full description in attachments. This assignment is also connected with the past couple weeks’ assignments. Thank you.
4-5
· The purpose of the evaluation, including specific questions to be answered
· The outcomes to be evaluated
· The indicators or instruments to be used to measure those outcomes, including the strengths and limitations of those measures to be used to evaluate the outcomes
· A rationale for selecting among the six group research designs
· The methods for collecting, organizing and analyzing data
Assignment: Designing a Plan for Outcome Evaluation
Social workers can apply knowledge and skills learned from conducting one type of evaluation to others. Moreover, evaluations themselves can inform and complement each other throughout the life of a program. This week, you apply all that you have learned about program evaluation throughout this course to aid you in program evaluation.
To prepare for this Assignment, review “Basic Guide to Program Evaluation (Including Outcomes Evaluation)” from this week’s resources, Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014b). Social work case studies: Concentration year. Retrieved from http://www.vitalsource.com , especially the sections titled “Outcomes-Based Evaluation” and “Contents of an Evaluation Plan.” Then, select a program that you would like to evaluate. You should build on work that you have done in previous assignments, but be sure to self-cite any written work that you have already submitted. Complete as many areas of the “Contents of an Evaluation Plan” as possible, leaving out items that assume you have already collected and analyzed the data.
By Day 7
Submit a 4- to 5-page paper that outlines a plan for a program evaluation focused on outcomes. Be specific and elaborate. Include the following information:
· The purpose of the evaluation, including specific questions to be answered
· The outcomes to be evaluated
· The indicators or instruments to be used to measure those outcomes, including the strengths and limitations of those measures to be used to evaluate the outcomes
· A rationale for selecting among the six group research designs
· The methods for collecting, organizing and analyzing data
Resource 1
McNamara, C. (2006a). Contents of an evaluation plan. In Basic guide to program evaluation (including outcomes evaluation). Retrieved from
http://managementhelp.org/evaluation/program-evaluation-guide.htm#anchor1586742
Contents of an Evaluation Plan
Develop an evaluation plan to ensure your program evaluations
are carried out efficiently in the future. Note that bankers or
funders may want or benefit from a copy of this plan.
Ensure your evaluation plan is documented so you can regularly
and efficiently carry out your evaluation activities. Record enough
information in the plan so that someone outside of the organization
can understand what you’re evaluating and how. Consider the following
format for your report:
1. Title Page (name of the organization that is being, or has
a product/service/program that is being, evaluated; date)
2. Table of Contents
3. Executive Summary (one-page, concise overview of findings and
recommendations)
4. Purpose of the Report (what type of evaluation(s) was conducted,
what decisions are being aided by the findings of the evaluation,
who is making the decision, etc.)
5. Background About Organization and Product/Service/Program that
is being evaluated
a) Organization Description/History
b) Product/Service/Program Description (that is being evaluated)
i) Problem Statement (in the case of nonprofits, description of
the community need that is being met by
the product/service/program)
ii) Overall Goal(s) of Product/Service/Program
iii) Outcomes (or client/customer impacts) and Performance Measures
(that can be measured as indicators toward the outcomes)
iv) Activities/Technologies of the Product/Service/Program (general
description of how the product/service/program is developed and
delivered)
v) Staffing (description of the number of personnel and roles
in the organization that are relevant to developing and delivering
the product/service/program)
6) Overall Evaluation Goals (eg, what questions are being answered
by the evaluation)
7) Methodology
a) Types of data/information that were collected
b) How data/information were collected (what instruments were
used, etc.)
c) How data/information were analyzed
d) Limitations of the evaluation (eg, cautions about findings/conclusions
and how to use the findings/conclusions, etc.)
8) Interpretations and Conclusions (from analysis of the data/information)
9) Recommendations (regarding the decisions that must be made
about the product/service/program)
Appendices: content of the appendices depends on the goals of
the evaluation report, eg.:
a) Instruments used to collect data/information
b) Data, eg, in tabular format, etc.
c) Testimonials, comments made by users of the product/service/program
d) Case studies of users of the product/service/program
e) Any related literature
Pitfalls to Avoid
1. Don’t balk at evaluation because it seems far too “scientific.”
It’s not. Usually the first 20% of effort will generate the first
80% of the plan, and this is far better than nothing.
2. There is no “perfect” evaluation design. Don’t worry
about the plan being perfect. It’s far more important to do something,
than to wait until every last detail has been tested.
3. Work hard to include some interviews in your evaluation methods.
Questionnaires don’t capture “the story,” and the story
is usually the most powerful depiction of the benefits of your
services.
4. Don’t interview just the successes. You’ll learn a great deal
about the program by understanding its failures, dropouts, etc.
5. Don’t throw away evaluation results once a report has been
generated. Results don’t take up much room, and they can provide
precious information later when trying to understand changes in
the program.
Resource 2
Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
Read the following section:
“Social Work Research: Planning a Program Evaluation”
Social Work Research: Planning a Program Evaluation
Joan is a social worker who is currently enrolled in a social work PhD program. She is planning to conduct her dissertation research project with a large nonprofit child welfare organization where she has worked as a site coordinator for many years. She has already approached the agency director with her interest, and the leadership team of the agency stated that they would like to collaborate on the research project.
The child welfare organization at the center of the planned study has seven regional centers that operate fairly independently. The primary focus of work is on foster care; that is, recruiting and training foster parents and running a regular foster care program with an emphasis on family foster care. The agency has a residential program as well, but it will not participate in the study. Each of the regional centers services about 45–50 foster parents and approximately 100 foster children. On average, five to six new foster families are recruited at each center on a quarterly basis. This number has been consistent over the past 2 years.
Recently it was decided that a new training program for incoming foster parents would be used by the organization. The primary goals of this new training program include reducing foster placement disruptions, improving the quality of services delivered, and increasing child well-being through better trained and skilled foster families. Each of the regional centers will participate and implement the new training program. Three of the sites will start the program immediately, while the other four centers will not start until 12 months from now. The new training program consists of six separate 3-hour training sessions that are typically conducted in a biweekly format. It is a fairly proceduralized training program; that is, a very detailed set of manuals and training materials exists. All trainings will be conducted by the same two instructors. The current training program that it will replace differs considerably in its focus, but it also uses a 6-week, 3-hour format. It will be used by those sites not immediately participating until the new program is implemented.
Joan has done a thorough review of the foster care literature and has found that there has been no research on the training program to date, even though it is being used by a growing number of agencies. She also found that there are some standardized instruments that she could use for her study. In addition, she would need to create a set of Likert-type scales for the study. She will be able to use a group design because all seven regional centers are interested in participating and they are starting the training at different times.
**The Whole book will be in an attachment if needed. Thanks
Resource 3
https://managementhelp.org/evaluation/outcomes-evaluation-guide.htm#anchor30249
McNamara, C. (2006b). Reasons for priority on implementing outcomes-based evaluation.In Basic guide to outcomes-based evaluation for nonprofit organizations with very limited resources. Retrieved from
http://managementhelp.org/evaluation/outcomes-evaluation-guide.htm#anchor30249
Social Work Case Studies
Concentration Year
Editors
Sara-Beth Plummer
Walden University
Sara Makris
Laureate Education
Sally Margaret Brocksen
Walden University
Published by
Laureate Publishing
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Director, Program Design: Lauren Mason Carris
Content Development Manager: Jason Jones
Content Development Specialist: Sandra Shon
Cover Design: Jose Luis Henriquez Galarza
Editorial Services: Christina Myers and Laureate Education, Inc.
Production Services: Absolute Service, Inc.
Copyright © 201
4
by Laureate Education, Inc.
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, any information storage and retrieval systems, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission requests, write to the publisher, addressed “Attention: Content Development Specialist,” at the address above.
ISBN-1
3
:
9
7
8
-1-62
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8-028-4 (Paperback edition)
ISBN-13: 978-1-62458-005-5 (VitalSource edition)
ISBN-13: 978-1-62458-017-8 (Kindle edition)
ISBN-13: 978-1-62458-018-5 (Apple edition)
ISBN-13: 978-1-62458-019-2 (Nook edition)
ISBN-13: 978-1-62458-020-8 (Adobe Digital Edition)
First Edition
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9 8 7 6 5 4 3 2 1
Contents
Introduction
Practice
Mental Health Diagnosis in Social Work:
The Case of Miranda
Social Work Supervision:
Trauma Within Agencies
Working With Children and Adolescents:
The Case of Chase
Working With Children and Adolescents:
The Case of Claudia
Working With Children and Adolescents:
The Case of Noah
Working With Clients With Compulsive Disorders:
The Case of Marjorie
Working With Clients With Dual Diagnosis:
The Case of Cathy
Working With Clients With Severe Persistent Mental Illness:
The Case of Emily
Working With Couples:
The Case of Keith and Matt
Working With Families:
The Case of Brady
Working With Families:
The Case of Carol and Joseph
Working With Groups:
Breast Cancer Support Group
Working With Groups:
HIV/AIDS Prevention With Teenage Moms
Working With Groups:
Latino Patients Living With HIV/AIDS
Working With Individuals:
The Case of Carl
Working With Individuals:
The Case of Roy
Working With Individuals:
The Case of Sam
Working With Organizations:
The Southeast Planning Group
Working With Survivors of Domestic Violence:
The Case of Charo
Working With Survivors of Sexual Abuse and Trauma:
The Case of Angela
Working With Survivors of Sexual Abuse and Trauma:
The Case of Brenna
Research
Social Work Research:
Chi Square
Social Work Research:
Planning a Program Evaluation
Social Work Research:
Qualitative Groups
Social Work Research:
Single Subject
Policy
Social Policy and Advocacy:
Violence Prevention
Social Work Agencies:
Administration
Social Work Policy:
Children and Adolescents
Social Work Supervision, Leadership, and Administration:
The Phoenix House
Social Work Supervision, Leadership, and Administration:
The Southeast Planning Group
Working With Clients With Addictions:
The Case of Jose
Working With the Aging:
The Case of Iris
Appendix
Reflection Questions
Practice
Mental Health Diagnosis in Social Work:
The Case of Miranda
Social Work Supervision:
Trauma Within Agencies
Working With Children and Adolescents:
The Case of Chase
Working With Children and Adolescents:
The Case of Claudia
Working With Children and Adolescents:
The Case of Noah
Working With Clients With Compulsive Disorders:
The Case of Marjorie
Working With Clients With Dual Diagnosis:
The Case of Cathy
Working With Clients With Severe Persistent Mental Illness:
The Case of Emily
Working With Couples:
The Case of Keith and Matt
Working With Families:
The Case of Brady
Working With Families:
The Case of Carol and Joseph
Working With Groups:
Breast Cancer Support Group
Working With Groups:
HIV/AIDS Prevention With Teenage Moms
Working With Groups:
Latino Patients Living With HIV/AIDS
Working With Individuals:
The Case of Carl
Working With Individuals:
The Case of Roy
Working With Individuals:
The Case of Sam
Working With Organizations:
The Southeast Planning Group
Working With Survivors of Domestic Violence:
The Case of Charo
Working With Survivors of Sexual Abuse and Trauma:
The Case of Angela
Working With Survivors of Sexual Abuse and Trauma:
The Case of Brenna
Research
Social Work Research:
Chi Square
Social Work Research:
Planning a Program Evaluation
Social Work Research:
Qualitative Groups
Social Work Research:
Single Subject
Policy
Social Policy and Advocacy:
Violence Prevention
Social Work Agencies:
Administration
Social Work Policy:
Children and Adolescents
Social Work Supervision, Leadership, and Administration:
The Phoenix House
Social Work Supervision, Leadership, and Administration:
The Southeast Planning Group
Working With Clients With Addictions:
The Case of Jose
Working With the Aging:
The Case of Iris
References
Trademarks and Disclaimers
Introduction
The following cases offer a glimpse into the real-life client experiences one might encounter as a social work professional. The social workers who contributed these true-to-life social work cases captured the everyday experiences you may encounter in the field as you work with individuals, families, groups, and organizations. Each case demonstrates content aligned with specific topics and modules in a typical master of social work program’s concentration year. These cases highlight the micro, mezzo, and macro approaches necessary to be an effective and successful social worker.
By exemplifying work on all levels of practice—individuals, families, groups, organizations, and communities—these cases will enable you to learn how social workers address their clients’ presenting problems. Each case includes a detailed description of the client’s background and presenting problem and an outline of the approaches used by the social worker to address the identified concern. The cases offer a detailed description of the clients’ scenarios and provide an explanation of the approaches, interventions, and corresponding theoretical underpinnings used by the social workers to address the problem. These cases offer a unique opportunity to integrate and connect theoretical concepts to practice. By reading and analyzing the detailed description of each case, you will be able to make clear connections between the theoretical foundations of social work and its practical applications. Certain aspects of some cases are intended to be ambiguous or open to interpretation as a way to promote discussion. Therefore, we encourage you to critically analyze the approaches provided and to apply the knowledge and skills learned in the classroom to further examine the cases.
The reflection questions answered by each social worker in the
appendix
delve further into the daily working relationships between social worker and client, providing insight into the social workers’ personal experiences, professional responses, and occasional struggles in the field. With all of these elements combined, the case studies compiled in this book will bring your course work to life and will offer a helpful learning experience.
Disclaimer:
For true-to-life cases and scenarios in this book, names, places, and details have been changed to protect the identities of the subjects. Any resemblance to real people, places, or events is purely coincidental.
Practice
Mental Health Diagnosis in Social Work: The Case of Miranda
Miranda is a 35-year-old, Scottish female who sought counseling for increased feelings of depression and anxiety. Her symptoms include constant worry, difficulty sleeping, irritability, increased appetite, unexplained episodes of panic, feelings of guilt and worthlessness, and feelings of low self-esteem. She denied any suicidal/homicidal ideation but verbalized feelings of wanting to be dead. She maintained these thoughts were fleeting and inconsistent. She reported an increase in alcohol consumption, although clarified it was only when she felt anxious. She denied any blackouts or reckless/illegal behavior while drinking. She denied any other drug use.
Miranda works in the fashion industry and reported that she is very well liked by her peers and clientele. She is regularly chosen to train other staff members and comanage the store. However, she is often given a heavier workload to compensate for coworkers who are unable to perform at the expected level of her employer. Miranda stated that she has trouble saying no and feels increasingly irritable and frustrated with her increased workload.
Miranda has been married to her husband for 3 years, and they have no children. She reported that both her mother and father have a history of mental illness. Miranda’s parents are divorced, and when they separated, Miranda chose to live with her mother. Miranda’s mother remarried a man she described as “vicious and verbally abusive.” Miranda stated that her stepfather called her names and told her that she was worthless. She said he made her believe that she was sick with chronic health issues and many times forced her to take medicine that was either unnecessary or not prescribed by a doctor. Eventually he asked Miranda to leave her mother’s home. Miranda stated that her mother was well aware of her stepfather’s behavior but chose not to intervene, stating, “He is a sick man. Just do what he says.” She denied any physical or sexual abuse in the home.
In order to treat Miranda’s symptoms, we first addressed the need for medication, and I provided a referral to a psychiatrist. The psychiatrist diagnosed her with panic disorder and major depressive disorder and prescribed appropriate medications to assist her with her symptoms. Miranda and I began weekly sessions to focus on managing her boundaries both at work and with her family. We discussed her behavior around boundary setting as well as the possibility of enlisting her husband as a support person to encourage and promote healthy boundaries. We also discussed unresolved issues from her childhood. This approach enabled Miranda to gain insight into the self and how her maltreatment as a child affected her functioning in the present time. This insight enabled Miranda to validate her feelings of anger, frustration, and sadness about her upbringing and further give herself permission to set appropriate boundaries in her relationships. We also discussed the need for relaxation and stress management. Miranda was able to identify that she used to enjoy cycling and running but had not been engaging in them because of the demands at work. After discussing the importance of self-care, Miranda began to exercise again and set a goal to enter local running and cycling events to encourage herself to continue.
After 1 year of therapy, Miranda decided to taper down her medication, which was monitored by her psychiatrist. She has chosen to remain in therapy weekly to monitor her mood as she decreases her medication. Miranda’s overall presentation has improved greatly. With the use of medication, behavioral therapy, relaxation techniques, and psychodynamic therapy, Miranda’s affect presents as stable and her symptoms of depression are gone. Miranda is a client that is able to verbalize the benefits of treatment in helping her gain insight and empower herself to validate her own emotional needs. She has been a highly motivated patient who enjoys the safety of being able to express her thoughts and feelings without judgment.
Social Work Supervision: Trauma Within Agencies
I was a program coordinator of a multiservice agency providing mental health services to children, adolescents, teens, and older adults. I supervised five programs as well as a staff of 45.
I had been home sick for 2 days when I received a phone call reporting that one of my therapists, Carla, had not shown up for work the previous day and had not yet arrived that morning. There was a client in the waiting room who had an appointment with her. The receptionist said she had not called in sick, which was unusual because Carla was a hard working and reliable staff member. I asked the receptionist to look at Carla’s master schedule, which she reported was full that day. I told the receptionist that I would call Carla at home to see if maybe she was ill or had requested time off, and I apologized for a possible oversight on my part. There was no answer at Carla’s home, however, so I left a message. I then called the agency back and told the receptionist to wait another 15 minutes, after which she should apologize to the client, see if they would like to see someone else (if in crisis), and tell them that Carla would call to reschedule the appointment.
After an hour passed, I called the agency again and was told that Carla had not come in, and another client had shown up to see her. I again told the receptionist to see if the client needed to see someone that day, apologize for the inconvenience, and tell them that Carla would call to reschedule an appointment. Because this was unusual behavior for Carla, I contacted the local police to do a welfare check to ensure that she was okay. Carla was found dead in her home. The sheriff stated that her death was being investigated as a homicide, and he would contact me soon to gather information.
I immediately contacted my supervisor, the mental health director, to notify him of Carla’s tragedy and to plan how to address this issue with both the staff and, more important, her clients. I contacted a local organization that dealt with crisis situations, Centre for Living With Dying, and asked if its staff would come to the agency the next day to help notify our staff of Carla’s death. I contacted my receptionist to send out both a voice mail and an e-mail to all staff requesting that they come to the agency the next day at lunchtime for a mandatory meeting.
The next day, the majority of staff gathered at the agency, and I notified them of Carla’s death. Carla was well liked and each staff member was overwhelmed with this tragic news. The director and staff from the Centre for Living With Dying provided crisis and grief counseling. Staff were also given information related to the organization’s Employee Assistance Program (EAP) services in case they desired continued support to address their emotions and feelings of grief.
I then needed to decide how to notify each of Carla’s clients and how much to share about her death. The local newspaper had covered this tragedy, but I did not know if her clients had seen the article. Her clients were divided up among the staff, and a team of two (a social worker and psychiatrist) set up appointments to share the news with each client. We decided to tell the clients only that Carla had died suddenly and that in order to maintain confidentiality, we could not share details. Fortunately, each of the clients handled the news as well as possible, and no one decompensated as a result.
The local police reported that Carla was shot multiple times. They suspected her neighbor with whom it was reported she had an ongoing argument related to land rights. The police had to check out other possible leads and asked for the names of her clients to rule them out as possible suspects. I mentioned confidentiality and explained that Carla saw primarily women and children who, following ethical standards, did not know where she lived. The police, however, insisted on Carla’s clients’ information, so I told them I would consult with the agency’s lawyer. That consultation resulted in the decision not to give the information to the police, and I requested a subpoena for any information related to Carla and her clinical work. Fortunately, this was not needed; evidence was found in the neighbor’s home, including a gun and bullets matching Carla’s injuries, paperwork related to a lawsuit Carla planned to file against this neighbor, and a computer stolen from Carla’s home. Carla’s neighbor was arrested, charged, and ultimately convicted of her murder.
Three months after Carla’s death, the staff, her family, and her clients gathered for a memorial at the agency. A tree was placed at the center of the room, and each person made an ornament that represented what Carla meant to them and how she had helped them. The tree was eventually planted in the agency parking lot in memory of Carla.
Working With Children and Adolescents: The Case of Chase
Chase is a 12-year-old male who was brought in for services by his adoptive mother. He is very small in stature, appearing to be only 8 years old. He also acts younger than his 12 years, carrying around toy cars in his pockets, which he proudly displays and talks about in detail.
Chase was adopted at age 3 ½ from an orphanage in Russia. The adoptive parents are upper middle class and have three biological children (ages 9, 7, and 5). Chase is reported to often get upset with his siblings and hit or kick them. His mother stated that Chase has always had issues with jealousy, and when her other children were younger, she had to closely monitor him when he was around them. She reported several occasions when she found Chase attempting to suffocate each of his younger siblings when they were babies.
The mother stated that Chase came to the United States without knowing any English. She knows very little about his family of origin other than that he lived with his biological parents until age 2 and then lived in the orphanage until he was adopted. She reported that the plane ride from Russia was horrible and that Chase cried the entire flight and refused to sleep for the first 2 days they had him.
The mother reported that Chase often hides food in his room and gorges himself when he eats. She does not understand this behavior because he always has enough food, and she never restricts his eating. In fact, because of his small size and weight, she often encourages him to eat more. She also reported that Chase hates any type of transition and will get upset and have temper tantrums if she does not prepare him for any changes in plans. He is reported to kick and hit both parents, and they have had to restrain him at times to stop him from hurting himself and others. The parents have never sought help before, but recently the school has been complaining of his inability to focus and increasing disruptive behaviors. His teachers report that he struggles with school, has no friends, and often has “meltdowns” when he does not get his way. Prior to our meeting, Chase had never had any testing for special education nor had he ever received any counseling services.
During intake, I met briefly with Chase alone. He appeared anxious, had pressured speech and facial tics, and was unable to keep his legs still. He chose to play a board game during our time in the session and talked in detail about World War II and each of the boats in the game. When asked how he knew all about warships, he stated that he often watched television documentaries on the subject.
Diagnosis:
|
Axis I: |
299.80 Pervasive developmental disorder NOS 307.21 Transient tic disorder |
|||
|
Axis II: |
799.90 Deferred |
|||
|
Axis III: |
V71.09 |
|||
|
Axis IV: |
Problems with primary support group; problems related to the social environment; educational problems |
|||
|
Axis V: |
45 |
Plan:
Initially Chase’s parents were unsure what to do about their son’s behaviors. His mother was the primary caretaker and his father thought she should handle any therapy or problems related to school. His mother reported that she was “at the end of her rope” and was ready to give her son up to foster care. She shared her frustration with her husband who “just did not understand how hard it was.” It was concerning that Chase had never received any services prior to our meeting and that the school had not properly referred him for testing to address his behaviors and his academic struggles.
Both parents were asked to come in for sessions together to work as a united front in addressing Chase’s behaviors and to be supportive of each other. The parents were taught behavior modification, and they were successful in establishing a reward system that motivated Chase to follow the rules in the home. In addition, the parents were provided with psychoeducation regarding autism, including how to parent an autistic child and how to advocate for Chase in the school system. The school complied with the parents’ request for testing, and Chase was found to meet criteria for special education, and an individual education plan (IEP) was established. In addition, a referral was made to psychiatry, and medication was prescribed to help Chase with his outbursts, his tics, and with focus while at school. Lastly, Chase was offered a socialization group with other children on the autism spectrum, and he developed better skills in making friends and eye contact and self-soothing and calming himself to avoid tantrums.
Working With Children and Adolescents: The Case of Claudia
Claudia is a 6-year-old, Hispanic female residing with her biological mother and father in an urban area. Claudia was born in the United States 6 months after her mother and father moved to the country from Nicaragua. There is currently no extended family living in the area, but Claudia’s parents have made friends in the neighborhood. Claudia’s family struggles economically and has also struggled to obtain legal residency in this country. Her father inconsistently finds work in manual labor, and her mother recently began working three nights a week at a nail salon. While Claudia is bilingual in Spanish and English, Spanish is the sole language spoken in her household. She is currently enrolled in a large public school, attending kindergarten.
Claudia’s family lives in an impoverished urban neighborhood with a rising crime rate. After Claudia witnessed a mugging in her neighborhood, her mother reported that she became very anxious and “needy.” She cried frequently and refused to be in a room alone without a parent. Claudia made her parents lock the doors after returning home and would ask her parents to check the locks repeatedly. When walking in the neighborhood, Claudia would ask her parents if people passing are “bad” or if an approaching person is going to hurt them. Claudia had difficulty going to bed on nights when her mother worked, often crying when her mother left. Although she was frequently nervous, Claudia was comforted by her parents and has a good relationship with them. Claudia’s nervousness was exhibited throughout the school day as well. She asked her teachers to lock doors and spoke with staff and peers about potential intruders on a daily basis.
Claudia’s mother, Paula, was initially hesitant to seek therapy services for her daughter due to the family’s undocumented status in the country. I met with Claudia’s mother and utilized the initial meeting to explain the nature of services offered at the agency, as well as the policies of confidentiality. Prior to the meeting, I translated all relevant forms to Spanish to increase Paula’s comfort. Within several minutes of talking, Paula noticeably relaxed, openly sharing the family’s history and her concerns regarding Claudia’s “nervousness.” Goals set for Claudia included increasing Claudia’s ability to cope with anxiety and increasing her ability to maintain attention throughout her school day.
Using child-centered and directed play therapy approaches, I began working with Claudia to explore her world. Claudia was intrigued by the sand tray in my office and selected a variety of figures, informing me that each figure was either “good” or “bad.” She would then construct scenes in the sand tray in which she would create protective barriers around the good figures, protecting them from the bad. I reflected upon this theme of good versus bad, and Claudia developed the ability to verbalize her desire to protect good people.
I continued meeting with Claudia once a week, and Claudia continued exploring the theme of good versus bad in the sand tray for 2 months. Utilizing a daily feelings check-in, Claudia developed the ability to engage in affect identification, verbalizing her feelings and often sharing relevant stories. Claudia slowly began asking me questions about people in the building and office, inquiring if they were bad or good, and I supported Claudia in exploring these inquiries. Claudia would frequently discuss her fears about school with me, asking why security guards were present at schools. We would discuss the purpose of security guards in detail, allowing her to ask questions repeatedly, as needed. Claudia and I also practiced a calming song to sing when she experienced fear or anxiety during the school day.
During this time, I regularly met with Paula to track Claudia’s progress through parent reporting. I also utilized psychoeducational techniques during these meetings to review appropriate methods Paula could use to discuss personal safety with Claudia without creating additional anxiety.
By the third month of treatment, Claudia began determining that more and more people in the environment were good. This was reflected in her sand tray scenes as well: the protection of good figures decreased, and Claudia began placing good and bad figures next to one another, stating, “They’re okay now.” Paula reported that Claudia no longer questioned her about each individual that passed them on the street. Claudia began telling her friends in school about good security guards and stopped asking teachers to lock doors during the day. At home, Claudia became more comfortable staying in her bedroom alone, and she significantly decreased the frequency of asking for doors to be locked.
Working With Children and Adolescents: The Case of Noah
Noah is a 10-year-old, multiracial male who is currently in foster care. Prior to the foster care placement, he was hospitalized three times in 3 months as a result of increased aggression, disruptive outbursts, and self-harm behaviors. Noah has a long history of dangerous behaviors, including twice jumping out of a moving vehicle, breaking a peer’s leg, making suicidal and homicidal threats, and killing a dog.
Noah was living with his mother, stepfather, full brother (Edgar), and three half-siblings in his home state before his dangerous behaviors increased in severity 2 years ago. At that point, Noah’s mother’s marriage ended, and she left Noah and his brother Edgar in the care of his paternal grandfather in another state. Noah’s behavior during this period included cutting himself, fighting, and threatening to burn the school down. The latter two incidents resulted in Noah’s suspension from school. His grandfather sought assistance from the county, and social services began working with the family. However, Noah continued to exhibit behavioral problems, including those that resulted in his hospitalizations. After his last hospitalization, Noah’s mother took him and Edgar to live with her in a different county. The hospital made a referral for a children’s mental health caseworker to work with the family.
Within a month of reuniting, Noah’s mother called law enforcement in response to Noah’s out-of-control behavior. Noah had been running down the highway and screaming that his mother had put bleach in his eyes. His mother explained her concerns to the case manager, saying that she was overwhelmed with Noah’s behavior and felt she could not handle him any longer. The county had been receiving child protection reports regarding Noah’s out-of-control behavior as well as concerns that his mother was not taking Noah to medical appointments or giving him medication as prescribed. Noah was then placed in his current foster home where he has been for the last 9 months. Child Protective Services developed a reunification plan upon his placement in the foster home.
Services provided for Noah include individual and family counseling, medication management, and weekly supervised visitation with his mother. Noah’s most current diagnosis is mood disorder, not otherwise specified (NOS); attention deficit hyperactivity disorder (ADHD), combined type; and learning disorder, NOS. His current medications include Abilify® and Concerta®. His full scale IQ is 72 and he receives special education services.
I began working with Noah after he was placed in his foster home. During my initial intake with his mother, she stated that Noah met all of his developmental milestones on time. She denied any alcohol or drug use during her pregnancy but admitted to smoking cigarettes. She described Noah as active and having a temper from an early age. She said his kindergarten teacher had voiced concerns about his inattention and behavior, and it had been recommended that he be evaluated for ADHD. After Noah had set a fire in his home’s bathroom, his mother had him examined, and he was diagnosed with ADHD and prescribed medication. There is no known history of sexual abuse, and Noah’s mother reports that while she and her ex-husband had frequent verbal fights, there was no physical abuse in the home.
Within his current foster home there have been some difficult moments, but Noah has acclimated to the family. He attends their church and is involved in the church’s youth program. Noah and his foster brother get along and enjoy each other’s company. Noah’s foster parents are active participants in working with Noah’s plan and maintain good communication with his providers.
At our first session, Noah explained he was in foster care because “my mother can’t take care of me.” I asked if there was anything he would like to change about himself, and he said to “act better” so he could live with his mother again. My assessment made clear that although Noah is 10 years old, his developmental level is younger. I began working with him using cognitive behavioral play therapy. Noah’s play was very aggressive, and he struggled with appropriately expressing himself and working through different play-based scenarios. I focused on improving Noah’s coping skills.
Noah has begun to identify his feelings, and he has learned about triggers related to his anger and the impact on his thoughts and feelings. Noah has continued to have scheduled supervised visitations with his mother; however, she has failed to keep many of her scheduled visits. On the days she misses appointments, Noah exhibits increased negative behaviors at school and at the foster home.
As part of my role, I am in contact with his foster mother and CPS social worker. It became clear that Noah’s mother had not been following through with the reunification plan, and social services is pursing termination of her parental rights. Noah’s foster mother reported that she and her husband would like to adopt Noah. They are unsure of how to talk to him about the upcoming termination hearing and their interest in adoption. I offered to facilitate this discussion with Noah and his foster parents.
In preparation for the upcoming court hearing to terminate parental rights, the social worker discovered Noah’s maternal grandmother was full-blooded Native American and has tribal registration. This information had not been in any of Noah’s prior records. According to the Indian Children Welfare Act (ICWA), the registered tribe needs to be included in Noah’s placement plan. ICWA sets federal requirements that apply to state child custody proceedings involving an Indian child who is a member of or eligible for membership in a federally recognized tribe. The CPS social worker states Noah will need to be placed in a Native American foster home.
Working With Clients With Compulsive Disorders: The Case of Marjorie
Marjorie is a 24-year-old, Caribbean American female. She was born in the West Indies. Her family immigrated to the United States when she was 4 years old and later became American citizens. Marjorie has four siblings: two older brothers, who live with their families in other states, and two younger sisters, who live at home with Marjorie and her mother. Her father passed away when she was 15 years old. Marjorie is unmarried, has no children, and has only a few social acquaintances from work and her church. Generally, Marjorie is in good physical health; she has never been hospitalized nor has she received past psychiatric treatment. She is employed part time as an administrative assistant at her church with an annual salary of $16,500. Marjorie attended college for three semesters but had to drop out for financial reasons. She would like to go back to school and complete her degree, but recently she has experienced difficultly managing her daily living activities, including her job responsibilities.
As a teenager, Marjorie began experiencing discomfort touching what she believed were “filthy” objects: toilet seats, outdoor seating areas, desk chairs, light switches, anything that had public contact. As her condition became more severe, she found herself needing to leave work several times a day, believing she was contaminated and needing to take a hot shower and change clothes. To feel safe and secure, Marjorie cleans the house from top to bottom several times a week. She washes her clothes on a daily basis, and she washes her hands 20–30 times a day until they are nearly raw. When Marjorie is at home, she is consumed with her bathing and cleaning rituals, showering for approximately one hour several times a day, using three to four washcloths. She changes clothes several times a day and avoids meeting new people for fear of physical contact that might contaminate her. She does not like to have strangers in the house because they “bring in germs.”
Marjorie recalls how she used to help her mother clean house while growing up. This always brought favorable attention from her parents, particularly her father. Her father always commented on how special she was because she was the “little helper” in the house. After her father passed away, Marjorie deeply missed the special attention she had received. Whenever she thought about him, she began to feel anxious and would begin her cleaning rituals, which helped her feel connected with his memory and gave her a feeling of control over her life.
Marjorie stated that her mother was aware that her behaviors might not be “normal” but that she had made no effort to seek professional support for her daughter because she did not trust “those hospitals,” especially because her husband died in a hospital. She believed that Marjorie would ultimately outgrow any problems, stating, “No child of mine has a mental health problem!”
Marjorie’s cleaning practices became more frequent concurrent with her compulsive thoughts about needing to feel secure and in control. Marjorie’s siblings became more concerned about her, and her employer expressed concern that she risked losing her job due to her increasing need to leave midshift. Her sister was able to talk Marjorie into making an appointment at the local mental health clinic.
When I first met Marjorie at the clinic, she seemed physically tired, quite thin, and very anxious. During our introductions, she did not shake hands with me, nor did she look at me directly. During intake, a general psychological assessment was completed. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used as part of the assessment to support a preliminary diagnosis of clinical obsessive-compulsive disorder (OCD).
My first sessions with Marjorie were dedicated to gathering her background history and developing a working relationship. Following a definitive diagnosis of OCD by a psychiatrist, Marjorie was initially prescribed Zoloft® (a selective serotonin reuptake inhibitor [SSRI]) along with individual therapy as a first-line approach to her treatment. As her social worker, I began working with her using cognitive behavioral therapy (CBT), specifically exposure and response prevention to address her OCD. In addition, we planned to talk about her family history to address the underlying factors leading to her OCD. Together Marjorie and I worked to set reasonable goals related to reducing the frequency of her compulsive acts and improving her social functioning.
In our subsequent sessions, Marjorie talked about the situations or objects that gave her the greatest anxiety, and we created a list from least avoidance to most avoidance. Our plan was to gradually increase direct or imagined exposure to items on the list until she reached a point of comfort with the items. It is anticipated that therapy with Marjorie could take considerable time and effort to get her to express her interpretations of the obsessions, to develop the appropriate strategies and techniques to reduce the frequency of obsessed thoughts and compulsive behaviors, and to positively associate with her social networks once again. I continue to work with her at this time on these goals.
Working With Clients With Dual Diagnosis: The Case of Cathy
Cathy is a 32-year-old, divorced, heterosexual African American female. She came to her first initial intake session with complaints of depression with passive suicidal thoughts, anxiousness, and trouble sleeping. Cathy’s primary concern is that she has been having episodes three to five times a week during which she reports she cannot breathe, her heart feels like it will explode, and she feels like the “walls close in.” She states that this has been going on for about a year, but lately it is getting worse. She self-referred after being prompted by her sister to contact a social worker. The following is a summary of the initial appointment and assessment we completed.
Cathy is the oldest of four children (two brothers and one sister), all of whom are married and live in the same community. Cathy works in a doctor’s office and lives in a one-bedroom apartment. She is the primary caretaker of her mother, who was involved in a car accident 20 years ago and was left a quadriplegic, going to her home daily to help with her personal hygiene.
Cathy has an arrest history and was incarcerated for 3 years for drug-related charges. She was charged with possession and intent to distribute. Cathy states that at that time she was addicted to heroin and using daily. When she completed her prison sentence, she was paroled and mandated to attend a 1-year outpatient drug treatment program, which she successfully completed. Cathy reported that she started using cocaine 2 years ago, stating that it helps her do her fast-paced job better and it keeps her energy up so she can help her mother early in the morning and late at night. She said no one in her family or at her job knows that she has been doing drugs. She drinks alcohol daily (two to three drinks). Cathy also takes numerous medications prescribed to her by her primary care doctor, including an antidepressant and pain medication.
As we discussed her presenting concerns, multiple issues came up. Cathy shared her feelings about being her mother’s primary caretaker, stating, “I love my mom, but everyone expects me to care for her. It feels so unfair, but it’s because I am not married and don’t have any children.” She said her father does not help with the care of her mother and that all he does is “hang out.” She feels increasingly frustrated with this added responsibility and resentful that her father and siblings have relegated this job to her. She also stated that she recently allowed one of her brother’s friends to move in with her as a favor because he was homeless and had nowhere to go. She said she believed he was a sweet person who just has had a hard time in life, and she wanted to help him. She has been supporting him financially over the last month, and she has become concerned because it appears that he has not made any effort to get a job. She fears she made a mistake allowing him into her home and worries she will not be able to get him to leave.
Cathy said that she and this new roommate had sex one time when he first moved in. She said they both got very intoxicated, and she is not sure exactly what happened, but she blacked out and found him in her bed, undressed. She then told him she had herpes, and he responded that it had been a “mistake” and that he did not want to have sex with her again because he was afraid of getting infected. Cathy explained that her ex-huband’s cheating had resulted in this lifelong disease, and she expressed anger and resentment toward him. She said even though the herpes is controlled with medication, she feels embarrassed and fears she will never have another healthy relationship. She also feels used and humiliated by this man now living in her home.
Cathy then shared that when she was 12 years old her father began molesting her. She stated that she tried to forget what happened to her, but this recent incident with her new roommate brought it up again. Cathy complained of recent nightmares related to the abuse and exaggerated startle reactions to other people’s movements.
The following is the diagnosis given to Cathy by the psychiatrist on staff and the plan of action that was created to address her needs and concerns.
Diagnosis:
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309.81 Post-traumatic stress disorder 296.32 Major depression recurrent, moderate 300.21 Panic disorder with agoraphobia 304.00 Opioid dependence in sustained full remission v304.30 Cocaine dependence with physiological dependence 305.00 Alcohol abuse |
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799.90 Diagnosis deferred R/O 301.83 Borderline personality disorder |
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Herpes |
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Problems with primary support group; problems related to the social environment; and occupational problems |
Plan:
Cathy agreed to go into a 30-day residential treatment program. She completed this program successfully and, once discharged from the program, resumed individual treatment. Her trauma and depression were effectively addressed with the combined use of eye movement desensitization and reprocessing (EMDR) and cognitive behavioral therapy (CBT).
Cathy currently continues in treatment and no longer reports experiencing panic attacks or nightmares related to her past trauma. Cathy is working on mindfulness and the establishment of healthy relationships using dialectical behavior therapy (DBT).
Working With Clients With Severe Persistent Mental Illness: The Case of Emily
Emily is a 62-year-old, single, heterosexual, African American female who seeks treatment for anxiety. She says she often hears a female voice directing her to punish herself by tweezing the hair from her head or by scrubbing her home clean. She reported that tweezing her hair eases her anxiety. She has arthritis in her spine and knee and uses a walker to help her manage mobility safely. She receives Social Security income and is not employed. Emily lives alone in a subsidized apartment in the same building as her 72-year-old, unmarried sister. She is reliant upon her sister for transportation and for a sense of social and emotional connection.
Emily and her sister shared an apartment for over 30 years, beginning when each of their marriages dissolved. When her sister began a romantic relationship 5 years ago, Emily reported that she began to feel very anxious and started to cry often. Emily moved into an apartment down the hall in the building and began to tweeze the hair from her head, hiding her hair loss by wearing wigs. Her sister learned of Emily’s tweezing after her wig slipped off one evening, and she encouraged Emily to seek treatment.
During our initial visit at a local mental health center, Emily shared that when she was 2 years old her mother died from tuberculosis, and the following year her father, an army officer, died from colon cancer. After his death, Emily lived with her paternal aunt from whom she felt no love. Her older brother and sister were placed in an orphanage, and Emily was permitted to see them on Sundays. When it became apparent that the children were entitled to death benefits, Emily’s aunt agreed to take custody of all three siblings. The household then consisted of Emily’s paternal aunt, her husband (who Emily described as an alcoholic), their three children, and Emily and her two older siblings.
Emily was briefly married in her early 20s but was disappointed and hurt by her husband’s infidelity. She moved in with her sister and enrolled in a cosmetology school, but had to stop working for health reasons when she was 58 years old.
Emily and I met for 50 minutes each week for counseling. She identified two goals of treatment: to integrate the female voice and to disengage from trichotillomania (the compulsive urge to pull out one’s own hair). Emily was collaborative during our sessions, conveying warmth and enthusiasm when she arrived to her appointments. During the sessions, I provided room for Emily to express her feelings so that she might develop healthy coping strategies for anxiety and find acceptance of past events and memories.
Diagnosis:
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General anxiety disorder with obsessive-compulsive symptoms |
| Deferred |
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Diabetes type 2 and arthritis |
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Few social supports |
|
55 |
Working With Couples: The Case of Keith and Matt
Keith and Matt are two homosexual Caucasian males who referred themselves for counseling in order to address their differences in parenting styles, which have caused discord in their relationship. They have been in a domestic partnership for 10 years and have adopted two children, Jackson (7) and Ellery (3). Keith is 38 years old and owns a hair salon, which is attached to the family’s home. Prior to meeting Matt, Keith was married for 3 years to his high school sweetheart. Matt is 38 years old and has never been married or in a prior long-term commitment. He has a PhD in chemistry and teaches at the local college. Matt also sits on the board of numerous organizations within the community.
Socially, Keith and Matt play in a coed volleyball league. Prior to having children, Keith and Matt had season tickets for the college hockey team. However, once they adopted Ellery, they did not renew their seats, although they try to take in at least a couple of games a season. Both Keith and Matt were raised Catholic. Currently they are attending a nondenominational church, which, in their words, is more accepting of their relationship. They have a strong support system in their minister and other members of the congregation.
Both men overall are healthy, although Keith smokes a pack of cigarettes a day. Matt was diagnosed with depression while completing his dissertation, which he attributes to the stress of his studies. He was placed on Zoloft and took it for about a year. He does not remember the dosage, but he took himself off when he began to feel better. They both drink socially, sometimes to excess (more than six drinks at a time), but not on a regular basis. Both men deny any illegal drug use.
Jackson and Ellery were foster children when they were adopted. Jackson was 3 weeks old when he was placed with them, and Ellery came to them directly from the hospital. Both children have special needs but to different extents. When Jackson was born, he tested positive for cocaine, and at 3 years of age, he began having behavioral problems and became very aggressive toward his fathers and others. Jackson was referred for an evaluation for attention deficit hyperactivity disorder (ADHD) when he was 4 years old and was prescribed medication.
Ellery was born with a cleft palate and jaw deformity, and she has difficulties eating, swallowing, and breathing. She had major surgery when she was 1 month old. She is legally blind without her glasses. Keith and Matt refer to Ellery as their little princess.
Jackson’s behaviors did not decrease with medication, so they began individual and family counseling. Keith and Matt felt disappointed with the sessions, as it seemed to them the majority of time was focused on Jackson’s behavior, and they did not get much direction and help with parenting skills. Neither parent thought the individual counseling was helping, so they discontinued it. As Jackson began school, his aggression and oppositional behavior increased. Keith and Matt were called daily with reports from the school, and at times they had to pick Jackson up. Jackson was suspended from the after-school day care program.
Both men reported that they have very different parenting styles, and it was causing them a great deal of conflict in their relationship. Keith described himself as the disciplinarian in the family. He said has very little tolerance for disrespect or tantrums and admitted to getting into verbal arguments with Jackson at times. Matt said he is much more tolerant of Jackson’s behaviors and avoided punishing him because he feels Jackson is struggling as a result of his developmental delay and the cocaine use by his birth mother. He does not believe Jackson has ADHD and does not support giving him medication. During our sessions, it became apparent that they were both overwhelmed and did not know how to address Jackson’s behaviors. Additionally, they said that they had no time for themselves as a couple anymore. For example, it was impossible to find a babysitter to enable them both to go to volleyball, so for the previous 6 months they had taken turns staying home. With the stress of parenting two children with disabilities and having minimal time to spend together, they felt as if they were drifting apart.
I used solution-focused therapy while working with Keith and Matt. They presented with specific concerns that would best be addressed by focusing on solution building. Initially, I began by asking a miracle question, which resulted in varied responses but a similar theme: both men would want to wake up without a sense of foreboding for what the day would bring regarding Jackson’s behavior.
Through the use of solution-focused goals, miracle questions, scaling questions, and constructing solutions and exceptions, Keith and Matt were able to positively address their concerns. First, they contacted Jackson’s social worker from the adoption agency to see if there was any assistance they would be eligible to receive. Then they placed Jackson in a specialized education program to better meet his educational needs, and Keith reached out to his family for support and babysitting assistance. They also agreed to make sure each day to focus some discussions on themselves and their relationship, making sure to say something positive and supportive to each other.
At a follow-up appointment 2 weeks later, Keith and Matt reported that they learned they would be able to get a personal care aide (PCA) to assist with Jackson after school. They also found that they qualify for respite services and plan to use this service once a month. They said they were arguing less since the last session, and they were making sure to devote time and energy to their own relationship daily.
Working With Families: The Case of Brady
Brady is a 15-year-old, Caucasian male referred to me by his previous social worker for a second evaluation. Brady’s father, Steve, reports that his son is irritable, impulsive, and often in trouble at school; has difficulty concentrating on work (both at home and in school); and uses foul language. He also informed me that his wife, Diane, passed away 3 years ago, although he denies any relationship between Brady’s behavior and the death of his mother.
Brady presented as immature and exhibited below-average intelligence and emotional functioning. He reported feelings of low self-esteem, fear of his father, and no desire to attend school. Steve presented as emotionally deregulated and also emotionally immature. He appeared very nervous and guarded in the sessions with Brady. He verbalized frustration with Brady and feeling overwhelmed trying to take care of his son’s needs.
Brady attended four sessions with me, including both individual and family work. I also met with Steve alone to discuss the state of his own mental health and parenting support needs. In the initial evaluation session I suggested that Brady be tested for learning and emotional disabilities. I provided a referral to a psychiatrist, and I encouraged Steve to have Brady evaluated by the child study team at his school. Steve unequivocally told me he would not follow up with these referrals, telling me, “There is nothing wrong with him. He just doesn’t listen, and he is disrespectful.”
After the initial session, I met individually with Brady and completed a genogram and asked him to discuss each member of his family. He described his father as angry and mean and reported feeling afraid of him. When I inquired what he was afraid of, Brady did not go into detail, simply saying, “getting in trouble.”
In the next follow-up session with both Steve and Brady present, Steve immediately told me about an incident Brady had at school. Steve was clearly frustrated and angry and began to call Brady hurtful names. I asked Steve about his behavior and the words used toward Brady. Brady interjected and told his dad that being called these names made him feel afraid of him and further caused him to feel badly about himself. Steve then began to discuss the effects of his wife’s death on him and Brady and verbalized feelings of hopelessness. I suggested that Steve follow up with my previous recommendations and, further, that he should strongly consider meeting with a social worker to address his own feelings of grief. Steve agreed to take the referral for the psychiatrist and said he would follow up with the school about an evaluation for Brady, but he denied that he needed treatment.
In the third session, I met initially with Brady to complete his genogram, when he said, “I want to tell you what happens sometimes when I get in trouble.” Brady reported that there had been physical altercations between him and his father. I called Steve in and told him what Brady had discussed in the session. Brady confronted his father, telling him how he felt when they fight. He also told Steve that he had become “meaner” after “mommy died.” Steve admitted to physical altercations in the home and an increase in his irritability since the death of his wife. Steve and Brady then hugged. I told them it was my legal obligation to report the accusations of abuse to Child Protective Services (CPS), which would assist with services such as behavior modification and parenting skills.
Steve asked to speak to me alone and became angry, accusing me of calling him a child abuser. I explained the role of CPS and that the intent of the call was to help put services into place. After our session, I called CPS and reported the incident. At our next session, after the report was made, Steve was again angry and asked me what his legal rights were as a parent. He then told me that he was seeking legal counsel to file a lawsuit against me. I explained my legal obligations as a clinical social worker and mandated reporter. Steve asked me very clearly, “Do you think I am abusing my son?” My answer was, “I cannot be the one to make that determination. I am obligated by law to report.” Steve sighed, rolled his eyes, and called me some names under his breath.
Brady’s case was opened as a child welfare case rather than a child protective case (which would have required his removal from the home). CPS initiated behavior modification, parenting skills classes, and a school evaluation. Steve was ordered by the court to seek mental health counseling. One year after I closed this case, Brady called me to thank me, asking that I not let his father know that he called. Brady reported that they continued to be involved with child welfare and that he and his father had not had any physical altercations since the report.
Working With Families: The Case of Carol and Joseph
Carol is a 23-year-old, heterosexual, Caucasian female and the mother of a 1-year-old baby girl. She is currently unemployed, having previously worked for a house cleaning company. The baby is healthy and developmentally on target, and she and the parents appear to be well bonded with one another. Carol lives in a rented house with her husband, Joseph. Joseph is a 27-year-old, heterosexual, Hispanic male. He was recently arrested at their home for a drug deal, which he asserts was a setup. Both parents were charged with child endangerment because weapons were found in the child’s crib and drugs were found in the home. The parents assert that the child never sleeps in the crib but in their bed. As a result of the parents’ arrest, Social Services was notified, and the child was temporarily placed in a kinship care arrangement with the maternal grandmother, who resides nearby. As a result of Joseph’s arrest, he was fired from the cleaning company where he worked, and the family is now experiencing financial difficulties.
After initial contact was made with the parents, a number of concerns were noted and the family was recommended for additional case management. Carol’s mother indicated that she had concerns about Carol’s drinking habits and stated that Carol’s father and grandfather were alcoholics. She and the father separated when Carol was a baby, and Carol has had only limited contact with him. There appears to be significant tension between the grandmother and Carol and Joseph. I addressed the alcohol issue with both parents, who denied there was a problem, but shortly after the discussion, Carol was involved in a serious car accident with the baby in the car. She was determined to have been under the influence of alcohol. I advised Carol that she could not have any unsupervised contact with her child until she completed intensive inpatient substance abuse treatment. I made arrangements for her placement, but after a week, she was discharged for noncompliance with the rules. She was then referred to an intensive outpatient program and began therapy there. Initially her attendance was erratic because she had lost her license as a result of the DUI. Eventually, however, she became engaged in the program and began to address her issues. She acknowledged that she had started using drugs at a very young age but said that she had only begun drinking in the previous year or so. We discussed the genetics of her family, and she said that she realized that she had deteriorated rapidly since beginning to drink and knew that she simply could not drink alcohol.
Joseph’s mother is deceased, and his father travels extensively in his job and is not available as a support. Joseph was very devoted to his mother and was devastated by her premature death. We discussed the strengths that he and Carol demonstrated in staying together and working out their problems. Joseph indicated that as a Hispanic man, family is very important to him and he wants his family to stay together. Although they have been struggling financially, Joseph has obtained stable employment landscaping for a large development and said he plans to take courses at the community college to learn the trade. He stated that he wants to provide a good life for his child. Carol has a lot of unresolved issues to deal with in therapy, not the least of which is the accident that could have killed her child and the legal ramifications that resulted from this incident. Although angry and hostile at the beginning, through the implementation of person-centered therapy, we were able to establish agreed-upon goals that showed respect for the client and encouraged her to find solutions to her problems. Although our relationship was tenuous at times, providing encouragement to her rather than judgment enabled her to forgive herself and take corrective action.
Working With Groups: Breast Cancer Support Group
I am a social worker employed in the oncology department of a hospital. The department offers a weekly support group for breast cancer survivors, which I facilitate. The department team decided the group would not be structured but would be revolving and open-ended. The support group meets every Wednesday morning from 10:00–11:00 a.m. in the conference room in the oncology building. I assisted the department in developing fliers, which were placed at the reception desk in the radiation department where they are given to patients as they sign in for their radiation treatment.
I currently have six women in the support group of varying ages and cultural backgrounds. Group attendance fluctuates due to the open-ended revolving status, and I can have as many as 10 women in a group at any given time. I facilitate this group in an informal manner, letting the conversation and topics flow as the patients direct. I encourage all the women to share, but there are a few who dominate the group and group topics, making it difficult for those who are not as outgoing to speak up and discuss what is on their minds. I have also noticed that the support group can deteriorate when the conversation focuses on forms of treatment and when the participants begin to compare treatments. This often causes some participants to panic and voice concerns that they may not be receiving proper or adequate treatment. At these times the group can become slightly chaotic with cross talking and the more dominant women offering suggestions. I have addressed this issue by reminding the group members that they have different stages and forms of breast cancer, and therefore treatment plans will vary.
While it was determined at its conception that this would primarily be a support group, I felt it might be more beneficial to the participants to have a more structured and topic-focused group. I met with my supervisor to discuss my concerns and the possibility of making some changes in the organization of the group. My supervisor listened to my concerns and suggested I go around the room giving each member of the support group an opportunity to discuss what is on their mind but was not inclined to make any other changes in the group structure.
After several similar group meetings, I met with my supervisor again to discuss the most recent sessions and the issues the patients presented to me. As a social worker, I felt it was important not just to listen closely to the needs they expressed, but also to provide the forum and support to meet those needs. I felt this included psychoeducation and structured topics for each week. My supervisor recognized my concerns and desire to make this a more meaningful and supportive experience for the patients but was unsure if administration would agree to make any changes to the current group structure. I asked if I could present the changes I would like to make and the rationalization for these changes at the next department meeting and was told I could.
I realized I could not address every concern that was presented to me by the patients, but I wanted to incorporate as many as possible. I developed a 6-week series that included discussion and information on developing family support by asking spouses and significant others to attend at least one session; nutrition information and meal planning with the assistance of our hospital dietitian; exercise plans developed with the physical therapy department; and information on complementary forms of treatment such as yoga and tai chi. I sought out venues such as local libraries and town centers where these classes were available for free or at minimal cost, and I suggested I could also lead a guided imagery group and teach relaxation techniques. I said I would also reach out to local shops for information and possibly recruit owners to be guest speakers to discuss how to choose a wig or purchase a prosthesis.
I met with my supervisor prior to the department meeting, and she reviewed and approved my presentation. I presented my plan to the department administration who informed me they will take it under advisement and let me know if I can move forward.
Working With Groups: HIV/AIDS Prevention With Teenage Moms
As part of a statewide planning process for developing HIV/AIDS prevention, groups were organized in eight cities throughout the state to include the diverse perspectives and experiences of young adults between the ages of 13 and 22. Each group was organized to reflect at-risk populations such as lesbian, bisexual, and transgendered youth in one city and lower income urban youth in another. I was responsible for facilitating a group of teenage mothers. The purpose of these meetings was not only to create an environment of support among members as they engage in behavior change to reduce their risk of infection but also to provide the “voice” of young people in the larger statewide planning process that was used to set priority areas for HIV/AIDS prevention funding and programs.
When I was assigned to the group of teenage moms, I assumed that the similarities between us would assist with developing rapport: We were all women of color, and at that time, I was not much older than some of the group members. However, I was initially concerned about how the fact that I was not a mother would influence the dynamic. During our first meeting, we took turns introducing ourselves and sharing our expectations for the group. The fact that I was not a mother was discussed but within a context I had not considered: The participants in the group were amazed that I was in my 20s and had completed undergraduate and graduate school without having at least one child. My experience was very different from what happened in their community, increasing my awareness that socioeconomic status may have more impact on the group than ethnicity and gender.
I was careful not to minimize their challenges associated with attending school, receiving financial support, and their intimate relationships as they attempted to engage in behaviors to reduce their risk for contracting HIV. I remained focused on the specific behaviors, attitudes, and beliefs that were relevant to their daily lives. As we developed trust, the participants would ask me questions about the college application process and share their ideas about what they wanted to do when they “grew up.” Although I was very careful with what personal information I disclosed with the group, my role over time expanded from facilitator to include a mentoring aspect. This role provided the opportunity for me to make the connection between their future plans and the behaviors necessary to achieve their goals and remain HIV negative.
Working With Groups: Latino Patients Living With HIV/AIDS
The support group discussed here was created to address the unique needs of a vulnerable population receiving services at an outpatient interdisciplinary comprehensive care center. The center’s mission was to provide medical and psychosocial services to adult patients living with HIV/AIDS (PLWH). Both patients and providers at the center expressed a need for a group to address the needs of the center’s Latino population. At the time the group was created, 36% of the center’s population identified as Latino, and 25% of this cohort identified Spanish as their primary language. The purpose of the group was twofold: 1) to reduce the social isolation felt by Latino patients at the center and 2) to create a culturally sensitive environment where Latino patients could explore common medical and psychosocial issues faced by PLWH within a cultural context.
Planning for the group consisted of 1) defining a format for the group, 2) recruiting appropriate members, and 3) building an appropriate group composition. When considering the format of the group, I thought about structure, time, place, and language. The group was designated a closed group in that new patients were not admitted once the initial membership was determined. The group was held in the center’s conference room, which was furnished with comfortable seating around a large conference table so that members were visible to each other during group sessions. The group met once a week for 90-minute sessions during which
60
minutes were spent on open discussion and the last 30 minutes were spent on having lunch. Given the importance of food in the Latino culture, I thought members would appreciate the opportunity to share a meal with their peers. I decided to designate the group as Spanish-speaking so that all sessions were held in Spanish. This offered members not only a sense of comfort and an opportunity to explore issues in their native tongue, but it also addressed the language barrier that often isolates Latino PLWH.
I used several strategies to recruit members. I hung flyers throughout the center, and I informed my colleagues about the group during interdisciplinary staff meetings. Referrals ultimately came from physicians, social workers, and even administrative staff who had developed relationships with patients at the center. When considering group composition, I focused on creating balance in group size and the characteristics of individual members. I worked to create a group with enough members so that discussions would be fruitful and differing opinions could be presented, but at the same time, individual members would have an opportunity to discuss their unique feelings, thoughts, and opinions. When it came to member characteristics, I strove to create a balance between homogeneity and heterogeneity across such domains as age, sex, sexual orientation, socioeconomic status, etc. The goal was to create a group where no member felt isolated by uniqueness while simultaneously promoting diversity between members. Prior to being admitted to the group, potential members were interviewed/screened in person or by phone. The focus of these interviews was to 1) assess the patient’s ability to communicate in Spanish, 2) describe the purpose of the group, 3) discuss individual expectations for the group, and 4) answer questions about group process and function. A total of 15 patients were referred. Four declined to participate before the group started and two did not show up after the first session. Of the remaining nine members, three were women and six were men. All of the men had a significant history of intravenous drug use (IVDU). Two of the men identified as gay, one identified as bisexual, and three considered themselves to be heterosexual. All of the women were heterosexual, identified a risk factor of unprotected heterosexual sex, and denied a history of IVDU. Members’ ages ranged from 36 to 60.
The group ran successfully for 18 months. Throughout the life of the group, several recurrent themes were discussed, including 1) stigma of HIV and homosexuality, 2) disclosure of HIV status, 3) safer sex practices, 4) adherence to HIV treatment, and 5) the doctor–patient relationship. Each of these themes was discussed within a cultural context giving light to issues such as familialism, collectivism, simpatia, machismo (gender roles), and Latino culture’s tendency to rely on a folk model of medicine.
As in most groups, certain members adopted roles within the group. For example, Anna, a 46-year-old female member, adopted the role of the “silent member.” She repeatedly came to sessions and sat in silence, only responding when she was prompted by direct questions from me or other members. The challenge with Anna was that as this behavior continued, other members tended to ignore her and leave her out of the discussion. In turn, it became my role to try to engage Anna as much as possible and draw her into the discussion. Another example is Diego, a 60-year-old male, who adopted the role of the “help-rejecting complainer.” Throughout group sessions, Diego repeatedly presented a problem or issue and engaged the entire group by asking for help. When members responded with suggestions or solutions, he came up with a myriad of excuses why none of them would work. I will admit I was not successful at altering Diego’s behavior in any way. I attempted to point out the pattern, and I tried to ask other members how it felt to constantly have their input rejected, but nothing seemed to work. Group members did express frustration and boredom with Diego. This was manifested in their body language and during group sessions when Diego was not present. When members spoke about Diego in his absence, I always encouraged them to bring these issues to his attention when he was present, but members were not able to do this because they were fearful of hurting his feelings.
Ultimately, the group served as an arena for mutual support and commonality. Group members forged relationships with peers with whom they would not have had contact in the absence of the group. They also had the opportunity to reflect on their illness and personal experiences within a safe and culturally sensitive environment. While a scientific evaluation of the group was not performed, I witnessed and members reported positive outcomes from the experience.
Working With Individuals: The Case of Carl
Carl is a 45-year-old, widowed, heterosexual African American male. A year ago, Carl lost his job in information technology for an electrical company due to downsizing. Currently, he is taking classes at the local community college. Carl is mayor of his small rural community where he was born and raised, a part-time position with many commitments during the evening hours. Overall, Carl is physically healthy, and he does not smoke or drink to excess.
Carl sought counseling to discuss the recent loss of his wife, to whom he had been married for 19 years. His wife, Rhonda, had been diagnosed with breast cancer 5 years earlier. She had been in remission until 4 months ago when she had a seizure and was hospitalized in a coma. In the hospital, it was discovered that her cancer had metastasized throughout her body. She never regained consciousness and passed away 2 weeks later. Carl and Rhonda have two daughters, Carla (14) and Courtney (8). Carl was on a church trip with Carla 500 miles from home when Rhonda had her seizure. As soon as they were notified, Carl and Carla returned home. Carl opted not to tell his daughters about the severity of Rhonda’s condition for a couple of days after he found out.
Prior to coming to counseling, Carl had talked to the family’s minister about his feelings of loss but did not think it helped. He had never sought help before but was encouraged to talk to a professional by several close friends. Carl admitted to having had problems sleeping for over a year, but more recently, he was feeling overwhelmed and did not have any energy. He had been trying to juggle his schedule, his children’s schedules, and the stress of dealing with the hospital bills and other paperwork related to Rhonda’s death.
Carl has a strong spiritual belief system and is involved with his church community, but he was struggling with his faith while trying to figure out why this happened to Rhonda. He was also struggling with feelings of guilt. Rhonda had discussed not feeling well at times, but neither one of them thought to follow up, and Carl now blamed himself for not realizing she was sick or being with her when she had the seizure.
Carl was feeling overwhelmed with the responsibilities of being a single parent. He had previously depended on Rhonda to run the family’s day-to-day life and to make sure the girls got to their commitments, but now he spent a great deal of time getting Carla and Courtney to their many extracurricular activities. Carl was also concerned about Carla’s anger toward him for keeping the extent of Rhonda’s prognosis to himself. Carla had been very distant and spending a lot of time away from the family.
Carl’s parents live in the same community, and while they are elderly and have difficulty getting around, Carl has been able to ask them for help with the girls for early evening activities. When Rhonda was first hospitalized and right after she died, many of their friends offered to help, but he said he did not have the energy to follow through with them.
While working with Carl, it became apparent that he met criteria for an adjustment disorder stemming from the multiple stressors in his life. Carl said that when he was laid off, he never dealt with the feelings attached to losing employment. The overall goal of treatment was to help Carl return to his pre-crisis level of functioning. Specifically, we planned to work on multiple goals to alleviate his emotional, psychological, and behavioral distress. Additional goals were planned to address his coping, problem-solving, and stress-management skills. After a few sessions, I also suggested that Carl schedule a doctor’s appointment to discuss the possible need for medication to address his symptoms of depression, specifically the lack of energy, feelings of anxiousness, and inability to sleep.
I utilized a combination of cognitive behavioral and interpersonal therapy with Carl to address his presenting concerns. Over the course of the next 12 weeks, Carl exhibited a commitment to treatment and made significant progress. Through cognitive restructuring, Carl was able to reframe the events surrounding his termination. Skills were also provided to help Carl redirect negative emotions and feelings of depression in more healthful, positive ways. Carl was encouraged to write in a journal to express his thoughts and feelings. He reached out to his support system and began accepting assistance from family and friends. Carl joined a car pool with families who also had children in the same activities as Carla and Courtney to assist with managing their busy schedules. Carl and Carla completed a family session to process Carla’s feelings about her father withholding information about Rhonda. Carl’s physician placed him on a low dose of Prozac®, which had a positive effect and allowed Carl to focus on the goals of the sessions.
Working With Individuals: The Case of Roy
Roy is a 34-year-old, divorced, Caucasian male. He has been divorced for 1 year and has three children, Jordon (7), Jared (6), and Jane (3). Roy met his ex-wife, Melissa, when she was 17 and he was 25, and soon afterward she became pregnant with their first child. As part of the divorce agreement, they were given joint custody, and Melissa was granted physical custody.
Roy had been working at a hog confinement farm for the prior 2 months. Previously, he had been a highway patrolman for 10 years. Roy was terminated from the force, and charges were filed against him, after he drove his patrol car into Melissa’s home. He was ordered to pay for the damages to the house and the patrol car and enroll in a batterer’s intervention program (BIP). Melissa was granted a permanent order of protection against him, and the court ordered that Roy’s visits with his children be supervised.
I met Roy during our intake and assessment meeting prior to beginning the BIP. As one of the co-facilitators, I met individually with many of the group members prior to our first group meeting to learn more about why they were referred to the BIP and to orient them to the group’s goals and objectives. Roy arrived at the intake and assessment session 30 minutes late, and he did not explain his tardiness. During the assessment, Roy spent much of the time talking about what he perceived as the reasons for his divorce. He categorically denied any history of domestic abuse, and he stated, “Me and Melissa would get into verbal arguments, but I never hit her.” He said they would fight about a number of ongoing things, such as money, “her partying,” and the children. When they were married, Melissa was a stay-at-home mother, and Roy felt she was irresponsible with “his money.” Roy also disagreed with Melissa’s desire for Jared, who was exhibiting behavioral problems, to be evaluated and medicated.
Roy said he went drinking and got drunk the night that he drove his patrol car into the house because he was upset that Melissa had refused him visitation of the children. Roy blamed his ex-wife for the loss of his job and felt his past employer had treated him unfairly. He told me that during his 10 years of employment, he had an exemplary work record, which should have been taken into consideration before he was fired. He felt like a suspension would have been more appropriate and fair. He expressed anger over having to attend this group and once again denied being abusive to his ex-wife.
Roy began attending the BIP a week after our intake meeting. The BIP is a program based on the Duluth Model, a 24-week educational program that focuses on abuse as a form of power and control and its origins in societal conditions. In keeping with the Duluth Model, the group is co-led by a male and female social worker to model appropriate gender interactions. The group provides education about power and control and feminist theory to understand why abuse occurs. The goal is to help the abusers recognize their behaviors and learn how their actions are negatively affecting those in their lives. In the group, Roy would complete the assignments and respond when spoken to, but he did not voluntarily contribute any information, and his homework assignments seemed to lack insight and were minimal.
At week 10, Roy was terminated from the program after we learned that he had violated the protective order and was arrested for driving under the influence. He had driven intoxicated to Melissa’s home and refused to leave the front door. Roy was sentenced to 3 months in jail and 1 year’s probation.
Working With Individuals: The Case of Sam
Sam is a 62-year-old, widowed, African American male. He is unemployed, receives Social Security benefits, and lives on his own in an apartment. Sam has minimal peer relationships, choosing not to socialize with anyone except his daughter, with whom he is very close. Sam raised his daughter as a single father after his wife passed away. Melissa is 28 years old and works as an emergency medical technician (EMT). When Sam was 7 years old, he was placed in foster care and has had very limited contact with his extended family. Prior to September 11, 2001, Sam had a steady employment history in food services and retail.
Sam became depressed and psychotic after 9/11 and was deemed unable to return to work after multiple psychiatric hospitalizations. He has no history of alcohol or substance abuse issues and has no criminal background or current legal issues. Sam reports his religious background is Catholic, but he is not affiliated with a congregation or church. He has a diagnosis of major depression with psychotic features, and he has a history of high blood pressure and migraines. Sam has been seeing a psychiatrist once a month for medication management for over a decade and is currently prescribed Depakote®, Abilify, and Wellbutrin®. Sam has a positive history of medication and treatment compliance. He had been treated by a social worker at an outpatient program for about 2 years after his hospitalizations for his psychosis and depression. He stopped attending sessions with the social worker after his symptoms stabilized, and termination was deemed appropriate; he continued to see the psychiatrist monthly for medication management.
After about 10 years of seeing only the psychiatrist, Sam scheduled a meeting with this social worker for increased feelings of depression. These feelings were brought on after his daughter moved out of the apartment they had shared for many years to live with her boyfriend. He reported difficulty adjusting to living alone and often feels lonely and anxious. He reported during our sessions that he speaks to his daughter frequently, and although she only lives 10 blocks away, he misses her terribly.
Our sessions for the last 3 months have focused on his mixed feelings around his daughter’s new life with her boyfriend. He is happy that she is happy but misses her very much. I emphasized his strengths and helped him reframe his situation by focusing on the positive changes in her life as well as his own life. Our goals were to help him reduce his symptoms of anxiety and begin searching for new opportunities for socialization outside of his daughter.
During our last two sessions, I became concerned because Sam, who is normally articulate, had been appearing confused and slightly disorganized. I asked him if he had a recent medication change and if he had been compliant with his current medications, but he denied noncompliance or any recent medication adjustment. I asked Sam if he was experiencing any physical health problems. He denied any ongoing problems but mentioned that he had collapsed on the street recently. He reported that he had been hospitalized and had undergone a number of tests, which he thinks were all negative. He said he still feels “foggy” at times, and sometimes time seems to be “missing.” I reviewed his medications with him and, as he went down the list, he reported taking Cogentin® and Ativan®, which according to his chart history had been discontinued months ago. When I asked Sam where he obtained these medications, he stated, “I got them out of the bag.” Sam reported he has a bag at home in which he puts all leftover and discontinued medications. He could not explain why he was taking discontinued medication or for how long. Sam stated, “I thought I was supposed to take it.” I called his daughter, and she verified he had recently been hospitalized, and the MRI, CT scan, and EEG tests were negative. I requested that Melissa go to her father’s apartment to look for the bag of medications he mentioned, because it seemed likely that her father was taking discontinued medications. I then scheduled a meeting with Sam and his daughter for later that week. During that session, Melissa reported that she found multiple vials of old medication on the kitchen counter mixed in with her father’s current medications. Melissa reported that she collected and disposed of all the old medications. I recommended obtaining a daily medication planner. Although the hospital tests were negative, I recommended scheduling an appointment with a neurologist, and both agreed. Sam saw a neurologist who reported that his test results were negative but did not rule out the possibility of a seizure disorder. The neurologist recommended a follow-up appointment in 3 months. He also contacted Sam’s psychiatrist and recommended that the Wellbutrin be discontinued because it is known to have the potential to cause seizures and that Sam start on another antidepressant. Sam began to focus and become more cognitively alert after the discontinued medications were disposed of and the Wellbutrin discontinued.
I scheduled another family session for Sam to discuss his feelings regarding Melissa moving out. Sam was tearful when he told Melissa he missed her and her dog Sonny. He also told her he was concerned he would not be financially able to remain in the apartment. Melissa reported working long and odd hours but did call her father often and invited him over to her apartment. She further reported that he often declined her invitations. Sam reported he declined because he did not want to intrude on her life or her boyfriend. Melissa assured her father that both she and her boyfriend wanted him to visit and be part of their lives. I asked Sam if Melissa’s dog had been company for him, and he replied, “Yes, and I miss him.” I asked Melissa if it would be possible for Sonny to spend some time with her father. Melissa reported her long work hours were making it difficult to take care of Sonny and asked her father if he would like Sonny to live with him. Sam replied, “I would like that.”
I discussed with Sam how he spends his time, which normally consists of reading a newspaper, watching television, or listening to talk radio. I suggested Sam increase his socialization and recommended a social club for older adults that is near his home. Sam said he would consider this idea. I asked Sam to discuss his financial concern that he may not be able to remain in his apartment. Sam stated that Melissa had been contributing to the household expenses but stopped when she moved out. He stated he had been too embarrassed and ashamed to discuss this with Melissa and had been keeping this to himself. Although Sam is on a fixed income, he is currently able to meet his expenses. However, he is concerned about his rent, which is his largest expense.
I explored state and federal rent assistance programs for seniors and the disabled. I found a program in which tenants that qualify can have their rent frozen at their current level and be exempt from future rent increases. Sam met the program requirement of being at least 62 years of age, currently living in a rent-controlled apartment, and having a household income that was within the specified guidelines. I obtained the required forms and personal documentation from Sam and completed the application, sending it to the appropriate agency.
Working With Organizations: The Southeast Planning Group
The Southeast Planning Group (SPG) is an organization that was created in 2000 to facilitate the Office of Housing and Urban Development’s (HUD) Continuum of Care planning process. The key elements of the approach were strategic planning, data collection systems, and an inclusive process that involved clients and service providers. The fundamental components of the system are 1) outreach, intake, and assessment; 2) emergency shelter; 3) transitional housing; and 4) permanent housing and permanent supportive housing. The outreach, intake, and assessment component identifies an individual’s or family’s needs in order to connect them with the appropriate resources. Emergency shelter provides a safe alternative to living on the streets. Transitional housing provides supportive services such as recovery services and life skills training to help clients develop the skills necessary for permanent housing. The final component, permanent housing, works with clients to obtain long-term affordable housing.
SPG works with the local government; service providers; the faith, academic, and business communities; homeless and formerly homeless individuals; and concerned citizens in the designated service area. During the first 5 years of its existence, SPG was staffed by one part-time and four full-time staff members and oversight was provided by a 21-member board. SPG’s founding director was well respected and liked in the community. She was noted for her ability to bring stakeholders together across sectors and focus on the single mission of ending homelessness.
After serving 5 years as the executive director, she abruptly resigned amidst rumors that she was forced out by the board. Although she had been effective in bringing people together, there were concerns that the goals and objectives had not been met, and there was a lack of confidence in her ability to grow the organization. Approximately one month after her resignation, a new executive director was hired.
One of the new director’s first priorities was to reconfigure the structure of the organization in order to increase efficiency. As a result of the restructuring, two positions were eliminated. The people who were let go had been with the organization since it was created, and similar to the previous director, they had strong ties to the community. Once the community and SPG’s partners learned about the changes, there was suspicion about the new leadership and the direction they wanted to take the organization. Stakeholders were split in their views of the changes—some agreed that they were necessary in order to advance the goals of the organization, while others felt the new leadership was “taking over” with a hidden agenda to promote its own self-interest.
I worked with the group as an evaluation consultant to assess the SPG partnership during this period of transition. In order to assess how these changes were perceived by the stakeholders, I conducted key informant interviews with various stakeholders, both internal and external to the organization. The partners shared many insights about how the month without consistent leadership contributed to the uncertainty about SPG’s purpose and strategy, and it was generally agreed that the leadership transition was not handled well. The results from the evaluation were used to help SPG identify strategies to improve communication with stakeholders and utilize the director’s leadership role to build upon the organization’s past successes while preparing for future growth.
Working With Survivors of Domestic Violence: The Case of Charo
Charo is a 34-year-old, heterosexual, Hispanic female. She is unemployed and currently lives in an apartment with her five children, ages 2, 3, 6, 7, and 8. She came to this country 8 years ago from Mexico with her husband, Paulo. During intake, Charo reported that she suffered severe abuse and neglect in the home as a child and rape as a young adult. Charo does not speak English and currently does not have a visa to work.
Charo initially came for services at our domestic violence agency because Child Protective Services (CPS) and the court ordered her to attend a domestic violence support group after allegations of domestic violence were made by one of her children to a teacher at their school. Her husband was ordered to attend a batterer’s intervention program (BIP). Charo attended the domestic violence support group but seldom said a word. Although she rarely shared during group, she also rarely missed a session. While she attended the group, she also met with me weekly for individual sessions. During these sessions I informed her of the dynamics of domestic violence and helped her create a safety plan. She often said that she was only attending the group because it was mandated and that she just wanted CPS to close her case. One week, Charo suddenly stopped attending group. When I called her, she said that she had been busy and unable to attend. That same day her husband called me to verify that I was who his wife said I was, as he often accused Charo of having affairs.
Charo showed up to group again one day after a 3-month absence. Her appearance was disheveled, and she had lost a significant amount of weight. The next day she called me and requested an emergency individual session. During the session, she reported that her husband had an imaginary friend who was telling him to kill her and that the previous weekend he had placed a knife on her pillow and threatened to take her life. Charo stated that her husband would force her to wear short skirts and bleach her hair. He would also throw plates of food on the floor and walls of the house whenever meals were not to his satisfaction. She said he would spend his days drinking alcohol with friends and would beat her relentlessly in front of the children. She told me she had thought he would change after CPS became involved but that, instead, his abuse became more calculating and discreet.
I worked on an updated safety plan with the client, and she agreed to hide herself and the children in the agency’s safe house. The safety plan included information on obtaining a restraining order, going into a safe house, identifying safe people she could talk to, and teaching the children safety planning strategies as well as tips on important documentation and the importance of journaling all significant details of the abuse. Charo’s husband showed up outside of the agency that day while she was there and called her phone repeatedly. Charo put the call on speaker so I could hear his voice. He ordered her to go outside and go home with him and made threats toward her. I called the police, and Charo’s husband was arrested outside of the agency. I went to the courthouse with Charo, helping her file a temporary restraining order and providing her with emotional support throughout the experience. After obtaining the restraining order, Charo and her five children were admitted to the agency’s safe house.
While at the safe house, Charo met with me weekly for individual counseling and continued to attend the domestic violence support groups. She reported feeling damaged, ugly, and unlovable. She also reported feeling anxious, depressed, and hopeless, crying often, and losing weight. Charo’s husband was eventually deported back to Mexico.
I discussed with Charo the dynamics of domestic violence and provided her with numerous resources that could serve as informal and formal supports to her and the children. Charo was referred to a psychiatrist, who prescribed 50 mg of Zoloft to help manage the anxiety and depressive symptoms she was experiencing. Charo began attending a church nearby where she quickly felt connected and also began attending English as a second language (ESL) classes twice a week. We met once a week for 9 months. During the first 3 months, we focused on stabilization. During the second 3 months, we focused on decreasing symptoms of anxiety and depression. During the final 3 months of our time together we focused on financial empowerment, reintegrating into the community, and renewing connections with family.
While Charo met with me for counseling and case management, her children participated in a 6-month trauma reduction art therapy program for children within the agency. At the 9-month mark, we agreed to terminate services. She continued to attend the group sessions for support and found new friends who had become a support network for her. She also completed a financial empowerment program, which further taught her how to manage her finances.
Working With Survivors of Sexual Abuse and Trauma: The Case of Angela
Angela is a 27-year-old, Caucasian female who first came to counseling to address her history of sexual abuse. She graduated from college with a BS in chemistry and has since been employed by pharmaceutical companies. After obtaining a new job, she relocated to an apartment in an East Coast city where she knew no one. Both of Angela’s parents live on the West Coast, and she has one younger brother who also lives in a different state. Angela has limited contact with both her mother and brother and does not have any contact with her father. Angela is obese and disclosed a history of struggling with her weight and eating issues. She has few friends, and those she does have live far away.
Angela has a long history of trauma in her life. She was sexually abused between the ages of 9 and 21 by her father, sexually assaulted at the age of 14 by a classmate in school, and mugged as a young adult. There was domestic violence in the home, also perpetrated by her father. Angela’s father is considered an upstanding member of the community, and he is well liked and respected by others. No one in Angela’s family believes that she was sexually abused, and her father joined a “false memory syndrome” group and is outspoken about that issue. There has been little discussion in her family about what took place in the home while she was growing up.
Angela struggled with daily functioning and exhibited symptoms of post-traumatic stress disorder (PTSD). She had a history of cutting herself and binge eating and displayed some characteristics of borderline personality disorder. Angela also mildly dissociated when under duress. Angela suffered from depression and anxiety and had trouble establishing new relationships, both socially and at work. Although Angela has a stable job and was able to complete her work each day, at times she became overwhelmed by her emotions and retreated to the bathroom where she cried and sometimes cut herself before returning to her workstation. Angela relied on writing, artwork, and her cat for solace and comfort. She was also very active outdoors, often hiking, biking, and going on camping trips by herself. Her goals in life were to own her own home, lose weight, enjoy relationships with others, and find peace with her traumas.
As a result of the abuse she experienced, it was necessary to begin treatment focusing heavily on establishing trust and a relationship with the client. After 1 year of therapy, deeper process work was being done around her traumas, and she was able to open up much more. She disclosed more painful experiences to the therapist and began expressing her feelings, including intense anger at her family members.
Angela also joined a group for survivors of sexual violence in the same program where she was receiving individual therapy. She was thus able to meet other survivors and engage them in relationship building and obtain support. Over time, she lost 100 pounds and made new friends, and her level of functioning increased dramatically. Six months into the group, however, I noticed boundary issues between the members of the group and the group facilitator. After speaking with the group facilitator about these concerns and others regarding her clinical judgment and boundary crossing, the decision was made to terminate her.
As a new group facilitator began engaging the group, I noticed that Angela was not sharing as much in her individual sessions and, overall, seemed guarded. I tried on numerous occasions to address the shift, and while Angela acknowledged that trust had become an issue, she would not directly express her concerns or feelings. After some discussion, I explained to Angela that while I could not discuss the issues concerning the group facilitator, she should feel free to talk about her feelings and concerns in general. However, it became obvious that trust could not be rebuilt, particularly in light of the professional boundary regarding issues with the group facilitator. I asked if she wanted to terminate counseling with me and find a new therapist, and Angela agreed. I provided Angela with three referrals so that she could continue her treatment. I learned that Angela and the former group facilitator had become friends and remained so after both had left the program in their respective capacities.
Working With Survivors of Sexual Abuse and Trauma: The Case of Brenna
Brenna is an 18-year-old, heterosexual, African American female. She is pregnant, residing in a homeless shelter, and has no income source. Brenna was raised by her biological mother in a one-bedroom apartment in an urban neighborhood. When Brenna was 15 years old, her mother began dating a new man. This man sexually assaulted Brenna while they were home alone one evening. She immediately disclosed the sexual assault to her mother who called her a liar and told her to move out. Brenna then lived in a variety of situations, sometimes residing with friends for short periods and sometimes living in a youth shelter. During this period she attended high school intermittently but did not graduate.
After her 18th birthday, Brenna moved in with her boyfriend, Cameron. Also living in the household were Cameron’s mother, his 16-year-old sister, and a 7-year-old brother. Shortly after moving in with Cameron, Brenna became pregnant with his child. Prior to the pregnancy, Cameron would often abuse her physically, verbally, and emotionally. When Brenna announced the pregnancy, Cameron became even more violent, accused her of sleeping with other men, and denied paternity of the baby. When Brenna was 4 months pregnant, Cameron attempted to strangle her, so Brenna moved to a shelter. Although the shelter was willing to house Brenna and her newborn temporarily, their policy required Brenna to secure new living arrangements prior to giving birth.
I was assigned to be Brenna’s social work case manager at this shelter. Brenna and I worked together to set manageable goals during her stay at the shelter and also developed a plan for ongoing mental health support. Utilizing individual case management sessions, I worked with Brenna to prioritize goals regarding financial stability, permanent housing, and medical care. Brenna had difficulty reading and writing, so we worked together to complete the applications for Medicaid; General Assistance; the Supplemental Nutrition Program for Women, Infants, and Children (WIC); and a local subsidized apartment complex. Brenna often became frustrated throughout this process, struggling to locate all required documents as a result of her frequent moves and changes in residency. I advocated for Brenna to receive medical care at the local hospital’s prenatal clinic while waiting for Medicaid approval, utilizing her completed Medicaid application to support the request. The hospital also agreed to enroll Brenna in prenatal support and education groups that met on a weekly basis.
Difficulty with reading and writing made it challenging to apply for jobs to list on her application for General Assistance, so I gathered information for Brenna on available educational and self-help centers in the community. She enrolled in a group at a local agency that provided free General Educational Development (GED) training, and she was able to enhance her reading skills during her stay at the shelter. By attending a group at the agency, Brenna met several single mothers in the area and built a new support network in the community.
Throughout this process, Brenna struggled with feelings of inadequacy, low self-esteem, loneliness, and powerlessness. I worked with her to validate and process these feelings and assisted her in contacting a local therapist with experience working with survivors of dating abuse and domestic violence. Although she was initially hesitant to engage in a therapeutic relationship, I assisted Brenna in making an informed decision to do so. She attended weekly therapy sessions throughout the duration of her stay at the shelter.
Brenna’s resiliency, self-sufficiency, and dedication to providing a healthy life for her unborn child gave her the motivation to set difficult goals, and she used her time at the shelter to attain them. One month prior to giving birth, Brenna’s housing application was accepted and she moved into a small two-bedroom apartment. Working with Social Services, she was granted a voucher and was able to furnish her apartment. I accompanied Brenna to the supermarket and assisted her in planning a monthly food budget with her Supplemental Nutrition Assistance Program (SNAP) and WIC funds. Through work with her therapist, Brenna cut off all contact with Cameron, choosing to raise her child on her own. She said she felt like a new person when she established a new phone number and address without informing Cameron, and when she left the shelter, although nervous, she expressed a sense of confidence in her ability to move forward with her new baby.
Research
Social Work Research: Chi Square
Molly, an administrator with a regional organization that advocates for alternatives to long-term prison sentences for nonviolent offenders, asked a team of researchers to conduct an outcome evaluation of a new vocational rehabilitation program for recently paroled prison inmates. The primary goal of the program is to promote full-time employment among its participants.
To evaluate the program, the evaluators decided to use a quasi-experimental research design. The program enrolled 30 individuals to participate in the new program. Additionally, there was a waiting list of 30 other participants who planned to enroll after the first group completed the program. After the first group of 30 participants completed the vocational program (the “intervention” group), the researchers compared those participants’ levels of employment with the 30 on the waiting list (the “comparison” group).
In order to collect data on employment levels, the probation officers for each of the 60 people in the sample (those in both the intervention and comparison groups) completed a short survey on the status of each client in the sample. The survey contained demographic questions that included an item that inquired about the employment level of the client. This was measured through variables identified as none, part-time, or full-time. A hard copy of the survey was mailed to each probation officer and a stamped, self-addressed envelope was provided for return of the survey to the researchers.
After the surveys were returned, the researchers entered the data into an SPSS program for statistical analysis. Because both the independent variable (participation in the vocational rehabilitation program) and dependent variable (employment outcome) used nominal/categorical measurement, the bivariate statistic selected to compare the outcome of the two groups was the Pearson chi-square.
After all of the information was entered into the SPSS program, the following output charts were generated:
TABLE 1. CASE PROCESSING SUMMARY
|
Cases |
|||||||||
|
Valid |
Missing |
Total |
|||||||
|
N |
Percent |
||||||||
|
Program |
59 |
98.3% |
1 |
1.7% |
60 |
100.0% |
TABLE 2. PROGRAM PARTICIPATION *EMPLOYMENT CROSS TABULATION
|
Employment |
|||||||
|
None |
Part-Time |
Full-Time |
|||||
|
Intervention |
Count % within Program Participation |
5 |
7 |
18 |
30 |
||
|
Comparison |
16 |
7 |
6 |
29 |
|||
|
21 |
14 |
24 |
59 |
TABLE 3. CHI-SQUARE TESTS
Value
df
Asymp. Sig. (2-sided)
Pearson Chi-Square
11.748
a
2
.003
Likelihood Ratio
12.321
2
.002
Linear-by-Linear Association
11.548
1
.001
N of Valid Cases
59
a
. 0 cells (.0%) have expected count less than 5. The minimum expected count is 6.88.
The first table, titled Case Processing Summary, provided the sample size (N = 59). Information for one of the 60 participants was not available, while the information was collected for all of the other 59 participants.
The second table, Program Participation Employment Cross Tabulation, provided the frequency table, which showed that among participants in the intervention group, 18 or 60% were found to be employed full time, while 7 or 23% were found to be employed part time, and 5 or 17% were unemployed. The corresponding numbers for the comparison group (parolees who had not yet enrolled in the program but were on the waiting list for admission) showed that only 6 or 21% were employed full-time, while 7 or 24% were employed part time, and 16 or 55% were unemployed.
The third table, which provided the outcome of the Pearson chi-square test, found that the difference between the intervention and comparison groups were highly significant, with a p value of .003, which is significantly beyond the usual alpha-level of .05 that most researchers use to establish significance.
These results indicate that the vocational rehabilitation intervention program may be effective at promoting full-time employment among recently paroled inmates. However, there are multiple limitations to this study, including that 1) no random assignment was used, and 2) it is possible that differences between the groups were due to preexisting differences among the participants (such as selection bias).
Potential future studies could include a matched comparison group or, if possible, a control group. In addition, future studies should assess not only whether or not a recently paroled individual obtains employment but also the degree to which he or she is able to maintain employment, earn a living wage, and satisfy other conditions of probation.
Social Work Research: Planning a Program Evaluation
Joan is a social worker who is currently enrolled in a social work PhD program. She is planning to conduct her dissertation research project with a large nonprofit child welfare organization where she has worked as a site coordinator for many years. She has already approached the agency director with her interest, and the leadership team of the agency stated that they would like to collaborate on the research project.
The child welfare organization at the center of the planned study has seven regional centers that operate fairly independently. The primary focus of work is on foster care; that is, recruiting and training foster parents and running a regular foster care program with an emphasis on family foster care. The agency has a residential program as well, but it will not participate in the study. Each of the regional centers services about 45–50 foster parents and approximately 100 foster children. On average, five to six new foster families are recruited at each center on a quarterly basis. This number has been consistent over the past 2 years.
Recently it was decided that a new training program for incoming foster parents would be used by the organization. The primary goals of this new training program include reducing foster placement disruptions, improving the quality of services delivered, and increasing child well-being through better trained and skilled foster families. Each of the regional centers will participate and implement the new training program. Three of the sites will start the program immediately, while the other four centers will not start until 12 months from now. The new training program consists of six separate 3-hour training sessions that are typically conducted in a biweekly format. It is a fairly proceduralized training program; that is, a very detailed set of manuals and training materials exists. All trainings will be conducted by the same two instructors. The current training program that it will replace differs considerably in its focus, but it also uses a 6-week, 3-hour format. It will be used by those sites not immediately participating until the new program is implemented.
Joan has done a thorough review of the foster care literature and has found that there has been no research on the training program to date, even though it is being used by a growing number of agencies. She also found that there are some standardized instruments that she could use for her study. In addition, she would need to create a set of Likert-type scales for the study. She will be able to use a group design because all seven regional centers are interested in participating and they are starting the training at different times.
Social Work Research: Qualitative Groups
A focus group was conducted to explore the application of a cross-system collaboration and its effect on service delivery outcomes among social service agencies in a large urban county on the West Coast. The focus group consisted of 10 social workers and was led by a facilitator from the local office of a major community support organization (the organization). Participants in the focus group had diverse experiences working with children, youth, adults, older adults, and families. They represented agencies that addressed child welfare, family services, and community mental health issues. The group included five males and five females from diverse ethnicities.
The focus group was conducted in a conference room at the organization’s headquarters. The organization was interested in exploring options for greater collaboration and less fragmentation of social services in the local area. Participants in the group were recruited from local agencies that were either already receiving or were applying for funding from the organization. The 2-hour focus group was recorded.
The facilitator explained the objective of the focus group and encouraged each participant to share personal experiences and perspectives regarding cross-system collaboration. Eight questions were asked that explored local examples of cross-system collaboration and the strengths and barriers found in using the model. The facilitator tried to achieve maximum participation by reflecting the answers back to the participants and maintaining eye contact.
To analyze the data, the researchers carefully transcribed the entire recorded discussion and utilized a qualitative data analysis software package issued by StatPac, which offers a product called Verbatim Blaster. This software focuses on content coding and word counting to identify the most salient themes and patterns.
The focus group was seen by the sponsoring entity as successful because every participant eventually provided feedback to the facilitator about cross-system collaboration. It was also seen as a success because the facilitator remained engaged and nonjudgmental and strived to have each participant share their experiences.
In terms of outcomes, the facilitator said that the feedback obtained was useful in exploring new ways of delivering services and encouraging greater cooperation. As a result of this process, the organization decided to add a component to all agency annual plans and reports that asked them to describe what types of cross-agency collaboration were occurring and what additional efforts were planned.
Social Work Research: Single Subject
Chris is a social worker in a geriatric case management program located in a midsize Northeastern town. She has an MSW and is part of a team of case managers that likes to continuously improve on its practice. The team is currently using an approach that integrates elements of geriatric case management with short-term treatment methods, particularly the solution-focused and task-centered models. As part of their ongoing practice, the team regularly conducts practice evaluations. It has participated in larger scale research projects in the past.
The agency is fairly small (three full-time and two part-time social work case managers) and is one of several providers in a region of approximately 50,000 inhabitants. Strengths of the agency include a strong professional network and good reputation in the local community as well as the team of experienced social workers. Staff turnover has been almost nonexistent for the past 3 years. The agency serves about 60–70 clients at any given time. The clients assisted by the case management program are older adults, ranging from their early 60s to over 100 years of age, as well as their caregivers.
To evaluate its practice approach, the team has decided to use a multiple-baseline, single-subject design. Each of the full-time case managers will select one client new to the caseload to participate in the study. The research project is explained to clients by the respective case manager and informed consent to participate is requested.
George was identified by Chris as a potential candidate for the evaluation. As a former science teacher who loved to do research himself, he agreed to participate in the project. George is 87 years old, and although he is not as physically robust as he once was, at 5 feet 9 inches tall, he has a strong presence. He has consistent back pain and occasional flare-ups of rheumatoid arthritis. His wife of 45 years passed away two summers ago after a long fight with cancer. After his initial grief, he has managed fairly well to adapt to life on his own. George entered the program after being hospitalized for fainting while at the grocery store. A battery of medical tests was conducted, but no specific cause of his fainting attack could be found. However, the physicians assessed signs of slight cognitive impairments/dementia and suggested a geriatric case management program.
An initial assessment by the case manager showed the need for assistance in the following areas: 1) personal care, 2) decrease in mobility, and 3) longer-term planning around living arrangement and home safety. The case manager also thought that George could benefit from setting up advance directives, which he did not want to discuss at that time. They agreed that the case manager could bring this topic up again in the future.
As part of the practice process, the case manager used clinical rating scales that were adapted from the task-centered model. At the beginning of each client contact, case manager and client collaboratively evaluated how well the practice steps (tasks) undertaken by client and/or case manager were completed using a 10-point clinical scale. Concurrently, they evaluated changes to the respective client problems, also using a 10-point clinical scale. George was able to actively participate in the planning and implementation of most care-related decisions. During the course of their collaborative work, most needs were at least partially addressed. Two tasks were completed regarding personal care, two regarding mobility, and three addressing home safety issues. Only personal mobility was still a minor problem and required some additional work.
After finishing the reassessment at 3 months, Chris completed gathering and evaluating the data for the single-subject design (SSD). As promised, she also provided George with the finished SSD findings. The following is an overview of the data that was collected for this case:
TABLE 1. TASK COMPLETION SCORES
|
WEEK: |
1 | 2 |
3 |
4 |
5 |
6 |
7 |
||||||||||||||||||||
|
Area: |
|||||||||||||||||||||||||||
|
Personal Care |
10 | ||||||||||||||||||||||||||
|
Mobility |
N/A |
||||||||||||||||||||||||||
|
Home Safety |
TABLE 2. PROBLEM CHANGE SCORES
| 7 | ||||
| 8 | 9 | |||
Policy
Social Policy and Advocacy: Violence Prevention
As a social worker in a private nonprofit organization, I was hired to coordinate the activities of a newly formed countywide committee to explore and address violence prevention. The newly formed prevention committee was funded privately and managed by a local nonprofit, family service organization. As committee coordinator, it was my role to work with the committee to identify programmatic and policy interests that could be addressed in the community. The county demographics varied by region, from affluent suburban areas to impoverished urban areas.
The prevention committee was composed of professionals and community members throughout the county. Social service workers, healthcare professionals, educators, law enforcement officials, domestic violence professionals, community members, and local government officials worked collaboratively on the committee. Through monthly meetings, I worked with members to collect data on various forms of violence within the county. Our goals were to gain a better understanding of violence in the community, clarify unmet needs, explore available services in place, and share knowledge on violence prevention with one another. By working toward these goals, we set objectives to 1) address unmet needs through collaboration and innovation, and 2) clarify a policy agenda the entire committee would be able to support.
I examined trends and incidence levels of violence in order to identify unmet needs and narrow the focus of our policy agenda. I gathered qualitative data from all committee members regarding areas of violence prevention relevant to their work in the community. Initial feedback was widely varied as a result of the broad range of fields represented on the committee. After continued discussion with committee members, an area of common concern was found related to dating violence education in local schools. While it was found that several individual schools were utilizing educational curricula to address dating violence, there were multiple concerns regarding large service gaps as well as inconsistencies across the school districts and the county as a whole.
The committee continued discussions on the topic of dating violence prevention, sharing research and knowledge on prevention programs. As the committee continued working, a new bill was introduced in the State General Assembly addressing the specific topic of dating abuse education in public school systems. The proposed legislation posited that each school district would be required to implement age-appropriate dating violence education as a part of the physical education and health curriculum. I proceeded with analyzing the contents of the bill by utilizing a social welfare policy analysis framework. I conducted additional research on the effectiveness of school-based dating violence prevention curricula. I compiled a body of peer-reviewed research demonstrating the effectiveness of educational programs similar to those supported by the committee. The programs I researched were quite similar to the proposal in the new bill. Prior to the next committee meeting, I obtained approval from the executive director of the sponsoring nonprofit organization to support this bill as the committee’s policy agenda.
The committee as a whole then voted to support the dating violence education bill. We collaboratively worked to draft a letter of support for the new legislation. Each committee member then utilized the letter to advocate for the new bill. Members sent letters to, called, and arranged for meetings with their local assemblymen and assemblywomen. I composed a letter on behalf of the committee as a whole and distributed it to local government representatives. I met with local school leaders and the county domestic violence agency’s educational program staff to discuss implementation of the new bill. The school leaders and the domestic violence education staff publicly supported the bill; the domestic violence education staff had already begun working to ensure their curriculum met the requirements of the new bill.
As the legislative process continued, I tracked the bill as it passed through the Assembly Education Committee. I provided regular updates to committee members, and I maintained communication with local legislators and continued publicly supporting the bill when I attended community meetings. The bill proceeded to the House, and with minimal amendments the final dating abuse prevention legislation was passed just as the prevention committee entered the second year of work.
Social Work Agencies: Administration
A countywide nonprofit organization, whose mission was empowering women, discovered that they would end the fiscal year with a large deficit if changes were not made. This organization had already experienced upheaval after the departure of the executive director of 6 years. For several months an interim director filled in until a new executive director was finally hired. During this time many staff members left the organization, causing transition issues on every level of the organization.
A consultant was hired to work with the finance department as this area was in great need of enhanced capacity and tighter controls. However, the consultant left after it was found that an oversight on his part contributed to an even deeper deficit, and a new chief financial officer (CFO) was hired. The CFO, the executive director, and several other managers were members of the senior management team, but only the executive director, the CFO, and the director of human resources were aware of the extent of the agency’s economic damage. During senior management meetings, the executive director invited very little feedback, and when one of the other managers provided their thoughts and suggestions, their ideas were dismissed.
Over time, the executive director relied solely on the CFO, excluding the director of human resources from meetings and other conversations. This, coupled with rising tension among all the managers as a result of poor communication from upper management, caused the director of human resources to ally with the other management team members. Then several members of the board of trustees resigned, leaving the organization with very few board members.
Confusion and low morale permeated the organization. Staff members were unaware of the specifics of what was happening because they were not given any information on the direction of the organization, yet they expressed feelings of stress and being overwhelmed with work. Upper management provided mixed messages, announcing that positions were going to be cut and/or departments consolidated, yet never following through. The managers began to talk with one another and shared the different messages received. Confusion and trust increasingly became an issue, and staff on every level became concerned about their jobs. Many staff members began openly discussing their job search efforts and interviewing schedules.
During this time, benefits were reviewed and renegotiated, and the organization’s contributions to its employees’ retirement was cut by 7%. Individuals from temp agencies were brought on part-time to avoid providing health insurance or other fringe benefits. Managers were told to cut their budgets by 20% across departments, yet additional staff members were being hired in other areas without explanation. The executive director and director of human resources drafted a document that each employee had to sign that barred any employee from discussing any of the business of the organization with any external individual or organization. A culture of silence, mistrust, and disempowerment permeated the organization.
Social Work Policy: Children and Adolescents
Susana is a 15-year-old, Caucasian female who lives with her parents and younger sister in a middle-class suburban neighborhood. Her family has been involved with the county Child Protective Services due to a persistent problem with truancy attending public school during a 6-month period. The school principal requested the agency’s intervention because Susana had only attended school for 1 day during the fall semester. Her attendance the previous year was also poor, as she had missed a total of 64 out of 175 days.
As the social worker assigned to the case, I met with the school principal as well as with Susana and her parents. The principal reported that Susana, other than her recent persistent truancy, had a good school record. He said that her teachers never reported any unusual behaviors other than that Susana was somewhat quiet, shy, and kept to herself during both class and recess times. Her grades and test scores were above average during her elementary and middle school years until last year when she started to fall behind as a result of missing so many school days. In accordance with school policy and state law (which mandates that all children up to age 16 attend school), school personnel called her parents and met with them on at least three occasions about the excessive truancy. The parents were described as concerned and cooperative but told the officials that they were unsuccessful in motivating Susana to go back to school. Eventually, the situation progressed to the point that the parents were being assessed fines by local magistrates for the continued truancy, and the case was referred to county family court for further evaluation.
When I conducted a home visit, I found that the living conditions appeared good and that both parents seemed to have a calm and relaxed approach in their communication with each other and their two daughters. They said they had always had good relationships with their daughters and that neither had ever had serious disciplinary issues. They said that Susana had always been more reserved and less outgoing than her younger sister, who was 12 years old. The father worked in a white-collar job, and the mother did not work outside of the home. They reported no history of serious physical or mental health issues or significant traumas that might have prompted Susana’s recent pattern of staying away from school. Susana seemed polite but also seemed reticent to discuss why she did not want to go back to school. She had few friends, seemed to stay at home all the time, and appeared very much attached to her mother, especially when compared to most other teens the same age. In contrast, her younger sister was described as having many friends and being involved with multiple extracurricular activities.
I explained to both Susana and her parents that school attendance was not only mandatory but also essential to Susana’s future career development. Because Susana seemed somewhat withdrawn and nonparticipatory during the interview process, I also told the parents to set up an appointment with her personal physician and that I would provide a referral to the local community mental health clinic for further assessment.
In the meantime, the truancies continued to accrue and the case was automatically referred to a hearing before the local family court judge later that same month. I prepared a recommendation to the court that both the parents and teen be assessed at the local community mental health center and that Susana be directed to return to school as soon as possible. Both Susana and her parents said that they concurred with these recommendations at the hearing before the judge. The judge said that he would make a decision and issue a ruling the following week. When the judge’s finding and order were received the following week, the social worker was surprised that instead of directing community-based intervention, the judge said that Susana should be immediately removed from her parents’ custody and placed in an institutional setting (a Catholic girls’ school for delinquents) located about 100 miles away.
I requested a conference with the judge, which was granted the following day. I explained to the judge that institutionalization was not seen as warranted in this case, and that the teen was quiet and withdrawn and would likely react poorly to a crowded setting populated with delinquent teens. Further, I added that Susana seemed very attached to her parents, and I was concerned how she might react if removed from the home. I advocated for her to remain in the home, explaining that state and federal courts had ruled since the 1970s that truancy is a dependent rather than a delinquent act, and that dependent and delinquent youths cannot be housed together. The judge responded angrily and said that he made his final decision.
I went to my supervisor to see if there was any alternative course of action but was told that there was no option but to follow the judge’s order and to prepare a placement summary. I replied that I could not follow through with these directives as I did not feel it was in the best interest of the child. I was removed from the case, and it was assigned to another worker to immediately carry out the order. I was suspended for 5 days on a charge of insubordination. Susana’s family quickly filed an appeal with a higher court, which found the judge’s ruling unlawful. Susana was not removed from her parents’ custody. I was still suspended without pay.
Social Work Supervision, Leadership, and Administration: The Phoenix House
I am the senior social worker at a program called Phoenix House. Phoenix House is an after-school program supporting at-risk middle school youth. It is funded in part by local school districts. Students are generally referred to Phoenix House by school administrators or parents.
I supervise a staff of four full-time social workers and two social work interns from a local university. Staff responsibilities generally include helping students with homework, individual and group counseling, field trips, and recreational games and activities.
Students are usually referred to Phoenix House when school administrators feel that the student is on the cusp of expulsion or long-term suspension from their school, usually due to disciplinary issues. Parents of students may also enroll their children in the Phoenix House program if they feel it will be beneficial. Parents are made aware of Phoenix House and its services through PTA meetings and via school administrators when a disciplinary incident takes place. Although it is free of charge and funded primarily through school district funds, parents are discouraged from using Phoenix House as an after-school or extracurricular activity for their children.
The average clients of Phoenix House are boys and girls between the ages of 11 and 14. The clients possess a range of presenting issues, mostly relating to inappropriate behavior. Some of the clients have been involved with the juvenile justice system in some form or fashion. Almost all of the clients have been suspended from their school at one point or another. Common problems with clients at Phoenix House include fighting, bullying, stealing, and vandalizing.
The staff I supervise have quite a bit of experience working with juveniles with behavioral issues. Some of them have worked in juvenile detention facilities and others have worked at court-mandated youth programs.
We have recently accepted a new client named Daniel. Daniel is a 13-year-old, Caucasian male. Daniel was enrolled by his mother when he was suspended from his school after a marijuana cigarette was found in his book bag by school security staff. It was the first time Daniel had been suspended from his school and the first time a disciplinary report had been filed on him.
Sarah, one of the social workers, asked to speak to me concerning Daniel. Sarah had spoken to Jim, one of our social work interns, about Daniel and the appropriateness of his presence at Phoenix House. Jim is concerned that Daniel is not a “good fit” at Phoenix House because he does not seem to match up with the character and attitudes of the other clients. Sarah shares Jim’s concern and is also concerned that the other clients may be a harmful influence to Daniel.
Sarah is Daniel’s counselor, as well, and has gotten permission from Daniel to share some of his statements from their counseling sessions. The statements indicate Daniel has no idea how the marijuana cigarette got into his book bag and that Daniel suspects it was put there by another student as a joke or as a means to get rid of it during bag searches. Sarah, who has years of experience working with at-risk youth, indicates that she believes Daniel. Daniel has also gone on to state that his mother has a tendency to overreact, and this may be the reason why she enrolled him in the Phoenix House program instead of listening to his explanations.
In response to Jim and Sarah’s concerns, I contacted Daniel’s mother, Lisa. Lisa listened to my concerns but did not feel that it would be right to remove him from the Phoenix House program. She said that even if he had done nothing wrong, Daniel could learn a valuable lesson about consequences by being in the Phoenix House program. I attempted to explain to Lisa that this is not really the purpose of the program and also indicated that Phoenix House is not meant to be a typical after-school or extracurricular program. Lisa retorted that it is her right to enroll her son in the program, and in her opinion, the end result of Daniel being in the program will be positive in nature.
I have shared this conversation with the staff at our weekly meetings. The staff seem convinced that Daniel will not have a positive experience at Phoenix House and feel he is being picked on and bullied by the other clients despite their efforts to prevent it. Some staff members have also pointed out that this may be an ethical issue because they feel the situation violates the social work value of “Do no harm.”
Social Work Supervision, Leadership, and Administration: The Southeast Planning Group
The Southeast Planning Group (SPG) is an organization that was created in 2000 to facilitate the Office of Housing and Urban Development’s (HUD) Continuum of Care planning process. The key elements of the approach were strategic planning, data collection systems, and an inclusive process that involved clients and service providers. The fundamental components of the system are 1) outreach, intake, and assessment; 2) emergency shelter; 3) transitional housing; and 4) permanent housing and permanent supportive housing. The outreach, intake, and assessment component identifies an individual’s or family’s needs in order to connect them with the appropriate resources. Emergency shelter provides a safe alternative to living on the streets. Transitional housing provides supportive services such as recovery services and life skills training to help clients develop the skills necessary for permanent housing. The final component, permanent housing, works with clients to obtain long-term affordable housing.
SPG works with the local government; service providers; the faith, academic, and business communities; homeless and formerly homeless individuals; and concerned citizens in the designated service area. During the first 5 years of its existence, SPG was staffed by one part-time and four full-time staff members and oversight was provided by a 21-member board. SPG’s founding director was well respected and liked in the community. She was noted for her ability to bring stakeholders across sectors together and focus on the single mission of ending homelessness.
After serving 5 years, the executive director abruptly resigned amidst rumors that she was forced out by the board. Although she had been effective in bringing people together, there were concerns that the goals and objectives had not been met, and there was a lack of confidence in her ability to grow the organization. Approximately one month after her resignation, a new executive director was hired.
One of the new director’s first priorities was to reconfigure the structure of the organization in order to increase efficiency. As a result of the restructuring, two positions were eliminated. The people who were let go had been with the organization from the beginning, and similar to the previous director, they had strong ties to the community. Once the community and SPG’s partners learned about the changes, there was suspicion about the new leadership and the direction they wanted to take SPG. Stakeholders were split in their views of the changes—some agreed that they were necessary in order to advance the goals of the organization, while others felt the new leadership was “taking over” with a hidden agenda to promote its own self-interest.
I worked with the group as an evaluation consultant to assess the SPG partnership during this period of transition. In order to assess how these changes were perceived by the stakeholders, I conducted key informant interviews with various stakeholders, both internal and external to the organization. The partners shared many insights about how the month without consistent leadership contributed to the uncertainty about SPG’s purpose and strategy, and it was generally agreed that the leadership transition was not handled well. The results from the evaluation were used to help SPG identify strategies to improve communication with stakeholders and utilize the director’s leadership role to build upon the organization’s past successes while preparing for future growth.
Working With Clients With Addictions: The Case of Jose
Jose is a 42-year-old, heterosexual, Latino male. He had been booked and charged for vagrancy three times in the last 2 months. He had also been arrested six other times over the past 10 years for various minor offenses, such as trespassing, public drunkenness, and disorderly conduct. After this last hearing, the judge mandated him to a drug treatment facility and gave him 2 years’ probation.
As a social worker at the county’s mental health and substance abuse agency, I was assigned to manage his case and to ensure he followed the judge’s ruling. My role was also to provide resources and referrals and advocacy, when needed. We met initially to complete the intake form so that I might get as much information as possible to assist him. Jose informed me immediately that he had no source of income, was homeless, and was very interested in services to address his alcoholism and substance abuse. He added that over the past 20 years, he had tried many times to get clean and sober but had little success. Jose identified himself as a “chronic relapser.” He was concerned that he was going to have to pay for the drug treatment facility and expressed surprise that the judge had not placed him in jail as he had been in the past.
I explained that our state had recently passed a law that required the judicial system to direct persons who were identified as primarily having addictive problems out of or away from incarceration and instead into alternative community-based drug treatment programs. I told him that a class action suit had been brought by a number of inmates for alternative services after a recent study was published that reported that more than two-thirds of state prison inmates had chronic and severe drug and alcohol abuse problems and that almost half of this group’s only convictions were for drug- and alcohol-related offenses. These findings had propelled the state to put this new policy into place. All of the counties quickly established a process to manage a new model.
I learned that Jose had not been steadily employed for the past 12 years, although he had been gainfully employed for at least a decade before then. He had graduated high school and appeared to have above-average intelligence. He had never been married nor had children. For the past 2 years, he said that he had primarily been living under a railroad bridge near a major freeway in the area. He reported no support or family in the area, but said that he still has occasional contact with a sister and an aunt in separate Southern states and a cousin on the West Coast.
Jose shared that he had moved to the West Coast from the South 8 years ago, hoping that a change of location would help him get sober. However, upon arrival and having no place to reside, he ended up living on the street and in pursuit of alcohol and cocaine. He was mostly supporting his habit by panhandling and recycling.
Jose stated that he comes from a family with members who have struggled with alcohol abuse and drug addiction. He said that his mother was placed in a nursing home at the age of 42 (when Jose was 8) and was diagnosed with dementia as a result of long-term alcoholism. His father committed suicide at the age of 47 (when Jose was 10). Jose said that his father suffered from depression and was a heroin intravenous drug user. As a result of his parents’ difficulties, Jose was almost completely raised by his grandmother in an urban public housing project. Jose said that he also had bouts of depression but had never sought professional help to address it. It was not clear if the depression was brought on by the substance abuse or if the drug abuse was being used to address the depressive symptoms.
Based on the information provided, we created a plan of action. After exploring alternatives for immediate assistance, I was able to arrange for Jose’s admission the next day into a 5-day detoxification center, followed by 30 days of inpatient treatment at a county-supported program. Jose and I would either meet or speak on the phone every week in order to track his progress so that I could complete a written report for the judge and Jose’s probation officer.
After Jose’s release from the inpatient program, we worked together to decide goals that seemed feasible for him and would continue his current trajectory toward a clean and sober life. A bed was found for him at a local sober living environment (SLE) house in the community that agreed to take him as long as he could start paying rent within the first two months. He seemed to adapt well to the new environment and reported that for the first time in many years he was feeling hopeful and was less depressed. The planned goals included continued and consistent attendance at Alcoholics Anonymous™ (AA) meetings, getting together with his sponsor for recovery support, and seeking employment. We worked together to build his resume and looked on the Internet for possible job leads.
Within a few weeks of living in the SLE, Jose was able to obtain employment conducting telephone sales for a local telemarketing company. Later that same year, Jose obtained his driver’s license and began working for a valet parking contractor. After 2 years he is still living in the same SLE residence and says that his life is now stable and productive. He is no longer mandated to meet with me, and his probation has expired with no incidences. He is in a relationship with a woman he met at work, and they plan to wed next year.
Working With the Aging: The Case of Iris
Iris is a 78-year-old, divorced, Caucasian female who lives alone in a mid-sized Southern city. Her main sources of income are a pension from her more than 35 years of work as an elementary school teacher and monthly Social Security retirement benefits. Iris has no children but was married for 34 years. Two years ago her husband, completely to the surprise of Iris, announced that he wanted an immediate divorce and was planning to marry a much younger woman he had met just a few months earlier.
Within 2 years of her divorce, Iris started noticing increasing challenges with her mobility. One day she fell while carrying groceries and had to be hospitalized overnight for an injured knee. To help meet Iris’ needs during her convalescent period, the local Older Adults Services Agency (OASA) arranged for Iris to receive daily Meals on Wheels deliveries, and her health plan arranged for visiting nurses to see her once every 2 weeks. Within about 3 months, Iris recovered to the extent that she could again drive short distances and walk with the assistance of a cane.
Iris was determined to fully regain her independence, but she was rapidly approaching the age of 80 and had no family and few friends who could assist her. She nevertheless insisted on continuing to drive longer distances even though her driving skills were significantly impaired. Over the course of a 3-week period, Iris was involved in three vehicle accidents, one in someone’s driveway, one near her home, and the last one in the parking lot of her local grocery store. The first two incidents were fairly minor fender benders, but the last accident was much more serious. When parking and getting out of her car, Iris neglected to place the vehicle in park and the car rolled backward, with the open door striking Iris and one of the vehicle’s tires running over her right foot.
Iris was severely injured and was hospitalized for more than 2 weeks. The local police suspended Iris’ driver’s license, and she agreed to no longer drive. The hospital social worker arranged for Iris to stay for 4 weeks at a licensed long-term care facility upon discharge. After her stay there, staff at the OASA found a moderately priced assisted living facility where Iris could live.
Iris is now living in the new facility, which includes about two dozen other older residents. She continues to tell the staff at the home and her OASA social worker that she is depressed, badly misses her independence, and wishes that she could go back to driving and traveling. Because Iris still has difficulty even getting back and forth to the bathroom and dining room, however, the prospects for this currently appear dim.
Appendix
Reflection Questions
The social worker in each of the cases answered select additional questions as follows.
Practice
Mental Health Diagnosis in Social Work: The Case of Miranda
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I referred the client to a psychiatrist. I used behavioral therapy, relaxation and stress management techniques, and psychodynamic and structural family theories to address underlying issues from childhood.
2.Which theory or theories did you use to guide your practice?
I used psychodynamic and structural family theories to address adult survivors of child abuse in order to help Miranda connect to the effects of her stepfather’s maltreatment, regain her sense of self, and recognize the unhealthy functioning in her present relationships and daily living.
3.What were the identified strengths of the client(s)?
Miranda was motivated, identified goals well, and had a supportive husband.
4.What were the identified challenges faced by the client(s)?
Miranda reported a mental health history.
5.What were the agreed-upon goals to be met to address the concern?
The initial goal was to decrease symptoms of anxiety and depression. As therapy progressed, the greater goal became gaining insight into Miranda’s childhood to allow for more self-care and stress management.
6.How can evidence-based practice be integrated into this situation?
Miranda’s case is a great example of the benefit of a combination of medication and talk therapy for overall improvement of emotional and mental health.
7.Is there any additional information that is important to the case?
It is important to note that prior to seeing me for treatment, Miranda had been to several psychiatrists who misdiagnosed her with borderline personality disorder and bipolar disorder specifically based on the fact that she was female and had a history of abuse. She had been given a series of medications that were ineffective due to misdiagnosis. When Miranda came in for the first session she was very distrusting of psychotherapy as well as medication. My ability to create a safe and trusting environment was of the upmost importance in order for Miranda to get well and work with her underlying issues.
8.Describe any additional personal reflections about this case.
Miranda’s case is a great example of the need for a thorough mental health history, mental status exam, as well as family history of mental health issues and relationships. With individuals, it is important to ask critical questions that reflect mood and affect presentation as well as history of drug and alcohol use, family dynamics, and any past history of abuse. There is almost always a reason for a patient’s mood deregulation. A proper evaluation session allows for accurate diagnosis and treatment planning as well as letting you, the social worker, know if this is a case that will fit within your practice.
Social Work Supervision: Trauma Within Agencies
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
This was a difficult tragedy to deal with, and it was difficult to know how to proceed. I had contacted the county (who funded the agency) for help. The people I contacted at the county did not know what to do and were of little help because, as they stated, they had never dealt with death of a staff member. I turned to my senior staff, and we as a group came up with a plan to notify each client in the most sensitive way possible. In addition, the use of another agency and our employee assistance program helped me and my staff mourn the loss of Carla.
2.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
I was called to testify for the murder trial because I was the person who contacted the police for the welfare check as well as being Carla’s direct supervisor. The defendant’s lawyer was attempting to show that one of Carla’s clients killed her, but this was easily dispelled by the district attorney trying the case. The defendant was convicted and given 25 years to life.
3.Describe any additional personal reflections about this case.
This tragedy has prepared me for similar tragedies. I have had five staff members die over the last 10 years, the most recent 3 months ago when an older staff member suffered a stroke. This was never an issue addressed in any training I attended as a supervisor, and I feel it needs to be addressed with clinicians planning to go into administration.
Important things for future administrators to think about are how to notify staff; how to notify clients; if the tragedy involves the police, how to handle confidential information they want access to; how to handle the press if they contact you for information; what information will be released if people call and ask to speak to the staff member; how to handle any court testimony; and access to home phone numbers and names and numbers of next of kin for all staff supervised.
Working With Children and Adolescents: The Case of Chase
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
Chase obviously had major developmental issues and issues related to socialization. Both parents were unaware of their rights and how to advocate for their son. In addition, the father was very traditional and thought that his wife was responsible for taking care of the children and that he did not need to be involved in parenting. It was necessary to get the father involved and for both parents to act as a unit. In addition, neither parent had demanded help for their son within the school system and they needed to be educated about their son’s educational rights and how to get his needs met.
2.Which theory or theories did you use to guide your practice?
Theories used in working with Chase included structural family therapy, behavior modification, parenting, case management, and psychoeducation. The use of these interventions was very successful in getting Chase diagnosed and receiving needed services in the educational system.
3.What were the identified strengths of the client(s)?
Chase was very bright and had a very loving family and two parents who were motivated to make parenting changes to keep Chase in their home.
4.What were the identified challenges faced by the client(s)?
The most serious challenge for Chase was that he went undiagnosed for autism spectrum disorder (ASD) until he was seen by me at age 12. Early intervention may have been useful to help mediate his social challenges as well as his educational challenges.
5.What were the agreed-upon goals to be met to address the concern?
Identified goals included the reduction of tantrums, an increased response to parents’ requests within three prompts, and an increase in age-appropriate socialization.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Chase was adopted from Russia, so research was done to understand challenges for children who were adopted from an orphanage as well as what type of support this family may receive from outside agencies to maintain placement. In addition, research was done to determine what option they had for relinquishment if the parents decided they could not continue to raise Chase.
7.What local, state, or federal policies could (or did) affect this case?
Chase had an international adoption but it was filed within a specific state, which allowed him and his family to receive services so he could remain with his adopted family. In addition, state laws related to education affected Chase and aided his parents in requesting testing and special education services. Lastly, state laws related to child abandonment could have affected this family if they chose to relinquish custody to the Department of Family and Children Services (DFCS).
8.How would you advocate for social change to positively affect this case?
Advocacy within the school system for early identification and testing of children like Chase would be helpful.
9.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
There was a possibility of legal/ethical issues related to the family’s frustration with Chase. If his parents had resorted to physical abuse, a CPS report would need to be filed. In addition, with a possible relinquishment of Chase, DFCS could decide to look at the children still in the home (Chase’s adopted siblings) and consider removing them as well.
Working With Children and Adolescents: The Case of Claudia
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
Specific intervention skills used were positive verbal support and encouragement, validation and reflection, and affect identification and exploration. Knowledge of child anxieties/fear and psychoeducation for the client and her mother were also utilized. Child-centered play therapy was utilized along with sand tray therapy to provide a safe environment for Claudia.
2.Which theory or theories did you use to guide your practice?
I used theoretical bases of child- (client-) centered nondirective play therapy.
3.What were the identified strengths of the client(s)?
Client strengths were a supportive parenting unit, positive peer interactions, and the ability to engage.
4.What were the identified challenges faced by the client(s)?
The client faced environmental challenges. Due to socioeconomic status, the client resided in a somewhat dangerous neighborhood, adding to her anxiety and fear. The client’s family also lacked an extended support system and struggled to establish legal residency.
5.What were the agreed-upon goals to be met to address the concern?
The goals agreed upon were to increase the client’s ability to cope with anxiety and increase her ability to maintain attention at school.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Language barriers existed when working with the client’s mother. I ensured that all agency documents were translated into Spanish. It was also important to understand the family’s cultural isolation. Their current neighborhood and culture is much different than the rural Nicaraguan areas Claudia’s parents grew up in. To learn more about this, I spent time with Paula, learning more about her experience growing up and how this affects her parenting style and desires for her daughter’s future.
7.What local, state, or federal policies could (or did) affect this situation?
The client and her parents are affected by immigration legislation. The client’s family was struggling financially as a result of their inability to obtain documented status in this country. The client’s mother expressed their strong desire to obtain legal status, but stated that lawyer fees, court fees, and overwhelming paperwork hindered their ability to obtain legal residency.
8.How would you advocate for social change to positively affect this case?
I would advocate for increased availability and funding for legal aid services in the field of immigration.
9.How can evidence-based practice be integrated into this situation?
Evidenced-based practice can be integrated through the use of proven child therapy techniques, such as child-centered nondirective play therapy, along with unconditional positive regard.
10.Describe any additional personal reflections about this case.
It can be difficult to work with fears and anxiety when they are rooted in a client’s environment. It was important to help Claudia cope with her anxiety while still maintaining the family’s vigilance about crime and violence in the neighborhood.
Working With Children and Adolescents: The Case of Noah
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized structured play therapy and cognitive behavioral techniques.
2.Which theory or theories did you use to guide your practice?
For this case study, I used cognitive behavioral theory.
3.What were the identified strengths of the client(s)?
Noah had supportive and loving foster parents who desired to adopt him. He quickly became acclimated to the foster home and started a friendship with his foster brother. He started to become engaged in extracurricular activities. Noah was an inquisitive and engaging boy who participated in our meetings.
4.What were the identified challenges faced by the client(s)?
Noah faced several challenges, most significantly the failure of his mother to follow through with the reunification plan. He has had an unstable childhood with unclear parental role models. There may be some unreported incidences of abuse and trauma.
5.What were the agreed-upon goals to be met to address the concern?
We agreed together to help him learn new and more appropriate coping skills. He stated he wanted to “act better,” so we helped him identify the triggers to his angry outbursts and find safe ways to express his emotions.
6.What local, state, or federal policies could (or did) affect this situation?
The Indian Children Welfare Act (ICWA) and the Adoption and Safe Families Act (ASFA) affected this case.
7.How would you advocate for social change to positively affect this case?
I would revisit family preservation procedures in child welfare, specifically the requirements of the ICWA and necessary reunification strategies.
Working With Clients With Compulsive Disorders: The Case of Marjorie
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used exposure and response therapy (ERT) to manage obsessive behaviors. Generally, ERT takes 13–20 weeks in 1- to 2-hour sessions, but it can take longer. She was prescribed selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) to control depression and anxiety. An initial dosage of 50 mg/day to a maximum of 200 mg/day is the general prescribed dosage. I recommended family education on OCD to enhance family support of Marjorie.
Marjorie was routinely monitored for depressive disorders and potential suicide risks using the Beck Depression Scale II and the Beck Scale Suicide Ideation, and she underwent regular monitoring of OCD intensity using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at prescribed intervals.
2.Which theory or theories did you use to guide your practice?
Cognitive behavior theory (CBT) is the basis for psychotherapeutic approach with the client. It is the foundation to support understanding, identification, and modification of dysfunctional behaviors. Exposure and response therapy is derived from CBT.
3.What were the identified strengths of the client(s)?
The client has several strengths including relatively good health, intelligence, a supportive family network, and a strong affiliation with her church.
4.What were the identified challenges faced by the client(s)?
Marjorie has a disorder that generally does not go away; it is viewed as a chronic condition and must be constantly managed. Risk of depression and suicide is evident with OCD clients and must be closely monitored. Learning how to manage is a challenge for any client with OCD; risk of relapse is high. Marjorie also has a very limited social network. Helping her to expand her supportive social network while working through her compulsive behaviors will be a challenge. Marjorie’s mother has a resistance to her daughter’s illness. How she affects Marjorie’s treatment will be a challenge without appropriate education and family counseling. Further, the lack of medical insurance may be a challenge to provide ongoing access to treatment.
5.What were the agreed-upon goals to be met to address the concern?
The initial task is to gain control over the obsessive-compulsive behaviors. I worked with Marjorie to 1) reduce the frequency of her behaviors, 2) address any possible underlying causes associated with obsessive-compulsive behaviors in therapy sessions, 3) enhance her family’s understanding of OCD, and 4) expand her social network for support. Eventually Marjorie would like to return to college to get her degree.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Marjorie’s family is from the West Indies, so it was important to understand cultural attitudes about mental illness and treatment modalities and to see how they might be a source of her mother’s resistance/reluctance to proactively seek assistance for her daughter. Working with family members was the primary way I learned about the family’s cultural background.
7.What local, state, or federal policies could (or did) affect this situation?
Marjorie’s treatment could require an extensive amount of time. Having access to medical insurance that will allow her uninterrupted treatment schedules is important. However, Marjorie works at a low-paying job with no medical insurance. Efforts should be made to determine her eligibility for state health insurance—Medicaid.
8.How would you advocate for social change to positively affect this case?
Understanding mental illness in communities of color is an ongoing challenge for mental health professionals. Planning, developing, and executing public awareness campaigns about mental illness in diverse communities is critical to reducing myths and suspicions about mental illness and treatment protocols.
9.How can evidence-based practice be integrated into this situation?
There are several measures (Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory, Beck Scale for Suicide Ideation) that were used to evaluate the client’s progress.
Working With Clients With Dual Diagnosis: The Case of Cathy
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
Cathy was resistant to seeking treatment for her substance abuse. She initially refused to seek out help and stated that she knew all about the 12 steps and could quit on her own. Motivational interviewing was used effectively, and she agreed to go into treatment after several failures to stop using cocaine on her own. In addition, she had many symptoms related to her abuse from her father as well as three other incidents (a gang rape, a stranger rape, and a date rape) she revealed later in treatment. Eye movement desensitization reprocessing (EMDR) was used effectively to address her flashbacks and negative associations with this abuse.
2.Which theory or theories did you use to guide your practice?
A combination of theoretical frameworks was used to address each area of concern. Motivational interviewing was used for her substance addiction, EMDR for her post-traumatic stress disorder, cognitive behavioral therapy for her anxiety/panic attacks and depression, and lastly dialectical behavior therapy to address her symptoms related to borderline personality disorder.
3.What were the identified strengths of the client(s)?
Cathy had many strengths, including being a caretaker for her mother, having a job, and being seen as a very helpful and loving woman by her family and friends.
4.What were the identified challenges faced by the client(s)?
Drug addiction and trauma were the primary challenges that initially needed to be addressed. Once Cathy had become clean and sober and no longer self-medicated, her trauma symptoms escalated and became the main focus, so she was at great risk for relapse.
5.What were the agreed-upon goals to be met to address the concern?
Our treatment goals included maintaining sobriety, building a clean and sober network for support, reducing panic attacks, decreasing flashbacks, decreasing depressive symptoms, and increasing self-efficacy and mindfulness.
6.What local, state, or federal policies could (or did) affect this case?
After a year of treatment, Cathy became actively suicidal and had to be involuntarily hospitalized several times. State laws related to involuntary hospitalization were used to ensure she was in a safe environment.
7.How would you advocate for social change to positively affect this case?
Although Cathy had health insurance, it was minimal, and she had to privately pay for drug treatment. Her family helped with a deposit of $1,000 but she still owes close to $25,000 to the drug treatment program and is still making payments. Advocacy is needed on both state and federal levels to allow for easy access and free drug/alcohol treatment for all.
8.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Legal and ethical issues include her family’s desire to know what was happening in treatment and her need to consent to release of information so I might speak with them when they called concerned. In addition, within a year of treatment commencing, Cathy was hospitalized five times as a result of being a danger to herself and holds were written to keep her hospitalized.
9.Is there any additional information that is important to the case?
Cathy continues to receive treatment in my private practice after 2 ½ years of treatment. Due to the extent of her sexual abuse and rape, it has taken time to address her symptoms in an effective manner. Currently Cathy has had no hospitalizations for 3 months and continues to maintain her sobriety.
Working With Clients With Severe Persistent Mental Illness: The Case of Emily
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used two specific strategies with Emily. First, I used a Hearing Voices Recovery Movement strategy to help Emily identify the voice giving her commands and find out what its needs were. I used cognitive behavioral therapy interventions to help Emily learn to “boss it back” when she felt compelled to pull out her hair.
2.Which theory or theories did you use to guide your practice?
I used behavioral theories to help guide my understanding of how to help Emily.
3.What were the identified strengths of the client(s)?
Emily was motivated for treatment.
4.What were the identified challenges faced by the client(s)?
Emily has a very limited support system, making it is easy for her to isolate and for her self-harm to go unnoticed.
5.What were the agreed-upon goals to be met to address the concern?
Emily wanted to feel less frightened of the voice she heard and less driven to comply with its demands of her.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
In reading scholarly articles about trichotillomania I learned more about the importance of having “good hair” among some African American women. I used this information to open discussions with Emily about how she felt about her hair and what caring for her hair and removing her hair means to her.
7.How can evidence-based practice be integrated into this situation?
Using Emily’s treatment plan, Emily and I were able to identify which interventions worked to reduce the amount of time Emily thought of pulling her hair and how often she actually removed hair.
Working With Couples: The Case of Keith and Matt
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used solution-focused tools such as miracle questions, scaling questions, and solution and exception questions.
2.Which theory or theories did you use to guide your practice?
I used solution-focused theory to address this case.
3.What were the identified strengths of the client(s)?
Matt and Keith were clearly committed to their relationship and to being the best parents they could for their children. They were both gainfully employed and had extracurricular interests. They had a great deal of family support.
4.What were the identified challenges faced by the client(s)?
Matt and Keith were challenged parenting two children with disabilities. Further, they had been previously unaware of the services available to them to care for their children.
5.What were the agreed-upon goals to be met to address the concern?
The goal was to find solutions to alleviate their frustrations and the discord in their relationship.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
I was aware and sensitive to the fact that they were a gay couple. I was cognizant of the possible biased reactions they might have received from administrators at Jackson’s school and their surrounding community. I inquired into their interactions with the adoption agency and the school to get a sense of any negative interactions that might have impeded service delivery. I also suggested a support group for lesbian and gay couples who adopt.
7.How would you advocate for social change to positively affect this case?
I would advocate for better education for foster and adoptive parents on the resources they may be eligible to receive.
8.How can evidence-based practice be integrated into this situation?
Using weekly scaling questions would be one way in which evidence-based practice could be implemented.
Working With Families: The Case of Brady
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used structural family therapy, particularly the use of a genogram. I addressed issues of grief and loss and child development. Finally, I used education to help them learn about services available and crisis intervention.
2.Which theory or theories did you use to guide your practice?
I used structural family therapy.
3.What were the identified strengths of the client(s)?
Brady’s bravery in disclosing the altercations between himself and his father showed great motivation and strength.
4.What were the identified challenges faced by the client(s)?
Steve was resistant to his own mental health needs and the effect on his relationship with Brady. Brady was not receiving proper evaluation and intervention for his presentation of developmental delays/disabilities. Brady and Steve were clearly dealing with unresolved grief due to the death of Brady’s mother.
5.What were the agreed-upon goals to be met to address the concern?
The goal was to obtain a second evaluation and then provide suggestions of services to improve Brady’s behavior in the home and at school.
6.What local, state, or federal policies could (or did) affect this situation?
The child abuse reporting laws were relevant to this case.
7.How would you advocate for social change to positively affect this case?
I would advocate for more education and support for children with developmental disabilities and their parents. It was clear that Brady had an intellectual disability that had not been previously acknowledged nor properly addressed.
8.Were there any legal/ethical issues present in the case? If so, what were they and how were they addressed?
While the reporting laws and ethics for clinicians are very clear in a case like Brady’s, there is always the concern that a parent might file a lawsuit against the social worker for making the report. These are cases in which the clinician’s documentation of the sessions needs to be accurate and thorough to justify the CPS report.
9.Describe any additional personal reflections about this case.
I am often asked by students, “Do you find it difficult to make calls to Child Protective Services and does it get any easier?” My answer to that question is no, I do not find it hard to make calls to CPS because those institutions are there to help. However, I do continue to find it hard to hear stories of abuse from children. That will never get easier. I have learned a great amount of humility in these cases. If a child (or adult) finds my office space safe enough and is able to disclose such complex issues as these to me, I feel honored. It is because a client trusts me enough to tell me these things that I feel responsible to do my job.
Working With Families: The Case of Carol and Joseph
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
This case required extensive use of active and passive listening and patience to enable the client to become sufficiently comfortable with me and to arrive at a point where she could work on her issues. Initially she was very angry, hostile, resistant, and very much in denial.
2.Which theory or theories did you use to guide your practice?
I work with people in their homes, which is their territory, not mine. I think it is very important to be aware of how I would feel if I were in their shoes. The person-in-environment perspective and Carl Rogers’ person-centered approach are crucial here.
3.What were the identified strengths of the client(s)?
She was smart and had a good support system in her husband and mother, who were very supportive during her treatment.
4.What were the identified challenges faced by the client(s)?
Carol was a severe alcoholic and had a drug problem to a lesser extent. She had psychological issues as well, including low self-esteem, depression, and anxiety. She also had transportation and legal problems as a result of losing her driver’s license after the DUI.
5.What were the agreed-upon goals to be met to address the concern?
The primary goal was to protect her child by keeping Carol sober and finding the intervention method that would be most appropriate for her to do that. This took time due to the resistance to treatment.
6.How would you advocate for social change to positively affect this case?
Treatment options and access to them need to be improved in rural areas. There were not many choices for this client, and losing her license in an area with no public transportation greatly affected her ability to seek treatment.
7.Is there any additional information that is important to the case?
I subsequently found out that there had been other serious episodes concerning Carol’s drinking that the family had failed to disclose to me because they were covering up for her.
Carol’s parents separated when she was very young, so she was mostly cared for by a family friend and grandparents. Carol’s mother seemed to have resented the child’s interference with her social life, and clearly the daughter resented her mother’s lack of involvement with her. Carol’s mother, who was from a Southern White Protestant family, seemed uncomfortable with Joseph’s culturally unfamiliar Hispanic Catholic background. She reported to me that she felt the son-in-law was lazy and did not work in the early stages of his relationship with her daughter, who she said worked very hard. During my involvement with this couple, I found Joseph to be hard working and doing his best to provide for all of them. He was very committed to doing whatever was necessary to keep his family intact, even if his judgment at times was poor.
Working With Groups: Breast Cancer Support Group
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
The oncology/radiation department initiated a breast cancer support group to assist in reducing stress and anxiety during radiation treatment. The team discussed the benefits of providing a mutual support group to improve coping with treatment and to reduce isolation.
2.What were the identified strengths of the client(s)?
The patients were making an effort to attend the support group and actively participate.
3.What were the identified challenges faced by the client(s)?
The patients had many challenges to cope with. There were family/spousal issues, health concerns, prognosis uncertainty, and treatment issues.
4.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
I have taken numerous oncology social work continuing education courses to work with this population.
5.Describe any additional personal reflections about this case.
The support group was intended to be a venue for mutual support during radiation treatment, but the group clearly expressed a need for additional support and information. It is my feeling that there is a discrepancy between what our department is currently providing and what the patients are expressing. I have undertaken the task of creating a new 6-week series that will address some of our patients’ concerns and have presented my ideas to the hospital administration and oncology department team.
Working With Groups: HIV/AIDS Prevention With Teenage Moms
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized my human development knowledge of adolescents and young adults and the stages of the group process.
2.Which theory or theories did you use to guide your practice?
I used the transtheoretical model, social learning, and the health belief model.
3.What were the identified strengths of the client(s)?
The clients were consistent and active participants, committed to change, and knowledgeable of their community and the resources that can be used for support.
4.What were the identified challenges faced by the client(s)?
The clients were faced with balancing teen motherhood with school, financial instability, and relationships with the fathers of their children.
5.What were the agreed-upon goals to be met to address the concern?
I collected data on factors influencing HIV/AIDS prevention among teen moms.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Because I had never worked with teen moms, I reviewed data on the characteristics associated with this broad population, factors that influence behavior, and the long-term effects of the role of becoming a teenage mother on health, socioeconomic status, and education. The group comprised African Americans and Latinas, so issues related to diversity existed, but their common experience being young mothers of color minimized the differences.
7.How would you advocate for social change to positively affect this case?
I would advocate for HIV/AIDS and pregnancy prevention for young adults prior to becoming sexually active. Because the young women in the group emerged as leaders, I would like to see opportunities for them to become involved in fund-raising efforts for HIV prevention and advocating for access to health care services for young women and girls to not only prevent pregnancy and HIV/AIDS and other sexually transmitted infections but also to encourage preventative health behavior.
8.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
The main ethical issue was confidentiality. Because the participants went to school with each other and knew a lot of the same people, it was important to protect what information was shared in the group. I addressed this by working with the group to develop rules and by having them hold each other accountable.
9.How can evidence-based practice be integrated into this situation?
Both social work and the public health disciplines have developed models for working with this population. Best practices for engaging teen moms and HIV/AIDS prevention strategies can be incorporated.
10.Describe any additional personal reflections about this case.
Although the focus of the group was on HIV/AIDS prevention, the leadership that emerged from the group cannot be ignored. Our approach was to allow them to take responsibility for certain aspects, such as ordering or preparing the food (we paid for all expenses) and leading a part of the discussion. Over time, the participants’ confidence in their leadership ability and potential increased.
Working With Groups: Latino Patients Living With HIV/AIDS
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used group work techniques and education to address this situation. My knowledge of HIV/AIDS and of Latino cultural characteristics and their effect on health care were applicable.
2.Which theory or theories did you use to guide your practice?
Psychodynamic theory and the strengths perspective guided my practice.
3.What were the identified strengths of the client(s)?
The clients were willing to attend group and seek out support and assistance.
4.What were the identified challenges faced by the client(s)?
The group members faced the following common challenges: physical illness, mental illness, social isolation, lack of financial resources, and lack of education about HIV/AIDS.
5.What were the agreed-upon goals to be met to address the concern?
The agreed-upon treatment goals included reducing social isolation of individual group members and creating a safe and culturally sensitive environment where group members could discuss issues faced by PLWH in a cultural context.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Cultural competence was an essential part of this case because one of the primary goals of the group was to provide a culturally sensitive environment to discuss issues. I had significant experience working with Latino patients. My initial research about Latino culture included my personal experience as a member of this cultural group and a literature review.
For reference, these are definitions of terms included in the case study.
Familialism refers to the significance of family, the primary unit in Latino culture. Embedded in this cultural concept are feelings of familial loyalty and the obligation to support the family emotionally and materially. In Latino culture, it is believed that family issues, including health care decisions, should be handled with family involvement.
Collectivism is emphasized over individualism in Latino culture. Latinos tend to think of collective well-being (i.e., that of the family) over one’s individual needs.
Simpatia refers to the desire of Latinos to maintain harmony, politeness, and respect in relationships. This can be applied to familial and external relationships.
Machismo reflects the male dominant role that is traditional in Latino culture. It is often portrayed in the behavior of men and serves as a social and political construct in Latino culture. Machismo promotes a man’s valor and his dedication to his family’s honor and welfare. It can also lead to the subordination of women and a rejection of homosexuality.
7.How would you advocate for social change to positively affect this case?
Advocacy for social change might include creating services targeting Latino patients, implementing programs to increase the health literacy of Latino patients, and providing additional services to Latino patients in Spanish.
8.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
In a medical setting one must always deal with issues of confidentiality and HIPAA. In addition, given that I worked with members’ individual social workers and physicians, I had to be careful about what information I shared with other providers and what information I kept “in the group.”
9.Describe any additional personal reflections about this case.
Facilitating the group was quite fascinating. In particular, my role in the group was very interesting. Initially, group members treated me like the “authority figure.” This is consistent with Latino culture, as health providers are often regarded as such. As time went on, members’ attitudes toward me changed. While I never totally shed the role of an authority figure, members began to include me as part of the group, especially when we shared lunch. On occasion, they also treated me in a protective manner, almost like a daughter. That being said, members maintained appropriate boundaries and were not intrusive. It should be noted that I was younger than all of the members, and I disclosed little about my personal life to the group. They did know that I was bilingual in English and Spanish and that my family had Latino cultural roots.
Clinically, I often found it difficult to treat Spanish-speaking patients, as I am not a native Spanish speaker and all of my clinical language is in English. On many occasions, I found myself thinking in English and having to translate my thoughts. In addition, there were many times that I could not find the words to say what I was thinking. I found this frustrating, and as a clinician, this made me feel inadequate. I felt like I was falling short and my Spanish-speaking patients were missing out on something I was able to provide my English-speaking patients. Truthfully, I never really “signed up” to be a “Spanish-speaking clinician” for this reason. But, there was a need at the center, I had a skill that others did not, so the number of Spanish-speaking patients on my caseload grew. It always struck me that, despite my feelings of inadequacy and lack of linguistic skill, patients did not seem to care. When I fumbled over my words or it took twice as long to explain something, they were not bothered. They were simply beyond grateful that there was someone who understood them and could hear what they had to say.
Working With Individuals: The Case of Carl
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized cognitive restructuring, journaling, and the strengths perspective to address Carl’s presenting concerns.
2.Which theory or theories did you use to guide your practice?
I used cognitive behavioral and interpersonal therapy with this client.
3.What were the identified strengths of the client(s)?
Carl was clearly committed to treatment and worked with me to achieve his goals. Carl and his children had a strong network of friends who offered their support throughout this difficult time. Further, they had the support and assistance of Carl’s parents. Carl exhibited his love for his children and his desire to address his concerns in order to be an effective father.
4.What were the identified challenges faced by the client(s)?
Carl experienced two serious losses at one time: his job and then his spouse of 19 years. Carl was unprepared for the challenges that he would need to address as a single parent.
5.What were the agreed-upon goals to be met to address the concern?
Carl wanted to address his feelings of sadness and loss around his wife. He also recognized that he needed to develop more effective coping skills to address the stressors he had incurred. Lastly, he wanted to work to repair his relationship with his older daughter, who had begun to pull away from the family.
6.How can evidence-based practice be integrated into this situation?
I used cognitive behavioral theory (CBT) to address the client’s negative thought process and related behaviors. Much research has been done to study the impact of CBT, and it is considered an evidenced-based practice.
Working With Individuals: The Case of Roy
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized the tools in the Duluth Model curriculum.
2.Which theory or theories did you use to guide your practice?
I used feminist theory to explain the etiology of abuse in our society and why it continues today.
3.What were the identified strengths of the client(s)?
Roy had obtained an associates degree prior to getting his job as a patrolman. He had a steady employment history for 10 years prior to the termination.
4.What were the identified challenges faced by the client(s)?
Roy faced a number of challenges, including the loss of a job he enjoyed very much and that he felt was a large part of his identity, limited insight into his use of power and control in his interactions with his wife during and after their marriage, and apparent issues with alcoholism.
5.What were the agreed-upon goals to be met to address the concern?
As with mandated clients, Roy did not want to attend the BIP and was initially unwilling to declare a goal. When we talked about creating a positive outcome for him, he said he wanted to finish the BIP and move on.
6.What local, state, or federal policies could (or did) affect this situation?
Roy was ordered by the court system to attend a BIP. Melissa was granted an order of protection against Roy to keep him away from her and the children (unless he was at supervised visitation).
7.How would you advocate for social change to positively affect this case?
The premise behind the Duluth Model is ongoing discussions between criminal and civil justice agencies, community members, and victims to close gaps and improve the community’s response to domestic abuse. I would advocate that all states and counties adopt this model to address domestic violence.
8.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Roy was arrested, jailed, and will be placed on probation for his actions.
9.How can evidence-based practice be integrated into this situation?
There is some research on BIPs in the literature, although the results are mixed. More studies need to be done to show the effectiveness of this model.
10.Is there any additional information that is important to the case?
I learned that Roy was given a long sentence after he attacked a female officer while in prison.
Working With Individuals: The Case of Sam
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I remained concerned about my client’s health and recommended further testing with a neurologist. My client and his daughter agreed and were able to follow through with this recommendation. I was able to engage my client’s daughter to participate in family sessions to address my client’s recent health issue, the loss he felt since his daughter moved out, and his financial concerns.
2.Which theory or theories did you use to guide your practice?
Family therapy/engagement was recommended and successful.
3.What were the identified strengths of the client(s)?
Sam has a number of strengths that include a long work history before becoming disabled, raising his daughter by himself, and a positive history of compliance with medication and treatment.
4.What were the identified challenges faced by the client(s)?
Sam was having a very difficult time adjusting to living alone and was concerned that he may not be able to continue to live in his current apartment because of limited finances. Sam was unable to convey these concerns to his daughter. Sam was also experiencing a new health concern.
5.What were the agreed-upon goals to be met to address the concern?
Sam was engaged in therapy and kept all his appointments. Sam agreed to family therapy to address his concerns.
6.What local, state, or federal policies could (or did) affect this case?
I explored local, state, and federal programs that might offer rent assistance programs. I also explored social programs for older adults.
7.Describe any additional personal reflections about this case.
Although Sam does not have a history of alcohol or substance abuse, there remains a question as to whether Sam may have been self-medicating with discontinued medications to relieve feelings of loneliness and anxiety. There is also the question of whether Sam had a seizure or not; and if Sam had a seizure, whether it was due to the Wellbutrin or the combination of medications Sam was taking.
Working With Organizations: The Southeast Planning Group
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used interviewing skills, qualitative data analysis, assessment, and strategic planning.
2.Which theory or theories did you use to guide your practice?
I used systems/ecological theory and organizational ecology.
3.What were the identified strengths of the client(s)?
The clients were concerned stakeholders who wanted to be engaged in the process.
4.What were the identified challenges faced by the client(s)?
The clients were facing a transition in leadership, ineffective communication from senior management, and the shifting focus of the organization.
5.What were the agreed-upon goals to be met to address the concern?
I worked to identify stakeholder perceptions of the planning process.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Cultural competence as it related to different organizational cultures and the diverse populations the stakeholders serve was important. For example, the nonprofit organizations wanted more structure in the process, while the smaller churches wanted increased flexibility in their participation and how the meetings were structured. Prior to beginning work with the organization, I reviewed their annual reports, meeting minutes, and other documentation of their efforts that happened before I started working with them.
7.What local, state, or federal policies could (or did) affect this situation?
Although a specific policy did not affect the situation, the local politics of the relationships between the stakeholders that were associated with the different counties and elected officials influenced who became involved.
8.How would you advocate for social change to positively affect this case?
I would advocate that the group continue to be inclusive of the perspectives of persons from the target population and not let them get “lost” in the perspectives of service providers on the relevant issues.
9.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
It was important to maintain confidentiality of the information shared. All identifying information was removed in the reports and the data were presented in aggregate.
10.How can evidence-based practice be integrated into this situation?
Existing research on collaborative partnerships, community engagement, and strategic planning can be used to guide the process in this situation.
11.Describe any additional personal reflections about this case.
I think this case is a great example of how leadership transitions can slow the momentum of community planning efforts and negatively affect an organization’s reputation if the change and its implications are not considered and addressed proactively.
Working With Survivors of Domestic Violence: The Case of Charo
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized psychoeducational support groups, case management, and solution-focused interventions.
2.Which theory or theories did you use to guide your practice?
I used learning theory and feminist empowerment and strengths-based perspectives to guide my practice.
3.What were the identified strengths of the client(s)?
Charo’s many strengths included her level of resilience and being a strong advocate for her children and a support to other survivors at the shelter. She also shared her resources with other survivors no matter how little she had. She was very kind.
4.What were the identified challenges faced by the client(s)?
The barriers for this client are enormous; aside from the domestic violence, some of the barriers include not speaking English, the involvement of Child Protective Services, a lack of affordable housing, obtaining employment without a visa, discrimination, and needing child care for five children.
5.What were the agreed-upon goals to be met to address the concern?
The three treatment goals we set were reducing depressive and anxiety symptoms, connecting to resources in the community that would help her become more stable, and obtaining therapy for the children.
6.What local, state, or federal policies could (or did) affect this situation?
The Violence Against Women Act (VAWA) affected the situation.
7.How would you advocate for social change to positively affect this case?
Victims should not be mandated to attend a domestic violence support group. Participation should be voluntary. These women have been coerced in their relationships and then they are coerced by the system and made to feel like they have done something wrong. Much more education is needed in the courts and with Child Protective Services.
8.How can evidence-based practice be integrated into this situation?
Clients are asked to complete client satisfaction surveys at termination. We also call the clients for follow-ups for up to a year. Lastly, clients complete a survey on a monthly basis, which is used statewide and called the Family Violence Prevention and Services Act (FVPSA) survey. The surveys mainly measure whether the client learned additional resources and additional ways of planning for safety.
9.Describe any additional personal reflections about this case.
When Charo’s husband was arrested outside of the agency, it broke my heart to see all five children playing in the waiting area and doing homework with no clue about what was happening with their father right outside the door. I became very attached to this family and had to take some very intentional steps to create boundaries. When the family was in crisis, I was always available to them, even when I was “off the clock.” I had to separate myself and involve other staff in the case as Charo was very attached to me and would only want to see me. I was able to set appropriate boundaries and stick to our weekly individual sessions and weekly group sessions and to redirect her to other staff when issues came up at the safe house.
Working With Survivors of Sexual Abuse and Trauma: The Case of Angela
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
Knowledge of trauma and child sexual abuse was key as was active listening, validation, boundary setting, and, at times, confrontation.
2.Which theory or theories did you use to guide your practice?
I applied relational, cognitive behavioral, empowerment, and strengths-based theories.
3.What were the identified strengths of the client(s)?
Angela’s strengths were her ability to persevere and be resilient, as well as her ability to find time for self-reflection and self-care. Despite everyone around her telling her otherwise, she was still able to stand firm in the knowledge that she was sexually abused and therefore needed to have clear boundaries with those who did not believe her.
4.What were the identified challenges faced by the client(s)?
Angela’s challenges included an occasional inability to function at work, self-harm, and isolation.
5.What were the agreed-upon goals to be met to address the concern?
The goals were to increase functioning, enhance ability to create and sustain relationships with others, reduce isolation, address and increase self-esteem, refrain from cutting, and work through early sexual trauma.
6.What local, state, or federal policies could (or did) affect this situation?
The statute of limitations in both civil and criminal cases affected Angela’s case.
7.How would you advocate for social change to positively affect this case?
I would advocate with legislators in the state to eliminate the statute of limitations so that survivors of sexual abuse could prosecute and/or sue their perpetrator when they were ready.
8.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
There were ethical issues regarding boundaries and dual relationships. The group facilitator in this case was inappropriate with her clients and became personal friends with this particular client along with the other women in the group. I addressed this by trying to work with the group facilitator, as well as by encouraging her to discuss this in her off-site clinical supervision. Because no change was occurring, eventually the group facilitator was terminated.
9.How can evidence-based practice be integrated into this situation?
The use of a sequenced, titrated approach using relational theory to address complex PTSD is incredibly helpful, especially for those survivors of sexual trauma with multiple victimizations and difficulty with daily functioning.
10.Describe any additional personal reflections about this case.
As the individual therapist, this case was heartbreaking for me. The relationship and trust I had built with this client was destroyed, and I was placed in a very precarious position. The client did not want to discuss the changing dynamic and had clearly been influenced by the group facilitator, who was incredibly friendly and outgoing. There was no other choice but termination, and the realization that the damage could not be repaired was disappointing. However, had I disclosed “my side” of what was happening, I would have been making the same errors as the group facilitator and involving myself in a dysfunctional and unhealthy dynamic, including crossing boundaries—exactly what survivors do not need. There are times when you must “swallow your pride” to do what is right and best for the client, especially given the different variables and considering the ethical issues at play.
Working With Survivors of Sexual Abuse and Trauma: The Case of Brenna
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used reflective listening and reframing to assist Brenna in setting goals and determining her unmet needs. I used knowledge of local systems and social service agencies to provide referrals and to secure needed services.
2.Which theory or theories did you use to guide your practice?
I utilized systems theory.
3.What were the identified strengths of the client(s)?
Brenna’s strengths were her resiliency and self-sufficiency. Brenna viewed her desire to provide a better future for her child as a strong motivating factor for changing her life.
4.What were the identified challenges faced by the client(s)?
Brenna lacked a familial support system and network of friends, and she was socially isolated. Upon entry to the shelter, she lacked medical care, employment, income, and housing. Brenna also struggled with difficulty reading and writing. Brenna had experienced trauma and violence in her past and would be raising her child alone.
5.What were the agreed-upon goals to be met to address the concern?
Brenna and I agreed to secure medical care, a housing plan, and a source of income. Brenna also set goals to improve her mental health.
6.What local, state, or federal policies could (or did) affect this situation?
State policies regarding photo ID affected Brenna’s ability to apply for various assistance programs through Social Services. Temporary Assistance for Needy Families (TANF) policies will also affect her ability to obtain financial assistance after giving birth. Paternity is required on forms for TANF, and she may need to explore domestic violence waivers when completing TANF applications.
7.How would you advocate for social change to positively affect this case?
I would advocate for improved assistance to be offered through Social Services. Brenna was often met with anger and frustration at Social Services due to her difficulty reading and writing, so she had given up on trying to secure medical care and financial assistance early in her pregnancy.
8.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Brenna and I discussed future plans for applying for TANF and the impact the child’s paternity has on approval of the application. We discussed the parental rights of Cameron and identified resources for legal assistance if needed in the future.
9.Describe any additional personal reflections about this case. When working on a strict timeline, it is important to balance client empowerment with health and safety.
Research
Social Work Research: Chi Square
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
The intervention used in this study was a 6-month vocational rehabilitation program for recent parolees from the state’s prison system.
2.What were the agreed-upon goals to be met to address the concern?
The goal for the program was to facilitate maximum employment possible among participants.
3.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
It should be noted that the relatively small sample size (30 total participants in each group) made it difficult to examine patterns among different ethnic, age, and other subgroups. However, the majority of participants in both the intervention and comparison groups closely matched the demographics of the state prison population, which consists of mostly African Americans and Latinos. Both of these groups have much higher unemployment rates in the general population and have been historically underrepresented in educational programs.
4.Is there any additional information that is important to the case?
This study took place in 2006 and 2007—just prior to the global economic recession. Local and regional unemployment rates doubled in the years immediately following this period, which likely would have affected both the long-term employment of the study group and any future cohorts who later enrolled in the program. Because the participants for this program were not randomly selected, it is also highly likely that those parolees who showed the greatest promise of success were likely favored for selection in the first group.
Social Work Research: Planning a Program Evaluation
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized basic research knowledge and skills, such as study design, sampling, data collection, data analysis, writing up findings, and dissemination.
2.Which theory or theories did you use to guide your practice?
I used basic research knowledge to guide my practice.
3.What local, state, or federal policies could (or did) affect this situation?
As in any research, federal and other regulations exist regarding the ethics of the study and how research can and/or should be conducted.
Laws, declarations, and code that may apply include the U.S. Federal Policy for the Protection of Human Subjects (also known as the Common Rule), the World Medical Association’s Declaration of Helsinki, a statement of ethical principles like the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research of the U.S. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and Institutional Review Board guidelines of the institution with which the research is affiliated.
4.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Legal and ethical issues in this case centered on informed consent and the protection of human subjects. When doing research, all study participants must be fully informed about the study and the implications for them as participants. All risks must be identified and minimized. In order to implement the study, an Institutional Review Board (IRB) was asked to evaluate the ethical correctness of the study. Only after IRB approval was obtained could the study be conducted. After completion of the study, a report was submitted for IRB review and the study was closed.
5.How can evidence-based practice be integrated into this situation?
As in any empirical research, the findings from this study can contribute to evidence-based practice. The group design described in the case study could be considered a quasi-experimental research design. Such designs, while not as strong as the classical experiment, are considered strong in terms of empirical strength. They are regularly included in databases such as the Cochrane Collaboration (
www.cochrane.org
).
6.Describe any additional personal reflections about this case.
Group research designs, such as this quasi-experimental study, can require a considerable amount of resources. They need good planning and require specialized research knowledge (e.g., statistics). Nevertheless, they are very useful and play a role in advancing clinical practice in social work.
Social Work Research: Qualitative Groups
1.Which theory or theories did you use to guide your practice?
System theory, which focuses on interactions and the exchange of energy between entities, could be applied to this study. The concepts of organizational culture and climate also could be linked to the issues being faced both within and between the participating agencies.
2.What local, state, or federal policies could (or did) affect this case?
A variety of state and local policies affect the ability of organizations to effectively interact with each other. These include different eligibility criteria, client privacy and confidentiality concerns, and competition between organizations for funding and staff.
3.How would you advocate for social change to positively affect this case?
One possible strategy for the organization to advocate for greater collaboration would be to add financial incentives to both current and prospective funded agencies that implement comprehensive interagency collaborative measures. The organization could also require all of their funded and prospective network agencies to clearly articulate both their current collaborative activities and their plans for making them more comprehensive.
Social Work Research: Single Subject
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized basic research knowledge and skills, such as study design, sampling, data collection, data analysis, writing up findings, and dissemination.
2.Which theory or theories did you use to guide your practice?
I used basic research knowledge to guide my practice.
3.What local, state, or federal policies could (or did) affect this situation?
As in any research, federal and other regulations exist regarding the ethics of the study and how research can and/or should be conducted. Laws, declarations, and code that may apply include the U.S. Federal Policy for the Protection of Human Subjects (also known as the Common Rule), the World Medical Association’s Declaration of Helsinki, a statement of ethical principles like the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research of the U.S. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and Institutional Review Board guidelines of the institution with which the research is affiliated.
4.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Legal and ethical issues in this case centered on informed consent and the protection of human subjects. When doing research, all study participants must be fully informed about the study and the implications for them as participants. All risks must be identified and minimized. In order to implement the study, an Institutional Review Board (IRB) was asked to evaluate the ethical correctness of the study. Only after IRB approval was obtained could the study be conducted. After completion of the study, a report was submitted for IRB review and the study was closed.
5.How can evidence-based practice be integrated into this situation?
As in any empirical research, the findings from this study can contribute to evidence-based practice. However, single-subject designs are not considered very strong when it comes to generalizability.
6.Describe any additional personal reflections about this case.
Single-subject designs are fairly easy to implement and can provide very useful information on the case level. While their empirical strength is often considered weak, their applicability and usefulness make them a good method for clinical practice and, if following a multiple baseline design, they can provide good research data as well.
Policy
Social Policy and Advocacy: Violence Prevention
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I utilized skills in community organizing, consensus building activities, policy research, social science research, and data analysis. Micro-practice skills of reflective listening, validation, and reframing were highly effective in processing individual committee members’ concerns and interests. These skills enabled the committee to reach consensus within a reasonable time frame, and thus maintained committee member participation and interest in overall goals.
2.Which theory or theories did you use to guide your practice?
I utilized the framework of social policy analysis presented by Gilbert and Terrell.
3.What were the identified strengths of the client(s)?
The strength within the community was a willingness to collaborate and cooperate across fields. Additional strengths were having participatory school representatives and a functional education program within the local domestic violence agency.
4.What were the identified challenges faced by the client(s)?
The identified challenges faced by the community were the inconsistent delivery of necessary dating violence prevention education services across the county and the complete lack of services in many districts.
5.What were the agreed-upon goals to be met to address the concern?
The agreed-upon goals were to increase equality, efficacy, and consistency of education services across the entire county. Goals were also set to support emerging legislation that would mandate dating violence education.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
I researched the community prior to working with the prevention committee. I utilized census data and available data from school districts and municipalities to better understand socioeconomic and racial characteristics of the county.
7.What local, state, or federal policies could (or did) affect this situation?
Emerging legislation in the state had a positive effect on the committee’s work in violence prevention.
8.How would you advocate for social change to positively affect this case?
I advocated for social change by supporting state legislation requiring all public schools to implement dating violence education programs.
9.How can evidence-based practice be integrated into this situation?
Evidence-based practice can be integrated by utilizing established policy analysis frameworks and by conducting thorough research and data analysis.
10.Describe any additional personal reflections about this case.
Managing legislative and political interests of a countywide committee is a delicate process.
Social Work Agencies: Administration
1.Which theory or theories did you use to guide your practice?
Empowerment is a central mission of this organization and is integral in working with women, especially with those who have experienced trauma, so integrating this theory is essential.
2.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Legal and ethical issues include proper financial and grants management, increased transparency across the organization, and increased communication across staff and from the board of directors down.
3.Describe any additional personal reflections about this case.
Because the organization is in a state of crisis and transition, there is tremendous opportunity at present. Engaging with staff directly and with respect and following those conversations up with an action plan would help management and create trust with staff.
Social Work Policy: Children and Adolescents
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
The intervention strategies used were assessment, including a social history; consultation with school officials; advocacy; and application of laws and policies related to the placement of youths chronically absent from school, a dependent (rather than a delinquent) act.
2.What were the identified strengths of the client(s)?
The strengths of the client included good relations with her parents and sibling, no history of acting out behaviors, and an expressed willingness to address her lack of attendance at school.
3.What were the identified challenges faced by the client(s)?
This client’s challenges included a lack of social skills outside of her relations with her immediate family, an absence of peer contacts and support, and what appeared to be increasing social anxiety about leaving her home.
4.What local, state, or federal policies could (or did) affect this case?
State laws generally mandate (with minimal exceptions) that all children under the age of 16 attend school. Both federal and state laws also prohibit the placement of dependent (abused, neglected, or truant) children in facilities designated for delinquent children (those who have been found guilty of committing criminal offenses).
5.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
The legal/ethical issues related to the social worker needing to challenge the judge’s inappropriate ruling to place the child in a delinquent institution.
6.Describe any additional personal reflections about this case.
Although the social worker’s advocacy in this case resulted in a 5-day work suspension for insubordination, the social worker (the author) went on to a highly successful career in social work and higher education.
Social Work Supervision, Leadership, and Administration: The Phoenix House
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used identification of presenting issues in this situation.
2.What were the identified strengths of the client(s)?
The client’s strengths included trust, intelligence, and a history of positive behaviors.
3.What were the identified challenges faced by the client(s)?
It was challenging for the client to have been placed in an inappropriate environment.
4.How would you advocate for social change to positively affect this case?
It should be explained to Lisa that the placement may cause harm to Daniel in the long run.
5.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
We struggled with whether we could or should remove Daniel from the program against the wishes of his mother.
Social Work Supervision, Leadership, and Administration: The Southeast Planning Group
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
I used interviewing skills, qualitative data analysis, assessment, and strategic planning.
2.Which theory or theories did you use to guide your practice?
Systems/ecological theory, organizational ecology, and founder’s syndrome theory guided my practice.
3.What were the identified strengths of the client(s)?
The clients were all engaged stakeholders.
4.What were the identified challenges faced by the client(s)?
The clients were facing a transition in leadership, ineffective communication from senior management, and the shifting focus of the organization.
5.What were the agreed-upon goals to be met to address the concern?
I worked to identify partner perceptions of the planning process.
6.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Cultural competence as it related to differences in organizational culture was important. For example, the new director operated from a business approach focused on outcomes while the previous director focused more on the relational aspects of working with stakeholders. Prior to beginning work with the organization, I reviewed their annual reports, meeting minutes, and other documentation of their efforts that happened before I started working with them.
7.What local, state, or federal policies could (or did) affect this situation?
Although a specific policy did not affect the situation, the local politics of the relationships between the stakeholders that were associated with the different counties and elected officials influenced who became involved.
8.How would you advocate for social change to positively affect this case?
I would advocate that the group continue to be inclusive of the perspectives of persons from the target population and not let them get “lost” in the perspectives of service providers on the relevant issues, regardless of the leadership style used.
9.Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
It was important to maintain confidentiality of the information shared. All identifying information was removed in the reports and the data were presented in aggregate.
10.How can evidence-based practice be integrated into this situation?
Existing research on leadership, collaborative partnerships, community engagement, and strategic planning can be used to guide the process in this situation.
11.Describe any additional personal reflections about this case.
I think this case is a great example of how leadership transitions can slow the momentum of community planning efforts and negatively affect an organization’s reputation if the change and its implications are not considered and addressed proactively.
Working With Clients With Addictions: The Case of Jose
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
Interventions for this client included short-term inpatient (detoxification) services, placement in a residential SLE (sober living environment) halfway house, outpatient assessment and support at a community-based agency, and ongoing attendance at 12-step (Alcoholics and Narcotics Anonymous) programs.
2.What were the identified strengths of the client(s)?
The client’s strengths included an ongoing willingness to seek help with his addiction and his development of a support network within the recovering community.
3.What were the identified challenges faced by the client(s)?
The challenges facing this client were a well-established family history of serious chemical dependencies, multiple relapses, and a multitude of misdemeanor criminal behaviors that were primarily related to his problems with addiction.
4.Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?
Cultural competency issues included the client’s challenges in moving from one region of the country to another and the complexities of growing up in a mixed-ethnic and largely segregated environment in a region of the country with a long history of discrimination and racial tensions.
5.How can evidence-based practice be integrated into this situation?
Evidence-based practice can be used in this case by carefully measuring and tracking Jose’s response to the various interventions provided and also by assessing the circumstances that triggered his relapses.
6.Is there any additional information that is important to the case?
Substance abuse treatment programs present many challenges to professionals due to the pervasiveness of relapse, problems with confirming compliance in maintaining sobriety, lack of community resources, and the element of denial among many clients in acknowledging their problems.
Working With the Aging: The Case of Iris
1.What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?
Interventions included outpatient mental health services, participating in a post-divorce support group, securing Meals on Wheels and in-home support services, and eventual placement in an assisted living residential facility.
2.Which theory or theories did you use to guide your practice?
Theories related to this case include Erickson’s last of eight stages of psychosocial development (ego integrity versus despair), disengagement theory (which sees seniors voluntarily slowing down due to societal expectations), and activity theory (which sees a correlation between keeping active and aging well).
3.What were the agreed-upon goals to be met to address the concern?
The early agreed-upon goals for this client were to gain greater insights into her divorce and needs to develop new social support networks, and to facilitate a high level of community involvement. Later treatment approaches included antidepressant and antianxiety medications and placement in a suitable assisted living residential facility.
4.What local, state, or federal policies could (or did) affect this case?
Local, state, and federal policies affecting this case include the Social Security Act; Medicare; and the funding of programs such as Meals on Wheels, in-home support services, and community mental health centers.
5.Is there any additional information that is important to the case?
A challenge facing many older adults is the failure of most community-based mental health agencies to respond to the high levels of depression, anxiety, and suicidal behavior evident among the oldest members of society. Because seniors tend to be underserved in many such situations, it is important for social workers and other professionals to recognize these problems and to advocate for their active treatment.
References
Working With Clients With Compulsive Disorders: The Case of Marjorie
Beck, A. T. & Steer, R. A. (1991). Beck scale for suicide ideation: Manual. San Antonio, TX: Psychological Corporation.
Beck, A. T. Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
Fisher, P. L. & Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behaviour Research and Therapy, 43(12), 1543–1558.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.
Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., Simpson, H. B., American Psychiatric Association. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry, 164(7S), 5–53.
Working With Clients With Severe Persistent Mental Illness: The Case of Emily
Coleman, R. & Smith, C. (1997). Working with voices: Victim to victor. Runcorn, England: Hansell.
Working With Groups: Latino Patients Living With HIV/AIDS
Acevedo, V. (2008). Cultural competence in a group intervention designed for Latino patients living with HIV/AIDS. Health and Social Work, 33(2), 111–119.
Yalom, I. D. (1995). The theory and practice of group psychotherapy. New York, NY: Basic Books.
Working With Organizations: The Southeast Planning Group
U.S. Department of Housing and Urban Development, Office of Community Planning and Development. (2002). Evaluation of Continuums of Care for Homeless People. Retrieved from
http://www.huduser.org/Publications/pdf/continuums_of_care
Social Policy and Advocacy: Violence Prevention
Gilbert, N. & Terrell, P. (2010). Dimensions of social welfare policy (7th ed.). Boston, MA: Allyn & Bacon.
Social Work Supervision, Leadership, and Administration: The Southeast Planning Group
U.S. Department of Housing and Urban Development, Office of Community Planning and Development. (2002). Evaluation of Continuums of Care for Homeless People. Retrieved from
http://www.huduser.org/Publications/pdf/continuums_of_care
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For true-to-life cases and scenarios in this book, names, places, and details have been changed to protect the identities of the subjects. Any resemblance to real people, places, or events is purely coincidental.
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