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Discussion 1: Assessment of Anxiety and Obsessive-Compulsive and Related Disorders

A client’s description of symptoms and the observations of the clinical social worker are not always reliable when determining a diagnosis for an anxiety disorder. Therefore, anxiety measurements are very useful in clinical practice. An anxiety scale can indicate the level of severity, which helps the clinician determine the appropriate treatment.

For this Discussion, review the case study, “Working with Clients with Severe Persistent Mental Illness: The Case of Emily,” and read the DSM-5 chapters on anxiety disorders and obsessive-compulsive and related disorders. Remember, you will determine a diagnosis for Emily. Also, read the article on anxiety disorders by Olatuni, Cisler, and Tolin (2007). Finally, search the literature for an evidence-based assessment scale that would assist you in your diagnosis.

· Post a clinical diagnosis for Emily based on the information provided in the case study, using the diagnostic criteria of the DSM-5. 

· Note that the diagnosis in the case study was based on the DSM-IV. Include other conditions that may be a focus of clinical attention in your diagnosis. 

· Compare the two diagnoses, particularly when using a person-in-environment approach

· What target behaviors and/or symptoms does the scale assess? 

· How valid and reliable is the assessment tool? 

· How is the scale administered? 

· How would this tool help you with your diagnosis?

References (use 3 or more)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

· “Anxiety Disorders” (pp. 189–223)

· “Obsessive-Compulsive and Related Disorders” (pp. 235–264)

Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27(5), 572–581.

In your reading for this week, you meet Jose and Iris, two individuals who are in situations that require assistance and guidance from a professional social worker and policy advocate.

In this Discussion, create a policy proposal that will impact the situations faced by either Jose or Iris. Describe the trade-offs you used to develop your proposal.

To prepare: In your text, review “Trade-Offs: Systematically Comparing Policy Options in Step 3” in Chapter 8.

· Post a brief summary of the policy proposal and its purpose that you created based on either Jose’s or Iris’s situation and the trade-offs you used to develop your proposal.

References (use 3 or more)

Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice (8th ed.). Pacific Grove, CA: Brooks/Cole Cengage Learning Series.

· Chapter 8, “Placing Policy Proposals in Policy Briefs in the Second, Third, and Fourth Steps of Policy Analysis” (pp. 246-283)

Plummer, S.-B, Makris, S., Brocksen S. (Eds.). (2014). Social work case studies: Concentration year.Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Stuart, P. H. (1999). Linking clients and policy: Social work’s distinctive contribution. Social Work, 44(4), 335–347.

Midgley, J., & Livermore, M. M. (Eds.) (2008). The handbook of social policy (2nd ed.). Thousand Oaks, CA: Sage Publications.

Chapter 6: “The Impact of Social Policy” (pp. 83–100) (PDF)

Working With Clients With Addictions: The Case of Jose

Jose is a 42-year-old, heterosexual, Latino male. He had been booked and charged for vagrancy three times in the last 2 months. He had also been arrested six other times over the past 10 years for various minor offenses, such as trespassing, public drunkenness, and disorderly conduct. After this last hearing, the judge mandated him to a drug treatment facility and gave him 2 years’ probation.

As a social worker at the county’s mental health and substance abuse agency, I was assigned to manage his case and to ensure he followed the judge’s ruling. My role was also to provide resources and referrals and advocacy, when needed. We met initially to complete the intake form so that I might get as much information as possible to assist him. Jose informed me immediately that he had no source of income, was homeless, and was very interested in services to address his alcoholism and substance abuse. He added that over the past 20 years, he had tried many times to get clean and sober but had little success. Jose identified himself as a “chronic relapser.” He was concerned that he was going to have to pay for the drug treatment facility and expressed surprise that the judge had not placed him in jail as he had been in the past.

I explained that our state had recently passed a law that required the judicial system to direct persons who were identified as primarily having addictive problems out of or away from incarceration and instead into alternative community-based drug treatment programs. I told him that a class action suit had been brought by a number of inmates for alternative services after a recent study was published that reported that more than two-thirds of state prison inmates had chronic and severe drug and alcohol abuse problems and that almost half of this group’s only convictions were for drug- and alcohol-related offenses. These findings had propelled the state to put this new policy into place. All of the counties quickly established a process to manage a new model.

I learned that Jose had not been steadily employed for the past 12 years, although he had been gainfully employed for at least a decade before then. He had graduated high school and appeared to have above-average intelligence. He had never been married nor had children. For the past 2 years, he said that he had primarily been living under a railroad bridge near a major freeway in the area. He reported no support or family in the area, but said that he still has occasional contact with a sister and an aunt in separate Southern states and a cousin on the West Coast.

Jose shared that he had moved to the West Coast from the South 8 years ago, hoping that a change of location would help him get sober. However, upon arrival and having no place to reside, he ended up living on the street and in pursuit of alcohol and cocaine. He was mostly supporting his habit by panhandling and recycling.

Jose stated that he comes from a family with members who have struggled with alcohol abuse and drug addiction. He said that his mother was placed in a nursing home at the age of 42 (when Jose was 8) and was diagnosed with dementia as a result of long-term alcoholism. His father committed suicide at the age of 47 (when Jose was 10). Jose said that his father suffered from depression and was a heroin intravenous drug user. As a result of his parents’ difficulties, Jose was almost completely raised by his grandmother in an urban public housing project. Jose said that he also had bouts of depression but had never sought professional help to address it. It was not clear if the depression was brought on by the substance abuse or if the drug abuse was being used to address the depressive symptoms.

Based on the information provided, we created a plan of action. After exploring alternatives for immediate assistance, I was able to arrange for Jose’s admission the next day into a 5-day detoxification center, followed by 30 days of inpatient treatment at a county-supported program. Jose and Iwould either meet or speak on the phone every week in order to track his progress so that I could complete a written report for the judge and Jose’s probation officer.

After Jose’s release from the inpatient program, we worked together to decide goals that seemed feasible for him and would continue his current trajectory toward a clean and sober life. A bed was found for him at a local sober living environment (SLE) house in the community that agreed to take him as long as he could start paying rent within the first two months. He seemed to adapt well to the new environment and reported that for the first time in many years he was feeling hopeful and was less depressed. The planned goals included continued and consistent attendance at Alcoholics Anonymous™ (AA) meetings, getting together with his sponsor for recovery support, and seeking employment. We worked together to build his resume and looked on the Internet for possible job leads.

Within a few weeks of living in the SLE, Jose was able to obtain employment conducting telephone sales for a local telemarketing company. Later that same year, Jose obtained his driver’s license and began working for a valet parking contractor. After 2 years he is still living in the same SLE residence and says that his life is now stable and productive. He is no longer mandated to meet with me, and his probation has expired with no incidences. He is in a relationship with a woman he met at work, and they plan to wed next year.

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