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DSM 5 …………………. Lloyd L. Lyter , Ph.D., LSW Professor Marywood University, Scranton, PA Sharon C. Lyter , Ph.D., LCSW Professor Kutztown University Brandywine November 5, 2013. David Kupfer, MD Chair of DSM-5 Task Force Thomas Detre Professor and Chair Department of Psychiatry - PowerPoint PPT Presentation

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  • *DSM 5 .

    Lloyd L. Lyter, Ph.D., LSWProfessorMarywood University, Scranton, PA

    Sharon C. Lyter, Ph.D., LCSWProfessorKutztown University

    Brandywine November 5, 2013

    Social Work Primacy, Social Work Ambivalence

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    David Kupfer, MDChair of DSM-5 Task ForceThomas Detre Professor and ChairDepartment of PsychiatryProfessor of NeuroscienceDepartment of PsychiatryThomas Detre Hall of the Western Psychiatric Institute and Clinic University of Pittsburgh3811 O'Hara StreetPittsburgh, PA 15213Dear Dr. Kupfer:We urge you to consider the role of Social Work professionals in the provision of mental health services in the United States and in the development of the upcoming Diagnostic and Statistical Manual of Mental Disorders, DSM-V. As stated by the National Association of Social Workers (NASW) Executive Director Elizabeth J. Clark, the DSM is widely used by social workers. Social workers are one of the largest providers of mental health services in the United States.We ask you to consider the voices of social work providers, represented here by the signatures of attendees at the annual conference of the New Jersey chapter of the National Association of Social Workers. Please consider our request for an active role in the development of the DSM-5.Sincerely,

    Social Work Primacy, Social Work Ambivalence

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    Social Work Primacy, Social Work Ambivalence

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    Social Work Primacy, Social Work Ambivalence

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    Who are the providers? Which is the largest provider discipline? social workerspsychiatristspsychologists???

    Social Work Primacy, Social Work Ambivalence

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    The Primacy of Social Work

    Social workers provide most of the countrys mental health services. Of mental health professionals

    45% -- social work 5% -- psychiatry17% -- psychology 24% -- counseling 9% -- marriage and family therapy

    Both social work and psychology have grown in number of trained mental health professionals in recent years, while psychiatry has remained stable.

    (Substance Abuse and Mental Health Services Administration, 2012).

    Social Work Primacy, Social Work Ambivalence

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    Where did you learn about DSM classroom, practicum? How did you learn about the DSM - from social workers? from psychologists? psychiatrists?Quality of learning?

    Social Work Primacy, Social Work Ambivalence

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    How should students be prepared regarding DSM? .

    Social Work Primacy, Social Work Ambivalence

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    What are the strengths and limitations of DSM? .

    Social Work Primacy, Social Work Ambivalence

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    Authority to diagnose . Licensure of educators

    Social Work Primacy, Social Work Ambivalence

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    Knowledge regarding DSM-5

    Social Work Primacy, Social Work Ambivalence

  • DSM Views: What do you know about NIMH?As an indicator of their involvement and interest in the development of DSM-5, participants were asked if they were aware of current efforts by NIMH (National Institutes of Mental Health) with regard to classification systems and, if so, to indicate their understanding. A quarter (26%) of the respondents affirmed that they were aware, but only 4 statements were accurate (i.e., focus on brain research, biomarker identification, NIMH has developed strategic planning around creating new ways to classify and diagnose mental disorders, revising to include neuroscience advances). Most mistakenly believed that NIMH and the APA the same organization.*

    Social Work Primacy, Social Work Ambivalence

  • DSM Views: What do you know about NIMH?NIMH director Thomas Insel noted in The Directors Blog on the NIMH website (2010) that The Diagnostic and Statistical Manual of Mental Disorders has validity problems and, furthermore, that The Research Domain Criteria (RDoC) is an initiative that will develop neuroscience-based criteria for classifying mental disorders (para. 4). In 2013, Insel, stated: That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories or sub-divide current categories to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system. The best reason to develop RDoC is to seek better outcomes.

    ByThomas InselonApril 29, 2013 Transforming diagnosis. http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml*

    Social Work Primacy, Social Work Ambivalence

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    Impact of personal experiences with mental illness

    Social Work Primacy, Social Work Ambivalence

  • Summary of Educator ViewsOverall, the study participants, social work educators, were licensed clinical professionals, live in states where social work has authority to diagnose, and favored a state level license for all social work educators and a clinical license for those who teach direct practice. They voiced support of all professions named-social work, psychology, and psychiatry-to diagnose. They favored retaining the DSM as it is but preferred that the Social Work profession have a role in developing and updating DSM. They favored incorporation of the strengths perspective and do not believe that DSM is sensitive to person-in-environment and family-in-environment perspectives. However, they agreed that even with its strengths and limitations, students are capable of understanding those nuances of DSM. They noted regard for DSM as an essential tool and a good fit for Social Work practice. They favored altering thresholds such that fewer people would be eligible for a DSM diagnosis of Attention Deficit Hyperactivity Disorder and for Autism. In addition, they would like to retain the grief exclusion under major depressive disorder.They expressed the belief that mental health content should include some DSM content at both BSW and MSW levels and noted, in fact, that this is true at their own schools; most favored giving a basic understanding at the BSW level and teaching to formulate a diagnosis at the MSW and doctoral levels. *

    Social Work Primacy, Social Work Ambivalence

  • *Despite the fact that Social Work was not represented on the DSM Task Force (as it had been in the past), there are signs of .. good news.

    Contributing psychosocial and environmental factors (previous Axis IV), client person-in-environment, and family-in-environment are now represented in part by:

    Z-codes and Cultural Formulation Interview

    Social Work Primacy, Social Work Ambivalence

  • *ICD-10 Z-CodesContributing psychosocial and environmental factors or other reasons for visits are now represented through an expanded selected set of ICD-9-CM V-codes and, from the forthcoming ICD-10-CM, Z-codes.

    These provide ways for clinicians to indicate other conditions or problems that may be a focus of clinical attention or otherwise affect the diagnosis, course, prognosis, or treatment of a mental disorder. These conditions may be coded along with the patients mental and other medical disorders if they are a focus of the current visit or help to explain the need for a treatment or test.

    Z-codes include family upbringing, child and adult maltreatment and neglect, and educational, occupational, and housing problems.

    Social Work Primacy, Social Work Ambivalence

  • Z63.4 High expressed emotion level within family.Z63.0 Relationship distress with spouse or intimate partner.T74.31XA Spouse or partner abuse, psychological, confirmed.

    *ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z62.29 Upbringing away from parents.Z62.898 Child affected by parental relationship distress.Z63.5 Disruption of family by separation or divorce. Z64.1 Problems related to multiparity.Z64.0 Problems related to unwanted pregnancy.

    *ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z60.2 Problem related to living alone.Z59.3 Problem related to living in a residential institution.Z59.2 Discord with neighbor, lodger, or landlord.Z59.0 Homelessness.

    *ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z59.5 Extreme poverty.Z59.1 Inadequate housing.*ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z59.4 Lack of adequate food or safe drinking water.

    Z60.5 Target of (perceived) adverse discrimination or persecution.

    *ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z64.4 Discord with social service provider, including probation officer, case manager, or social services worker.Z75.4 Unavailability or inaccessibility of other helping agencies.Z75.3 Unavailability or inaccessibility of health care facilities.

    *ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z56.82 Problem related to current military deployment status.

    *ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • Z65.4 Victim of crime.Z65.4 Victim of terrorism or torture.Z65.0 Conviction in civil or criminal proceedings without imprisonment.Z65.1 Imprisonment or other incarceration.Z65.2 Problems related to release from prison.*ICD-10 Z-Codes

    Social Work Primacy, Social Work Ambivalence

  • 1. depression2. anger3. mania4. anxiety5. somatic symptoms6. suicidal ideation7. psychosis8. sleep problems9. memory10. repetitive thoughts and behav

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