Intervention in Micro and Mezzo Level of Practice

1. Intervention in Micro and Mezzo Level of Practice Chapter 8

2. LEARNING OBJECTIVES • Understand that intervention is the time to carry out goals and objective specified in the contract • Understand and apply the basic principles of counseling with individuals and small groups • Understand and apply the basic principles for facilitating information and referral • Understand and apply the basic principles for engagement in crisis intervention, case management, small task group interventions, psychosocial intervention groups, and team work • Understand the basic principles underpinning different intervention modalities at micro and mezzo levels of practice

3. Intervention in Social Work • The Goal: • Empower client systems to interact and engage with their environment in healthy ways • The Means: • 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

4. Empowerment • A generative process through which disenfranchised and vulnerable are enabled to: • Mobilize resources • Exercise greater control over their environment • Meet their needs and achieve goals

5. Yes or No… • 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

6. Are you ready to work with… The mentally ill The developmentally challenged The disenfranchised The poor The outcast

7. Social Work intervention attempts to empower the client system Rescuer (Practitioner) Self Empowered person Oppressor Facilitator (Practitioner) Oppressor Victim Social Work & Empowerment (Adams 2003)

8. …Empowering the Mentally Ill http://www.t-mha.org/TheShakenTree.htm For Example…

9. Empowerment Learning Techniques • Problem-Solving • Educational Drama • Assertiveness Training • Social Skills Training • Client-centered counseling • Group Work

10. 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.

11. 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

12. Counseling • Requires: • Broad range of relationship and strengths-based problem solving strategies • Contemporary strategies and techniques used include: • Eco-maps • Sculpting • Genograms • Force-field analysis • Adolescent Grid

13. Eco-maps • 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. 

14. Eco-Map

16. Force Field Analysis • This technique gives you a way of: • Diagnosing a situation • Planning for change • Implementing a change strategy and programme.

17. Driving forces are factors that indicate an openness towards change. They are positive forces for change. • Restraining forces maintain the status quo. They hinder change. Equilibrium

18. Useful tool when working with clients on goal-setting

19. Information and Referral Occurs in social work practice when the client system does not have the information or resources necessary for problem resolution

20. 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

21. Referral • Directing clients to another resource for help with an identified problem or need • Successful referral requires: • 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

22. Making a Referral • Questions you are likely to be asked: • 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

23. Sample Referrals Forms • http://www.southwark.gov.uk/Uploads/FILE_9457.pdf • http://www.bloorview.ca/pages/documents/outpatientreferralform.doc • http://www.togethertrust.org.uk/section_nav/uploads/18949606.pdf • http://www.daisyhouse.org/DHreferralform.pdf • http://www.nenqayni.com/_images/pdf/fadpintakeassesment.pdf • http://www.vch.ca/home_page/mood/docs/MDC_Referral_Form.pdf

24. 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

25. 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

26. Crisis- good outcome Perception of event realistic Situational support adequate Coping mechanism adequate No crisis Crisis- development Perception of event distorted Situational support inadequate Coping mechanisms inadequate Crisis CRISIS INTERVENTIONBALANCING FACTORS

27. PHASES OF CRISIS PERSONALITY DISORGANIZATION (CRISIS) SEVERE ANXIETY TRIAL & ERROR SOLUTIONS USUAL COPING MECHANISMS INEFFECTIVE OR STRESS ANXIETY NEW PROBLEM- SOLVING SOLUTIONS AND SUPPORT ANXIETY PRE-CRISIS LEVEL OF FUNCTIONING

28. Crisis Intervention: Assessment • Perception of event: • What happened that prompted you to seek help?; How are you feeling now?; etc. • Coping mechanisms: • Suicidal?; Plans?; What helps you feel better?; etc. • Support systems: • With whom do you live with?; Who is available to help you?; Who is most helpful?; etc • Mental status, previous history • Identify client’s strengths • Self-assessment: Social Worker’s feelings

29. Crisis Intervention • 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: • http://brief-treatment.oxfordjournals.org/cgi/reprint/1/1/17.pdf • There are however, a number of practice and assessment tools however that can help you.

30. Sample Crisis Assessment and Intervention Tools and Plans • http://www.dhh.louisiana.gov/offices/publications/pubs-305/sq06030.pdf • http://www.mh.state.oh.us/cmtymh/soqic/manual/i030.pdf • Children’s Crisis Intervention Tool • http://ibhas.in.gov/Documents/CANS-CAT%20Indiana%20.pdf

31. Crisis Intervention Goals Social Worker • 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 Client Resource System

32. Small Group Intervention Applying methods in generalist practice to Meet group member needs Resolve targeted problems in psychosocial functioning Complete specified tasks

33. Task Groups • Small collectivities of people drawn together by mutual concerns and interested in accomplishing specific tasks

34. Tasks Groups • Intervention with task groups moves through • different phases: • Orientation • Accommodation of groups members to each other • Generation of ideas about needs and solutions • Integrative problem-solving • Task completion

35. Psychosocial Intervention Groups • Focus on enabling members to benefit from the group. • Goals: • 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

36. 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.

37. NASW Standards for Case Management

38. Commonly Involves Referral Assessment Action Plan Intervention Review

39. 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

40. Case Management Resources • Case Management in Healthcare • http://www.sswlhc.org/docs/swbest-practices.doc • Integrated Case Management • http://www.mcf.gov.bc.ca/icm/pdfs/ICM_quickref_upper_island.pdf • Case Management Society of America • http://www.cmsa.org/HOME/tabid/67/Default.aspx

41. Teamwork • 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. • The result of this is called TEAMWORK • Increasingly, dealing with clients involves coordinated and integrated service delivery across education, health and social services. • This is referred to as multidisciplinary collaboration

42. Obtaining sanctions Building a supportive team structure Identifying and maximizing the use of resources Meeting regularly Specifying task activities in relation to goals and objectives Setting up a process of monitoring and evaluation of goal accomplishments Sharing responsibilities Team Work A coordinated group service delivery process across different professional systems. Typically, effective team work involves:

43. Teamwork Phases • Clarify the problem and purpose for organizing • Share data • Agree on goals and a plan for intervention • Assign tasks • Evaluate • Terminate contact

44. Monitoring Intervention It is important to monitor and document the intervention process

45. Monitoring Intervention • Entails a variety of activities including: • Narrative documentation • Qualitative Assessment • Direct Observation • Consultation • Documentation Review • Phone Calls • Face to Face Interviews • Site Visits

46. Quantified monitoring scale • Convert the observational and narrative accounts you have of your client system intervention to a scale related quantitative measure • -1 = movement away from goal achievement • 0 = no movement • 1-2 = some progress • 3-4 = progress • 5 = goals achieved

47. Summary • Counseling, Information and Referral, Crisis Intervention, Small group intervention and case management and teamwork • Can apply more than one of the above in social work practice