This article was downloaded by: [ArizonaState University]On: 22 October 2014, At: 08:35Publisher: RoutledgeInforma Ltd Registered in England andWales Registered Number: 1072954Registered office: Mortimer House, 37-41Mortimer Street, London W1T 3JH, UK

JournalofTeachinginSocialWorkPublicationdetails,includinginstructionsfor authorsandsubscriptioninformation:http://www.tandfonline.com/loi/wtsw20

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IntegratingPsychopharmacologyintoSocialWorkCurriculumKia J.Bentley PhDa & JaneReeves MSWb

a AssistantProfessor,VirginiaCommonwealthUniversity,Richmond,VA23284-2027

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b Director,BSWProgram,VirginiaCommonwealthUniversitySchool ofSocial Work,Richmond,VA,23284-2027Publishedonline: 18Oct 2008.

To cite this article: Kia J. Bentley PhD& Jane Reeves MSW (1993) IntegratingPsychopharmacology into Social WorkCurriculum, Journal of Teaching inSocial Work, 6:2, 41-58, DOI: 10.1300/J067v06n02_05

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To link to this article: http://dx.doi.org/10.1300/J067v06n02_05

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Integrating Psychopharmacology into Social Work Curriculum:

Suggested Content and Resources Kia J. Bentley Jane Reeves

ABSTRACT. Social work students who move into the mental health field often realize that their education has failed to provide a founda- tion in aspects of psychopharmacology needed to meet real life role expectations. In an attempt to close this gap between current practice in mental health and current curriculum, this paper suggests a series of teaching units on psychopharmacology that are targetedspecifical- ly to alleviate the medication related dilemmas of the social worker. In addition, the paper proposes creative strategies for integrathg these materials into curriculum and provides a comprehensive bibli- ography for further study.

Research on the efficacy of psychotropic medication as a therapeu- tic intervention for those with a severe mental illness has affirmed their role as an important aspect of treatment with this population. Along with scientific developments in psychopharmacol&i&l treat- ment, social work roles in medication mananement and ~sychoeduca- tion with the mentally ill and their families have expanded. Social work students, however, who move into the mental health field quick- ly realize that their education has often failed to provide a foundation in aspects of psychopharmacology needed to meet real life role ex- pectations.

Kia J. Bentley, PhD, is Assistant Professor, and Jane Reeves, MSW, is Director, BSW Program, Virginia Commonwealth University School of Social Work, 1001 West Franklin Street, Richmond, VA 232342027.

This paper is a revised version ofa presentationat the Annual Program Meeting of the Council on Social Work Education, March 3-6,2990 in Reno, NV.

Journal of Teaching in Social Work, Vol. 6(2) 1992 @ 1992 by The Haworth Press, Inc. All rights reserved. 41

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42 JOURNAL OF TEACHING IN SOCIAL WORK

A survey in the Fall of 1989 by the Council on Social Work Educa- tion assessed the extent of psychopharmacology content in graduate and undergraduate programs and would seem to confirm this failure. In this study (Libassi, 1990), fifty seven percent of the BSW programs responding reported that their curriculum contained no content on psychopharmawlogy. Althoughonly 28.6% of MSW programs total- ly omitted this content, often coverage was quite limited. On the other hand, students at both levels indicated very high levels of interest (62.8% BSW, 79% MSW) and an overwhelming majority of faculty (85%) saw a need to include this content in curriculum.

In hopes of addressing these gaps, this paper suggests a series of teaching units on relevant aspects of psychopharmacology which target specific medication-related dilemmas and demands of the so- cial worker. In addition, strategies for integrating the materials into curriculum are offered and suggestions are made for individual and group classroom activities and outside assignments, all of which are easily adopted (and adapted) by instructors.

Specific content such as basic knowledge about drug names and effects, clinical techniques to medication management, and how to deal with ethical and political questions match the current practice realities that call for social workers to educate patients and families about psychotropic drugs, to monitor medications, to assist with ad-

'

herence, cope with side effects, collaborate on interdisciplinary teams, and to advocate for a patient's right to receive (e.g., Clozapine) or refuse medications (Bentley, Rosenson, & Zito, 1990; Cohen, 1989; Davidson & Jamison, 1983; Gerhart & Brooks, 1983). On the other hand, the reader will not find suggestions here that social work- ers in mental health become experts in neurotransmission and know all the chemical names of drugs and their contraindications. This approach would seem to blur lines of responsibility rather than to clarify them.

The three goals of the proposed curriculum content are that stu- dents be:

AWARE of the hcts and fictions about psychotropic medication, ARTICULATE in the language of the field, and, ACTIVE in intervening in their client's medication-related con- cerns. D

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Kin J. Bentley and Jane Reeves 43

Specifically proposed, is a series of six teaching units. For each unit, this paper provides a title, a stated purpose, a description of issueslcontent that might be addressed, one or more strategies for integrating the content into curriculum, and an up-to-date bibliogra- phy (organized by unit at the end of the paper). Although the units could be organized into a single elective course, instructors may choose to incorporate materials into existing courses. The categoriza- tion into six units is somewhat arbitrary, given the admitted overlap in some areas as well as the fact that many units could be subdivided further.

The titles of the proposed six teaching units are:

1. Public and professional attitudes about psychotropic medica- tion.

2. Changing social work roles in psychopharmacology. 3. Medication content in patient and family psychoeducation. 4. Medication management techniques for social workers. 5. Ethical and legal issues in patient refusal of medication. 6. Research and resources.

The purpose of this unit is to provide students with the societal context of psychotropic drug use in mental health and expose them to the tremendous variability, yet consistent intensity, in emotion sur- rounding the topic. In this unit, two important issues that might be opened for discussion include personal and professional experiences with medications in general, and psychotropic medications in particu- lar, and the depiction of psychotropic drugs in the movies, on TV, in magazines and books.

Several homework assignments might facilitate learning in this regard. For example, students might participate in a small scale re- search project by taking a brief pre-post attitudinal and/or knowledge measure that the instructor composes (see Berg &Wallace, 1987 for ideas). In addition, students could conduct live structured interviews with patients, family members, or psychiatrists and report their find- ings to the class. Students might critique popular movies, past and D

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44 JOURNAL OF TEACHING INSOCIAL WORK

present, regarding their portrayal of psychotropic medication use. Recent movies "Nuts," "The DreamTeam," and "Crazy People" are good choices and are widely available at rental stores. This discussion of public attitudes towards medication can be easily couched in a larger discussion of public opinion and media portrayal of mental illness in general.

CHANGING SOCIAL WORK ROLES

The purpose of this unit is to provide a historical context to the current expansion of roles for social workers and a continued forum for student's ambivalences and ambiguities in psychopharmacology. Because the literature on social work and psychopharmacology is so limited, it is not difficult to have students abstract literally all the available articles, and then report on differences and similarities in author's positions.

In general, the literature will introduce students to the range of roles and tasks each may use in practice with clients with a long-term mental illness and their families. Students will also be exposed to content about social workers being placed in the inappropriate posi- tion of prescribing medication (Abroms & Greenfield, 1973; Elliot & Kittzer, 1973) and the assertion that it is inappropriate for social workers to encourage medication use (Cohen, 1988).

In order to have students more clearly formulate their own posi- tions regarding social work's role in medication, it might be helpful for them to write a "memo" to "their" staff (perhaps their field agency) clarifying the responsibility of the social worker in regard to medication. Writing a job description is another approach.

The discussion of the changing role-and perceptions of the ap- propriate role-of social work is likely to take place in context of the renewed emphasis on the biological model of mental illness. Like- wise, the changing social work roles can be discussed in contrast to the roles of the psychiatrist, nurse, and other team members, together with our "turf" battles. Brown (1985), for example, provides a not- so-radical and enlightening perspective on the relationship between the recent renewed interest in "biologism," the physician's exclusive prescribing privileges, and their financial and philosophical domi- nance in society.

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Kia J. Bentley and Jane Reeves 45

A powerful way to highlight the interprofessional difficulties is to have students role-play several scenarios of an interdisciplinary staf- fing of a patient who seems to be overmedicated. The potential frustrations and rewards of advocacy will become readily apparent.

MEDICATION CONTENT IN PSYCHOEDUCATION

The purpose of this unit is to teach student's how to teach the medication content often found in psychoeducation programs for pa- tients and families. In learning to teach the material, students learn the content themselves (a concept not too far removed from our own reality !). Educating patients and families is fast becoming a necessary treatment component. A brief review of several programs (Bentley, Rosenson, & Zito, 1990) found many similarities in the medication content presented. Most programs included the rationale and benefits of medication, classes of the most commonly used drugs (chemical and brand names), dosage issues, side effects and warning signs and how to recognize and cope with each, the effect of alcohol and drug use, and nutrition. Many programs also include information on emerging areas of research, such as drug holidays, intermittent drug use, and rapid neuroleptization. Social workers should be sure to include information on possible negative effects of medications such as bodily changes or effects on sexual functioning.

An excellent way to relay this information to students is to model an actual educational session with a "family" in class. Falloon, Boyd, and McGill (1984) provide extensive details, indeed practically a script, of their education session #2 on medication (part of a larger package of family intervention). Handouts, which review the material and provide for dialogue, are available horn the authors. The senior author has used these handouts in conjunction with a newsprint pad highlighting the main points. Similarly, Whittlin (1988) is an excel- lent and widely available resource for educational materials (as well as information on medication management in general).

MEDICATIONiWWAGEMENTAND COMPLIANCE

The purpose of this unit is to teach students how to help patients and their families to adhere to recommended medication regimens. This D

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task is essentially two prong. First, students must learn the wide vanety of techniques available to improve compliance. Communica- tion skills such as expressing positive and negative feelings, making appropriate requests of others, asking questions, reflecting, using appropriate eye contact and prompts, and problem-solving skills are crucial for patients and families to eEEectively negotiate with psychia- trists or to deal with medication-related conflicts among themselves. Likewise, certain cognitive (self-instruction, guided imagery, refram- ing, relaxation, thoughtstopping) and behavioral (reinforcement, re- minders, tailoring, contracting) strategies can be employed. For the number of students already lrcing tm&t thesc seemingly basic case- wdrksklll,, 11 1s iusln maarrot'w~deninetheira~~licahilitvto media- . . - .* tion management. Several resources on this topic are available (e.g., Bentley, Rosenson, &Zito, 1990; MeichenbaumBrTurk, 1987;Turk, Salovey, & titt, 1986; DiMatteo & DiNiada, 1982; Dunbar, Mar- shall, & Hovell, 1979).

In order to enrich the learning, have students role-play patient task groups attempting to address medication-related problems. Case ex- amples might include clients trying to cope with bothersome side effeas(drowsiness, weight gaiq restlessness, forexample)ordealing with intimidation or patronizing behavior by their physician. Ideally students wuld design task-oriented treatment strategies to increase medication adherence with the real management problems of their clients in field placen~ent.

The second aspect of teaching students how to help patients in '

medicationmanagement is to teach students how to recognize prodro- ma1 symptoms and side effects, and to teach them how to teach their clients to do the same (McCandless-Glimcher et a]., 1986). In this way, socialworkerscan assistdientsand theirpsychiatrists in making assessments about the medication's effects and the possibility of needed changes in lifestyle, environment, or medication. Local mem- bers of the National Alliance of the Mentally 111 are always willingto come speak and the topicof medication and its management is likely to provide fruitful discussion.

Recagnizingsymptoms and side effects involves a number oEtasks which cut across teaching units. It obviously involves learning about various psychotropic drugs and their common side ef'fects, typical dosing requirements, and expeaed action. It also involves becoming

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Kia J. Bentley and Jane Reeves 47

comfortable with psychiatric terminology and language, and to a cer- tain extent sharing that knowledge with clients. It involves placing additional emphasis on learning to listen to, to observe, and to trust their clients.

It might be important to emphasize that the purpose of students learning more about medications i s not to become more closely identi- fied with the medical profession or to give them some illusion of pqwer or authority. It is simply to be a more effective clinician for their clients.

LEGAL AND ETHICAL ISSUES IN PATIENT REFUSAL

The purpose of this unit is for students to learn the major arguments on various points on the continuum of the question: To what extent should psychiatric patients have a right to refuse medication? Topics to be discussed are most certain to include social work's stated value of self-determination, the uncertainties of patient competence inmen- tal illness, and the very nature of authority and using it to encourage medication use. If the rest of the teaching units err on the side of emphasizing the benefits of medications, this literature and these discussions will usually uncover and fully explore the risks of me- dication, particularly tardive dyskinesia and neuroleptic malignant syndrome.

This author has had excellent success in making these issues come alive by having students participate in a formal debate on a patient's right to refuse medication. Students are placed in teams of two orthree on each side and given time for presentations and rebuttals. Another strategy is to have students draft a model agency "policy and proce- dure'' for cases of medication refusal. Students placed in mental health settings might share their agency's existing policies, if any, on tardive dyskinesia liability, or other relevant policies such as informed consent of medication administration.

The numerous court cases involving medication refusal are excel- lent sources of discussion a s well (e.g., Rogers v. Commissioner, 1983; Rennie v. Klein, 1983). Students can be asked to research, write and present a legal "case brief," much like law students do in their classes. Information can be organized into a one page summary (with D

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wpies for every class member) of the facts, issues, decision, and reasoning of each case.

RESEARCH AND RESOURCES

The purpose of this generically labeled unit is to provide students with up-to-date research findings about the efficacy of medications, partiu;larly with the major mental illnesses (schizophrenia, bipolar, maior denression). In addition. the Duroose is to nmvide them with ~-~ > ' . -~ r ~. resources that are relatively concise and widely available with more in-depthinformation, whenit isneeded. Many of the references inthis section of the bibliography serve both purposes.

As has been stated, it would be inappropriate, if not impossible, to suggest to social workers in mental health to stay up with all the research concerning all psychotropic dmgs for all mental and emo- tional disorders. Luckily, summary information is available in major textbooks in psychiatry that are published or updated frequently. When students in mental health practice are asked to research treat- ment techniques being used with specific mental disorders, it is not difficult to ask them to include a brief report on the relevant medica- tions (and then point them to chapters like Kaplan & Sadock, 1988; Silver & Yudofsky. 1988; or Klerman, 1986).

Another assignment might have students wntact a particular phar- maceutical company for their propaganda on drug efficacy and clini- cal trials. This assignment may begin with student's often shocking purview of the advertisements in major psychiatric journals. Another exercise is to write a number of medication-related questions that client or family member might askand send studentson a "scavenger hunt'' for the answers using only reference books (particularly the Physician's Desk Reference).

CONCLUSION

This paper has outlined aseriesoEteachingunits for social workon psychopharmawlogy which emphasizes wntent needed for new and

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Kia J. Bentley and Jane Reeves 53

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Appelbaum, P. & Gutreil,T. (1980). Drug refusal: A study of psychiatricinpatients. American Journal ofpsychiatry, 137,340-346.

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Brooks, A. (1987). The right to refuse medications: Law and policy. RutgersLaw Review, 39,339-376.

Brown, P. (1985). The transfer of care: Psychiatric dei~itutionalization and ris aftermath. Boston, M A : Routledge & Kegan Paul.

Callahan, L. & Longmere, D. (1983). Psychiatric patients' right to refuse psycho- tropic medication: A national survey. Mental and Physical Disability Law Re- porter, 1,494-499.

Chamberlin, 1. (1982). Refusing treatment: The patient's view. In A.E. Doudera & J.P. Swazey (Eds.)Refusing treatment in medal institutions: Values in conflict (pp. 164-168). Washington,D.C.: AssociationofUniversity Programs inHealth Administration.

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schizophrenia: Do the benefits to the patient justify involuntary treatment? Minnesota Law Review, 60, 1149-1218.

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