Time Management and Test Preparation

This blog contains lots of information that might help you on social work licensing exam, but it's only the beginning. There's much, much more info to digest. The posts here can only really serve as reminders about what you've already memorized or as prompts for further review.

That raises the question: further review when?...memorized how?

Here's a site that aims to help you get those important questions answered. What is the best way to go about learning all the information that may show up on the LCSW exam? And how can you best organize your time to make room for all that learning? The too long; didn't read version is this: You already know how to learn and how to make time for learning. You've been doing it your whole life, running a decades-long experiment about what works best for  you.

That doesn't mean you can't use additional guidance. So check out the test preparation and time management skills detailed at studygs.net. The site quotes William Shakespeare for inspiration: "Study is like the heaven's glorious sun. You may feel differently about it. But with the study tips detailed on the site, you at least don't have to be completely in the dark regarding best study practices. Enjoy and good luck!

The Code of Ethics - Core Values

Exam item writers live in the same world that you do and read the same headlines. Don't be too surprised to see items in future versions of the LCSW exam that pull from the conflicts that occupy your news and social media feeds today. One simple way to stay grounded in social work ethics as you approach these questions is to remember the six core values spelled out in the NASW Code of Ethics:

• service
• social justice
• dignity and worth of the person
• importance of human relationships
• integrity
• competence

They're right at the top of the Code of Ethics. Give the descriptions a careful read! http://www.socialworkers.org/pubs/Code/code.asp They're not easy principles to live and work (and answer vignette questions) by...but definitely worth the effort. Good luck!

The Code of Ethics - Self-Determination

There's just no way to successfully make your way through the social work licensing exam without having a good working knowledge of the NASW Code of Ethics. This has been stressed on this blog before, but it bears repeating. Social work is too vast a subject to be covered in every respect by the exam. But this area--social work ethics and how to put them to use--is guaranteed to show up on the exam. With that in mind, let's take a look at an especially exam-friendly section of the code:

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.

For exam item writers, this may be a particularly alluring paragraph. Social workers are usually by nature caretakers, givers, helpers. But when is helping unhelpful or just plain unethical? Don't be surprised to find questions about close-call situations that put your caregiving instincts at odds with the principle of self-determination. A client chooses to live on the street...chooses addiction over recovery...chooses anything that may not ultimately be in their self-interest. Remember this part of the code and you'll know how to answer.

For further reading try this article from Social Work Today:

Into the DSM - Schizophrenia

Schizophrenia will doubtless come up for social workers employed in clinic settings. That means it's one of the diagnoses that you may find appear on the social work licensing exam. Here are the criteria:

A. At least two of the following for a significant portion of the time during a one-month period:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (e.g., flat affect)

B. Level of functioning is markedly below level at onset of symptoms.

C. Disturbance persists at least six months.

D. Schizoaffective, depressive, and bipolar disorder ruled out.

E. Symptoms not attributable to the effects of a substance.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, a schizophrenia diagnosis is made only if prominent delusions or hallucinations are present for at least one month.

Specifiers include:

• First episode, currently in acute episode
• First episode, currently in partial remission
• First episode, currently in full remission
• Multiple episodes (acute, partial, or full remission)
• Continuous
• With catatonia

DSM-5 also includes a severity rating for schizophrenia--each symptom can receive its own rating ranging from 0 (not present) to 4 (present and severe).

For further reading, including risk factors and treatment, take a look at http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Into the DSM - Autism Spectrum Disorder

New in DSM-5, autism spectrum disorder covers a wide array of symptoms. It's wise to review them ahead of sitting for the social work licensing exam. Here we go...

A. Persistent deficits in social communication and social interaction across multiple contexts, for example:

• Deficits in social-emotional reciprocity (back-and-forth conversation, sharing of interests)
• Deficits in nonverbal communication (eye contact, body language)
• Deficits in developing, maintaining, and understanding relationships (adjusting behavior to context, making friends)

B. Restricted, repetitive patterns of behavior, interests, or activities, including at least two of the following:

• Stereotyped or repetitive motor movements (lining up toys, echolalia, idiosyncratic phrases)
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior 
• Highly restricted, fixated interests that are abnormal in intensity or focus
• Hyper- or hyporeactivity to sensory input (indifference to pain/temperature, adverse response to specific sounds...)

C. Symptoms present in early development.

D. Symptoms cause clinically significant impairment.

E. Disturbances not better explained by an intellectual development disorder or global developmental delay.

Specifiers include:

• With or without intellectual impairment
• With or without language impairment
• Associated with a medical or genetic condition or environmental factor
• Associated with another neurodevelopmental, mental, or behavioral disorder
• With catatonia

Since ASD encompasses old (DSM-IV-TR) diagnoses of autistic disorder, Asperger's disorder, and pervasive developmental disorder, severity levels play an important part in the diagnosis. More about those in a future post!

For further reading try NIMH and/or the CDC.

Into the DSM - Panic Disorder

Panic disorder can be summed up in four words: Recurrent unexpected panic attacks. But there's more to it than that. First, what's a panic attack (and what's not a panic attack)? The DSM answers: A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. During that time, four of the following symptoms occur:

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
12. Fear of losing control or "going crazy."
13. Fear of dying.

With that you know most of what you need to know about the diagnosis, but not all. There's a crucial addition--criterion B: At least one of the attacks has been followed by one month (or more) of one or both of the following:

1. Persistent concern or worry about additional panic attacks or their consequences.
2. A significant maladaptive change in behavior related to the attacks (e.g., avoidance)

Of course, there are the usual "not better explained by" caveats. And that's it.

Risk factors for panic disorder include:

• Family history of panic.
• Major life stress or life changes.
• Trauma.
• Excessive caffeine intake and/or smoking.
• History of childhood physical or sexual abuse.

With the above information digested, consider yourself readied for a panic disorder question on the ASWB exam. For further study try: Panic attacks and panic disorder at MayoClinic.org.

Mental Status Exam

The questions in the mental status exam include all the basic of social work assessment. While the MSE's lack of full exploration into the biopsychosocialspiritual components of client experience makes it an imperfect tool for social work, it's still a good start. That's why you'll see the MSE used in many clinical settings and why you shouldn't be surprised to see a question about the MSE on the social work licensing exam (e.g., "A social workers asks a client to spell a word backwards. What is the social worker assessing for?")

The general elements covered in the MSE are as follows:

• General Appearance
•  Psychomotor Behavior
• Mood and affect
• Speech
• Cognition
• Thought Patterns
•  Level of Consciousness

There's too much detail in the exam to recount here, but click through to the further reading to get more comfortable with the details of the exam. 

Further reading: "How to Do a Mental Status Exam," and Mental Status Examination at Wikipedia.

Into the DSM - Bipolar I Disorder

To meet criteria for bipolar I disorder, a manic episode is required--it may be followed by a hypomanic or major depressive episode. (For bipolar II, a hypomanic episode + a current or past major depressive episode are required.) Here are the criteria for a manic episode:

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood with increased goal-directed activity or energy, lasting at least 1 week.

B. Three or more of the following during the mood disturbance:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Increased talkativeness
4. Racing thoughts or flight of ideas
5. Distractibility
6. Increased goal-directed activity or psychomotor agitation
7. Excessive risk-taking

C. Mood disturbance severe enough to cause impairment.

D. Episode is not attributable to effects of a substance or another medical condition.

Hypomanic episodes include many of the same symptoms, but are not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

Specifiers for bipolar I disorder include:

• With anxious distress
• With mixed features
• With rapid cycling
• With melancholic features
• With atypical features
• With mood-congruent psychotic features
• With mood-incongruent psychotic features
• With catatonia
• With peripartum onset
• With seasonal pattern

Risk factors include:

• Having a first-degree relative (e.g., parent or sibling) with the disorder.
• Substance abuse
• High stress
• Major life changes (e.g., death of loved one)

For further study: Bipolar I Disorder at MayoClinic.org

Into the DSM-5 - Schizoaffective Disorder

If you've encountered schizoaffective disorder in your work  with clients, questions about the diagnosis on the licensing exam shouldn't give you much trouble. For everyone else, here's a quick primer. The essential formula to remember with schizoaffective disorder is psychotic symptoms + mood symptoms which are independent of the psychotic symptoms. Common rule-outs: schizophrenia, bipolar disorder, MDD with psychotic features.

There are two essential criteria:

• Major mood episode concurrent with symptoms of schizophrenia
• Delusions or hallucinations in the absence of mood symptoms at some point

 Specifiers include:

• Bipolar type
• Depressive type
• With catatonia

Risk factors: Having a blood relative with schizophrenia, schizoaffective disorder, or bipolar disorder; stress; drug use.

For further study: Schizoaffective disorder at MayoClinic.com

Theories and Methods - Attachment Theory

Attachment Theory, conceived by John Bowlby and furthered by Mary Ainsworth, explores the centrality of attachment bonds in human development and emotional life. Particular attention is paid to the degree of security infants and children feel in relationship to their caregivers and the consequences when a felt sense of security is lacking (as in cases of even mild emotional neglect). Mary Ainsworth's experimental "strange situation" examined the responses of children to different caregiver behaviors and identified a set of attachment patterns (e.g., anxious-resistant, avoidant...) which followed the children into their adult relationships. Radical when originated, attachment theory has since been thoroughly integrated into much clinical practice, especially that of social workers.

For futher review: Attachment theory at Wikipedia, at Simply Psychology, attachment theory books at Amazon.

Studying with Social Work Podcasts

Some people learn best via text, others via charts and images, still others like to listen their way to knowledge. Everyone can benefit from the free audio exam preparation available on the net. Podcasts are a great way to load up on information and general social work knowledge. Early episodes of the Social Work Podcast are especially useful as they cover the very theories and approaches that may show up on the ASWB exam. (Here's a helpful menu of useful Social Work Podcast episodes.) Other podcasts may make for inefficient but effective social work exam studying. An episode of inSocialWork, focused on one content area (and not designed for exam preparation) will give you the type of depth of knowledge that will make it impossible to miss a question on that topic. But will that topic actually show up on the exam? There's no saying. What you will get is a ever-increasing sense of what it means to be a social worker and how social workers think about difficult questions. That's something you can bring to just about every question on the exam! Links:

• The Social Work Podcast
• inSocilWork Podcast
• Podsocs

Developmental Theory to Know for the Social Work Exam

It seems that straightforward knowledge questions have been phased out of the social work licensing exam over time. You're not likely to see something asking, "The areas in Freud's tripartite theory of personality are:" Too dry, simple, and unsocialworky to make it onto the test. (You know the answer: Superego, Ego, Id.) Be less surprised to see vignettes that draw upon your understanding of various theories, while also testing your basic social work grounding. "A mother brings her 8-year-old to see a social worker reporting [some difficult, upsetting controversial, or otherwise heartbreaking symptom]. A social worker using attachment theory is MOST likely to see these symptoms as:" You've had to weather the impact of the symptoms, keep your eye on what's being asked, and, as a bonus, know something about attachment theory. Answer enough of those correctly, and you're a licensed social worker! Toward that end, here's Wikipedia's list of developmental psychology theories (from the page about developmental psychology, naturally). To lightly review:

• Attachment theory
• Constructivism
• Ecological systems theory
• Psychosexual development
• Stages of moral development
• Stages of psychosocial development
• Theories of cognitive development
• Stages based on the model of hierarchical complexity
• Zone of proximal development
• Evolutionary developmental psychology

It's worth restating here that light review is what's called for. You will not be expected to have deep knowledge about all of the above. The ASWB exam is designed to assess beginning social workers, not PhD candidates (and not psychologists). Adjust your study intensity appropriately. Good luck!

Study Resource: Eye on Ethics

Let's dig a little deeper into one of the free exam prep resources linked in the previous post. Frederic Reamer, PhD's Social Work Today column, "Eye on Ethics" looks at the kind of ethical dilemmas that social workers face every day. Those are the very same ethical quandaries you're likely to see posed as questions on the LCSW exam. Some "Eye on Ethics" columns include vignettes that are strikingly similar to those that appear on the exam. If exam writers are getting some inspiration from the colum, it wouldn't be a huge surprise. Take a look at some of these for starters--a semi-informed take on some of "Eye on Ethics" greatest hits:

• The Limits of Confidentiality 
• Managing Boundaries and Dual Relationships
• The Complexities of Client Privacy, Confidentiality, and Privileged Communication
• Parents' Access to Minors' Counseling Records: An Example of Evolving Standards 
• Boundaries Among Colleagues
• The Complexities of Informed Consent
• Terminating Services

Reading Reamer's column is a relatively painless way to soak up social work ethics and prepare for the licensing exam maybe without feeling like you're studying. Enjoy.