Term Case Competition. Group 2: Kristina Charles Melissa Hervas Dayana Lewandowski Marcella Ortega Daylen Torres Maridellis Utset November 20th, 2016 Background: C.W. Williams Healthcare Center was started by the first African American surgeon from Charlotte’s largest hospital in 1980. His passion for the health needs of the poor and wanting to make the world a better place for those less fortunate, was his ultimate concern. In essence, the ACA, signed into law March 2010 by President Barack Obama will focus on … the uninsured Americans granted health insurance provide all screenings, and services as recommended by the U.S. Preventive Services Task Force. establish lower healthcare costs enhance system productivity Major Ruling Beneficial to C.W. Williams The ACA provides new options and incentives to help states rebalance their Medicaid long-term care programs in favor of community-based services and supports rather than institutional care (Paradise, 2015). Accountable Care Organizations Group of doctors, hospitals and other health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of Accountable Care Organizations are to avoid unnecessary duplication of services and preventing medical errors. This ultimately results in savings for the Medicare program. Goal of ACOs C.W. Williams and ACOs Currently one of C.W. Williams obstacles is the consortium being formed with the state to pay for Medicaid patients. If the state agrees to partake in this, all of C.W.’s patients, that require hospitalization, will no longer have the choice of which hospital they'd like to be admitted to. CMC has expressed an interest in the patients of C.W. Williams Older patients of C.W. Williams prefer CMC over Presbyterian. It’ll be easier to form an ACO since the majority will be Medicare patients and there will only be one hospital affiliation. Patient- Centered Medical Home (PCMH) Patient-centered medical home is a model of care that aims to transform the delivery of comprehensive primary care to children, adolescents and adults. Through this model, practices seek to improve quality, effectiveness and efficiency of the care they deliver while responding to each patient’s unique needs and preferences. Anti-Kickback & Stark Law Implications Anti-Kickback Statute Prohibits: Offering, paying, soliciting or receiving anything of value to induce or reward referrals to generate Federal health care program business. Stark Law Prohibits: A physician from referring Medicare patients for designated health services to an entity with which the physician has a financial relationship unless an exception applies. References Centers for Medicare & Medicaid Services (2015). Accountable Care Organizations (ACO). Retreived November 11, 2016, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/ Harris, D.M. (2014). Contemporary Issues in H ...

1. Term Case Competition.
Group 2:
Kristina Charles
Melissa Hervas
Dayana Lewandowski
Marcella Ortega
Daylen Torres
Maridellis Utset
November 20th, 2016
Background:
C.W. Williams Healthcare Center was started by the first
African American surgeon from Charlotte’s largest hospital in
1980. His passion for the health needs of the poor and wanting
to make the world a better place for those less fortunate, was his
ultimate concern.
In essence, the ACA, signed into law March 2010 by
President Barack Obama will focus on …
the uninsured Americans granted health insurance
provide all screenings, and services as recommended by the
U.S. Preventive Services Task Force.
establish lower healthcare costs
enhance system productivity
Major Ruling Beneficial to C.W. Williams
The ACA provides new options and incentives to help states
rebalance their Medicaid long-term care programs in favor of
community-based services and supports rather than institutional

2. care (Paradise, 2015).
Accountable Care Organizations
Group of doctors, hospitals and other health care providers who
come together voluntarily to give coordinated high quality care
to their Medicare patients.
The goal of Accountable Care Organizations are to avoid
unnecessary duplication of services and preventing medical
errors. This ultimately results in savings for the Medicare
program.
Goal of ACOs
C.W. Williams and ACOs
Currently one of C.W. Williams obstacles is the consortium
being formed with the state to pay for Medicaid patients. If the
state agrees to partake in this, all of C.W.’s patients, that
require hospitalization, will no longer have the choice of which
hospital they'd like to be admitted to.
CMC has expressed an interest in the patients of C.W. Williams
Older patients of C.W. Williams prefer CMC over Presbyterian.
It’ll be easier to form an ACO since the majority will be
Medicare patients and there will only be one hospital affiliation.
Patient- Centered Medical Home (PCMH)
Patient-centered medical home is a model of care that aims to
transform the delivery of comprehensive primary care to
children, adolescents and adults. Through this model, practices
seek to improve quality, effectiveness and efficiency of the care
they deliver while responding to each patient’s unique needs
and preferences.

3. Anti-Kickback & Stark Law Implications
Anti-Kickback Statute Prohibits:
Offering, paying, soliciting or receiving anything of value to
induce or reward referrals to generate Federal health care
program business.
Stark Law Prohibits:
A physician from referring Medicare patients for designated
health services to an entity with which the physician has a
financial relationship unless an exception applies.
References
Centers for Medicare & Medicaid Services (2015). Accountable
Care Organizations (ACO). Retreived November 11, 2016, from
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/ACO/index.html?redirect=/aco/
Harris, D.M. (2014). Contemporary Issues in Healthcare Law &
Ethics. Chicago, IL. Health Administration Press.
National Association of Community Health Centers (NACHC).
(2004). Affiliations Between Health Centers and Other
Community-Based Providers. p. 25. Retrieved November 11,
2016, from
http://bphc.hrsa.gov/archive/technicalassistance/resourcecenter/
managementandfinance/affiliationsbetweenhealthcentersandothe
rcommunitybas.pdf
Paradise, J. (2015, March 09). Medicaid Moving Forward.
Retrieved November 11, 2016, from http://kff.org/health-
reform/issue-brief/medicaid-moving-forward/
The Henry J. Kaiser Family Foundation (2013). Community
Health Centers in an Era of Health Reform: An Overview and
Key Challenges to Health Center Growth. Retrieved November
11, 2016, from http://kff.org/health-reform/issue-

4. brief/community-health-centers-in-an-era-of-health-reform-
overview/
Week 5 Discussion Questions
· 1. Review the diagnostic clusters of personality disorders.
Choose cluster A B or C and discuss the challenges of
conducting research on that cluster.
Cluster A: Includes paranoid, schizoid, and schizotypal
personality disorders. People with these disorders often seem
odd or eccentric, with unusual behavior ranging from distrust
and suspiciousness to social detachment.
· Notes: This study estimated that about 10 percent of the
population exhibits at least one personality disorder, with 5.7
percent in Cluster A, Since their entry into the DSM in 1980,
the personality disorders have been coded on a separate axis,
Axis II. This was because they were regarded as different
enough from the standard psychiatric syndromes (which were
coded on Axis I) to warrant separate classification. However, in
DSM-5, the multiaxial system was abandoned. Personality
disorders are now included with the rest of the disorders we
discuss in this textbook. Even with structured interviews, the
reliability of diagnosing personality disorders typically is less
than ideal. Most researchers today agree that a dimensional
approach for assessing personality disorders would be
preferable.
· ● It is difficult to determine the causes of personality
disorders as categories because most people with one
personality disorder also have at least one more and because
most studies to date are retrospective.
Difficulties Doing Research On Personality Disorders
Before we discuss the clinical features and causes of personality
disorders, we should note that several important aspects of

5. doing research in this area have hindered progress relative to
what is known about many other disorders. Two major
categories of difficulties are briefly described.
Difficulties in Diagnosing Personality Disorders
A special caution is in order regarding the diagnosis of
personality disorders because more misdiagnoses probably
occur here than in any other category of disorder. There are a
number of reasons for this. One problem is that diagnostic
criteria for personality disorders are not as sharply defined as
they are for most other diagnostic categories, so they are often
not very precise or easy to follow in practice. For example, it
may be difficult to diagnose reliably whether someone meets a
given criterion for dependent personality disorder such as “goes
to excessive lengths to obtain nurturance and support from
others” or “has difficulty making everyday decisions without an
excessive amount of advice and reassurance from others.”
Because the criteria for personality disorders are defined by
inferred traits or consistent patterns of behavior rather than by
more objective behavioral standards (such as having a panic
attack or a prolonged and persistent depressed mood), the
clinician must exercise more judgment in making the diagnosis
than is the case for many other disorders.
With the development of semistructured interviews and self-
report inventories for the diagnosis of personality disorders,
certain aspects of diagnostic reliability increased substantially.
However, because the agreement between the diagnoses made
on the basis of different structured interviews or self-report
inventories is often rather low, there are still substantial
problems with the reliability and validity of these diagnoses
(Clark & Harrison, 2001; Livesley, 2003; Trull & Durrett,
2005). This means, for example, that three different researchers
using three different assessment instruments may identify
groups of individuals with substantially different characteristics
as having a particular diagnosis such as borderline or
narcissistic personality disorder. Of course, this virtually
ensures that few obtained research results will be replicated by

6. other researchers even though the groups studied by the
different researchers have the same diagnostic label (e.g., Clark
& Harrison, 2001).
Given problems with the unreliability of diagnoses (e.g., Clark,
2007; Livesley, 2003; Trull & Durrett, 2005), a great deal of
work over the past 20 years has been directed toward
developing a more reliable and accurate way of assessing
personality disorders. Several theorists have attempted to deal
with the problems inherent in categorizing personality disorders
by developing dimensional systems of assessment for the
symptoms and traits involved in personality disorders (e.g.,
Clark, 2007; Krueger & Eaton, 2010; Trull & Durrett, 2005;
Widiger et al., 2009). However, a unified dimensional
classification of personality disorders has been slow to emerge,
and a number of researchers have been trying to develop an
approach that will integrate the many different existing
approaches (e.g., Markon et al., 2005; Krueger, Eaton, Clark et
al., 2011a; Widiger et al., 2009, 2012).
The model that has perhaps been most influential is the five-
factor model. This builds on the five-factor model of normal
personality mentioned earlier to help researchers understand the
commonalities and distinctions among the different personality
disorders by assessing how these individuals score on the five
basic personality traits (e.g., Clark, 2007; Widiger & Trull,
2007; Widiger et al., 2009, 2012). To fully account for the
myriad ways in which people differ, each of these five basic
personality traits also has subcomponents or facets. For
example, the trait of neuroticism is comprised of the following
six facets: anxiety, angry-hostility, depression, self-
consciousness, impulsiveness, and vulnerability. Different
individuals who all have high levels of neuroticism may vary
widely in which facets are most prominent—for example, some
might show more prominent anxious and depressive thoughts,
others might show more self-consciousness and vulnerability,
and yet others might show more angry-hostility and impulsivity.
And the trait of extraversion is composed of the following six

7. facets: warmth, gregariousness, assertiveness, activity,
excitement seeking, and positive emotions. (All the facets of
each of the five basic trait dimensions and how they differ
across people with different personality disorders are explained
in Table 10.2 on p. 335.) By assessing whether a person scores
low, high, or somewhere in between on each of these 30 facets,
it is easy to see how this system can account for an enormous
range of different personality patterns—far more than the 10
personality disorders currently classified in the DSM.
Within a dimensional approach, normal personality trait
dimensions can be recast into corresponding domains that
represent more pathological extremes of these dimensions:
negative affectivity (neuroticism); detachment (extreme
introversion); antagonism (extremely low agreeableness); and
disinhibition (extremely low conscientiousness). A fifth
dimension, psychoticism, does not appear to be a pathological
extreme of the final dimension of normal personality
(openness)—rather, as we will discuss later in the chapter in the
section on schizotypal personality disorder, it reflects traits
similar to the symptoms of psychotic disorders (e.g.,
schizophrenia) (Watson et al., 2008).
With these cautions and caveats in mind, we will look at the
elusive and often exasperating clinical features of the
personality disorders. It is important to bear in mind, however,
that what we are describing is merely the prototype for each
personality disorder. In reality, as would be expected from the
standpoint of the five-factor model of personality disorders, it is
rare for any individual to fit these “ideal” descriptions. And, as
the Thinking Critically About DSM-5 box below illustrates, this
situation will not change in DSM-5.
Reference:
Butcher, J. N., Hooley, J. M., & Mineka, S. (2014). Abnormal
Psychology (16th ed.). Boston MA: Pearson
2. Summarize the etiology of addiction within the current
substance use-misuse-abuse continuum. Provide an example of a

8. person in the media who is at the abuse stage of addiction.
Support your answer with peer-reviewed research.
NOTES: Even with structured interviews, the reliability of
diagnosing personality disorders typically is less than ideal.
Most researchers today agree that a dimensional approach for
assessing personality disorders would be preferable.
It is difficult to determine the causes of personality disorders
as categories because most people with one personality disorder
also have at least one more and because most studies to date are
retrospective.
Remarkable Recoveries from Life-Threatening Substance Abuse
Lyle Prouse was born in Wichita, Kansas, in 1938 of American
Indian heritage. As a child he was very interested in aviation
and won his first airplane ride by writing an essay for
Beechcraft Aircraft Company. Prouse, who grew up in the
Indian community in Wichita, had a serious, long-term
substance abuse problem, as did his parents, both of whom died
from alcohol abuse. Many of his friends and associates were
heavy alcohol abusers. After he finished high school he joined
the U.S. Marines, became a pilot, and served in the Vietnam
War. He was awarded several medals for his service in Vietnam.
He left the military and obtained a flying position at Northwest
Airlines, where he attained the rank of captain and worked for
22 years, flying Boeing 727 passenger aircraft. In 1990, Captain
Prouse and his flight crew enjoyed a night of heavy drinking
while on a layover in Fargo, North Dakota. Prouse consumed a
number of rum-and-Diet-Cokes, and his crew drank several
pitchers of beer and apparently were very loud and belligerent.
Although his crew left the bar earlier, Prouse remained longer
and continued drinking. During their drinking binge the flight
crew angered a customer in the pub, who later called the FAA,
warning them against the problem drinking of the crew. The
next morning the Northwest crew continued their flight to
Minneapolis and were arrested and given substance use tests.
They showed high levels of alcohol in their bloodstreams and
were charged with violating a federal law, which included

9. prison time as a result of operating a public transportation
carrier under the influence of drugs or alcohol. Captain Prouse
and his crewmembers served 12 months of the 16-month
sentence they received. All three pilots lost their jobs and their
pilot’s licenses as a result of the substance use violations.
Captain Prouse felt a great deal of depression and shame at the
problems that he created for himself and others following the
loss of the aviation career that he loved. He also experienced a
great deal of financial problems from his employment
termination. On several occasions he contemplated committing
suicide. Captain Prouse entered inpatient substance abuse
treatment not long after the incident. After completing his
recovery in an inpatient substance abuse treatment center,
Prouse began a long and difficult process of rehabilitation and
effort to restore his life without using alcohol. He made many
public speeches describing his substance abuse and later wrote a
book detailing what he had gone through (Prouse, 2001).
Throughout his recovery he was determined to regain his flying
status. It was necessary for him to retrain and retake all of the
FAA licensing examinations in order to have his qualifications
restored because he was required to requalify for every one of
his licenses and ratings. Captain Prouse was assisted in his
recovery by a number of people who were impressed by his
public disclosure of wrong-doing and his high motivation to
recover from his substance abuse. After he appealed to the court
to allow him the opportunity to obtain recertification, the court
waived the legal restrictions that had been placed upon him at
the trial. A friend of his who owned a trainer aircraft allowed
him to earn the necessary flying time needed to be relicensed as
a pilot. The CEO of Northwest Airlines, John Dasburg, who
himself had grown up in a family with alcoholic abuse
problems, took personal interest in Prouse’s struggle and
encouraged his return to duty. He returned to flying with
Northwest Airlines. Captain Prouse’s efforts and success at
rehabilitation were indeed impressive. In 2001 he was granted a
presidential pardon by President Clinton. Interestingly, another

10. one of the pilots on the Northwest “drunk pilots” flight, flight
engineer Joe Balzer, who also spent 12 months in federal
prison, also rehabilitated himself. He became involved with
Alcoholics Anonymous and, over time, requalified for the
aviation certification, eventually returning to the cockpit as a
pilot for American Airlines (see his autobiographical account in
Balzer, 2009). The extensive problem of substance abuse and
substance dependence in our society has drawn both public and
scientific attention. Although our present knowledge is far from
complete, investigating these problems as maladaptive patterns
of adjustment to life’s demands, with no social stigma involved,
has led to clear progress in understanding and treatment. Such
an approach, of course, does not mean that an individual bears
no personal responsibility in the development of a problem. On
the contrary, individual lifestyles and personality features are
thought by many to play important roles in the development of
substance-related disorders and are central themes in some
types of treatment. Substance-related disorders can be seen all
around us: in extremely high rates of alcohol abuse and
dependence, and in tragic exposés of cocaine abuse among star
athletes and entertainers. Addictive behavior—behavior based
on the pathological need for a substance—may involve the
abuse of substances such as nicotine, alcohol, Ecstasy, or
cocaine. Addictive behavior is one of the most prevalent and
difficult-to-treat mental health problems facing our society
today. The most commonly used problem substances are those
that affect mental functioning in the central nervous system
(CNS)—psychoactive substances: alcohol, nicotine,
barbiturates, tranquilizers, amphetamines, heroin, Ecstasy, and
marijuana. Some of these substances, such as alcohol and
nicotine, can be purchased legally by adults; others, such as
barbiturates or pain medications like OxyContin (or marijuana
in some states), can be used legally under medical supervision;
still others, such as heroin, Ecstasy, and methamphetamine, are
illegal. The material described in this chapter was designed to
provide both a historic and contemporary view of important

11. research and theoretical strategies in understanding addictive
disorders thus we will, in places, refer to the substance abuse
versus substance dependence distinction. The following
distinctions are important to understanding and diagnosing
substance-related disorders: • Substance abuse generally
involves an excessive use of a substance resulting in (1)
potentially hazardous behavior such as driving while intoxicated
or (2) continued use despite a persistent social, psychological,
occupational, or health problem. • Substance dependence
includes more severe forms of substance-use disorders and
usually involves a marked physiological need for increasing
amounts of a substance to achieve the desired effects.
Dependence in these disorders means that an individual will
show a tolerance for a drug and/or experience withdrawal
symptoms when the drug is unavailable. • Tolerance—the need
for increased amounts of a substance to achieve the desired
effects—results from biochemical changes in the body that
affect the rate of metabolism and elimination of the substance
from the body. • Withdrawal refers to physical symptoms such
as sweating, tremors, and tension that accompany abstinence
from the drug.
Reference: Butcher, J. N., Hooley, J. M., & Mineka, S.
(2014). Abnormal Psychology (16th ed.). Boston,
MA: Pearson
3. Describe the effectiveness of treatment in substance abuse as
evidenced in research studies.
4. Describe the biopsychosocial as it relates to the development
of substance abuse disorders.
5. What are three reasons for the high frequency of
misdiagnoses of personality disorders?

12. 6. Why Were No Changes Made to the Way Personality
Disorders Are Diagnosed?NOTES: DSM-5 THINKING
CRITICALLY about DSM-5: Why Were No Changes Made to
the Way Personality Disorders Are Diagnosed?
Many new and innovative proposals were offered for inclusion
in the personality disorders section of DSM-5. Indeed, the
proposed revisions were among the most radical for any of the
disorders covered in this book. The details were hotly debated,
although the general goal was to incorporate a more
dimensional approach to the assessment and diagnosis of
personality pathology (Livesley, 2011; Skodol et al., 2011;
Widiger et al., 2009).
In the end, the DSM-5 task force proposed revisions that
reflected a hybrid dimensional–categorical model. This
consisted of both categorical components and dimensional
components. This model includes a set of general criteria for all
personality disorders, an overall dimensional measure of the
severity of personality dysfunction, a limited set of personality
disorder types, and a set of pathological personality traits that
could be specified in the absence of one of the personality
disorder types. The proposed categorical component also
retained 6 of the original 10 specific personality disorder types
(antisocial, avoidant, borderline, narcissistic, obsessive-
compulsive, and schizotypal).
The greatest change to the status quo came from the
incorporation of dimensional components. The new personality
domain was intended to describe personality characteristics of
all patients, even those without a specific personality disorder.
The proposals would have allowed clinicians to rate the level of
impairment in personality functioning, reflecting aspects of
both identity (having a stable and coherent sense of self and the

13. ability to pursue meaningful life goals) and interpersonal
functioning (the capacity for empathy and intimacy). In
addition, diagnosticians could indicate the degree to which the
patient showed substantial abnormality on five trait domains
(negative affectivity, detachment, antagonism, disinhibition,
and psychoticism), which are based primarily on the five-factor
trait model discussed in this chapter.
In the end, however, the Board of Trustees of the American
Psychiatric Association vetoed all of the proposed changes and
decided to retain the old categories of personality disorders. In
other words, personality disorders in DSM-5 are the same as
they were in DSM-IV. Why were no changes accepted? We
cannot be sure. But, as you may have gathered from our
description above, the new system was very complicated.
Although it may have led to a better classification system, the
fact that it was not very intuitive or user-friendly may have
been a problem. The primary audience for the DSM is clinicians
who diagnose and treat people with mental disorders. We
suspect that the new proposed system was rejected because it
was quite cumbersome and judged too time-consuming for
overworked clinicians to learn and use. Moreover clinicians
probably would not have found the proposed system to be user-
friendly in part because the idea of rating people on dimensions
is foreign to the way clinicians have been taught to think. The
new proposals were not dismissed entirely, however. They now
appear in Section III of DSM-5, which describes disorders in
need of further study. This may have been a wise course of
action. Perhaps with more time and more research, it will
become apparent whether or not the new approach provides
enough benefits to make people willing to accept the challenges
learning to use it will require.
Reference:
Butcher, J. N., Hooley, J. M., & Mineka, S. (2014). Abnormal
Psychology (16th ed.). Boston MA: Pearson

14. 7. What are the features of antisocial personality disorder and
psychopathy?
Antisocial Personality Disorder
Individuals with antisocial personality disorder (ASPD)
continually violate and show disregard for the rights of others
through deceitful, aggressive, or antisocial behavior, typically
without remorse or loyalty to anyone. They tend to be
impulsive, irritable, and aggressive and to show a pattern of
generally irresponsible behavior. This pattern of behavior must
have been occurring since the age of 15, and before age 15 the
person must have had symptoms of conduct disorder, a similar
disorder occurring in children and young adolescents who show
persistent patterns of aggression toward people or animals,
destruction of property, deceitfulness or theft, and serious
violation of rules at home or in school
· ● A person with psychopathy shows elevated levels of two
different dimensions of traits: (1) an affective-interpersonal set
of traits reflecting lack of remorse or guilt, callousness/lack of
empathy, glibness/superficial charm, grandiose sense of self-
worth, and pathological lying, and (2) antisocial, impulsive, and
socially deviant behavior; irresponsibility; and parasitic
lifestyle. A person diagnosed with ASPD is primarily
characterized by traits from the second dimension of
psychopathy.
· ● Genetic and temperamental, learning, and adverse
environmental factors seem to be important in causing
psychopathy and ASPD.
· ● Psychopaths also show deficiencies in fear and anxiety as
well as more general emotional deficits.
· ● Treatment of individuals with ASPD psychopathy is
difficult, partly because they rarely see any need to change and
tend to blame other people for their problems.
8. What is drug abuse and dependence?