Friday, November 21, 2014

DSM Changes to Help Clinical Social Workers Transition

Fall     I S S U E     2 0 1 4

Mirean Coleman, LICSW, CT
Senior Practice Associate

There are changes in the Diagnostic and Statistical Manual for Mental Disorders (DSM) clinical social workers should familiarize themselves with as the mental health industry transitions from the DSM-IV to the DSM-5. NASW has prepared the following list of 10 key changes to help clinical social workers transition.

• Substance abuse with substance dependence was consolidated into a single disorder called substance use disorder which is measured on a continuum from mild to severe. Drug craving was added to the list of symptoms and law enforcement problems were eliminated.

• Hoarding Disorder is a new diagnosis in the DSM and reflects persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them.

• Premenstrual Dysphoric Disorder was moved to the main body of the DSM.

• Binge Eating Disorder was elevated to the main body of the DSM. Criteria was changed to an average frequency of at least once weekly over the last three months

• Attention Deficit Hyperactivity Disorder (ADHD) must now appear by age 12. Research indicated that ADHD occurs after age 7 when a child may be challenged by school requirements.

• Intellectual Disability replaces the term mental retardation. Intelligent Quotients (IQs) scores and adaptive functioning are both germane factors in determining a person’s ability.

• The bereavement exclusion was eliminated in the DSM which applied to a major depressive episode that lasted less than two months following the death of a loved one. Bereavement is listed in the DSM-5 Section III, “Conditions for Further Study.”

• Major Neurocognitive Disorder replaces the term dementia. Mild Neurocognitive Disorder was added with support from evidence-based literature that this population could benefit from diagnosis and treatment.

• Neurodevelopmental Disorder is a new chapter which combines the following different disorders:

Intellectual Disability
Communication Disorder
Autism Spectrum Disorder
Attention Deficit Hyperactivity Disorder
Specific Learning Disorder
Motor Disorder

• Suicidal Behavior Disorder is a new category listed in the DSM-5 Section III, “Conditions for Further Study” and identifies the risk factors associated with suicide attempts including depression, substance use or lack of impulse control. Patient must have attempted suicide within the last two years.


NASW has a Webinar training on the DSM-5 which may be access at the following Web link: DSM-5 Depressive and Grief Disorders: Mastering the Changes, Understanding the Controversies:

• A Practice Perspectives, DSM-5 Frequently Asked Questions by Clinical Social Workers, is available online at:

• NASW members can receive a 15 percent discount when purchasing the DSM-5 from the American Psychiatric Association when using the discount code NASWMEM at 800.368.5777 or online at


American Psychiatric Association. 2013.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Arlington, VA: Washington DC.

Social/Emotional Assessment for Child Study Teams

Social/Emotional Assessment

I.                   Understanding of the purpose of Social Assessment:

A Social Assessment is part of a comprehensive Child Study Team evaluation that is conducted to determine whether or not a child can be found eligible for Special Education and Related services under the Individuals with Disabilities Education Act (IDEA). It is presented to an IEP (Individual Educational Planning) Team that consists of teachers, parents, the student (when appropriate), administrators, a school psychologist, an LDT-C (Learning Disabilities Teacher Consultant), and possibly other specialists such as Occupational, Physical and Speech/Language Therapists as well as other professionals that may need to be involved such as Behaviorists (that specialize in spectrum disorders), Neurodevelopmental doctors and other healthcare professionals. The purpose of the social assessment is to:

A.    Present a comprehensive narrative of the whole child within their environment, including their strengths and challenges.
B.     Assess the parent’s & student’s perspective of the problematic issues and their receptiveness to change.
C.     To provide the IEP team with pertinent information about the student's social-emotional functioning and how this impacts their learning process, as well as provide recommendations to ameliorate problematic issues.  

II.                Components of the Social Assessment

A.    Identifying information. 
Basic information such as name, address, phone number, age, grade, etc. A cover page on this document should indicate that this is confidential information.

B.     Reason for referral.
Why is the team conducting this evaluation? The history of their functioning or lack thereof can be elaborated on in the other sections of the report. There are basically two reasons to evaluate a child:
1.      Student is being reevaluated as part of the mandated triennial requirement. 
2.      Parent/ Teacher requested the Child Study Team conduct an initial evaluation due to the student’s continued academic difficulties which cannot be ameliorated within the regular education program.

C.     Sources of information.
Several sources should be considered when conducting a social assessment. They are:
1.      Observation of the pupil
2.      Pupil interview
3.      Parent interview
4.      Teacher interview
5.      Review of educational history

D.    Family and social development.
This purpose of this section is to provide the team with a basic profile of the family and any history of learning disabilities within. It is also the section when current familial situations are explored and their subsequent impact on the child’s learning process considered.  The Social/Emotional Development of the child is also covered in this section.

1.      Elements to include for the Family History are:

a.       The parent’s marital status
b.      If the parents are divorced, information about custody/visitation, etc.
c.       All the names, ages and occupations of adults in the family as well as their relationship to and with the child
d.      Names ages and educational status of children in the home as well as their relationship to and with the child
e.       History of where the family has lived
f.       The general (emotional) climate in the home
g.      Educational history of parents and any other significant family members
h.      Any significant changes in the family that may have a social/emotional impact on the student
i.        Activities that the family participates in together
j.        Any other pertinent information the family would like to share as part of the investigation

2.      Social/Emotional Development of the child
This is the section where you want to assess their adaptive behaviors as well as determine whether or not there are any emotional/social issues that need to be addressed. The main thing to remember is everything needs to be related back to how and why any dysfunction in this area would adversely affect the learning process.

The following questions should be considered to construct a clear picture of how the child is functioning in the social/emotional realm:

a.       How is the child’s general demeanor at home?
b.      Does the child generally get along with the other family members?
c.       How does the child manifest anger? Sadness? Fear? Happiness? (Are any manifestations to these feelings particularly problematic?)
d.      Does the child exhibit any fearlessness? Do they exhibit appropriate caution for their own safety?
e.       What methods do you use to foster compliance when the child is resistant?
f.       How do you positively reinforce the child
g.      How would you characterize the student’s self –esteem? Do they ever make any negative comments about themselves?
h.      Is the child able to make and maintain friendships?
i.        Do they participate in peer related activities?
j.        What are their strengths? Challenges?

E.     Developmental History:
When a child is initially evaluated, part of the evaluation is a comprehensive health update conducted by the school nurse or a doctor. It’s important to rule out any physical issues with a child’s senses or brain function before proceeding with a CST evaluation. Most healthcare professionals will provide a detailed outline of developmental milestones and note any issues with the child’s achievement of this. For younger children, this section of the report is mostly completed by the nurse or doctor, however for older children the following should be considered:

1.      Has the student has achieved all the developmental milestones within age appropriate time limits.
2.      Was there any history of Developmental delays? Did they have to see a specialist for treatment and what was the outcome?
3.      How is their overall current health?
4.      Are they on any medications?
5.      How are their eating habits? Sleeping habits? Hygienic habits?

F.      School History
This section is where a detailed educational history is explained as well as how the student is currently functioning. Questions to be considered are:

1.      What are the student’s current classes and grades?
2.      If this is a re-evaluation, what is the special education history of the child?
3.      What interventions have been tried to help the child with their learning issues? What was the outcome of these attempts?
4.      What are the team’s overall concerns about how the child is academically functioning?
5.      What do the teacher’s say about how the student functions?
6.      What do the parents hope this evaluation process will do for their child?

G.    Evidence of student’s functioning and its relationship to the educational setting
Relevant Behavior and Impact
This is the most important section of this report. Now that the social/emotional narrative has been provided for this child, how this impacts their learning process is crucial information to the team. Whether or not a child had the adaptive behaviors to adjust to changes in their educational program is important to their success.

Elements to consider in this section are:
1.      Is the student receptive to help?
2.      What strengths does the child possess that can be utilized to help them address their challenges?
3.      How do their emotional or social issues impact their learning?
The second part of this section should include some strategies to address any issues noted. For example, techniques and activities to support personal and social development are:

a.       Provide opportunities for success
b.      Utilize praise and encouragement
c.       Point out accomplishments and strengths, not shortcomings and weaknesses
d.      Clearly define limits and expectations
e.       Encourage peer support and approval
f.       Assist student in developing positive peer relationships

H.    Observation & Interview
The team is required to do at least one observation of the student in their classroom setting. This is usually done by the Learning Consultant or School Psychologist. The Psychologist will also conduct an interview as part of their evaluation. The Social worker however should also do both an observation of the student and an interview.

1.      Observation. Elements to note are:
a.       Is the student able to make and maintain eye contact?
b.      What is their basic demeanor and affect?
2.      Interview: Elements to note are:
a.       What is the student’s perception of the evaluation process?
b.      Are they receptive to receiving assistance? Can they effectively access resources?

I.       Summary
Typically, and IEP will provide the summaries of all the evaluations from which data is received, so it’s important to make sure the most important elements you want the team to know about this student is included in this section. Teachers will also typically skim the summaries of reports when learning about new students.

J.       Signature
For your social assessment to be official, it needs to be signed and dated by the certified social worker and/or the intern who prepared the report

Resources for School Social Workers

Here are some resources for those of us in School Settings.

Standards for School Social Work Services

Standards for the Practice of Social Work with Adolescents

I highly recommend reading these books:

Painful Passages by Elizabeth Dane, PhD

Far From the Tree by Andrew Solomon

Wednesday, September 10, 2014

Self Care

One of the things we stress to social work students is the importance of self-care.  Much of our work involves our emotions and feelings and it is crucial to create a safe way to process our experiences and to decompress. 

But you're grad students! Who has the time??? Right? ;)

Make the time. You deserve it.

Being a social worker professional is an amazing experience, as I'm sure you are all discovering as you progress in your field placements.  As I often tell students, "be in it for the long haul... we need you."

Here are some resources about Compassionate Fatigue in the field of Social Work:

Kathleen Cox and Sue Steiner
NASW Press

 (the link in this document to the ProQOL is defunt.. use this one instead:
By Tracy C. Wharton, M.Ed., MFT

There is also very simple stress-reducing method at your immediate disposal whenever you are feeling stressed or overwhelmed.... it's called.... breathing. Sometimes we just need to take a nice deep breath and regroup. I know it seems obvious, but I can't tell you how often I've had to remind folks to just breathe.

Remember, you are part of a supportive network! Reach out.