perspective and diagnostic
classification system to for-
mulate differential diagnoses

Directions for each case study include Diagnosis:
Prepare the following: a diagnosis, the rationale
for the diagnosis, and additional information you
would have wanted to know in order to make a
more accurate diagnosis.

P.B. 2.1.7.Fa: Utilize
conceptual frameworks
to guide the processes of
assessment, intervention,
and evaluation.

Strengths-based assessment techniques, solution-
focused therapy, and motivational interviewing
are covered in chapter 2. Theories of evidence-
based intervention are covered for each mental
disorder.

P.B 2.1.7b: Critique and
apply knowledge to
understand person and
environment

Directions for each case study include
Biopsychosocial Risk and Resilience Assessment:
Formulate a risk and resilience assessment, both
for the onset of the disorder and for the course of
the disorder, including the strengths that you see
for this individual and the techniques you would
use to elicit them.

Competency 2.1.3—
Apply critical thinking
to inform and com-
municate professional
judgments
P.B. 2.1.3.b: Analyze
models of assess-
ment, prevention,
intervention, and
evaluation (S)

P.B. 2.1.3.a: Distinguish,
appraise, and integrate
multiple sources of
knowledge, including
research-based knowledge,
and practice wisdom (S)

Directions for each case study include Goal
Setting and Treatment Planning: Given your risk
and resilience assessments of the individual, your
knowledge of the disorder, and evidence-based
practice guidelines, formulate goals and a pos-
sible treatment plan for this individual.

xv Preface

acknowledgments

The case studies that make up this book are based on our clinical practice and the
contributions of our students and other professionals. As the application of assessment
competencies is a core element of this book, we are truly grateful to the following students
who offered case contributions: Susan Bienvenu, Treva Bower, Lindsay Doles, Martha Dunn,
Gidget Fields, Lisa Genser, Carolynn Ghiloni, Christine Gigena, Dana Gilmore, Kristine
Kluck, Elizabeth Lincoln, Pamela McDonald, Jodee Mellerio, Cynthia Ormes, Kristi Payne,
Constance Ritter, Zoe Rizzuto, Heather Roberts, Anne Ross, Amelia Schor, Tina Shafer,
Rebecca Sorensen, Megan Vogel, Raquelle Ward, and Dallas Williams. We are also indebted
to the following social work professionals: Kim Giancaspro, Kris McAleavey, and Adina
Shapiro. Most of all, we want to thank Shane Fagan for tirelessly reading over case studies
and offering her valued clinical opinions.

We thank the reviewers for their suggestions: Chrystal Baranti, California State
University; Laura Boisen, Augsberg College; Daphne S. Cain, Louisiana State University;
Rebecca T. Davis, Rutgers University; and Judith H. Rosenberg, Central Connecticut State
University.

As always, thanks to Patrick Corcoran for his diligent and conscientious proofreading,
helping us to prepare the best book we can put forward.

This text is available in a variety of formats—digital and print. To learn more about our
programs, pricing options, and customization, visit www.pearsonhighered.com.

Competency Practice behaviors Casebook application

Competency
2.1.10—Assess
with individuals,
families, groups,
organizations, and
communities

P.B. 2.10.d: Collect,
organize, and interpret
data (P)

Directions for each case study include Diagnosis:
Given the case information, prepare the
following: a diagnosis, the rationale for the
diagnosis, and additional information you would
have wanted to know in order to make a more
accurate diagnosis.

P.B. 2.10.e: Assess client
strengths and limitations (P)

Directions for each case study include
Biopsychosocial Risk and Resilience Assessment:
Formulate a risk and resilience assessment, both
for the onset of the disorder and for the course of
the disorder, including the strengths that you see
for this individual and the techniques you would
use to elicit them.

P.B. 2.10.g: Select
appropriate intervention
strategies (P)

Directions for each case study include Goal
Setting and Treatment Planning: Given your risk
and resilience assessments of the individual, your
knowledge of the disorder, and evidence-based
practice guidelines, formulate goals and a pos-
sible treatment plan for this individual.

This page intentionally left blank

1

Diagnosis and the Social Work
Profession

Henry Williams, a 59-year-old African American, was in the hospital after undergoing surgery for
removal of a brain tumor. His past medical history included seizures, insulin-dependent diabetes
mellitus, and pancreatitis (an inflammation of the pancreas that causes intense pain in the upper
abdomen). Currently, Mr. Williams was taking several medications, including Dilantin (used to
treat epilepsy), insulin, and steroids (to decrease swelling around his tumor).

About six days after the surgery, Mr. Williams woke up in the middle of the night and
was very loud in

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