Intervention Processes and Techniques

Question 1

What are some interview techniques?

Answer 1

Universalization: The generalization or normalization of behaviour

Clarification: reformulate problem in a client’s words to make sure that the SW is understanding (paraphrasing?)

Confrontation: calling attention to something

Interpretation: Pulling together patterns of behaviour to get a new understanding

Reframing & Relabelling: stating a problem in a different way so a client can see possible solutions

Question 2

How should a SW use interpreters?

Answer 2

• Not appropriate to use family to interpret as valuable information may be missed
  - SW should speak direclty to client not interpreters

Question 3

What are the 6 steps of problem solving (EAPIET?)

Answer 3

1. Engagement
2. Assessment
3. Planning
4. Intervention
5. Evaluation
6. Termination

Question 4

What is done during the engagement phase?

Answer 4

SW should be involved in determining why treatment was sought, what has precipitated the desire to change, the parameters of the helping relationship (defining roles), and expectations for treatment (what will happen and when)

Question 5

What is done during the assessment phase?

Answer 5

Client is source of info to define problem & solutions as well as identifying collateral sources

Question 6

What is done in the planning phase?

Answer 6

○ Must develop common understanding of client’s preferred lifestyle, this is where goals come from
Specific action plans are developed & agreed upon to specify who does what, what and how resources will be needed and used, and timelines for implementation and review

Question 7

What is done in the Intervention phase?

Answer 7

○ Client involved in mobilizing support network & must bring up issues that threaten goal attainment
Progress based on client reports must be tracked, plans adjusted accordingly

Question 8

What is done in the evaluation phase?

Answer 8

○ Subjective reports of client + objective indicators used to determine whether goals have been met & new ones should be set
Client self-monitoring is a good way to help a client see and track their progress

Question 9

What is done in the termination phase?

Answer 9

○ Client should reflect on what has been achieved and have supports in place if problem arises again
Still requires active involvement even though it’s the last step

Question 10

What cultural considerations should an intervention plan include?

Answer 10

• Should include: identification of cross-cultural barriers which may hinder a client’s engagement/progress in treatment
  - Also an ethical mandate to take info learned when working with individual clients and adapt agency resources to meet others who may have similar cultural considerations/language needs

Question 11

What culture provide/influence in the assessment/intervention processes?

Answer 11

• Should understand & validate each client’s cultural norms, beliefs and values, areas that can be greatly influenced:
  ○ Identification of strengths & problems
  ○ Goals & objectives
  ○ Modalities of treatment
  
  • Culture can provide strengths in the intervention process:
    ○ Supportive family & community relations
    ○ Community and cultural events and activities
    ○ Faith & spiritual/religious beliefs
    ○ Multilingual capabilities
    ○ Healing practices & beliefs
    ○ Participation in rituals *religious, cultural, familial, spiritual, community
    - Dreams & aspirations

Question 12

How can culture affect intervention?

Answer 12

• Client must feel safe to explore their problems within their cultural context, intervention will also be most effective in this situation
  
  • The following should be considered given their cultural appropriateness:
    ○ Individual vs. group treatment
    ○ Alternative treatment approaches (yoga, aromatherapy, music, writing)
    ○ Medication (western, traditional, alternative)
    ○ Family involvement
    ○ Location/duration of intervention
  • Different cultures & communities exhibit/explain symptoms in various ways - important to be aware of relevant contextual info stemming from client’s cultures, races, ethnicities, religious affiliations/geographical origins to more accurately diagnose & treat problems
  • Specific diagnostic criteria changed in DSM 5 to better apply across diverse cultures
    Cultural Formulation Interview Guide included to help SW assess cultural factors influencing client’s perspectives

Question 13

Criteria used in selecting intervention/treatment modalities

Answer 13

• Client/Client System, Abilities, Culture, Life stage
  
  • Intervention plan is developed by consulting the relevant practice research and flexibly implementing an approach to fit a client’s needs and circumstances
    ○ Driven by assessment data
    ○ Theories inform SW about what skills, techniques and strategies must be used - which are then outlined in an intervention plan
    An intervention plan should be reviewed during intervention, at termination and if possible after termination to make adjustments, ensure progress, and determine sustainability of change after treatment

Question 14

Components of Intervention, Treatment, & Service Plans

Answer 14

• Goals of intervention and means to achieve them are incorporated in a contractual agreement between client & SW
  
  • Can be informal or written
    
    • Contract (intervention plan) specifies problem(s) to be worked on, goals to reduce problems, clients & SW roles, interventions or techniques to be employed, means of monitoring progress, stipulations for renegotiating the contract, time, place, fee, and frequency of meetings

Question 15

What are psychotherapies, what do they do + examples

Answer 15

• Aims to treat clients with mental disorders/problems by helping them understand their illness or situation
  
  • Use verbal techniques to teach clients strategies to deal with stress, unhealthy thoughts, and dysfunctional behaviours
  • Should not use a one size fits all approach
  • Some have been tested more than others for particular disorders
    ○ CBT used for depression, anxiety & other disorders
    - DBT developed to treat people with suicidal thoughts and actions - now used for BPD as well

Question 16

What is the impact of immigration, refugee, or undocumented status on service delivery?

Answer 16

• Immigration law is complex and changes often, quite exclusionary at the moment & has turned to conflating criminality with undocumented status (US mostly but not exclusively)
  
  • Federal jurisdiction
  • Professional SW standards support immigration & refugee policies that uphold and support equity and human rights - can cause dilemmas for SW working within restrictive policies
    
    • Important to understand legal & political as well as psychological and social issues surrounding immigration

Question 17

What are some reasons discharge may occur?

Answer 17

○ Client may have met their goals & no longer needs services
○ Decides to not continue with a particular SW or in general
- Requires a different level of care

Question 18

What should be considered around termination according to the NASW?

Answer 18

○ Should terminate services to clients & professional relationships when no longer required or no longer serve client needs or interests
○ Should take reasonable steps to avoid abandoning clients who are still in need of services - should withdraw services precipitously only in unusual circumstances and after considering all factors. Appropriate arrangements for continuation of services should be made when necessary
○ SW in fee-for-service settings may terminate services who are not paying an overdue balance if financial contractual obligation has been made clear, if they don’t pose imminent danger to self or others, and if clinical consequences of current nonpayments have been addressed and discussed
○ Should not terminate services to pursue a social, financial, or sexual relationship with the client
○ SW who anticipate the termination or interruption of services hsould notify clients promptly and seek the transfer, referral or continuation of services and benefits
§ It is unethical to continue to treat clients when services are no longer needed or in their best interests
○ SW should make reasonable efforts to ensure continuity of services in the event services are interrupted by unavailability, relocation, illness, disability, or death
○ Must involve clients & their families (when appropriate) in making decisions about follow up services/aftercare - at minimum a discussion of preferences
- Quick return of clients suggests that they did not receive needed follow up or services were inadequate, termination may have occurred prematurely
- Those are risk of developing problems after services have ended should receive regular assessments after discharge to determine whether services are needed or discharge plans are being implemented as planned

Question 19

What are the stages of change? (Transtheoretical Model)

Answer 19

1. Precontemplation - denial ignorance
2. Contemplation - ambivalence, conflicted emotion
3. Preparation - experimenting with small changes, collecting info about change
4. Action - taking direct action toward achieving goal
5. Maintenance - maintaining a new behaviour, avoiding temptation
6. Relapse - feelings of frustration & failure

Question 20

What is the core of the helping process?

Answer 20

The relationship between SW and client. Expressed through interaction both verbally and non-verbally

Question 21

What are some techniques of building and maintaining a helping relationship

Answer 21

• Helping is based on acceptance of a client’s situation and ability of them to make changes if desired
  - SW is to assist in this process and influence them in further autonomy, understanding, effectiveness and skill
  
  • SW cannot be useful in helping others unless they understand and are willing to accept the difficulties that all human beings encounter in trying to meet their needs
  • The potential for all the weakness and strength known to humanity exists at some level in every person
  • Recognize the + & - aspects of each client and how that will influence change & goal attainment
    
    • Both a client and social worker have objectives as well as their own thoughts, feelings and attitudes – both have power to influence the situation

Question 22

What does the process of engagement include?

Answer 22

• During engagement, limits to confidentiality must be explicitly stated at the start
  
  • SW must explain their roles & how they can assist clients in addressing their problems
  • It is important to consider how a client feels about coming for help & to deal with negative client feelings - must be willing to discuss these openly because very little can be changed until negative feelings are addressed
  • A working alliance between SW & client should be established
  • SW should express hopefulness that change can occur
    
    • Resistance may occur during this stage, if clients are resistant to engage, SW should clarify the process or specify that will happen and discuss this ambivalence

Question 23

What is the client’s role in the problem solving process?

Answer 23

• Client’s often feel that their problems are unique and that no one could understand them
  ○ May even enjoy this, as a defense against exploring their fears of being like others
  
  • Some concerns over whether SW can really be trusted - generally afraid of what others may think of them and can stem from childhood experiences
  • Client may only be looking for sympathy, support, and or empathy rather than searching for a new way to solve difficulties - may not seen that change needs to occur
    
    • When a SW points out how the client contributes to their problems - they have stopped listening. Solving the problem often requires a client to uncover some aspects that they have avoided thinking about

Question 24

What is the problem solving model?

Answer 24

• Problem-Solving approach is based on the belief that an inability to cope with a problem is due to some lack of motivation, capacity, or opportunity to solve problems in an appropriate way
  ○ Client’s problem-solving capacities or resources are maladaptive or impaired
  - Goal is to enhance client mental, emotional, and action capacities for coping with problems and/or making accessible the opportunities and resources necessary to generate solutions to problems

Question 25

What are short term interventions + examples

Answer 25

- Vary greatly in duration - Research suggests that SW & client's views on time of treatment is more important than duration of treatment itself - Ex: ○ Crisis intervention ○ Cognitive behavioural model Psychoanalysis started out short term - can be short or long

Question 26

How does a SW engage & motivate clients?

Answer 26

- Want to create doubt that everything is okay and help client's recognize consequences of current behaviours of conditions that contribute to dissatisfaction - Sometimes clients are incapacitated by conditions that need to be addressed first (depression for ex.) - Role is to create an atmosphere that is conducive to change and to increase client's intrinsic motivation so that change arises from within instead of being imposed externally

Question 27

Engagement & Motivation techniques?

Answer 27

``` ○ Clearly identifying the problem or risk area ○ Explaining why change is important ○ Advocating for specific change ○ Identifying barriers and working to remove them ○ Finding the best course of action ○ Setting goals ○ Taking steps toward change ○ Preventing relapse - Empathy ```

Question 28

How do SW engage/motivate involuntary clients?

Answer 28

- Ex. Families in child protection system, those in CJS - May want no contact or only participate because they feel like they have no choice - Often requires SW to have peer support or supervision to process struggles & reassert themselves because clients may test or direct anger at SW

Question 29

What are some methods to engage/motivate involuntary clients?

Answer 29

○ Acknowledging clients’ circumstances and understanding how they came about given clients’ histories ○ Listening to clients’ experiences in order to try to understand how they feel about intervention ○ Engaging in clear communication because involuntary clients struggle to understand what is happening to them ○ Making clear what the purpose of the intervention is, what clients have control over and what they do not, what is going to happen next, and what the likely consequences will be if they do not participate ○ Assisting at an appropriate pace as progress may be slow ○ Building trust, even on the smallest scale, by consistently being honest and up-front about the situation and why a social worker is involved ○ Giving clients practical assistance when needed to help them fight for their rights ○ Paying attention to what is positive in clients’ behavior and celebrating achievements - Showing empathy and viewing clients as more than the problems that brought them into services

Question 30

What are 10 methods to obtain & provide feedback?

Answer 30

1. Feedback may be verbal or nonverbal so SW must try to see what clients are trying to convey verbally or via their behaviour and nonverbal cues in order to see whether interventions should be altered 2. When SW involve consultants or others in the feedback process related to client care, clients should provide consent 3. SW should ask for feedback in difficult circumstances - not just in neutral/positive ones. Difficult feedback should be talked through with supervision as well 4. Feedback is especially critical at key decision points (when transferring/closing cases) 5. Important to guard against influencing people to respond in a particular way - can be unintentional due to power/influence of SW over client 6. Confidentiality should be respected when informant wants it 7. Always be clear about why feedback is needed and what will be done with the information 8. Documentation of feedback is essential 9. Be aware that feedback may be very different depending upon when it is solicited - critical to realize how recent events may influence information - multiple different times may be helpful 10. SW must make sure that the communication method is appropriate - online for younger, face to face for older, jargon free and language, culture, disability may affect the ways in which people both understand and react to requests for feedback

Question 31

What are principles of Active Listening & Observation?

Answer 31

- Can be achieved by showing interest in client's words - communication will be more open - Speaking using mirroring techniques to paraphrase and reflect back to clients what has been said - In macro intervention - with key policy influences, community members etc. - As an observer - SW can take many roles - complete participant (living experience), participant as observer (removed from activity)

Question 32

What are some verbal & nonverbal communication techniques?

Answer 32

- Active Listening - Silence - Questioning - Reflecting/validating - Paraphrasing/Clarifying - Reframing - Empathy

Question 33

Define Active Listening

Answer 33

body language, sitting straight, leaning in, relaxed and open (not crossed legs/arms), commenting on statements, asking open ended questions, making statements

Question 34

Define Silence

Answer 34

by social workers, can show acceptance of clients’ feelings and promotes introspection or time to think about what has been learned (very effective when used with a client who is displaying a high degree of emotion).

Question 35

Define Questioning

Answer 35

using open- and closed-ended formats to get relevant information in a non-judgmental manner.

Question 36

Define Reflecting/Validating

Answer 36

to show empathetic understanding of clients’ problems. These techniques can also assist clients in understanding negative thought patterns.

Question 37

Define Paraphrasing/Clarifying

Answer 37

social workers rephrase what clients are saying in order to join together information. Clarification uses questioning, paraphrasing, and restating to ensure full understanding of clients’ ideas and thoughts.

Question 38

Define Reframing

Answer 38

social workers show clients that there are different perspectives and ideas that can help to change negative thinking patterns and promote change.

Question 39

Define Empathy

Answer 39

denotes understanding the ideas expressed as well as the feelings of a client ○ Differs from sympathy in that sympathy denotes pity or feeling bad for a client ○ To be empathetic, a SW must accurately perceive a client's situation, perspective and feelings as well as communicate this understanding in a helpful way Establishing boundaries to create a safe environment for change

Question 40

What are 2 of the other core conditions?

Answer 40

Genuineness: needed in order to establish a therapeutic relationship - involves listening and communicating without distorting messages, being clear and concrete Unconditional Positive Regard: ability to view a client as being worthy of caring about and as someone who has strengths and achievement potential. Built on respect and usually communicated nonverbally. Listening, Attending, Suspending Value Judgements, and Helping

Question 41

What are some limit setting techniques?

Answer 41

- Facilitative as clients DO NOT feel safe or accepted in a completely permissive environment - Compassion is important but so is maintaining the relationship, understanding and maintaining boundaries is essential

Question 42

What is Role Play?

Answer 42

- Teaching strategy that can happen between supervisor and supervisee or SW & client - Usually raises interest in a topic as clients are not passive recipients - Teaches empathy and understanding of different perspectives as clients take on the role of another, learning and acting as that individual would in the specified setting - Helps embed concepts, gives clarity - Emphasizes personal concerns, problems, behaviour and active participation - Improves interpersonal communication skills

Question 43

What new skill has role modelling been helpful with?

Answer 43

Assertiveness

Question 44

What does role modelling do?

Answer 44

- Emphasizes importance of learning from observing and imitating and has been used successfully in helping clients acquire new skills - Works well when combined with role play & reinforcement

Question 45

What are some types of role modelling?

Answer 45

○ live modeling: watching a real person perform the desired behaviour ○ symbolic modeling: filmed or videotaped models demonstrating the desired behaviour. Self-modeling is another form in which clients are videotaped performing the target behaviour ○ Participant modeling: individual models anxiety-evoking behaviours for a client and then prompts client to engage in the behaviour - Covert modeling: clients are asked to use their imagination, visualizing a particular behaviour as another describes the imaginary situation in detail

Question 46

What are the two different categories of role modelling?

Answer 46

- Can be presented as coping or mastery models ○ Coping model is shown as initially fearful or incompetent and then gradually becomes comfortable/competent - Mastery model shows no fear and is competent from the beginning of the demonstration

Question 47

What are some methods to obtain sensitive information?

Answer 47

- Start with open ended, nonthreatening questions to gather background and get a client used to talking about their situation before disclosing sensitive material - Gives client time to "test the waters" w/ SW & gauge their reaction - Trust often needed before complete honesty - Be aware of verbal & non-verbal cues - may avoid eye contact, fail to answer a question, look down when speaking, laugh nervously when anxious - SW may want to repeat question/probe further into this area to see if something undisclosed is causing this behaviour - Client engaged in couple/family/group treatment may worry about the confidentiality of revealing sensitive information as well as reactions of others to such disclosure - explore individual treatment - SW may want to review the professional mandate for confidentiality & what info will be stored in the file - Client may be reluctant to reveal sensitive info if they think there could be negative repercussions or lack of security - Much more likely to disclose if SW reacts to disclosures with acceptance and a neutral stance rather than judgement, and not interrupting

Question 48

What is the harm reduction approach?

Answer 48

any program, policy, intervention that seeks to reduce or minimize the adverse health & social consequences associated with an illness, condition, and/or behaviour such as substance use without requiring a client to practice abstinence, discontinue use or completely extinguish the behaviour

Question 49

What are key concepts in harm reduction?

Answer 49

- Complements prevention because it is based on the acceptance that despite best efforts clients will engage in behaviours and are unwilling to stop on command - Clients may prefer non-clinical methods to reduce consumption/risks - Harm Reduction is practical, feasible, effective, safe, and cost-effective - HR acknowledges the significance of ANY positive change that a client makes in their lives - Recognizes that intervention can be seen as a continuum

Question 50

What are some methods to teach coping & self care to clients?

Answer 50

- Recognizing how their histories have shaped them - Needs associated with medical/behavioural health conditions - Developmental issues related to various phases across the lifespan - Workings of systems in which they operate - Ways of coping in various situations ** Can collaborate/inform clients of colleagues that can assist with more formal teaching such as learning to read, obtaining a drivers license etc.

Question 51

What are some client self-monitoring techniques?

Answer 51

- Clients may keep thought or emotion logs that include 3 components 1. Disturbing emotional states 2. Exact behaviours engaged in at the time of emotional states 3. Thoughts that occurred when the emotions emerged In CBT homework is often done between sessions to record these encounters, client self monitoring is central to this approach

Question 52

What can a SW do in crisis?

Answer 52

- Need to address distress, impairment, and instability by operating in a logical & orderly process - Comprehensive plans allow for responses that are active & directive but do not take problem ownership away from clients Should meet clients where they are at, assessing their levels of risk, mobilizing client resources, and moving strategically to stabilize crisis and improve functioning

Question 53

Again, what are the 7 stages of what SW should do to promote crisis stabilization, resolution & mastery?

Answer 53

1. Plan and conduct a thorough biopsychosocial and lethality/imminent danger assessment 2. Make psychological contact and rapidly establish the collaborative relationship 3. Identify the major problems, including crisis precipitants 4. Encourage an exploration of feelings and emotions 5. Generate and explore alternatives and new coping strategies 6. Restore functioning through implementation of an action plan 7. Plan follow-up and “booster” sessions.

Question 54

What are 4 methods of conflict resolution?

Answer 54

1. Recognition of an existing or potential conflict 2. An assessment of the conflict situation 3. The selection of an appropriate strategy 4. Intervention

Question 55

What can a SW do when all other methods of conflict resolution has failed?

Answer 55

- When previous attempts have only escalated conflicts, a useful technique is to structure interactions between parties: 1. Decreasing the amount of contact between the parties in the early stages of conflict resolution 2. Decreasing the amount of time between problem-solving sessions 3. Decreasing the formality of problem-solving sessions 4. Limiting the scope of the issues that can be discussed 5. Using a third-party mediator

Question 56

What does Crisis intervention require?

Answer 56

- Crisis is time limited - most last 4-6 weeks - Directive & requires high levels of activity and involvement from SW - Sets specific goals to increase a client's sense of mastery & control - Brief intervention during crisis usually provides maximum therapeutic effect - Process of actively influencing the psychosocial functioning of clients during a period of disequilibrium or crisis Does NOT need to be precipitated by a major life event

Question 57

What are the goals of crisis intervention?

Answer 57

○ Relieve the impact of stress with emotional & social resources ○ Return a client to a previous level of functioning (equilibrium) ○ Help strengthen coping mechanisms during crisis period ○ Develop adaptive coping strategies >>> Focus is on the here and now

Question 58

What physical problems can lack of control over anger control?

Answer 58

heart disease, stress related illness, insomnia, digestive issues, headaches

Question 59

What are some anger management techniques?

Answer 59

``` Relaxation Exercises ○ Deep breathing ○ Meditation/repeating calming words/phrases ○ Guided imagery ○ Yoga ○ Stretching/physical exercise ``` Cognitive Techniques ○ Replacing destructive thoughts with healthy ones ○ Focusing on goals as a way of finding solutions to problems ○ Using logic to get a more balanced perspective ○ Not using an all or nothing approach ○ Putting situations into perspective Communication Skills ○ Slowing down speech to avoid saying something not meant or regrettab;e ○ Listening to what others are saying ○ Thinking about what you say before speaking ○ Avoiding defensiveness ○ Using humour to lighten the situation Environmental Change ○ Walking away or leaving situation ○ Avoiding people/situations in the future that evoke anger Not starting conversations/situations that may cause anger when tired or rushed

Question 60

What are some stress management techniques?

Answer 60

- Stress is a psychological/physical reaction to life events - most people experience it regularly 1. Monitor stress levels & identify stress triggers - Can be major life events but also associated with day to day life: job, relationship, finances - Positive events: getting a job promotion, married, children can also be stressful 2. Assist clients in identifying what aspects of a situation they can control As well as using stress-reduction techniques - deep breathing, exercise, massage, tai chi, yoga, etc.

Question 61

What are goals of Cognitive & Behavioural interventions & what do they do?

Answer 61

- CBT is a hands on, practical approach to problem solving - Goal is to change patterns of thinking/behaviour that are responsible for client's difficulties and change the way they feel - Works by changing attitudes and behaviour by focusing on thoughts, images, beliefs and attitudes that are held (cognitive processes) and how this relates to behaviour as a way of dealing with emotional problems Combo of psychotherapy and behavioural therapy - Approach is active, collaborative, structured, time limited, goal oriented and problem focused Brief treatment, well delineated techniques, goal & problem oriented, empirically supported evidence of effectiveness

Question 62

What is psychotherapy?

Answer 62

emphasizes the importance of the personal meaning & how thinking patterns begin in childhood

Question 63

What is behavioural therapy?

Answer 63

therapy pays attention to relationship between problems, behaviours and thoughts

Question 64

What are the 5 steps in cognitive restructuring?

Answer 64

1. Accepting that their self-statements, assumptions, and beliefs determine or govern their emotional reaction to life’s events 2. Identifying dysfunctional beliefs and patterns of thoughts that underlie their problems 3. Identifying situations that evoke dysfunctional cognitions 4. Substituting functional self-statements in place of self-defeating thoughts 5. Rewarding themselves for successful coping efforts *** Self-Monitoring is foundational

Question 65

What can a SW do to facilitate empowerment?

Answer 65

○ Establish a relationship aimed at meeting a client’s needs and wishes such as access to social services and benefits or to other sources of information ○ Educate a client to improve his or her skills, thereby increasing the ability for self-help ○ Help a client to secure resources, such as those from other organizations or agencies, as well as natural support networks, to meet needs - Unite a client with others who are experiencing the same issues when needed to enable social and political action

Question 66

What are 3 change strategies & what do they do?

Answer 66

Modify systems: The decision to help a client on a one-to-one basis or in the context of a larger system must take into consideration a client’s preferences and previous experiences, as well as the degree to which a client’s problem is a response to forces within the larger system and whether change can be readily attained by a change in the larger system. Modify individual thoughts: A social worker may teach how to problem solve, alter his or her self-concepts by modifying self-defeating statements, and/or make interpretations to increase a client’s understanding about the relationship between events in his or her life. Modify individual actions: A social worker may use behavior modification techniques such as reinforcement, punishment, modeling, role playing, and/or task assignments. Modeling and role modeling are very effective methods for teaching. They should be used whenever possible.

Question 67

How can thoughts and behaviours be modified?

Answer 67

Thoughts can be modified by feedback from others and behaviors can be modified through the actions of others in a system (by altering reinforcements).

Question 68

What are two social work roles in facilitating change?

Answer 68

- A social worker can also advocate for a client and seek to secure a change in a system on his or her behalf. - A social worker can be a mediator by helping a client and another individual or system to negotiate with each other so that each may attain their respective goals.

Question 69

Define Partializing

Answer 69

Partialization: assist a client to break down problems/goals into less overwhelming and more manageable components -- breaking complex issues into simpler ones - Useful because it may assist a SW & client to identify goals that are easier to achieve first - enabling client to see change more quickly and gain success in making harder changes - Can help individuals to order problems/goals that need more immediate help (prioritizing) - Can use Maslow's Hierarchy to assist in making decisions about more pressing needs - Additionally, a client should be asked to prioritize their concerns or goals

Question 70

What is assertiveness training?

Answer 70

- When procedures are used to teach clients how to express their positive & negative feelings and to stand up for their rights in ways that will not alienate others ○ Typically begins with clients thinking about areas in life where they have difficulty asserting themselves ○ Then moves to role plays designed to help clients practice clearer and more direct forms of communicating with others - feedback is provided to improve responses - Promotes the use of I statements to help clients express feelings ○ Tells others how their actions may cause clients to be upset but less blaming/aggressive than you statements - Techniques like self-observation skills, awareness of personal preferences and assuming personal responsibility are more important components

Question 71

What is the task centered approach?

Answer 71

- Aims to quickly engage clients in problem-solving and maximize their responsibility for treatment outcomes - Duration of treatment usually limited due to setting constraints, limitations imposed by 3rd party payers, etc. - Expectation is that interventions from learning theory and behaviour modification will be used to promote completion of a well-defined task to produce measurable outcomes - Often preferred by clients as they see immediate results - Problem partialized into clearly delineated tasks to be addressed consecutively - Client must be able to identify a precise psychosocial problem and a solution confined to a specific change in behaviour/circumstances - Client must also be willing to work on problem - SW style must be highly active, empathic and sometimes directive - Termination begins almost immediately upon onset of treatment

Question 72

What are psychoeducation models?

Answer 72

- Ex. Acknowledging, supporting, normalizing - Providing information necessary to make informed decisions that will allow them to reach their respective goals - Also provides support and coping skills development - Provided to those who are experiencing some sort of issue/problem with the rationale that with a clear understanding of the problem, self-knowledge or strengths, community resources, and coping skills, clients are better equipped to deal with problems & contribute to their emotional well being - CORE principle is that education has a role in emotional & behavioural change With an improved understanding of the causes and effects of problems, psychoeducation broadens client's perceptions & interpretations of them -- feel less helpless & more in control

Question 73

What is group work?

Answer 73

Group Work: working with 2+ people for personal growth, enhancement of social functioning, for the achievement or socially desirable goals - Individuals remain the focus of concern and the group is the vehicle of growth and change - When individual problems arise they are directed to the group for possible solutions SW must remind group members that confidentiality cannot be guaranteed though it should try to be

Question 74

What are contraindications for groups?

Answer 74

client in crisis, suicidal, compulsively needy for attention, actively psychotic/paranoid

Question 75

Groups can be ___ or ___

Answer 75

Open: New members can join at any time or Closed: All members begin the group at the same time Short term or long term

Question 76

What happens at the beginning, middle, and end of groups?

Answer 76

Beginning: SW identifies purpose of the group and their role - Time to convene, organize, set a plan - Members likely distant, removed until they have had time to develop relationships Middle: Almost all group work occurs during this stage - Relationships strengthened as a group so tasks can be worked on - Group leaders less involved End: Group reviews accomplishments, feelings associated with termination addressed

Question 77

What are family therapy models, interventions, & approaches

Answer 77

- Not just treating an individual but all those in the family unit - focus of assessment & intervention is directed at the interaction of family members - Treats family as a unified whole - system of interacting parts in which any change affects the functioning of the overall system - Social roles & interpersonal interaction are the focus of treatment - Behaviours and communication that affect current life situations are addressed Goal is to interrupt circular pattern of pathological communication and behaviours and replace it with a new pattern

Question 78

What MUST a SW do in family therapy?

Answer 78

1. Understand the development of, as well as the historical, conceptual, and contextual issues influencing, family functioning 2. Have awareness of the impact of diversity in working with families, particularly race, class, culture, ethnicity, gender, sexual preference, aging, and disabilities 3. Understand the impact of a social worker’s family of origin, current family structure, and its influence on a social worker’s interventions with families 4. Be aware of the needs of families experiencing unique family problems (domestic violence, blended families, trauma and loss, adoptive families, etc.)

Question 79

What are key clinical issues of family therapy?

Answer 79

- Establishing a contract with the family - Examining alliances within the family - Identifying where power resides - Determining the relationship of each family member to the problem - Seeing how the family relates to the outside world - Assessing influence of family history on current family interactions - Ascertaining communication patterns - Identifying family rules that regulate patterns of interaction - Determining meaning of presenting symptom in maintaining family homeostasis - Examining flexibility of structure and accessibility of alternative action patterns - Finding out about sources of external stress and support

Question 80

What are the 3 types of Family therapy?

Answer 80

1. Strategic Family Therapy 2. Structural Family Therapy 3. Bowenian Family Therapy

Question 81

What is strategic family therapy?

Answer 81

- SW initiates what happens during therapy, designs a specific approach for each person's presenting problem, and takes responsibility for directly influencing people - Roots in structural family therapy and built on communication theory - Active, brief, directive & task-centered - More interested in behaviour change than change in understanding - Based on the assumption that families are flexible enough to modify solutions that don't work and adjust - Assumes all problems have multiple origins - Presenting problem is viewed as a symptom of and response to current dysfunction in family interactions - Therapy focuses on problem resolution by altering the feedback cycle that maintains symptomatic behaviour SW task is to formulate the problem in solvable, behavioural terms and to design and intervention plan to change the dysfunctional family pattern

Question 82

What are concepts/techniques of strategic family therapy?

Answer 82

○ Pretend technique—encourage family members to “pretend” and encourage voluntary control of behavior ○ First-order changes—superficial behavioral changes within a system that do not change the structure of the system ○ Second-order changes—changes to the systematic interaction pattern so the system is reorganized and functions more effectively ○ Family homeostasis—families tend to preserve familiar organization and communication patterns; resistant to change ○ Relabeling—changing the label attached to a person or problem from negative to positive so the situation can be perceived differently; it is hoped that new responses will evolve Paradoxical directive or instruction—prescribe the symptomatic behavior so a client realizes he or she can control it; uses the strength of the resistance to change in order to move a client toward goals

Question 83

What is structural family therapy?

Answer 83

- Stresses the importance of family organization for the functioning of the group and the well-being of its members - SW "joins" (engages) the family in an effort to restructure it - Family structure is defined as the invisible set of functional demands organization interaction among family members

Question 84

How do boundaries & rules control families in Structural Family Therapy?

Answer 84

- Boundaries & rules determining who does what, where and when are crucial in 3 ways: 1. Interpersonal boundaries define individual family members and promote their differentiation and autonomous yet interdependent functioning - Dysfunctional families tend to be characterized by either a pattern of rigid enmeshment or disengagement 2. Boundaries with the outside world define the family unit, but boundaries must be permeable enough to maintain a well-functioning open system, allowing contact and reciprocal exchanges with the social world 3. Hierarchical organization in families of all cultures is maintained by generational boundaries - Rules differentiating parents & child roles, rights and obligations Restructuring is based on observing & manipulating interactions within therapy sessions, often by enactments of situations as a way to understand and diagnose the structure & provide opportunity for restructuring

Question 85

What is Bowenian Family Therapy?

Answer 85

- Unlike other models, goal is not symptom reduction but rather improving the intergenerational transmission process - Consistent whether working with an individual, couple, or entire family Assumed that improvement in overall functioning will ultimately reduce a family members symptomatology

Question 86

What are the 8 major theoretical constructs of Bowenian Family Therapy?

Answer 86

Differentiation: CORE CONCEPT! The more differentiated, the more a client can be an individual while in emotional with the family Emotional Fusion: counterpart of differentiation, refers to the tendency for family members to share an emotional response. - Result of poor interpersonal boundaries between family members, in a fused family there is little room for emotional autonomy Multigenerational Transmission: stresses the connection of current generation to past generations as a natural process - Gives historical context that can focus the SW on the differentiation in the system and on the transmission process Emotional Triangle: Network of relationships among 3 people. - Bowen's theory states that a relationship can remain stable until anxiety is introduced - Almost impossible for 2 people to interact without triangulation Nuclear Family: Most basic unit in society - concern over degree to which emotional fusion can occur Family Projection Process: Primary way that parents transmit their emotional problems to children - Projection process can impair child functioning and increase vulnerability to clinical symptoms Sibling Position: factor in determining personality. Where a client is in birth order has an influence on how they relate to their parents & siblings. Determines the triangles that clients grow up in Societal Regression: in contrast to progression, is manifested by problems such as the depletion of natural resources. Can be used to explain social anxieties and social problems because Bowen viewed society as a family -- an emotional system with its own multi-generational transmission, chronic anxiety, emotional triangles, cutoffs, projection processes and fusion/differentiation struggles

Question 87

Define Permanency planning

Answer 87

Permanency Planning: an approach to child welfare that is based on the belief that children need permanence to thrive - CPS should focus on getting children into and maintaining permanent homes Legislation in the US promotes permanency planning & creates mandates related to child placements

Question 88

What are the goals of permanency planning?

Answer 88

- First goal is to get children back into their original homes ○ Can be achieved with a thorough investigation into child protection situations to determine if homes are safe and if needed, exploring ideas for making them safer or more enriching for children ○ Supports can include: caregiver services, education If they can't return to their original homes, steps need to be made so that they can get into permanent living situations as quickly as possible with adults with whom they have continuous and reciprocal relationships, including those made available through adoption

Question 89

What kind of service do SW provide the bulk of in the US?

Answer 89

Mental Health Services. - Significant number of people seek services expecting providers to be aware and knowledgeable about alternatives and complements to Western medical approaches for symptom relief and healing Increasing # seeking Complementary & Alternative Medicine (CAM) or integrated health care (IHC)

Question 90

Define Mindfulness

Answer 90

Mindfulness: practice of paying close attention to what is being experienced in the present both inside the body and mind and in the external world - conscious effort to be with whatever is going on at the moment - Being awake, aware and accepting of ourselves - Integral to efforts to reduce stress and increase capacity to cope Can stand alone as treatment or be incorporated with other treatments

Question 91

What are the components of Case Management?

Answer 91

- Based on the belief that clients often need assistance in accessing services in today's complex systems as well as the need to monitor duplication and gaps in services - Clients may have a specific need met in one program & many related needs ignored because of lack of coordination - Systems are highly complex, fragmented, duplicative, and uncoordinated Primary goal of case management is to optimize client functioning and well-being by providing & coordinating high-quality services in the most effective manner possible to those with multiple complex needs

Question 92

What are the 5 activities of Case Management?

Answer 92

5 Activities (APLMA) - Assessment - Planning - Linking - Monitoring - Advocacy

Question 93

What techniques can be used for follow up?

Answer 93

- Follow up meeting often important to ensure change maintenance - many clients continue to progress after termination and this is a chance to acknowledge and encourage continuation - Can mitigate unanticipated difficulties - Allow for longitudinal evaluation of practice effectiveness - Must not be intrusive or send the message that clients cannot function on their own - Clients who have difficulty terminating may use follow-up meetings as ways to prolong SW-client relationship beyond what is needed - Have to be clear boundaries & goals for follow up - Any NEW problems should be seen for assessment

Question 94

Define Case Presentation

Answer 94

When a SW communicates with others in order to ensure comprehensive and complete care for clients

Question 95

What are case presentations and when are they used?

Answer 95

- Used in professional development & learning to provide input into options for treatment & ensure services are being delivered effectively & efficiently - No universal format but some standard elements: ○ Identifying data - demographics, cultural considerations ○ History of presenting problem (family history) ○ Significant medical/psych history (diagnoses) ○ Significant personal/social history (legal issues, academic/work problems, crisis/safety concerns) ○ Presenting problem (assessment, mental status, diagnosis) ○ Impressions & Summary (interview findings) ○ Recommendations (treatment plan/intervention strategies, goals, theoretical models) Content can be added/eliminated based on reason for pres.

Question 96

What are methods of service delivery

Answer 96

- To meet needs, SW must have work environments that support ethical practice & are committed to standards & quality services - A + working environment is created where values & principles of SW are reinforced in agency policies & procedures - Employers must understand SW practice, provide supervision, workload management, and continuing PD with best practices - SW should never be required to do something that would put their ability to uphold ethical standards at risk (confidentiality, consent, safety/risk management) - policies should be clear - The public should be clear on policy & procedures & know how to make complaints/raise concerns - Must be policies that do not tolerate dangerous, discriminatory, and or exploitative behaviour - Policies on workload & caseload management contribute to provision of quality services - Continuing PD and further training lets SW strengthen & develop skills, orientation and other training when hired is essential - Regular, quality supervision is necessary Rates of pay need to be comparable with similar professionals, skills & qualifications must be recognized

Question 97

Define Policy analysis

Answer 97

Policy Analysis: a systematic approach to solving problems through policies - Identifying problem, developing alternatives, assessing impacts of alternatives (cost/benefit), selecting desired option, designing & implementing policy & evaluating outcomes - Critical is the identification of alternative policy options & evaluation of these options ○ Includes identifying who benefits & who doesn't Often many stakeholders - government, community leaders, clients -- all of which have their own values

Question 98

What are theories & methods of advocacy?

Answer 98

- Advocacy one of SW most important tasks - have an ethical mandate to make systematic changes to address the problems experience by vulnerable people - Can occur at all levels - Fundamental is advocating to change the factors that create & contribute to problems - May engage in getting legislative support or using media attention - SW should be working with clients to have their voices heard, NOT speaking for them - Must inform clients of appeal processes Goal of SW advocacy is to assist clients to strengthen their own skills in this area - can assist by locating sources of power that can be shared with clients to make changes

Question 99

Define community organizing

Answer 99

Community Organizing: focused on harnessing the collective power of communities to tackle issues of shared concern - Challenges government, corporations, and other power-holding institutions in an effort to tip power balance more in favour of communities - Essential to understand sources of power to access them for betterment of the community - Organizing members to focus these sources of power on problems & mobilizing resources to assist is critical ○ Coercive: power from control of punishment ○ Reward: power from control of rewards ○ Expert: power from superior ability or knowledge ○ Referent: power from having charisma or identification with others who have power ○ Legitimate: power from having legitimate authority ○ Informational: power from having information - Enhances participatory skills of citizens - develops leadership with emphasis on ability to conceptualize and act on problems Strengthens communities to better deal with future problems - develop capacity

Question 100

Define social planning

Answer 100

Social Planning: the process by which a group/community decides its goals & strategies relating to societal issues - Not limited to gov, but includes activities of private sector, social movements, professions etc - Models of social planning in SW are based on community participation rather than planning "for" communities - engage "with" SW can help facilitate process of planning at all stages: organizing community members, data gathering related to the issue (economic, political, social causes), problem identification, weighing alternatives, implementation, evaluation

Question 101

What are techniques for mobilizing community participation?

Answer 101

- Community participation informs others about needed changes that must occur - Policies, programs, & services that were effective or appropriate previously may have become ineffective or inappropriate - Creates relationships & partnerships among diverse groups Puts decision making partly/wholly with the community - ensuring involvement

Question 102

What are the stages of community participation?

Answer 102

1. Orientation Stage: community members meet and start to get to know each other 2. Conflict Stage: Disputes, little fights, arguments, eventually worked out 3. Emergence Stage: members begin to see & agree on a course of action 4. Reinforcement stage: members make a decision and justify why it was correct

Question 103

What are methods to develop & evaluate measurable objectives

Answer 103

- For clients/systems in intervention, treatment &/or service plans - May be benchmarks that must be learned to reach the ultimate goal - Objectives break down goals into discrete components or subparts Criteria: What behaviour must be exhibited, how often, over what period of time & under what conditions to demonstrate achievement of goal? Method for evaluation: How will progress be measured? Schedule for evaluation: When, how often, and on what dates or intervals of time will progress be measured

Question 104

What are techniques to evaluate progress?

Answer 104

- Can be simple or complex - Can rely on quantitative (data in behaviour reduction, health improvement, symptom decrease) or qualitative - Should gather all needed info & identify factors that helped or hindered the progress - SW should assist clients in understanding the progress they made to clearly understand and celebrate their accomplishments & identify areas that need attention Should understand WHY progress happened & what needs to happen to ensure growth continues

Question 105

What is Primary prevention?

Answer 105

Primary Prevention: goal is to protect people from developing a disease, experience injury, engage in behaviour in the first place - Typically considered most cost-effective Ex: ○ Immunizations ○ Education on seatbelts & helmets ○ Screenings to identify illness risk factors ○ Controlling hazards in workplace & at home ○ Regular exercise & good nutrition Counselling about dangers of subtances

Question 106

What is secondary prevention?

Answer 106

Secondary Prevention: occurs after disease, injury, illness. Aims to slow progression or limit long-term impacts. Often implemented when asymptomatic but risk factors are present. May also focus on preventing reinjury Ex. ○ Telling those with heart conditions to take daily, low-dose aspirin ○ Screening for those with risk factors for illness Modifying work assignments for injured workers

Question 107

What is Tertiary prevention?

Answer 107

Tertiary Prevention: focuses on managing complicated, long-term disease, injury, illness. Goal is to prevent further deterioration and maximize QOL because disease is now established and primary prevention unsuccessful. - Early detection through secondary intervention may have minimized impact of disease Ex: ○ Pain management groups ○ Rehab programs Support Groups'

Question 108

What are the stages of a comprehensive ethics audit?

Answer 108

1. Appointing a committee or task force of concerned and informed staff and colleagues 2. Gathering information from agency documents, interviews with staff and clients, accreditation reports, and other sources to assess risks associated with client rights; confidentiality and privacy; informed consent; service delivery; boundary issues; conflicts of interest; documentation; client records; supervision; staff development and training; consultation; client referral; fraud; termination of services; professional impairment; misconduct, or incompetence; and so on 3. Reviewing all collected information 4. Determining whether there is no risk, minimal risk, moderate risk, or high risk in each area 5. Preparing action plans to address each risk, paying particular attention to policies that need to be created to prevent risk in the future and steps needed to mitigate existing risk 6. Monitoring policy implementation and progress made toward reducing existing risk, as well as ensuring that procedures adhere to SW's core ethical principles

Question 109

What is the impact of violence on the helping relationship

Answer 109

- Common thread in all abusive relationships is the abuser's need for power & control over their partner - DV occurs across all demographics - Signs are varied: ○ Suspicious injury ○ Somatic complaints without a specific diagnosis (chronic pain) ○ Behavioural presentation (crying, minimizing, no emotional expression, anxious/angry, defensive, fearful eye contact) ○ Controlling/Coercive behaviour of partner (hovering, overly concerned, wont leave client unattended, client defers to partner, fear of speaking in front of partner/disagreeing - Often learn abusive behaviour from family of origin, peers, media, personal experience - View victims as possessions and treat them like objects - very self centered and feel entitled to have their needs met no matter what - Have control over their impulses but give themselves permission to be abusive - Victims dehumanized to justify battering Leaving is a process, over time client realizes abuser wont change, each time they try to leave they gather more info

Question 110

What is social exchange theory?

Answer 110

Social Exchange Theory: based on idea of totalling potential benefits & losses to determine behaviour

Question 111

What is the Cycle of Violence?

Answer 111

1. Tension Building 2. Battering incident - shortest period 3. "Loving-contrition" - absence of tension "honeymoon", batterer offers profuse apologies, assures attacks will never happen again, declares love

Question 112

Why do some clients stay in violent relationships?

Answer 112

- Hope that the abuser will change. If the batterer is in a treatment program, the client hopes the behavior will change; leaving represents a loss of the committed relationship - Isolation and lack of support systems - Fears that no one will believe the seriousness of abuse experienced - Abuser puts up barricades so client won’t leave the relationship (escalates threats of violence, threatens to kill, withholds support, threatens to seek custody of children, threatens suicide, etc.) - Dangers of leaving may pose a greater danger than remaining with the batterer Client may not have the economic resources to survive on his or her own

Question 113

What are some guidelines for interventions in violent relationships?

Answer 113

Ø Guidelines for Interventions - Traditional marital/couples therapy is not appropriate in addressing abuse in the family. Puts victims in greater danger of further abuse - Medical needs & safety are priority - consider hierarchy of needs Trust is a major issue in establishing therapeutic alliance

Question 114

What are indicators of Readiness for termination?

Answer 114

- When meetings become uneventful and tone more cordial than challenging - No new ground discovered for several sessions In termination: ○ Evaluate degree to which goals have been attained ○ Acknowledge and address issues related to end of relationship Plan for subsequent steps a client may take relevant to the problem that don't involve SW -- seeking out new service

Question 115

What is a formative evaluation?

Answer 115

examine the process of delivering services - Ongoing, allow for feedback to be implemented during service delivery - Allow changes as needed to achieve goals Ex. Needs assessments

Question 116

What is a summative evaluation?

Answer 116

examine outcomes, occur at end of services & provide overall description of effectiveness - Determins if objectives were met - Enable decisions to be made about future services Ex. Impact eval, cost-benefit analysis

Question 117

What is evidence based practice?

Answer 117

- Combines research knowledge, professional/clinical expertise, SW values & client preferences - Dynamic and fluid, evaluate best current practices to make decisions - Places well being of clients at forefront - providing best service possible - Requires SW only use services & techniques found effective by rigorous, scientific, empirical studies - outcome research Programs with proven track records - CBT - takes a long time to become evidence based

Question 118

What are some questions that can help guide selection of an intervention modality?

Answer 118

- How will the recommended modality assist with the achievement of the treatment goal and will it help get the outcomes desired? - How does the recommended treatment modality promote client strengths, capabilities, and interests? - What are the risks and benefits associated with the recommended modality? - Is there research or evidence to support the use of this modality for this target problem? - Is this modality appropriate and tested on those with the same or similar cultural background as the client? - What training and experience does a social worker have with the recommended modality? - Is the recommended modality evidence-based or consistent with available research? If not, why? - Was the recommended modality discussed with and selected by a client? - Will the use of the recommended modality be assessed periodically? When? How? - Is the recommended treatment modality covered by insurance? What is the cost? How does it compare to the use of other options?