LICSW

Subpoena

A legal document that orders an individual to appear in court or produce documents relevant to a case. In social work, it often pertains to cases involving client confidentiality and the legal obligations of licensed professionals.

Subpoena 1st Step

Notify the client about the subpoena and discuss potential implications for confidentiality. Prevent unecessary disclosure.

Subpoena 2nd Step

Evaluate the relevance and scope of the subpoena, and determine what information may be disclosed while protecting client confidentiality. Assert Privilege.

Subpoena

SW does NOT automatically release records. Protects confidentiality, asserts privilege, and discloses only what’s legally required.

Defense Mechanisms

Unconscious. Protect the ego. Reduce anxiety.

A new manager takes over an agency with low employee morale, increasing client demand, and poor outcomes. What should the manager do FIRST?

Mission → Outcomes → Staff → Policies

Clinical + FIRST Question

Assess First. Emotional Safety & Acceptance.

Manager + FIRST Question

Agency’s Mission

Safety Issue + FIRST Question

Protect client.

Ethics Issue + FIRST Question

Consult/Protect Confidentiality

Sexual Relationship Between Therapist and Client

Notify supervisor & protect the client. Serious boundary and ethics violation.

Conduct Disorder

A pattern of behavior in children and adolescents characterized by disruptive and antisocial actions, such as aggression, rule violations, and deceit.

Conduct Disorder Duration

3+ symptoms in 12 months, with 1 in the last 6 months. Can be diagnose up to age 17.

Antisocial Personality Disorder cannot be diagnosed before age 18.

Continuity of Care

Hospital→Discharge Planning—>Community Supports—>Relapse Prevention

Frequent Re-Admissions

Look outside the hospital.

Collaborative Team

A group of professionals from various disciplines working together to achieve common goals for client care, often enhancing support and outcomes through shared expertise and resources.

Mutual Interdependence/Systems Theory

Most common amongst African Americans.

• "The whole family changed..."

• "One member's behavior affected everyone..."

• "Changes in one part of the system..."

• "Reciprocal influence..."

• "Interaction between family members..."

Transgender

Transgender describes a person whose gender identity differs from the sex they were assigned at birth.

Gender Dysphoria

6 months + distress.

Self-Neglect & Adult Protective Services (APS)

Occurs when a person fails to meet their own basic needs, putting their health or safety at risk. Assess immediate safety & decision-making capacity. Then determine the least restrictive intervention that protects the client while respecting self-determination.

Systems Approach

If the question mentions:

• Family dynamics

• Community resources

• School collaboration

• Interdisciplinary teams

• Environmental influences

• Social supports

Ethnicity

Shared cultural identity—Latino/Hispanic.

It may include:

• National origin

• Language

• Traditions

• Customs

• Shared history

• Cultural heritage

Race

A socially constructed way of categorizing people, often based on physical characteristics such as:

• Skin color

• Hair texture

• Facial features

Collateral Information

Information obtained from people other than the client to help with assessment, diagnosis, treatment planning, or risk evaluation.

Collateral Information Memory Rule

Client first → consent → collateral → integrate information

Agoraphobia

Fear of places where:

➡ "I can't get out."
➡ "No one can help me."

6 months+

Agoraphobia Treatment

CBT & Exposure Therapy

Social Anxiety Disorder

Fear of social judgment → 6+ months

Anxiety Disorders With A 6-Month Rule

• Social Anxiety Disorder

• Agoraphobia

• GAD

• Specific Phobia

Specific Phobia

Fear of a specific object (spiders, elevators, needles) —>6+ Months

Panic Disorder

Repeated unexpected panic attacks —>6+ Months

CPL: Who’s My Client? What’s the Presenting Problem? Last Sentence. Does My Answer Address the Problem?

Who’s My Client: Individual, Couple, Family or Community. Intervention must align.

Qualifier

First, Next, Best & Most

FIRST Questions

You will do A, B, C. Does the answer address the presenting problem? Least intrusive first.

NEXT Questions

In the moment. Client is in front of you. Pay attention to the last TWO sentences of the vignette.

A client tells a social worker they are transgender, and the social worker has never worked with a transgender client. What should the social worker do?

❌ Refer immediately because they lack experience.
✅ Seek education/consultation and provide affirming care if competent.

Referral Process

First Assess → Consult → Refer if Needed

When to refer out?

➡ Lack competence + CANNOT obtain it = refer.
➡ Need to learn more = consult and improve competence.

CPL Method

Client, Problem, Last Sentence

10 Months Without Alcohol Use Disorder Symptoms

Early Remission

Fear of Social Judgment for 6+ months

Social Anxiety Disorder

Fear of being unable to escape situations.

Agoraphobia

Diagnosis is usually NOT the FIRST action!

• Assess

• Ensure safety

• Gather information

• Establish rapport

• Then diagnose/treat

"FIRST" Questions

Assess before diagnosing/intervention.

Group treatment and peer support are very commonly associated with substance use disorders.

Client wants to connect with others who understand recovery.

Support Group

A client in early recovery needs education about cravings and relapse.

Psychoeducation Group

Client is NOT ready to stop using.

✅ Motivational interviewing—> Client us unsure about quitting
✅ Explore ambivalence
✅ Harm reduction

Client is in recovery and wants support.

Peer Support Group

Client is actively intoxicated or unsafe.

Assess safety. Medical Stabilization if needed.

Client needs therapeutic processing.

Group Therapy

Cocaine

UP and Activated—Client is energized, agitated, paranoid, and not sleeping, think stimulant (cocaine/amphetamines).

A client reports feeling depressed. What should the social worker do FIRST?

Assess before educating.

A client is suicidal and has a plan.

Safety Before Education

E = Education comes after
A = Assessment
S = Safety
E = Engagement

Engagement, Safety, Assessment, and the Education (if needed).

How To Respond Sequence

• Assess

• Ensure safety

• Validate/engage

• Educate

• Refer/treat

If the answer choice says "educate", ask:

"Has the social worker already assessed what the client needs?"
If not, assessment usually wins.

A social worker has direct knowledge that another social worker's impairment is interfering with effective practice. What should the social worker do FIRST?

Consult with the colleague when feasible and assist the colleague in taking remedial action.

Is there immediate danger?

➡ Take immediate protective action
➡ Notify appropriate authority/supervisor

No immediate danger?

➡Talk with the colleague first (when feasible).

"Reporting immediately to the licensing board" is usually wrong as the first step unless:

• Serious client harm is occurring

• The colleague refuses assistance

• The situation cannot be resolved internally

Dichotomous Thinking

Black and White Thinking

All or Nothing

Pollarized Thinking

Non-Organic Failure to Thrive (NOFTT)

A condition in which an infant or child has poor growth or weight gain due to psychosocial or environmental factors, rather than a medical illness.

Causes of NOFTT

Neglect
Inadequate feeding routines
Caregiver depression
Substance use in caregiver Lack of parenting knowledge
Food insecurity/poverty
Chaotic home environment
Poor caregiver-child attachment

A social worker should not assume the problem is neglect or psychosocial.

1. Medical assessment to rule out organic causes

2. Psychosocial assessment

3. Assess caregiver-child relationship

4. Provide supports/interventions

Poor growth does not automatically equal abuse.

1. Assess

2. Determine cause

3. Evaluate safety

Non-organic Failure to Thrive

Assess caregiver-child interaction and environmental factors.

Early Remission

3-11 Months

Sustained Remission

12 Months

1. Pre-Contemplation (Stages of Change)

"I don't have a problem."

The client:

• Does not recognize a need for change

• Not considering change

• May be defensive

1. Pre-Contemplation Social Worker Response

✅ Increase awareness
✅ Explore concerns
✅ Use motivational interviewing
✅ Provide information without pushing

2. Contemplation (Stages of Change)

“Maybe I should change.”

Client:

• Recognizes a problem

• Has mixed feelings

• Weighs pros and cons

2. Contemplation Social Worker Response

Motivational Interviewing

Social worker response:

✅ Explore ambivalence
✅ Discuss benefits/costs of change
✅ Strengthen motivation

3. Preparation (Stages of Change)

“I am ready to make a change”

3. Preparation Social Work Response

Create a quit plan.

4. Action (Stages of Change)

"I am actively changing."

4. Action SW Response

✅ Reinforce progress
✅ Teach coping skills
✅ Address triggers
✅ Provide relapse prevention

5. Maintenance (Stages of Change)

"I am keeping the change going."

5. Maintenance SW Response

✅ Strengthen coping strategies
✅ Support continued success

6. Relapse (Stages of Change)

"I returned to the old behavior."

6. Relapse SW Response

✅ Explore triggers
✅ Identify what was learned
✅ Re-engage in the change process

5 Stages of Change

1. Pre

2. Contemplation

3. Action

4. Maitenance

5. Relapse

OCD Treatment

CBT with Exposure and Response Prevention (ERP).

OCD

• Can’t Stop

• Intrusive unwanted thoughts

• Rituals to reduce anxiety

• Repetitive checking/cleaning/counting

• Take more than 1 hour per day

• Present for 6 months

• Cause significant distress or impairment

Obsessive-Compulsive Personality Disorder (OCPD)

• Won’t Stop

• Perfectionism + control

• Often believes behavior is justified.

• Rigid, perfectionist, controlling

• No specific time requirement; enduring pattern beginning by early adulthood

Parallel Process

Clinician behaving with the supervisor in a way that mirrors the client’s behavior.

Community Decision Making Stages (4)

1. Emerging —> Becoming Aware

2. Coalescing —> Begin Discussion

3. Mobilizing

4. Mantainning/Reinforcement

Anorexia

Osteoporosis, Constipation, Low Blood Pressure

Anorexia

1. Low Weight

2. Restriction

3. Distorted Body Image

4. No minimum duration

Bulimia Nervosa

1. Binge Eating → 1x/week for 3 months

2. 1x/week for 3 months

Anorexia Treatment

1. Restore Healthy Weight

2. Address Psychological Issues

3. Eliminate Behaviors

If a vignette shows that changing one person's behavior changes the behavior of others, the best answer is often mutual interdependence, a core principle of Systems Theory.

Tort = Civil Lawsuit

A tort is a civil wrong that causes harm to another person and may result in a lawsuit for money damages (not criminal punishment).

Failure to act as a reasonably competent social worker would.

Example:

• Failing to assess suicide risk

• Ignoring signs of child abuse

• Missing obvious safety concerns

A social worker accidentally emails a client's records to the wrong person.

Tort: Breach of confidentiality

Malpractice = Professional Negligence

Negligence ⭐ (Most Tested Tort)

Failure to act as a reasonably competent social worker would.

Examples:

• Failing to assess suicide risk

• Ignoring signs of child abuse

• Missing obvious safety concerns

A social worker fails to report suspected child abuse when required by law, and the child is seriously injured afterward.

Malpractice (Professional Negligence)

A social worker accidentally leaves a client's chart in a public waiting room.

Breach of Confidentiality (Tort)

Tort = Fruit & Malpractice = Apple

Every apple is a fruit, but not every fruit is an apple.