Termination

1. Termination Chapter 11

2. LEARNING OBJECTIVES • Understand the meaning of termination • Demonstrate knowledge skill, and sensitivity in working with positive and negative client system feelings and reactions toward termination • Understand how termination may take place at micro, mezzo, and macro levels of practice • Be able to contract for an effective termination plan based on concurrent client system needs • Be able to perform the core tasks of termination

3. Lisa is 7 years and has been sexually abused. She had been seeing a psychiatrist for a long time without any clear improvement of symptoms. She then started seeing a social worker. • She improves after the first session with the social worker and on the way to the second session she turns to her foster-mother and says: "Mom, how long do we have to continue to see the social worker? Is it till I think I’m OK, or is it till he thinks I’m OK?" • Her fostermother answers that she doesn’t know and that they will have to ask the social worker. They ask the question together and the social worker looks very seriously at Lisa and assures her that it is when she feels that she is OK. She looks very relieved.

4. Oliver 30 years old, failed to attend the fourth session with his social worker. He had a history of 15 years of poly-drug abuse and several years of homelessness. By the 3rd session with his worker there was minimal change. • WHAT WOULD YOU DO AT THIS POINT? • WHAT HAPPENED IN THIS CASE? • 1 month later the worker meets him in a treatment institution for addicts where he works as a janitor. He takes her aside and explains he didn’t come back because he "decided to do it by himself". One year later he is an active partner in a self-help-program for the homeless.

5. To Terminate, When to Terminate, andHow to Terminate??? These are the ultimate questions

6. Goals achieved Problem improved Found help elsewhere Transportation problems Environmental restraints or considerations Client moving Stigma associated with accessing services Could not attend or receive services during hours they were offered Not treated in a professional manner Discomfort with worker Death of client Worker changing agencies List some Possible Reasons for Terminating…

7. What the NASW has to say… • Termination occurs for a number of reasons, including the client’s attainment of stated goals, rehabilitation, client or family noncompliance, the client or the case manager’s withdrawal, or the client’s death. • Termination also may occur because of limited service availability. In such instances, the client should be transferred to another suitable case management program, whenever possible, to ensure continuity of care. • Although an agency will set certain criteria for terminating a case, it is the responsibility of the case manager, the client, and significant others to prepare for the effects of termination. The case manager should make appropriate arrangements with the service providers and conclude the financial aspects of the case.

8. Termination • Consists of the time taken and the processes used in: • Stabilizing progress • Disengaging from the social work/client system relationship • Formally ending services.

9. Termination Commonly Involves… • Looking back to examine where one has been • Integrating and consolidating goal achievement and mastery • Mobilizing resourcefulness • Dealing with reactions to endings • Moving from the present toward a more autonomous future with enhanced strengths, assets, resources, and problem-solving ability

10. Core Termination Activities • Deciding to terminate • Reviewing progress • Reinforcing strengths-based problem-solving skills • Generalizing to the future • Addressing reactions to endings • Stabilizing change

11. Monitor the Termination Process The social work generalist reviews the present level of achievement by asking: 1.How well did the client or action system accomplish the contracted goals? 2. Has the client system achieved an adequate level of social functioning? The social work generalist reviews the future level of achievement by asking: 1. How well is the system likely to maintain this level of social functioning?

12. 3 Parts to Termination • Celebrating accomplishments • Ending the strengths-based problem-solving process • Beginning anew with stronger functioning

13. What reactions do clients and social workers experience during termination? • Reports from 59 experienced MSWs suggest that termination reactions more often include positive affect and evaluationof treatment goals and processes than negative affect. • Clinical Social Work Journal • Volume 15, Number 2 / June, 1987

14. Micro Client System Reactions In addition to celebration, ending reactions may include: • Denial • Anger • Bargaining • Depressive symptoms • Acceptance

15. Mezzo Client System Families • Ask the family unit what changes have occurred for the family as a whole and for individual members after increasing the family’s strengths-based problem-solving capacity. Groups • Ask the group members what changes have occurred for the group as a whole and for individual members given the particular purpose of the group.

16. Macro Client Systems • Review the macro work products including needs assessments, quality assurance assessments, planning reports, vision statements, grant applications, legislation, institutional rulings, or constitutions for community organizations.

17. Macro Client Systems Ask whether • The instituted changes are the planned changes • There are any unintended consequences to be addressed prior to the conclusion of their work • The changes are acceptable • The changes are sustainable with current and local resources

18. Termination • Examine the reactions of the generalist social worker to termination with the client, action, and target system. • The timing, planning, and processing of termination must be individualized according to each client system’s needs.