Social Work in Health and Mental Health

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San José State University

School of Social Work

Social Work 281, Social Work in Health and Mental Health, Section

, Fall 2014

Instructor:

Office Location:

Telephone:

Email:

Office Hours:

Class Days/Time:

Classroom:

Mae (MaryJane) Conroy

Washington Square Hall 217

(408) 378-0841

Maryjane.conroy@sjsu.edu

Canvas and MYSJSU Messaging

Our course, SW 281, will be using San Jose State’s online learning management system

Canvas for the upcoming semester.

Login URL: https://sjsu.instructure.com

Please note that it should NOT have the “www” at the start of the URL like many other websites.

Username : SJSU 9-digit ID number.

Password: Self-generated password for your SJSUOne account.

Courses: Once logged into Canvas, you will see your course or courses listed in the Courses

Heading on the top of the page. From the dropdown menu, click on the course name, and you will be entered into the course. Note: That link will not be active until the start date of the course.

It is recommended that you visit the eCampus Canvas website at http://www.sjsu.edu/at/ec/canvas/ . This website offers a number of Quick Start Learning Guides to help you navigate Canvas tools. Also, detailed guides can be found at http://guides.instructure.com/ .

For questions regarding the course or course materials, please contact me, the instructor.

For issues related to Canvas, please contact the eCampus Help Desk. The Help Desk can give technical support for issues encountered in Canvas Courses.

Phone: (408) 924-2337

Submit a help ticket using the following

URL: https://isupport.sjsu.edu/ecampus/ContentPages/Incident.aspx

.

 While logged into Canvas, click on the word Help on the upper right corner of the screen .

You are responsible for regularly checking with the messaging system through MySJSU (or other communication system as indicated by the instructor).

Catalog Description

Knowledge and skill development for multi-systems practice in health/mental health settings.

Emphasis on Latino/a, African American, and Asian American clients/client systems interacting with service delivery systems. Conceptual frameworks for practice at micro, mezzo and macro levels. (3 units. An elective)

Course Description

The course “Social Work in Health/Mental Health” explores multiple facets of social work practice applying multi-systems and transcultural perspectives in health and mental health settings with diverse populations. The course places special emphasis on theories and tools used for assessment, treatment plan development, intervention, and evaluation of work with vulnerable populations also experiencing health problems or having been diagnosed with mental disorders. The combination of life circumstances, the consequences of health/mental health problems, the sequalae of fragmented and poorly coordinated treatment systems, and the resulting stigma lead to a number of challenges that further places vulnerable populations at-risk. The emphasis of the course is on providing students with knowledge of critical health problems faced by marginalized and disenfranchised members of society—including relevant cultural, political, economic and social issues—and clinical practice skills and methods used by social workers, and health and mental health service providers from an empirical evidence- based perspective

Course Competencies & Practice Behaviors (Student Learning Objectives)

The following competencies are realized through this course:

1.

Identify as a professional social worker and conduct oneself accordingly.

2.

Apply ethical principles, codes of conduct and professional social work values skillfully in practice and in resolving ethical conflicts.

3.

Apply critical thinking skills using logic, scientific inquiry, and reasoned discernment in order to synthesize information, communicate professional judgments, and practice effectively in the context of specific fields of practice.

4.

Engage diversity and difference in practice.

7.

Apply knowledge of human behavior and the social environment.

8. Respond to contexts that shape practice

10.

Engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities.

Upon completion of ScWk 281 students will be able to:

1.

Practice personal reflection and self-correction to assure continual professional development

PB: 1 (b)

2.

Attend to professional roles and boundaries PB: 1 (c)

3.

Recognize and manage personal values in a way that allows professional values to guide health and mental health practice. PB: 2 (a)

4.

Make ethical decisions by applying standard of the NASW Code of Ethics in health and mental health settings PB: 2 (b)

5.

Apply strategies of ethical reasoning to arrive at principled decisions in health and mental health services PB 2 (d)

6.

Analyze models of health and mental health assessment, prevention, intervention and evaluation PB: 3 (b)

7.

Recognize the extent to which a culture’s structures and values may oppress, marginalize, alienate or create or enhance privilege and power for clients in health and mental health systems PB: 4 (a)

8.

Demonstrate awareness social conditions, emerging trends and cultural contexts relevant to practice in health and mental health . PB: 9 (a)

9.

Utilize conceptual frameworks (such as the bio-psycho-social-cultural-spiritual framework) to guide the processes of health/mental health assessment, intervention and evaluation. PB 7

(b)

10.

Develop a mutually agreed upon focus of work and desired outcomes PB: 10 (a) (c)

11.

Collect, organize and interpret client data PB 10 (a) (b)

12.

Assess client strengths and limitations in the assessment, formulation and treatment planning activities for health and mental health clients PB 10 (b) (a)

13.

Select appropriate intervention strategies PB 10 (b) (d)

14.

Facilitate transitions and endings as part of health/mental health treatment interventions PB

10 (c) (e)

15.

Social workers critically analyze, monitor and evaluate health/mental health interventions PB

10 (d) (a)

Mental Health Competencies:

This course covers many of the CalSWEC II Mental Health Competencies for the

Advanced/Specialization Year in the following areas: Culturally and linguistically competent mental health practice; Advanced mental health practice with individuals; Practice with families; Practice with community; Human behavior and the mental health environment; Program planning and evaluation.

Required Texts/Readings

All course readings are available through canvas course site or will be provided in class. It is strongly suggested that students obtain a copy of the DSM-5 for use in assessment of client and the case presentation assessment.

Diagnostic and statistical manual of mental disorders: DSM-5.

(5th ed.). (2013). Washington,

D.C.: American Psychiatric Association.

Taubman, S. (2012). California LCSW Exam Review Workbook . Berkeley: Berkeley Training Associates.

Available through the course instructor.

Library Liaison

For assistance in the library go to the King Library Reference Desk (2 nd

floor; 808-2100) and/or utilize the Social Work Research Guide available at http://libguides.sjsu.edu/scwk. The Social

Work Library Liaison is: Teresa Slobuski, who may be reached by phone (408.808.2015) or email (Teresa.Slobuski@sjsu.edu).

Classroom Protocol

Students are expected to arrive on time, participate in class discussions and exercises, and to be attentive to lectures and discussions. It is important to be courteous and respectful to ones peers as well as to the instructors. Students are asked to refrain from using cell phones, earphones or other devices.

Students are expected to use laptop computers for classroom related work. Cell phone and equipment use for other coursework or outside communication does not demonstrate advanced social work practice skill.

Dropping and Adding

Students are responsible for understanding the policies and procedures about add/drops, academic renewal, etc. Refer to the current semester’s Catalog Policies section at http://info.sjsu.edu/static/catalog/policies.html. Add/drop deadlines can be found on the current academic calendar web page located at http://www.sjsu.edu/academic_programs/calendars/academic_calendar/. The Late Drop Policy is available at http://www.sjsu.edu/aars/policies/latedrops/policy/ . Students should be aware of the current deadlines and penalties for dropping classes. Information about the latest changes and news is available at the Advising Hub at http://www.sjsu.edu/advising/.

Assignments and Grading Policy

Your grade in this course will be based on your presentations, written work, tests and participation as follows:

Assignment

Self

Biopsychosocialcultural

Assessment

Biopsychosocialcultural

Points

25

Due Date Course Student Learning

Objective/Competency

(SLO)

PB:1, 2,3,4,7, 8, 9

25 PB: 5, 7, 8, 9, 10

Assessment Penal ty for

Late

Work

All assignments will be turned at the start of class by the due date. Assignments turned in after the due date will be subject to an automatic 5% deduction. Errors in spelling, grammar and syntax will also be subject to a grade penalty.

Assignment 1

Self Bio-psycho-social-cultural-spiritual Assessment

Additional information regarding this assignment will be distributed and available on the course website.

Each student will conduct a complete assessment of self. The assessment will include all available biological, psychological, social, spriritual and cultural information. The assessment will include a case formulation, at least one theoretical framework, assessment of systems, family, culture and community.

Discuss resilience and strengths.

Include the following three attachments to the assessment: (1) a cultural, class and ethnicity focused genogram (2) an eco-map (3) a developmental timeline

Assignment 2

Bio-psycho-social-cultural-spiritual Assessment of a Client

Additional information regarding this assignment will be distributed and available on the course website.

Each student will conduct a complete person centered client assessment. The assessment will include available biological, psychological, social and cultural information. The assessment will include a theoretical framework, assessment of systems, family, culture, and community, risk assessment across categories, a diagnostic formulation, a comprehensive treatment plan and proposed interventions. Address resilience and strengths.

Include the following three attachments to the assessment: (1) a cultural, class and ethnicity focused genogram (2) an eco-map (3) a developmental timeline

Assignment 3

Case studies will be conducted from field placement or vignettes. One page written summaries and a verbal presentation will constitute this portion of student learning. Case Study Presentation guides will be provided to students. Presentation will be 10 minutes in duration, 7 minutes of presentation and 3 minutes of questions from the class. The one page summary will include (1) a developmental timeline and (2) a genogram.

The presentation will demonstrate the advanced practice skills acquired through the course. This includes exhibition of understanding of the bio-psycho-social-cultural-spiritual context of the presentation as well as professional dignity.

Participation-Seminar Leadership

Students will sign up for one seminar leadership opportunity. Students will prepare two to three discussion questions to prompt an in depth dialog during seminar on at least one class session. Students are responsible for preparation to discuss readings in each class session, answering the questions provided by the seminar leader and engaging in discussion of the seminar topic.

Students are encouraged to attend all class sessions. Students should notify the instructor in advance if they are not able to attend class or if they need to leave class early. To minimize class disruptions please arrive prior to the start of class. During the weekly sessions, there will be assigned readings that students will be expected to be able to discuss in class the following week. Students are expected to share ideas, listen to the ideas of others and participate in class discussions. In terms of class/group participation grade, instructor will use evidence of observed classroom and group participation to determine a letter grade for each student. Class and group participation of a quality nature will show evidence of having read and understood reading assignments, giving relevant information and critical analysis, raising questions and issues relevant to the topic, participating or volunteering for case presentations, role plays, etc. In summary, your grade will reflect your positive contribution to the learning of the entire class. The quality of cases presented or contributions made in class and enlightened discussions of reading materials will all serve to improve your individual grades in this area.

APA Format and Writing Requirements:

Specific APA and writing requirements should be described. Wording should be determined base on sequence and should requirements (wording below is a sample, not required).

All papers must follow current American Psychological Association (APA) format guidelines

(6th edition) with the following exceptions: the use of running heads is optional . All papers must use standard, 12-point fonts (e.g., Times Roman) and be free of typographical, formatting, spelling, and content errors, as the quality of the writing will be evaluated as part of the grade for all written assignments. Be sure to carefully review and edit all drafts prior to submission. All ideas, quotes, and information taken or derived from other sources must be appropriately cited and referenced in accordance with APA rules.

Use of Turnitin.com:

Due to the increase of scholarly works being plagiarized, San José State University and its faculty are beginning to implement safeguards, one of which is an electronic anti-plagiarism service called Turnitin.com. For the protection and education of all students, using an antiplagiarism service will add your scholarly papers to the academic database so that others cannot plagiarize your hard work. Details will be discussed in class.

Grading

The grading and evaluation distribution for the class is outlined below.

Percentage .

Grade .

97-100% .

93-96% .

90-92% .

87-89% .

83-86% .

80-82% .

77-79% .

73-76% .

70-72% .

67-69% .

A +

A .

A -

B +

B .

B -

C +

C .

C -

D +

63-66% .

60-62% .

Below 60% .

D .

D -

F ..

University Policies

Academic integrity

Your commitment as a student to learning is evidenced by your enrollment at San Jose State

University. The University’s Academic Integrity policy, located at http://www.sjsu.edu/senate/S07-2.htm, requires you to be honest in all your academic course work. Faculty members are required to report all infractions to the office of Student Conduct and

Ethical Development. The Student Conduct and Ethical Development website is available at http://www.sa.sjsu.edu/judicial_affairs/index.html.

Instances of academic dishonesty will not be tolerated. Cheating on exams or plagiarism

(presenting the work of another as your own, or the use of another person’s ideas without giving proper credit) will result in a failing grade and sanctions by the University. For this class, all assignments are to be completed by the individual student unless otherwise specified. If you would like to include your assignment or any material you have submitted, or plan to submit for another class, please note that SJSU’s Academic Policy S07-2 requires approval of instructors.

Campus Policy in Compliance with the American Disabilities Act

If you need course adaptations or accommodations because of a disability, or if you need to make special arrangements in case the building must be evacuated, please make an appointment with me as soon as possible, or see me during office hours. Presidential Directive 97-03 at http://www.sjsu.edu/president/docs/directives/PD_1997-03.pdf requires that students with disabilities requesting accommodations must register with the Disability Resource Center (DRC) at http://www.drc.sjsu.edu/ to establish a record of their disability.

School of Social Work Policies

School of Social Work Writing Policy

The Instructor will return selected assignments (as specified elsewhere in the syllabus) ungraded if at least five unique errors are found in grammar, punctuation, sentence structure, spelling, typos, APA style, or other basic writing errors. Late penalty points may apply, as specified in the syllabus.

A unique error is an error that will be counted 1 time . For example, if a possessive apostrophe is left off of a word 5 times in a paper, it will be counted as 1 error (i.e. a possessive apostrophe error). It is the student’s responsibility to make corrections throughout the paper and ensure there are no additional instances of the error in the paper before re-submitting the paper and submitting next assignments.

University Resources (EACH OF THE FOLLOWING IS OPTIONAL)

Student Technology Resources

Computer labs for student use are available in the Academic Success Center at http://www.sjsu.edu/at/asc/ located on the 1 st

floor of Clark Hall and on the 2 nd

floor of the

Student Union. Additional computer labs may be available in your department/college.

Computers are also available in the Martin Luther King Library. A wide variety of audio-visual equipment is available for student checkout from Media Services located in IRC 112. These items include digital and VHS camcorders, VHS and Beta video players, 16 mm, slide, overhead,

DVD, CD, and audiotape players, sound systems, wireless microphones, projection screens and monitors.

SJSU Peer Connections

The Learning Assistance Resource Center (LARC) and the Peer Mentor Program have merged to become Peer Connections. Peer Connections is the new campus-wide resource for mentoring and tutoring. Our staff is here to inspire students to develop their potential as independent learners while they learn to successfully navigate through their university experience. Students are encouraged to take advantage of our services which include course-content based tutoring, enhanced study and time management skills, more effective critical thinking strategies, decision making and problem-solving abilities, and campus resource referrals.

In addition to offering small group, individual, and drop-in tutoring for a number of undergraduate courses, consultation with mentors is available on a drop-in or by appointment basis. Workshops are offered on a wide variety of topics including preparing for the Writing

Skills Test (WST), improving your learning and memory, alleviating procrastination, surviving your first semester at SJSU, and other related topics. A computer lab and study space are also available for student use in Room 600 of Student Services Center (SSC).

Peer Connections is located in three locations: SSC, Room 600 (10th Street Garage on the corner of 10 th

and San Fernando Street), at the 1st floor entrance of Clark Hall, and in the Living

Learning Center (LLC) in Campus Village Housing Building B. Visit Peer Connections website at http://peerconnections.sjsu.edu for more information.

SJSU Writing Center (Optional)

The SJSU Writing Center is located in Room 126 in Clark Hall. It is staffed by professional instructors and upper-division or graduate-level writing specialists from each of the seven SJSU colleges. Our writing specialists have met a rigorous GPA requirement, and they are well trained to assist all students at all levels within all disciplines to become better writers. The Writing

Center website is located at http://www.sjsu.edu/writingcenter/about/staff/.

Social Work 281 / Social Work in Health and Mental Health, Fall

2014, Course Schedule

List the agenda for the semester including when and where the final exam will be held. Indicate the schedule is subject to change with fair notice and how the notice will be made available.

This schedule is subject to change with fair notice. I will announce any changes in class.

2

3

Table 1 Course Schedule

Week Date

1

Topics, Readings, Assignments, Deadlines

Course overview: introduction of the lifespan development perspective; introduction of integrated health and mental health perspective; introduction of person centered assessment including biological, psychological, social, cultural and spiritual; introduction and overview of theoretical frameworks, assessment and treatment planning in health and mental health settings.

Accurate case formulation PB: 6, 9, 10, 11

Labor Day

4

Biological assessment including conception, birth and developmental issues. PB: 10 (b)

Attachment assessment (relational assessment)

Psychological assessment

Social assessment

Cultural assessment

Spiritual assessment

Screening tools-brief screening and prevention

Transcultural concepts of health, wellness and recovery. PB:6, 9, 10,

11, 12, 13

Reading:

The boy who was raised as a dog and other stories from a child psychiatrist's notebook: What traumatized children can teach us about loss, love, and healing . Perry, Bruce D.; Szalavitz, Maia New York, NY, US:

Basic Books. (2006). Chapter 7.

Perry B, et al. (1998) Homeostasis, Stress, Trauma and Adaptation, A

Neurodevelopmental View of Childhood Trauma. CIVITAS, Chicago

(2 nd

)

Sori C., Schnur S., (2013) Integrating a Neurosequential Approach in the Treatment of Traumatized Children: An Interview With Eliana

Gil, Part II The Family Journal: Counseling and Therapy for

Couples and Families

201X, Vol XX(X) 1-8

LCSW Handbook [3, [4],

Behavioral health and substance abuse, stages of change and harm reduction. DSM 5 diagnosis and limitations. PB: 6, 7, 9, 11, 12

Hall-Lipsey E., Chisholm-Burns M., (2010) Pharmacotheraputic disparities: Racial, ethnic and sex variations in medication treatment,

American Society of Health System Pharmacists (4)

Whitaker R., (2002) Bedlam in Medicine, Healing Hand of

5

6

7

Week Date Topics, Readings, Assignments, Deadlines

Kindness 3-38. Mad In America NY, Penguin. (3 rd )

Sands R. G. (2001) The Biopsychosocial Assessment; A

Biopsychosocial Conceptual Framework, Clinical Social Work Practice in Behavioral Mental Health (9 th

)

Perry, B. (2009) Examining Child Maltreatment Through a

Neurodevelopmental Lens: Clinical Applications of the

Neurosequential Model of Therapeutics, Journal of Loss and

Trauma, 14:240–255

Family Assessment

Family and consumer issues

Consumer culture

Transcultural assessment

PB: 1, 2, 3, 7, 8, 9

Cassidy J. (2008) Nature of the Child’s Ties,

Handbook of

Attachment Theory Research and Clinical Applications: NY (2 nd

)

McCullough-Chavis A., Waites C. (2004) Genograms with

African American Families, Considering Cultural Context: Journal of

Family Social Work (8)

Fleming C, (1996) Cultural Formulation of Psychiatric

Diagnosis, Case No. 1 An American Indian Woman Suffering From

Depression, Alcoholism and Childhood Trauma. Cultural Medicine and

Psychiatry (7)

LCSW Handbook [10]

Legal and ethical issues

HIPPA compliance and confidentiality

Legal concepts

Legal requirements

Ethical assessment and treatment

PB: 1, 2, 3, 4, 15

Readings:

Orr R., (2010) Medical Ethics and the Faith Factor: The

Endangered Right of Conscience, Milborne Press (4)

Fields A., (2010) Multicultural Research and Practice:

Theoretical Issues and Maximizing Cultural Exchange: Professional

Psychology (41): 196-201

LCSW Handbook [8], [9]

Trauma informed practice

Family violence

Intimate partner violence

Veteran treatment

Immigration

Compassion fatigue and self-care

8

9

Week Date Topics, Readings, Assignments, Deadlines

PB: 1, 2, 4, 5, 6, 8, 9

Readings: LCSW Handbook [6]

Yarvis J. (2011): A Civilian Social Worker’s Guide to the

Treatment of War

Induced PTSD , Social Work in Health Care , 50:1, 51-72

Beckerman N., Corbett L., (2008): Immigration and Families:

Treating

Acculturative Stress From a Systemic Framework. Family Therapy (35)

Perry B., Pollard R., Blakley T., Baker W., Vigilante T. (1995)

Childhood Trauma, the Neurobiology of Adaptation, and “Usedependent” Development of the Brain: How States Become

Traits. Infant Mental Health Journal (16) 271-291

Solomon E, Heide K., (2005) The Biology of Trauma,

Implications for Treatment. Journal of Interpersonal Violence (20)

Johnson D., Zlotnick C. (2009) HOPE for Battered Women with

PTSD in Domestic Violence Shelters. Professional Psychology (40):

234-241

Medical social work

Terminology

Medical model

PB: 11, 12, 14, 15

Readings:

Gregorian C.,(2005) A Career In Hospital Social Work, Do You

Have What It Takes. Social Work In Health Care 40:3, 1-14

Paek M., Lim J. (2012): Factors Associated with health Care

Access and Outcome, Social Work in Health Care, 51:6, 506-530

Judd R., Sheffield S. (2010): Hospital Social Work:

Contemporary Roles and Professional Activities, Social Work in Health

Care , 49:9, 856-871

Medical social work

End of life issues

Transitions

Grief and loss

Being and “exquisite witness”

Self-determination concepts in health settings

PB: 11, 12, 14, 15

Readings:

Kitchen A. Brook J.(2005): Social Work at the Heart of the

Medical Team, Social Work in Health Care , 40:4, 1-18

Wagner W., Austin B., Von Korff M., (1996): Organizing Care for Patients with Chronic Illness, The Milbank Quarterly (74 )

Week

10

11

12

Date Topics, Readings, Assignments, Deadlines

Cambridge MA: 511-542

Crisis work

Emergency interventions

Working in team in crisis

Brief interventions

Critical Incident Stress Debriefing Model

PB: 1, 6, 9, 13, 14

Readings:

Naturale A. (2007) Secondary Traumatic Stress in Social

Workers Responding to Disasters: Reports from the Field

LCSW Handbook [5], [7] p67-71

Severe and persistent mental health

Theoretical Frameworks

Substance Overuse/co-occurring disorders

Harm reduction

PB: 6, 7, 8, 9

Readings:

Hopper E., et al. (2009) Shelter From the Storm: Trauma

Informed Care in Homelessness Service Settings. Open Health Services and Policy Journal

LCSW Handbook [7] p2-66

. Sands R., (2001) Clinical Practice with Clients Who Abuse

Substances. In Clinical Social Work Practice in Behavioral Mental

Health, NY, Pearson.

Mate, G. (2010). The Keys of Paradise. In In The Realm of

Hungry Ghosts . (1st ed.). (pp. 35-48). Berkeley , California:

North Atlantic Books.

Mate, G. (2010).You Wouldn’t Believe My Life Story. In

In

The Realm of Hungry Ghosts . (1st ed.). (pp. 49-58). Berkeley

, California: North Atlantic Books.

Severe and persistent mental health

Community interventions

Group interventions

Peer facilitated support

PB: 8, 9, 10, 15

Readings:

Holden G. et al. (2012) A Few thoughts on Evidence in

Social Work, Social Work in Health Care , 51:6, 483-505

Mate, G. (2010).Freedom of Choice and the Choice of

Week

13

14

15

16

Date Topics, Readings, Assignments, Deadlines

Freedom. In In The Realm of Hungry Ghosts . (1st ed.). (pp.

301-312). Berkeley , California: North Atlantic Books.

Depression diagnosis and treatment planning

Cultural context

Evidence based practices

Treatment planning

PB: 6, 7, 8, 9, 13, 15

Readings:

Epstein R. et al. (2009) “I Didn’t Know What Was Wrong”:

How People with Undiagnosed Depression Recognize Name and

Explain Their Distress.

LCSW Handbook [4], DSM IV-TR Depressive Disorders

Poleshuck E., Gamble S., Cort S. (2010) Interpersonal

Psychotherapy for Co-occuring Depression and Chronic Pain .

Professional Psychology (8)

DSM 5 Depression Disorders

Anxiety diagnosis and treatment planning

Cultural context

Evidence based practices

Treatment planning

PB 7, 8, 9, 10, 13, 14

Readings:

.Roberta G. Sands (2001) Clinical Practice with Clients with

Anxiety Disorders Clinical Social Work Practice in Behavioral Mental

Health ,

Horwitz A.(2010) How and Age of Anxiety Became an Age of

Depression. Milbank Quarterly (88)

DSM 5 Anxiety Disorders

Treatment plan evaluation

Continual assessment

Evaluation

Termination of treatment, information and referral

Resilience, empowerment and advocacy

PB: 3, 5, 6, 7, 8, 9, 13, 14

Mate, G. (2010). A Word to Families, Friends, Caregivers. In

In The Realm of Hungry Ghosts . (1st ed.). (pp. 400-410).

Berkeley , California: North Atlantic Books.

Resilience, empowerment and advocacy (continued)

Course summary

Week Date Topics, Readings, Assignments, Deadlines

PB: 3, 5, 6, 7, 8, 9, 13, 14

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