Week 3: The Diagnostic Interview: The Mental Status Exam and Risk and Safety Assessments The process of clinical diagnosis begins with a diagnostic interview. During this interview, a social worker co

Week 3: The Diagnostic Interview: The Mental Status Exam and Risk and Safety Assessments

The process of clinical diagnosis begins with a diagnostic interview. During this interview, a social worker conducts a Mental Status Exam (MSE) and assesses suicide, violence, and other safety risks. Suicide risk is on the rise in the United States overall and within many populations, such as teens. Suicide attempts are common in individuals with mood disorders, posttraumatic stress disorder, substance use disorders, and borderline personality disorder. The diagnostic interview plays an important role, then, not only in understanding a client’s mental state and presenting symptoms but in identifying potential for self-harm.

This week, you focus on individual elements of the diagnostic process. You start with how to conduct a diagnostic interview and MSE. You also consider the risk assessments that are part of the diagnostic interview, particularly how to respond to a positive suicide risk assessment.

Learning Objectives

Students will:

• Analyze an example of a suicide assessment
• Develop a safety and response plan based on a suicide risk assessment
• Analyze an example of a diagnostic interview
• Develop a Mental Status Exam (MSE) write-up based on a case

Learning Resources

Required Readings

Morrison, J. (2014). Diagnosis made easier: Principles and techniques for mental health clinicians (2nd ed.). New York, NY: Guilford Press.Chapter 10, “Diagnosis and the Mental Status Exam” (pp. 119–126)Chapter 17, “Beyond Diagnosis: Compliance, Suicide, Violence” (pp. 271–280)American Psychiatric Association. (2013t). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasuresFocus on the “Cross-Cutting Symptom Measures” section.Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar, B. (2013). A tool for the culturally competent assessment of suicide: The Cultural Assessment of Risk for Suicide (CARS) measure. Psychological Assessment, 25(2), 424–434. doi:10.1037/a0031264Osteen, P. J., Jacobson, J. M., & Sharpe, T. L. (2014). Suicide prevention in social work education: How prepared are social work students?. Journal of Social Work Education, 50(2), 349-364.Blackboard. (2018). Collaborate Ultra help for moderators. Retrieved from https://help.blackboard.com/Collaborate/Ultra/ModeratorNote: Beginning in Week 4, you will be using a feature in your online classroom called Collaborate Ultra. Your Instructor will assign you a partner and then give you moderator access to a Collaborate Ultra meeting room. This link provides an overview and help features for use in the moderator role.Document: Case Collaboration Meeting Guidelines (Word document)Document: Collaborating With Your Partner (PDF)Document:Diagnostic Summary Example (Word document)Note:This is an example of a diagnostic summary that can be used as a template for Part I of the Assignment.

Required Media

Accessible player --Downloads--Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018b). Psychopathology and diagnosis for social work practice podcast: The diagnostic interview, the mental status exam, risk and safety assessments [Audio podcast]. Baltimore, MD: Author.MedLecturesMadeEasy. (2017, May 29). Mental status exam [Video file]. Retrieved from https://youtu.be/RdmG739KFF8Sommers-Flanagan, J., & Sommers-Flanagan, R. (Producers). (2014). Clinical interviewing: Intake, assessment and therapeutic alliance [Video file].Watch the “Suicide Assessment Interview” segment starting at 01:44:37. This is the interview with Tommi, which will be used for the Discussion.Watch the “Mental Status Examination” segment starting at 01:22:23. This is the case of Carl, which will be used for the Application.

Optional Resources

First, M. B. (2014). Handbook of differential diagnosis. Washington, DC: American Psychiatric AssociationChapter 1, “Differential Diagnosis Step by Step” (pp. 14–24)Document: Suggested Further Reading for SOCW 6090 (PDF)Note: This is the same document introduced in Week 1.

Discussion: Assessing Suicide Risk

As a social worker, you will likely at some point have a client with a positive suicide risk assessment. Many individuals with suicidal ideation also have a plan, and that plan may be imminent. Even when the risk is not urgent at a given moment, current research shows that most suicides occur within 3 months of the risk being assessed within a formal appointment. Ideation can quickly become a suicide.

For this Discussion, you view an initial suicide risk assessment. As you evaluate the social worker’s actions, imagine yourself in their place. What would you do, and why?

To prepare:

• Explore an evidence-based tool about suicide risk assessment and safety planning. See the Week 3 document Suggested Further Reading for SOCW 6090 (PDF) for a list of resources to review.
• Watch the “Suicide Assessment Interview” segment in the Sommers-Flanagan (2014) video to assess how it compares to your findings.
• Access the Walden Library to research scholarly resources related to suicide and Native American populations.

By Day 3

Post a response in which you address the following:

• Identify elements of Dr. Sommers-Flanagan’s suicide risk assessment.
• Describe any personal emotional responses you would have to Tommi’s revelations and reflect on reasons you might experience these emotions.
• Describe the elements of safety planning that you would put in place as Tommi’s social worker in the first week and in the first months.
• Identify a suicide risk assessment tool you would use at future sessions to identify changes in her risk level. Explain why you would use this tool.
• Explain any adjustments or enhancements that might be helpful given Tommi’s cultural background. Support your ideas with scholarly resources.

By Day 6

Respond to at least two colleagues in the following ways:

• Provide suggestions to manage the emotional responses your colleague identified.
• Explain why consideration of culture is important when working with diverse clients.

Note:You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum.If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.

Submission and Grading Information

Grading Criteria

To access your rubric:Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:Week 3 Discussion

Assignment: Conducting a Diagnostic Interview With a Mental Status Exam

Before moving through diagnostic decision making, a social worker needs to conduct an interview that builds on a biopsychosocial assessment. New parts are added that clarify the timing, nature, and sequence of symptoms in the diagnostic interview. The Mental Status Exam (MSE) is a part of that process.

The MSE is designed to systematically help diagnosticians recognize patterns or syndromes of a person’s cognitive functioning. It includes very particular, direct observations about affect and other signs of which the client might not be directly aware.

When the diagnostic interview is complete, the diagnostician has far more detail about the fluctuations and history of symptoms the patient self-reports, along with the direct observations of the MSE. This combination greatly improves the chances of accurate diagnosis. Conducting the MSE and other special diagnostic elements in a structured but client-sensitive manner supports that goal. In this Assignment, you take on the role of a social worker conducting an MSE.

To prepare:

• Watch the video describing an MSE. Then watch the Sommers-Flanagan (2014) “Mental Status Exam” video clip. Make sure to take notes on the nine domains of the interview.
• Review the Morrison (2014) reading on the elements of a diagnostic interview.
• Review the9 Areas to evaluate for a Mental Status Exam and example diagnostic summary write-up provided in this Week’s resources.
• Review the case example of a diagnostic summary write-up provided in this Week’s resources.
• Write up a Diagnostic Summary including the Mental Status Exam for Carl based upon his interview with Dr. Sommers-Flanagan.

By Day 7

Submita 2- to 3-pagecase presentationpaper in which you complete both parts outlined below:

Part I: Diagnostic Summary and MSE

Provide a diagnostic summary of the client, Carl. Within this summary include:

• Identifying Data/Client demographics
• Chief complaint/Presenting Problem
• Present illness
• Past psychiatric illness
• Substance use history
• Past medical history
• Family history
• Mental Status Exam (Be professional and concise for all nine areas)
  • Appearance
  • Behavior or psychomotor activity
  • Attitudes toward the interviewer or examiner
  • Affect and mood
  • Speech and thought
  • Perceptual disturbances
  • Orientation and consciousness
  • Memory and intelligence
  • Reliability, judgment, and insight

Part II: Analysis of MSE

After completing Part I of the Assignment, provide an analysis and demonstrate critical thought (supported by references) in your response to the following:

• Identify any areas in your MSE that require follow-up data collection.
• Explain how using the cross-cutting measure would add to the information gathered.
• Do Carl’s answers add to your ability to diagnose him in any specific way? Why or why not?
• Would you discuss apossible diagnosiswith Carlat time point in time? Why?

Support Part II with citations/references. The DSM 5 and case studydo notneed to be cited.Utilize the other course readings to support your response.