Transcript No Slide Title

Intervention in Micro and Mezzo
Level of Practice
Chapter 8
LEARNING OBJECTIVES
1. Understand that intervention is the time to carry
out goals and objective specified in the contract
2. Understand and apply the basic principles of
counseling with individuals and small groups
3. Understand and apply the basic principles for
facilitating information and referral
4. Understand and apply the basic principles for
engagement in crisis intervention, case
management, small task group interventions,
psychosocial intervention groups, and team work
5. Understand the basic principles underpinning
different intervention modalities at micro and
mezzo levels of practice
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Intervention in Social Work
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The Goal:
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Empower client systems to interact and engage
with their environment in healthy ways
The Means:
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Strengthen client’s efficacy when it comes to
taking action
Develop client system critical thinking skills
Support client knowledge and skill development
Develop client support systems
Develop client’s ability to take action that leads to
change
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Empowerment
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A generative process
through which
disenfranchised and
vulnerable are enabled
to:
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Mobilize resources
Exercise greater control over
their environment
Meet their needs and achieve
goals
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Yes or No…
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Having a mentally ill friend or neighbor is OK by me.
Homosexuality is normal.
It is OK for educated homeless people to be
teachers of children.
Families with homosexual parents should be
portrayed in some children's books.
It is OK for homeless people to get legally married,
and receive the legal benefits of marriage.
It is OK for mentally ill people to raise children.
It would be OK by me if one or more of my children
were developmentally challenged
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Are you ready to
work with…
The mentally ill
The developmentally challenged
The disenfranchised
The poor
The outcast
Social Work intervention attempts to
empower the client system
Self
Empowered
person
Rescuer
(Practitioner)
Oppressor
Victim
Facilitator
(Practitioner)
Oppressor
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Social Work & Empowerment (Adams 2003)
For Example…
…Empowering the Mentally Ill
http://www.tmha.org/TheShakenTree.ht
m
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Empowerment Learning Techniques
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Problem-Solving
Educational Drama
Assertiveness Training
Social Skills Training
Client-centered counseling
Group Work
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Counseling
of the Client-Centered
Kind
We're seeing a much larger
influx here. They're not looking
for doctors or lawyer, but for
counselors and emotional
healing.
Counseling
 A strengths-based problem-solving process that
takes the form of dialogue, questions, actions,
and transactions that guide and facilitate:
 Resolution and mitigation of problems or
issues
 Acquisition or strengthening of internal
personal resources
 Development of affective coping and
adaptation
 Enhancement of well-being
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Counseling
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Requires:
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Broad range of relationship and strengths-based
problem solving strategies
Contemporary strategies and techniques
used include:
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Eco-maps
Sculpting
Genograms
Force-field analysis
Adolescent Grid
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Eco-maps
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Paper-and-pencil assessment
tool used to assess specific
troubles and plan intervention
for clients.
A drawing of the client or client
family in its social
environment.
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Eco-Map
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Force Field Analysis
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This technique gives you a way of:
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Diagnosing a situation
Planning for change
Implementing a change strategy and
programme.
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Driving forces
are factors that
indicate an
openness
towards change.
They are positive
forces for
change.
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Restraining
forces maintain
the status quo.
They hinder
change.
Equilibrium
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Useful
tool when
working
with
clients on
goalsetting
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Information and Referral
Occurs in social work practice when
the client system does not have the
information or resources necessary
for problem resolution
Information and Referral
A process in which the generalist social worker :
Clarifies the problem or need for which help is
being sought
Gathers information about appropriate and
available resources
Provides information to the client system
Discusses options for problem resolution
Examines the means through which client system
can gain access to selected service option
Facilitates means of referral
Discusses means for follow-up
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Referral
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Directing clients to another resource for
help with an identified problem or need
Successful referral requires:
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Clear and concise description of problem
Identification of available resources
Discussion of referral options with client
Planning and contracting with referral
sources
Meeting referral source with the client
Monitoring and following up on interaction
between client and referral source
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Making a Referral
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Questions you are likely to be asked:
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Does the client know about the referrals?
Demographics
Physical, Psychological, Behavioral Client Profile
Degree of risk
Family History
Environmental context
Available Supports
Major issues/problems
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Sample Referrals Forms
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http://www.southwark.gov.uk/Uploads/FILE_9
457.pdf
http://www.bloorview.ca/pages/documents/out
patientreferralform.doc
http://www.togethertrust.org.uk/section_nav/u
ploads/18949606.pdf
http://www.daisyhouse.org/DHreferralform.pdf
http://www.nenqayni.com/_images/pdf/fadpint
akeassesment.pdf
http://www.vch.ca/home_page/mood/docs/MD
C_Referral_Form.pdf
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What a Crisis?
A temporary state of upset and disorganization,
characterized by an inability to cope with a
particular situation using customary methods of
problem solving, and by the potential for a radically
positive or negative outcome
Crises…
 Occur
in everyone’s lives
 Not necessarily pathological, may
encourage growth and change
 Time limited to a brief period, 4-6 weeks
except death
 A person’s perception determines the
crisis
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CRISIS INTERVENTION
BALANCING FACTORS
Crisis- good outcome
1. Perception of event
realistic
2. Situational support
adequate
3. Coping mechanism
adequate
No crisis
Crisis- development
1. Perception of event
distorted
2. Situational support
inadequate
3. Coping mechanisms
inadequate
Crisis
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PHASES OF CRISIS
SEVERE
ANXIETY
PERSONALITY
DISORGANIZATION
(CRISIS)
TRIAL & ERROR
SOLUTIONS
STRESS
ANXIETY
USUAL COPING
MECHANISMS
INEFFECTIVE
OR
NEW PROBLEM- SOLVING
SOLUTIONS AND SUPPORT
ANXIETY
PRE-CRISIS LEVEL
OF FUNCTIONING
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Crisis Intervention: Assessment
a. Perception of event:
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What happened that prompted you to seek help?;
How are you feeling now?; etc.
b. Coping mechanisms:
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Suicidal?; Plans?; What helps you feel better?;
etc.
c. Support systems:
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With whom do you live with?; Who is available to
help you?; Who is most helpful?; etc
d. Mental status, previous history
e. Identify client’s strengths
f. Self-assessment: Social Worker’s feelings
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Crisis Intervention
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Social workers are frequently called upon to
make a rapid and accurate assessment of the
magnitude of a client's crisis state.
A single valid crisis assessment instrument
with strong psychometric properties does not
exist.
See:
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http://brieftreatment.oxfordjournals.org/cgi/reprint/1/1/17.pdf
There are however, a number of practice and
assessment tools however that can help you.
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Sample Crisis Assessment and
Intervention Tools and Plans
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http://www.dhh.louisiana.gov/offices/pub
lications/pubs-305/sq06030.pdf
http://www.mh.state.oh.us/cmtymh/soqic
/manual/i030.pdf
Children’s Crisis Intervention Tool
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http://ibhas.in.gov/Documents/CANSCAT%20Indiana%20.pdf
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Crisis Intervention Goals
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Alleviate Stressful Impact
Mobilize Client system strengths
and resources
Support client in developing
strengths-based problem-solving
skills
Assist client in regaining optimal
levels of psychosocial functioning
Social
Worker
Client
Resource
System
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Small Group Intervention

Applying methods in generalist
practice to
Meet group member needs
 Resolve targeted problems in
psychosocial functioning
 Complete specified tasks
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Task Groups
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Small collectivities of people drawn
together by mutual concerns and
interested in accomplishing specific
tasks
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Tasks Groups
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3.
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Intervention with task groups moves through
different phases:
Orientation
Accommodation of groups members to each
other
5. Generation of ideas about needs and
solutions
6. Integrative problem-solving
7. Task completion
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Psychosocial Intervention Groups
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Focus on enabling members to benefit
from the group.
Goals:
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Identify issues/problems of concern
Education
Social skills and self-efficacy development
Foster mutual support among group members
Promote strengths
Achievement of personal goals
Change behavior
Develop problem-solving skills
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Case Management
A process of actions taken by the
generalist social worker to mobilize,
bring together, and coordinate a
continuum of care of client system
services.
NASW Standards for Case Management
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Commonly Involves
Referral
Assessment
Action Plan
Intervention
Review
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Case Management
Typically, the process includes:
 Assessment of client system needs, assets, strengths,
and use of resources in relation to problems or issues
 Identification of informal and formal resources
 Enabling and empowering the client system by
promoting self-determination in making choices and
acting
 Enabling primary groups in the client system’s
environment to expand their care giving capacity
 Facilitating effective negotiations for resources
between various formal and informal systems of care
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Case Management Resources
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Case Management in Healthcare
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Integrated Case Management
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http://www.sswlhc.org/docs/swbestpractices.doc
http://www.mcf.gov.bc.ca/icm/pdfs/ICM_quickr
ef_upper_island.pdf
Case Management Society of America
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http://www.cmsa.org/HOME/tabid/67/Default.as
px
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Teamwork
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As a case manager your role will most
likely require to bring together a variety of
resources to work together in common
planning, decision making, and
consolidated action.
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The result of this is called TEAMWORK
Increasingly, dealing with clients involves
coordinated and integrated service delivery
across education, health and social
services.
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This is referred to as multidisciplinary
collaboration
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Team Work
A coordinated group service delivery process
across different professional systems. Typically,
effective team work involves:
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Obtaining sanctions
Building a
supportive team
structure
Identifying and
maximizing the use
of resources
Meeting regularly
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Specifying task
activities in relation
to goals and
objectives
Setting up a process
of monitoring and
evaluation of goal
accomplishments
Sharing
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responsibilities
Teamwork Phases
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Clarify the problem and purpose for
organizing
Share data
Agree on goals and a plan for
intervention
Assign tasks
Evaluate
Terminate contact
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Monitoring Intervention
It is important to monitor and
document the intervention process
Monitoring Intervention
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Entails a variety of activities including:
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Narrative documentation
Qualitative Assessment
Direct Observation
Consultation
Documentation Review
Phone Calls
Face to Face Interviews
Site Visits
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Quantified monitoring scale
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Convert the observational and narrative
accounts you have of your client system
intervention to a scale related quantitative
measure
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-1 = movement away from goal achievement
0 = no movement
1-2 = some progress
3-4 = progress
5 = goals achieved
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Summary
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Counseling, Information and
Referral, Crisis Intervention,
Small group intervention and
case management and
teamwork
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Can apply more than one of the
above in social work practice
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