Confidentiality and its Limits

We've touched briefly upon this ASWB exam outline item before and offered this simple guidance:

Suggested reading (and rereading): NASW Code of Ethics sections 1.07, Privacy and Confidentiality, and 2.02 Confidentiality with Colleagues. Also, as a bonus, here's NASW's helpful HIPAA Highlights for Social Workers. 

Let's dig in a little further here. This is a ripe area for exam writers; expect to see privacy, confidentiality, and/or reporting questions on the social work licensing exam--more than once in a 170-question test. May as well be prepared!

In addition to the above reading, consider these confidentiality-themed columns from Eye on Ethics, Fredric Reamer's column at Social Work Today:

• The Limits of Confidentiality
• The Complexities of Client Privacy, Confidentiality, and Priviledged Communication
• Sharing Client Information with Colleagues: Ethical Challenges
• The Challenge of Facing Subpoenas--Protecting Client Confidentiality
• The Limits of Confidentiality & Revisiting the Limits of Client Confidentiality
• When to Break Client Confidentiality with Minors

Each column contains material for a bunch of different licensing exam questions. Take a moment to imagine that you're an exam writer charged with generating new exam material. What would you ask?

From the subpoena article, you might picture something like this:

A social worker receives a subpoena for client records. How should she respond?

Some possible answers:

Refuse to comply with the subpoena.

Comply with the records request.

Comply with the records request, withholding information about drug or alcohol use.

Comply partially with the records request.

Comply partially with the records request, per the client's wishes.

Consult with an attorney.

Consult with a supervisor.

Consult with the client.

Consult with a colleague who has recently been through the same situation.

On the real exam, you'll just face four answers, A-D. The best answer will depend upon the group. Here's Reamer on the basic ethical principles social workers ought to consider when facing this legal request:

To protect clients and adhere to the Code of Ethics, social workers should understand their obligation to challenge subpoenas in the absence of client consent or a court order. Usually with the benefit of legal consultation (which may include consulting the client's attorney, with the client's consent), social workers may object to the subpoena or file a motion to quash the subpoena. Depending on the circumstances, social workers may challenge the subpoena on the grounds that it requests confidential or privileged information that the social worker is not authorized to release (for example, because the client did not consent to disclosure or disclosure would violate relevant laws) or that the scope of information requested by the subpoena is overly broad and needs to be narrowed. The law recognizes the importance of protecting certain communications between professionals and clients and grants them a privileged status during legal proceedings. For example, both state and federal laws prevent certain professionals, such as social workers, from being forced to testify or submit documents about their clients (although there are some narrow exceptions).

Happy reading and preparing. Remember that you're not alone--practice tests are very helpful for this topic and many others.

Good luck on the exam. Congratulations in advance!

Social Worker Roles

Here's a vague item from the ASWB content outline: The types of social work interventions/treatments. That could mean more-or-less anything. The advanced generalist outline narrows down: The social worker’s role in the change process.

You may have seen a list of social work roles--broker, mediator, enabler, facilitator, and so forth. They're probably worth reviewing. As usual, we're not going to retype everything here, but instead send you off to a helpful, already completely typed, free resource on the web for the info.

Here you go:

• BSW Practice Roles (CSU School of Social Work)
• Roles of a Social Worker (Inspired Consulting)
• LMSW Exam Flash Cards (Flashcard Machine)

You don't need all three links--one will do. But there they are if you're feel like extra clicking and reading. Looks like the role of this blog today is "broker"--linking the exam-prepping community with resources--helpful sites and practice tests. Hope it's helpful. Good luck on the exam!

KSA of the Day: Techniques for Stress Management

Here's an ASWB exam content outline item that may come in handy before and after you sit for the social work licensing exam: Techniques for Stress Management.

Social workers experience all manner of stressors, even in ideal work situations. Burnout, secondary trauma, and collapsing self-care are common. Figuring out how to manage your own stress--by making changes to what you face and how you face it--is a great first step in being able to help clients with stress management. And knowing some (widely accepted, empirically validated) techniques to lessen stress may have the additional benefit of getting you through a question or two on the test!

To get started with the "how you face it" solutions, here's a list from the Mayo Clinic.

• Autogenic Relaxation
• Progressive Muscle Relaxation
• Visualization
• Deep breathing
• Hypnosis
• Massage
• Meditation
• Tai chi
• Yoga
• Biofeedback
• Music and art therapy 

 Most of these you may have encountered or tried. But what's that first one refer to again?

Autogenic relaxation. Autogenic means something that comes from within you. In this relaxation technique, you use both visual imagery and body awareness to reduce stress.
You repeat words or suggestions in your mind to relax and reduce muscle tension. For example, you may imagine a peaceful setting and then focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one.

Ah, okay, thanks Mayo Clinic! Here's another list from the NIH: 

• Autogenic Training
• Biofeedback-Assisted Relaxation
• Deep Breathing or Breathing Exercises
• Guided Imagery
• Progressive Relaxation
• Self-Hypnosis

The NIH page takes a look at the research about relaxation's effects on various conditions. E.g., anxiety:

Studies have shown relaxation techniques may reduce anxiety in people with ongoing health problems such as heart disease or inflammatory bowel disease, and in those who are having medical procedures such as breast biopsies or dental treatment. Relaxation techniques have also been shown to be useful for older adults with anxiety.

On the other hand, relaxation techniques may not be the best way to help people with generalized anxiety disorder. Generalized anxiety disorder is a mental health condition, lasting for months or longer, in which a person is often worried or anxious about many things and finds it hard to control the anxiety. Studies indicate that long-term results are better in people with generalized anxiety disorder who receive a type of psychotherapy called cognitive-behavioral therapy than in those who are taught relaxation techniques.

Important to note: social work's systems/holistic/biopsychosocial/macro view will often point a different direction. Instead of sharing techniques to reduce the effects of stress, social workers should find ways to help clients advocate to reduce the stressors themselves. Don't be too surprised if a question tries to lure you in with appealing distractors like autogenic relaxation when the real, BEST answer is to make changes around, not within, the client.

Hope that helps. Good luck with the exam!

KSA of the Day: Client Self-Determination

We've been hopping around in the ASWB's KSA outline for a while now. Let's jump down to the bottom today, into the Value Issues section, part C of Professional Values and Ethics, which makes up 18% of the exam. The nice thing about these KSA items is this: you probably already know your way around professional values and ethics in social work. And if you don't, or want to get refreshed on social work values and ethics, there's just one, simple place to turn: the NASW Code of Ethics.

Take this KSA: Client Self-Determination. It's in the code a couple of times. First in the Ethical Principles, up top:

Value: Dignity and Worth of the Person

Ethical Principle: Social workers respect the inherent dignity and worth of the person.

Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. Social workers promote clients’ socially responsible self-determination. Social workers seek to enhance clients’ capacity and opportunity to change and to address their own needs. Social workers are cognizant of their dual responsibility to clients and to the broader society. They seek to resolve conflicts between clients’ interests and the broader society’s interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession.

Want it more spelled out? The code is ready to do just that, in 1.02, Self-Determination:

Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.

Social workers don't have to agree with everything their clients believe and do. Gently exploring pros and cons is one thing, but imposing values and judgments on clients is another.

How might this show up on the social work licensing exam? Take a look at this free practice question from SWTP to get an idea. If a client isn't planning to do harm to self or others--imminent harm--social workers are to back off. Clients get to choose how to live their lives. Sometimes it's hard to watch, but that's all part of being an ethical social worker.

For more about client self-determination, take a look at these Eye on Ethics columns from Social Work Today: Making Difficult Decisions and The Challenge of Paternalism in Social Work. But really all you have to do is read the above section of the Code of Ethics, and you're up to speed!

Good luck on the exam!

KSA of the Day: Risk Factors Related to Suicide

Here's an item on the ASWB exam outline that's good to have a deep understanding of whether or not you're prepping for the social work licensing exam: Risk factors related to suicide.

This is knowledge that can be tested for in all different manner of licensing exam questions. The ASWB exam focuses on safety above just about all else. Correctly identifying suicide risk is a vital first step in keeping clients safe. This is material worth knowing.

As you're reviewing risk factors for suicide, it's good to take note of these words from the American Foundation for Suicide Prevention:

There’s no single cause for suicide. Suicide most often occurs when stressors exceed current coping abilities of someone suffering from a mental health condition. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Conditions like depression, anxiety and substance problems, especially when unaddressed, increase risk for suicide. Yet it’s important to note that most people who actively manage their mental health conditions lead fulfilling lives.

This intro is followed by a good list of risk factors. As usual, the internet has the answers to your exam-prep questions well answered. We won't waste time writing lists from scratch, but instead point you to a few valuable sites to get up to speed on this KSA. Here you go:

• Risk Factors (SuicidePreventionHotline.org)
• Suicide: Risk & Protective Factors (CDC.gov)
• Teen Suicide Risk Factors (ChildMind.org)

There are plenty more good lists just a web search away. But these'll get you the knowledge you need on the test--and in practice. Use them well. Good luck! 

KSA of the Day: The Concept of Empathy

Empathy is either the bread or butter of social work. But which? That's not a question you're likely to see on the ASWB exam. But "the concept of empathy" is on the knowledge skills and abilities list. Do you have the concept down? Can you define it? How is empathy different than sympathy?

Here's a simple conclusion from a blog-post long answer on the subject at dictionary.com:

Sympathy is feeling compassion, sorrow, or pity for the hardships that another person encounters, while empathy is putting yourself in the shoes of another.

You might see this on the exam as a "which statement exemplifies the use of empathy"-type question. Watch out for distractors that involve sympathy, mirroring, congruence, or some other clinician behavior that isn't empathy.

Whether or not an empathy question comes up in the exam, it'll come up every day and every way in social work practice. Check with yourself: Are you expressing sympathy with clients at the expense of empathy. Sympathy has its place, of course. But expressing authentic empathy is the bread and the butter of good social work practice.

For more on the topic, try:

• Mincing Words: Empathy and Sympathy (NASW-DC)
• Breaking Boundaries with Empathy (New Social Worker)
• Can Social Work Students Learn Empathy? (Social Work Today)

Happy reading, happy studying. Not enjoying it? We feel your pain.

Good luck on the exam!

KSA of the Day: Substance Use Disorders

Next up in our hopping around through the ASWB exam outline: substance use disorders . It's part of the Addictions section of the outline, a subset of HUMAN DEVELOPMENT, DIVERSITY AND BEHAVIOR IN THE ENVIRONMENT, which all-in-all accounts for 31% of exam questions.

What exactly do you need to know about substance use disorders? The outline doesn't say. But since substance use disorders also shows up in the DSM, you have all the more reason to get them understood.

We're not going to spell out all of the details about the topic here. But we can link you to some helpful sources of info. Start with these:

• Substance Use Disorders (SAMHSA)
• Revised Criteria (PsychCentral)

PsychCentral summarizes DSM-5 criteria like this:

The DSM-5 states that in order for a person to be diagnosed with a disorder due to a substance, they must display 2 of the following 11 symptoms within 12-months:

• Consuming more alcohol or other substance than originally planned
• Worrying about stopping or consistently failed efforts to control one’s use
• Spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain them
• Use of the substance results in failure to “fulfill major role obligations” such as at home, work, or school.
• “Craving” the substance (alcohol or drug)
• Continuing the use of a substance despite health problems caused or worsened by it. This can be in the domain of mental health (psychological problems may include depressed mood, sleep disturbance, anxiety, or “blackouts”) or physical health.
• Continuing the use of a substance despite its having negative effects in relationships with others (for example, using even though it leads to fights or despite people’s objecting to it).
• Repeated use of the substance in a dangerous situation (for example, when having to operate heavy machinery, when driving a car)
• Giving up or reducing activities in a person’s life because of the drug/alcohol use
• Building up a tolerance to the alcohol or drug. Tolerance is defined by the DSM-5 as “either needing to use noticeably larger amounts over time to get the desired effect or noticing less of an effect over time after repeated use of the same amount.”
• Experiencing withdrawal symptoms after stopping use. Withdrawal symptoms typically include, according to the DSM-5: “anxiety, irritability, fatigue, nausea/vomiting, hand tremor or seizure in the case of alcohol.”

The two sites above should cover you, but for more reading on substance use disorders try:

• Substance Use Disorders (Wikipedia)
• Substance Use Disorders (MentalHelp.net)

Off topic: We mentioned outline sections above. What are the sections of the outline, you ask?

• HUMAN DEVELOPMENT, DIVERSITY AND BEHAVIOR IN THE ENVIRONMENT, 31%
• ASSESSMENT, DIAGNOSIS AND TREATMENT PLANNING is 26% of the exam
•  PSYCHOTHERAPY, CLINICAL INTERVENTIONS AND CASE MANAGEMENT is another 25%
• PROFESSIONAL ETHICS AND VALUES makes up 18%.

That's the full 100%. If it's not included in one of those main areas, it's not going to be on the social work licensing exam.

Happy studying and good luck!

KSA of the Day: The Effects of Trauma

Here is a cluster of bullet points from the Human Behavior in the Environment section of the ASWB Clinical Outline to take a look at as you prepare for the social work exam:

• The effects of abuse and neglect on victims
• The effects of trauma on behavior
• The effects of trauma on self-image

All are addressed at some length in on this page from the National Child Traumatic Stress Network (NCTSN). At the start:

The majority of abused or neglected children have difficulty developing a strong healthy attachment to a caregiver. Children who do not have healthy attachments have been shown to be more vulnerable to stress. They have trouble controlling and expressing emotions, and may react violently or inappropriately to situations. Our ability to develop healthy, supportive relationships with friends and significant others depends on our having first developed those kinds of relationships in our families. A child with a complex trauma history may have problems in romantic relationships, in friendships, and with authority figures, such as teachers or police officers.

Trauma and abuse can be experienced at all ages, of course, but the effects of trauma are somewhat universal. Covered on the page, trauma's impact on:

Attachment and Relationships
Physical Health: Body and Brain
Emotional Responses
Dissociation
Behavior
Cognition
Self-Concept & Future Orientation
Long-Term Health Consequences
Economic Impact

Assessing for and helping with trauma is one of the central features of what social workers do. Do not be surprised to see the ASWB exam touching upon the topic.

For more reading about the effects of trauma, try:

• Understanding the Impact of Trauma (SAMHSA)
• Trauma, Attachment, and Stress Disorders
• The Effects of Trauma Do Not Have to Last a Lifetime (APA)

KSA of the Day: Psychological Defense Mechanisms

Take a look at the ASWB Knowledge, Skills, and Abilities outline, section 1B, Human Behavior in the Environment. You'll find a bunch of basic social work stuff that you've probably learned at some point during social work school, working, or even in an undergraduate Psych 101 course. This bullet pointed item may have shown up in all three: "Psychological Defense Mechanisms." "Psychological" as opposed to swords and shields, we guess.

Getting prepared for defense mechanism questions on the social work licensing exam is simple. Just look over a list of defense mechanisms and some examples. We're not going to retype it all for you but are happy to provide some helpful links and this chart via Simply Psychology. First, a few of the the most common defense mechanisms:

Next, lists and explanation aplenty:

• Defense Mechanisms (Wikipedia)
• Defense Mechanisms (Simply Psychology)
• 15 Common Defense Mechanisms (PsychCentral)

Happy brushing up and good luck on the exam!

KSA of the Day: Child Development

Only a small portion of those who sit for the social work licensing exam have had the opportunity to do clinical work with children. That leaves some studying to do. On the ASWB exam, it's not wildly uncommon to find questions that test your ability to understand the basics of what to expect of children at different stages and how to assess problems. Those are the questions covered in the simple, two-word KSA item: child development.

Child development is a topic that can't be even close to adequately covered in a single blog post. Happily, many others have written at length about the topic, leaving you with lots to read and digest. Here are a few stand-outs. If you find others, please don't hesitate to post them in comments. It takes a village of social workers to help each social worker pass the ASWB exam!

Links like these (from one gov't website to another) can start to get you up to speed:

Normal growth and development

Preschoolers

School age children

Stages of Adolescence

Adolescents

Check out these info-rich sites for lots and lots and lots and lots and lots more:

• CDC/ChildDevelopment
• ChildDevelopment.info
• Wikipedia
• Theory Overview

Don't stop there. Search engines are your friend. Happy learning and good luck on the exam!

KSA of the Day: The Concept of Attachment and Bonding

Attachment and bonding may or may not come up on the social work licensing exam. But they'll come up every day you're a living and breathing social worker (and person). Preparing for the exam is a good excuse to gain a better, deeper understanding of the thinking and theorizing on the subject.

What springs to mind when you hear "attachment and bonding"? How about John Bowlby? How about Mary Ainsworth? How about Harlow's monkey?

Let's start with the monkey.

Harlow's monkey gets milk from a fake wire monkey, but clings to the cozier fake cloth monkey. Attachment and bonding!

Attachment theory can't be summed up quite as quickly. But how's this: Attachment theory posits that attachment isn't a byproduct of other psychological drives, but an essential drive in and of itself. Attachment is so crucial that the quality of early attachments affects the way a person relates to others for their entire lifetime. Attachment researchers have identified several typical patterns of attachment between infants and caregivers--some secure and some insecure--and witnessed their longterm stickiness. Young children with a certain attachment pattern grow into adults with that same attachment pattern.

But don't just take it from this blog. Read up. Here are some places to get smart and smarter about attachment:

• Attachment Theory (Wikipedia)
• Attachment Theory (Simply Psychology)
• Attachment Styles (verywell.com)

That should do it to get your prepared for attachment and bonding questions on the ASWB exam.
Stay cozy and good luck!

KSA of the Day: Personality Theories

Paying a visit again to the Knowledge, Skills, and Abilities list (available at ASWB.org)--the Ks, Ss, and As you might need to grasp in order to correctly answer questions on the social work licensing exam. Up next: personality theories.

Here again, you at some point have probably learned everything you need to know on the topic that you need to know to get through the exam. What you probably need is a refresher--to dig the info out of deep long term memory and get it somewhere more accessible for exam day.

Wikipedia is so very ready to help you with this, we end up with not so much to say about the subject. Only this: as you go through Wikipedia's personality theories list, remember this: if you haven't ever heard of it,  you probably don't really need to know it. Freud rings a bell, right? Worth reviewing. Allport, Catell, Gittinger? They may not have come up in that HBSE class. It may be safe to move on.

For your clicking and browsing ease, here's Wikipedia:

• Trait theories
• Type theories
• Psychodynamic theories
• Behaviorist theories
• Social cognitive theories
• Humanistic theories
• Biopsychological theories
  • Genetic basis of personality
• Evolutionary theory

 For more about personality theory elsewhere on the web, try:

• Theories of Personality (About.com)
• Theories of Personality (SlideShare)

A web search will bring up more and more and more.

 

Happy learning, happy studying, and good luck on the exam!

KSA of the Day: "The theories of human growth and development"

We haven't posted about a KSA in a long, long while. But the Knowledge, Skills, and Abilities list is still a good guide for help getting a sense of what to expect on the social work licensing exam (it's posted on the ASWB's website, if you want to see it). What's really on the social work exam is never everything on the giant KSA list. Remember, it's a list of possibilities. Among those possibilities are the bread-and-butter, real-world, everyday pieces of social work knowables--those are the ones you can be more certain will show up on the exam. Basic diagnoses, social work ethics, and the like.

Rather than bury yourself in the KSA list and eating up all your time looking for explanations of obscure items in your old textbooks or on the web, we suggest spending that time studying practice questions. If you work your way through enough decent practice tests, you're likely to encounter most of the useful stuff on the KSA list eventually.

That said, for today, let's take look at the very first item on the list: "The theories of human growth and development."

It's kind of broad, isn't it? "The theories." There are lots of theories out there. Which ones are you supposed to actually know? One way to answer: which ones do you already know? Which are the ones covered in your MSW program. Freud? Erikson? Piaget? You've probably encountered each at least a little. If you haven't ever heard of a theory, chances are you can pass the exam without learning it from scratch. The exam is designed to assess the know-how of beginning social workers, not PhDs. And it is "know-how" that's being assessed with most questions, not flash card memorization. If Erikson, for example, shows up on the exam, what's more likely is "A social worker using Erikson's stages is MOST likely to..." ABCD. It's not just memorizing; it's applying.

Here's some of what Wikipedia has to offer on these and several more on it's developmental psychology page.  (You'll recall that psychosexual = Freud, psychosocial = Erikson, etc.) As good a place as any to get started reviewing:

• Attachment theory
• Psychosexual development
• Stages of moral development
• Stages of psychosocial development
• Theories of cognitive development

We say this again and again: don't overstudy. A rough understanding of developmental theory is just as likely to help you pass the ASWB exam as a deeper dive.

You've got it covered. Good luck!

Additional resources:

• Theories of Development (About.com)
• Theories of Human Development (SlideShare)
• Theories of Human Growth and Development (Study.com; membership required)
• Social Work Exam Prep (Pinterest <--charts!)

KSA of the Day: Value Issues

Here's the final KSA of the Day: VALUE ISSUES.  How to prepare?  The NASW Code of Ethics identifies six core values for social workers (links below go to the code):

1. Service
2. Social Justice
3. Dignity and Worth of the Person
4. Importance of Human Relationships
5. Integrity
6. Competence

Reading the entire Frederic Reamer book may be overdoing it, but if that's your thing, let us know how it goes.
That does it for the KSAs.  Find the complete collection using the KSA of the Day tag.  Thanks for studying along with Pass the ASWB Exam and good luck on the test!

KSA of the Day: Confidentiality and Its Limits

Here's the KSA of the Day with the shortest list of bullets: CONFIDENTIALITY AND ITS LIMITS.  Don't be tricked--this material will come up on the exam--more than two bullet-points worth! 

Suggested reading (and rereading): NASW Code of Ethics sections 1.07, Privacy and Confidentiality, and 2.02 Confidentiality with Colleagues. Also, as a bonus, here's NASW's helpful HIPAA Highlights for Social Workers. 

KSA of the Day: Ethical Issues

Next section of the exam is Professional Ethics and Values--18% of the current exam.  The first KSA of the Day from the section: ETHICAL ISSUES.  You already know where to go for this stuff, right?  The NASW Code of Ethics.  Covers everything on the list below.

Don't feel like reading?  Here's some listening on the topic from the Social Work Podcast.

KSA of the Day: Consultation and Interdisciplinary Collaboration

KSA of the Day: CONSULTATION AND INTERDISCIPLINARY COLLABORATION. Will you be tested on this? Yes--chances are.  The ASWB naturally wants to assess whether social workers understand the limits of what a social workers can do.  A client presents with a diagnosis that could be accounted for by a medical condition?  Refer to an MD.  A client has a problem you have no experience with?  Seek supervision.  Like that.   Some topics covered and potentially helpful links: Models of peer supervision; Consultation approaches; Elements of a case presentation; Client referral for services

KSA of the Day: Management of Cases

KSA of the Day: MANAGEMENT OF CASES.  Some topics and potentially helpful links: Case recording for practice evaluation or supervision (pdf); The concept of client advocacy (ppt);  Documentation and the management of practice records (pdf slides)

In addition to the above links, you might also review the NASW Code of Ethics (always a good idea--tends to show up a lot on the exam) and the NASW Standards of Practice.

KSA of the Day: The Intervention Process

Here's  a long one--a really long one. KSA of the Day: THE INTERVENTION PROCESS.  Some helpful links for this section:  Crisis intervention/treatment approaches; Solution-focused and brief interventions; Partializing techniques; Models of family-centered social work practice

Also, more broadly:

• Wikipedia Psychology Portal 
• AllPsych.com
• SimplyPsychology.org 

KSA of the Day: Therapeutic Relationship

Next up, the next section, which accounts for a quarter of the exam: Psychotherapy, Clinical Interventions, and Case Management.  The first KSA of the Day from this section: THERAPEUTIC RELATIONSHIP, all about what you do when you do therapy. A couple of links: The principles of relationship building; Concepts of transference and counter-transference.

And here are 52 slides covering a lot of the topic: