Intervention Processes and Techniques for Use Across Systems (7)

Role playing activities can be divided into four stages:

1.Preparation and explanation of the activity 2.Preparation of the activity 3.Role playing 4.Discussion or debriefing after the role play activity

METHODS OF CONFLICT RESOLUTION Management of conflict entails four steps:

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

Many treatment techniques are used with individuals that can be adapted in work with couples, including: Insight-oriented psychotherapy

A good deal of time is spent studying interactions between individuals in order to develop a hypothesis concerning what caused individuals to react to each other in the way they do.

METHODS AND APPROACHES TO TRAUMA-INFORMED CARE

A good trauma-informed approach is multidimensional.

In order to work effectively with families, social workers must:

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.)

Steps in Cognitive Restructuring Assist clients in:

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 Foundational to this treatment is client self-monitoring. Clients are encouraged to pay attention to any subtle shift in feelings. Clients frequently keep thought or emotion logs that include three components: (a) disturbing emotional states, (b) the exact behaviors engaged in at the time of the emotional states, and (c) thoughts that occurred when the emotions emerged. Homework is often done between sessions to record these encounters.

When previous attempts to resolve a conflict have only escalated the conflict, a useful technique is to structure the interactions between the parties. Structuring techniques include:

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

Four things are critical in consultation:

1.Defining the purpose of the consultation 2.Specifying the consultant's role 3.Clarifying the nature of the problem 4.Outlining the consultation process

A social worker engages in the problem-solving process via the following steps:

1.Engaging 2.Assessing (includes a focus on client strengths and not just weaknesses) 3.Planning 4.Intervening 5.Evaluating 6.Terminating

METHODS TO OBTAIN AND PROVIDE FEEDBACK Cont.

1.Feedback may be either verbal or nonverbal, so social workers must make efforts to see what clients are trying to convey verbally or via their behavior and nonverbal cues in order to see whether interventions should be altered. 2.When social workers involve consultants or others in the feedback process related to client care, clients should provide consent. 3.Social workers should ask for feedback in difficult circumstances—not just when circumstances appear neutral or positive. It can be tempting only to ask for feedback from people who will say something positive. Sometimes the best learning can be from those who will be critical. Talking through difficult feedback in supervision is important. 4.Feedback is especially critical at key decision points (such as when transferring or closing cases). 5.It is important to guard against influencing people to respond in a particular way; this influence may be unintentional, because a social worker may have more influence or power than the individual from whom feedback is sought. 6.Confidentiality should be respected if the 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 the feedback may be very different depending upon when it is solicited. It is critical to realize how recent events may have influenced information received. Getting feedback repeatedly at several different times may be needed to see if responses differ. 10.A social worker must make sure that the communication method is appropriate. For a younger person, texting, email, or an online questionnaire may work, whereas a face-to-face conversation may be needed for others. The language should be jargon free and issues such as language, culture, and disability may affect the ways in which people both understand and react to requests for feedback. A social worker may want to use close-ended questions and/or open ones to capture needed data.

Structural Family Therapy Boundaries and rules determining who does what, where, and when are crucial in three 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, the rules differentiating parent and child roles, rights, and obligations. Restructuring is based on observing and manipulating interactions within therapy sessions, often by enactments of situations as a way to understand and diagnose the structure and provide an opportunity for restructuring.

There are ethical standards that must be followed when evaluating practice (NASW Code of Ethics, 2008—5.02 Evaluation and Research). Some of these guidelines include:

1.Obtaining voluntary and written informed consent from clients, when appropriate, without any implied or actual deprivation or penalty for refusal to participate; without undue inducement to participate; and with due regard for participants' well-being, privacy, and dignity 2.Informing clients of their right to withdraw from evaluation and research at any time without penalty 3.Ensuring clients in evaluations have access to appropriate supportive services 4.Avoiding conflicts of interest and dual relationships with those being evaluated

TECHNIQUES FOR HARM REDUCTION FOR SELF AND OTHERS

A harm reduction approach refers to any program, policy, or intervention that seeks to reduce or minimize the adverse health and social consequences associated with an illness, condition, and/or behavior, such as substance use, without requiring a client to practice abstinence, discontinue use, or completely extinguish the behavior. This definition recognizes that many clients are not unwilling or unable to abstain from behaviors or use at any given time and that there is a need to provide them with options that minimize the harm caused by their condition to themselves, to others, and to the community. Harm reduction complements prevention approaches because it is based on the acceptance that, despite best efforts, clients will engage in behaviors such as substance use, and are unable or unwilling to stop using substances at any given time. In addition, clients who use substances may prefer to use informal and nonclinical methods to reduce their consumption or reduce the risks associated with use. Harm reduction is practical, feasible, effective, safe, and cost-effective. Most harm reduction approaches are inexpensive, easy to implement, and have a high impact on individual and community health. Harm reduction acknowledges the significance of ANY positive change that clients make in their lives; these interventions are designed to "meet clients where they are" currently. Harm reduction recognizes that intervention can be seen as a continuum with the more feasible options at one end and less feasible, but desirable, ones at the other end. Though desirable, abstinence can be considered difficult to achieve. Thus, social workers should partner with clients to identify actions that can be taken to minimize impacts of their illnesses, conditions, and/or behaviors.

METHODS TO ENGAGE AND MOTIVATE CLIENTS/CLIENT SYSTEMS

A motivational approach aims to help clients realize what needs to change and to get them to talk about their daily lives, as well as their satisfaction with current situations. Social workers want to create doubt that everything is "OK" and help clients recognize consequences of current behaviors or conditions that contribute to dissatisfaction. It is much easier if clients believe goals can be achieved and life can be different. Sometimes clients are incapacitated by conditions that need to be addressed first (i.e., depression). Social workers can help clients think of a time when things were better or create a picture of what their lives could look like with fewer stresses. The role of a social worker is to create an atmosphere that is conducive to change and to increase a client's intrinsic motivation, so that change arises from within rather than being imposed from without.

CLIENT/CLIENT SYSTEM CONTRACTING AND GOAL-SETTING TECHNIQUES

A social worker and client work together to develop a contract (intervention or service plan), including an agreement on its implementation or the activities used to help a client attain his or her goals. Modification of the contract may be required as new information about a client's situation emerges and/or as the situation changes. When clients seek to attain their goals, changes may need to be made to themselves, groups, families, and/or systems in the larger environment. This choice of targets is an even more complex issue than it first appears because the process of changing one system may bring about changes in others.

Group process Beginning

A social worker identifies the purpose of the group and his or her role. This stage is characterized as a time to convene, to organize, and to set a plan. Members are likely to remain distant or removed until they have had time to develop relationships.

Change Strategies 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.

Change Strategies 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.

CRISIS INTERVENTION AND TREATMENT APPROACHES

A state of crisis is time limited. Brief intervention during a crisis usually provides maximum therapeutic effect. Crisis intervention is a process of actively influencing the psychosocial functioning of clients during a period of disequilibrium or crisis. A crisis does not need to be precipitated by a major life event. The goals are to alleviate stress and mobilize coping skills, psychological capabilities, and social resources. The goals of crisis intervention are to (a) relieve the impact of stress with emotional and social resources, (b) return a client to a previous level of functioning (regain equilibrium), (c) help strengthen coping mechanisms during the crisis period, and (d) develop adaptive coping strategies. Crisis intervention focuses on the here and now, is time limited (most crises last from 4 to 6 weeks), is directive, and requires high levels of activity and involvement from a social worker. A social worker sets specific goals and tasks in order to increase a client's sense of mastery and control.

TASK-CENTERED APPROACHES

A task-centered approach aims to quickly engage clients in the problem-solving process and to maximize their responsibility for treatment outcomes. In this modality, the duration of treatment is usually limited due to setting constraints, limitations imposed by third-party payers, or other reasons. Thus, at the outset, the expectation is that interventions from learning theory and behavior modification will be used to promote completion of a well-defined task to produce measurable outcomes. The focus is on the "here and now." This type of practice is often preferred by clients, as they are able to see more immediate results. The problem is partialized into clearly delineated tasks to be addressed consecutively (assessment leads to goals, which lead to tasks). A client must be able to identify a precise psychosocial problem and a solution confined to a specific change in behavior or a change of circumstances. A client must also be willing to work on the problem. It is essential that a social worker and client establish a strong working relationship quickly. A social worker's therapeutic style must be highly active, empathic, and sometimes directive in this approach. Assessment focuses on helping a client identify the primary problem and explore the circumstances surrounding the problem. Specific tasks are expected to evolve from this process. Consideration is given to how a client would ideally like to see the problem resolved. Termination, in this modality, begins almost immediately upon the onset of treatment.

THE PRINCIPLES OF ACTIVE LISTENING AND OBSERVATION

Active listening skills are an essential part of building relationships and trust. The active part in the listening process can be achieved by showing interest in clients' words. Once clients notice that social workers are understanding what is said and really taking an interest, communication will be more open. Active listening establishes trust and respect, so clients will feel comfortable confiding in social workers. Thus, it helps build a therapeutic alliance. Active listening can also include speaking by using mirroring techniques to paraphrase and reflect back to clients what they have just said. For example, a client may say, "I hate my job and my boss yells at me all the time." An active listening response might involve saying something such as, "So you feel like your boss doesn't appreciate you or treat you with respect." Responses need to be tailored to what clients are saying to demonstrate listening and engagement in what is being said. Although most information that a social worker uses during assessment comes from the social work interview, direct observation of interactions between family members and the client's nonverbal behavior can produce a lot of information about emotional states and interaction patterns. Social workers also may use observation as part of macrolevel intervention in order to assess the extent of a problem/issue, driving and restraining forces for change, key policy influencers, and community members who can work as part of a task group for reform. When functioning as an observer, a social worker can take many roles, including complete participant (living the experience as a participant), participant as observer (interacting with those who are participating), observer as participant(limited relationship with others participating—primarily observer), or complete observer (removed from activity—observer only). Observation is also a method used in scientific inquiry to collect data.

METHODS TO ENGAGE AND WORK WITH INVOLUNTARY CLIENTS/CLIENT SYSTEMS Some methods that can be helpful in working with involuntary clients include:

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

There are many verbal and nonverbal communication methods, including:

Active listening, - in which social workers are sitting up straight and leaning toward clients in a relaxed and open manner. Attentive listening can involve commenting on clients' statements, asking open-ended questions, and making statements that show listening is occurring. Silence - by social workers, which 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). Questioning - using open- and closed-ended formats to get relevant information in a nonjudgmental manner. Reflecting or validating - to show empathetic understanding of clients' problems. These techniques can also assist clients in understanding negative thought patterns. Paraphrasing and clarifying - by social workers to 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. Reframing - by social workers shows clients that there are different perspectives and ideas that can help to change negative thinking patterns and promote change. Exhibiting desirable facial expressions, - which include direct eye contact if culturally appropriate, warmth and concern reflected, and varied facial expressions. Using desirable postures or gestures, - which include appropriate arm movements and attentive gestures.

Group process Middle

Almost all of the group's work will occur during this stage. Relationships are strengthened as a group so that the tasks can be worked on. Group leaders are usually less involved.

ANGER MANAGEMENT TECHNIQUES

Although everyone gets angry, clients may come to social workers because they are not able to control their anger, causing problems. Anger can also increase risk for developing physical health problems, such as heart disease, stress-related illnesses, insomnia, digestive issues, and/or headaches.

ASSERTIVENESS TRAINING

Assertiveness training is when procedures are used to teach clients how to express their positive and negative feelings and to stand up for their rights in ways that will not alienate others. Assertiveness training typically begins with clients thinking about areas in their life in which they have difficulty asserting themselves. The next stage usually involves role plays designed to help clients practice clearer and more direct forms of communicating with others. Feedback is provided to improve responses, and the role play is repeated. Clients are asked to practice assertive techniques in everyday life. Assertiveness training promotes the use of "I" statements as a way to help clients express their feelings. "I" statements tell others how their actions may cause clients to be upset, but are in contrast with "you" statements, which are often seen as blaming or aggressive. Learning specific techniques and perspectives, such as self-observation skills, awareness of personal preferences, and assuming personal responsibility, are important components of the assertiveness training process.

Many treatment techniques are used with individuals that can be adapted in work with couples, including:

Behavior modification—Successful couples counseling methods will address and attempt to modify any dysfunctional behavior so that couples can change the way each individual behaves with the other. Insight-oriented psychotherapy—A good deal of time is spent studying interactions between individuals in order to develop a hypothesis concerning what caused individuals to react to each other in the way they do. There are also specific couples therapy approaches, including the Gottman Method, which is based on the notion that healthy relationships are ones in which individuals know each other's stresses and worries, share fondness and admiration, maintain a sense of positiveness, manage conflicts, trust one another, and are committed to one another. The Gottman Method focuses on conflicting verbal communication in order to increase intimacy, respect, and affection; removes barriers that create a feeling of stagnancy in conflicting situations; and creates a heightened sense of empathy and understanding within relationships. With all approaches, there are actions that a social worker can take to facilitate effective couples' treatment. For example, when developing a collaborative alliance with each person, a social worker should validate the experience of each and explore each person's reservations about engaging in couples therapy. In addition, when developing an alliance with the couple as a unit, a social worker can reframe individual problems in relationship terms and support each person's sense of himself or herself as being part of a unit, as well as a separate individual.

THE COMPONENTS OF CASE MANAGEMENT

Case management has been defined in many ways. However, all models are 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 treatment and care. Although there may be many federal, state, and local programs available, there are often serious service gaps. A client might have a specific need met in one program and many related needs ignored because of the lack of coordination. Systems are highly complex, fragmented, duplicative, and uncoordinated. Social workers provide case management services to different client populations in both nonprofit and for-profit settings. The primary goal of social work case management is to optimize client functioning and well-being by providing and coordinating high-quality services, in the most effective and efficient manner possible, to individuals with multiple complex needs (NASW Standards for Social Work Case Management, 2013). Five case management activities are (a) assessment, (b) planning, (c) linking, (d) monitoring, and (e) advocacy.

CASE RECORDING FOR PRACTICE EVALUATION OR SUPERVISION

Case records are often an excellent source of information for evaluating the impacts of services. They are existing sources of data, so there is no additional cost or time associated with their collection. However, there are a few limitations. If looking at records completed by multiple workers, there may be inconsistencies in recording styles or details that may impact on the evaluation. Also, information of interest may not be contained in the records; evaluations would need to be limited to only information that is explicitly stated, which may not reflect all progress that has been made. In addition, the opinions about how a client views both the process and outcome of service delivery are also critical and may not be fully captured in the record. Ensuring that a client's views are the center of any practice evaluation is critical. Thus, a social worker may want to use the case record as one source of information, but include others as well, to ensure all aspects of a client's care, including satisfaction with services, are included. Social workers engaged in formal evaluation beyond that used to determine individual client progress should obtain voluntary and written informed consent from clients regarding the use of their records without any penalty for refusal to participate or undue inducement to participate (NASW Code of Ethics, 2008—5.02 Evaluation and Research). Review of case records by supervisors is also essential. This review will ensure that a social worker is documenting properly and recording information in an unbiased manner. Clients must understand and consent to supervisory review of records. When reviewing information, supervisors should adhere to the same standards of confidentiality as a social worker. The supervisor should not review the records unless it is for the betterment of a client and only within the supervisory context to ensure the quality of services. If the supervisor is a consultant, a client must consent unless there is a compelling need for such disclosure.

There are many methods that social workers use to facilitate communication with clients.

Central to the formation of a therapeutic alliance is displaying empathy. Empathy is distinguished from sympathy as the latter denotes pity or feeling bad for a client, whereas the former means that a social worker understands the ideas expressed, as well as the feelings of a client. To be empathetic, a social worker must accurately perceive a client's situation, perspective, and feelings, as well as communicate this understanding in a helpful (therapeutic) way. A social worker should also display genuineness in order to build trust. Genuineness is needed in order to establish a therapeutic relationship. It involves listening to and communicating with clients without distorting their messages, as well as being clear and concrete in communications. Another method is the use of positive regard, which is the ability to view a client as being worthy of caring about and as someone who has strengths and achievement potential. It is built on respect and is usually communicated nonverbally. Communication is also facilitated by listening, attending, suspending value judgments, and helping clients develop their own resources. A social worker should always use culturally appropriate communication. It is also essential to clearly establish boundaries with clients to facilitate a safe environment for change.

Motivation is a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. Some additional techniques include:

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 is a factor that increases motivation, lowers resistance, and fosters greater long-term behavioral change.

CLIENT/CLIENT SYSTEM SELF-MONITORING TECHNIQUES

Clients are encouraged to pay attention to any subtle shift in feelings. Clients frequently keep thought or emotion logs that include three components: (a) disturbing emotional states, (b) the exact behaviors engaged in at the time of the emotional states, and (c) thoughts that occurred when the emotions emerged. In cognitive behavioral therapy, homework is often done between sessions to record these encounters. This homework involves client self-monitoring, which is central to this approach.

LIMIT SETTING TECHNIQUES

Clients of all ages are frequently desperate for an environment with consistent boundaries. For this reason, it is helpful if social workers can learn limit-setting skills. Limit setting is facilitative as clients do not feel safe or accepted in a completely permissive environment. In addition, although compassion is important for a social worker, it is important to maintain a client-social worker relationship. Understanding boundaries and being able to maintain those boundaries with clients are essential.

COGNITIVE AND BEHAVIORAL INTERVENTIONS

Cognitive behavioral therapy (CBT) is a hands-on, practical approach to problem solving. Its goal is to change patterns of thinking or behavior that are responsible for clients' difficulties, and so change the way they feel. CBT works by changing clients' attitudes and their behavior by focusing on the thoughts, images, beliefs, and attitudes that are held (cognitive processes) and how this relates to behavior, as a way of dealing with emotional problems. CBT can be thought of as a combination of psychotherapy and behavioral therapy. Psychotherapy emphasizes the importance of the personal meaning placed on things and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the relationship between problems, behaviors, and thoughts. This approach is active, collaborative, structured, time limited, goal oriented, and problem focused. This approach lends itself to the requirements posed by managed care companies, including brief treatment, well-delineated techniques, goal and problem oriented, and empirically supported evidence of its effectiveness.

THE CONCEPT OF CONGRUENCE IN COMMUNICATION

Communication can be verbal and nonverbal, so an assessment of clients' communication skills must involve both. Role playing is a good way to assess and enhance clients' communication skills. It also allows a social worker to see if there is congruence between nonverbal and verbal communication. Congruence is the matching of awareness and experience with communication. It is essential that a client is able to express himself or herself and that this communication is reflective of his or her feelings. Congruence is essential for the vitality of a relationship and to facilitate true helping as part of the problem-solving process.

METHODS TO DEVELOP AND EVALUATE MEASURABLE OBJECTIVES FOR CLIENT/CLIENT SYSTEM INTERVENTION, TREATMENT, AND/OR SERVICE PLANS When social workers are creating intervention or service plans, it is essential that goals are written in observable and measurable terms. In order to achieve this aim, the following should be included in each goal contained in the intervention or service plan.

Criteria: What behavior must be exhibited, how often, over what period of time, and under what conditions to demonstrate achievement of the 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? There may also be benchmarks or the intermediate knowledge, skills, and/or behaviors that must be learned/achieved in order for a client to reach his or her ultimate goal. Objectives break down the goals into discrete components or subparts, which are steps toward the final desired outcome.

For example, social workers may help clients see:

How their histories have shaped them Needs associated with medical and/or behavioral health conditions Developmental issues related to various phases across the lifespan The workings of systems in which they operate Ways of coping in various situations A social worker must use the problem-solving process to teach clients skills needed to make changes in their lives. In addition, social workers may collaborate with or inform clients of colleagues who may also assist with more formal teaching, such as learning to read, obtaining a driver's license, and so on.

Bowenian Family Therapy Eight major theoretical constructs:

Differentiation - is the core concept of this approach. The more differentiated, the more a client can be an individual while in emotional contact with the family. This allows a client to think through a situation without being drawn to act by either internal or external emotional pressures. Emotional fusion - is the counterpart of differentiation and refers to the tendency for family members to share an emotional response. This is the result of poor interpersonal boundaries between family members. In a fused family, there is little room for emotional autonomy. If a member makes a move toward autonomy, it is experienced as abandonment by other members of the family. Multigenerational transmission - stresses the connection of current generations to past generations as a natural process. Multigenerational transmission gives the present a context in history. This context can focus a social worker on the differentiation in the system and on the transmission process. An emotional triangle - is the network of relationships among three people. Bowen's theory states that a relationship can remain stable until anxiety is introduced. However, when anxiety is introduced into the dyad, a third party is recruited into a triangle to reduce the overall anxiety. It is almost impossible for two people to interact without triangulation. The nuclear family - is the most basic unit in society and there is a concern over the degree to which emotional fusion can occur in a family system. Clients forming relationships outside of the nuclear family tend to pick mates with the same level of differentiation. Family projection process - describes the primary way parents transmit their emotional problems to children. The projection process can impair child functioning and increase vulnerability to clinical symptoms. Sibling position - is a factor in determining personality. Where a client is in birth order has an influence on how he or she relates to parents and siblings. Birth order 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. Bowen's theory can be used to explain societal anxieties and social problems, because Bowen viewed society as a family—an emotional system complete with its own multigenerational transmission, chronic anxiety, emotional triangles, cutoffs, projection processes, and fusion/differentiation struggles.

PARTIALIZING TECHNIQUES

During the problem-solving process, a social worker may need to assist a client to break down problems or goals into less overwhelming and more manageable components. This is known as partialization and aims to break complex issues into simpler ones. Partialization is useful because it may assist a social worker and a client to identify the goals that are easier to achieve first, enabling a client to see results more quickly and gain some success in making harder changes. Partialization can also help individuals to order the problems or goals that need more immediate help from those that can be addressed later. A social worker can use Maslow's hierarchy of needs as one tool to assist in making decisions about more pressing needs. In addition, a client should be asked to prioritize his or her concerns or goals.

The following list includes several elements that indicate a good, trauma-informed program:

Environment of Care - Soothing colors for decor and paint - Overall quiet; soft music - Neutral or pleasant aroma - Individual chairs with discrete seating areas - Individual bathroom options Staff Appearance - Attire connotes professionalism; easy to identify staff members - Clothing not sexually provocative Staff Behavior - Clearly demonstrate proper manners and respect - Make every effort to minimize delays - Speak in clear, nonthreatening tones - Make eye contact - Smile and demonstrate a generally pleasant demeanor - Open physical stance, nodding - Open to change/not rigid Organizational Understanding - Trauma policy/philosophy in place - Commitment to trauma-informed care articulated - All staff/clients/family members taught about trauma and its impact - Universal trauma screenings for all clients - Trauma status continually assessed - Clear organization plan for dealing with behavioral crises - Discrete areas for calming or crisis management identified - Feedback valued and concerted outreach efforts made Treatment Considerations - Treatment goals reflect consumer preferences - Treatment integrated across disciplines - Offering choice of treatment provider when possible - Everyday language used - All statements of abuse acknowledged and addressed - Sensitivity to seating configuration and proximity of seating options - Co-occurring treatment needs assessed and incorporated into service provided - Culture of origin respected and incorporated into service planning - Recognize the importance of physical boundaries and aware that touch—sometimes even a handshake—could trigger trauma - Avoid jokes and stories which can serve as triggers

To facilitate empowerment, a social worker should:

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 Social workers should also use an empowerment process with groups, communities, and institutions so they may gain or regain the capacity to meet human needs, enhance overall well-being and potential, and provide individuals control over their lives to the extent possible. A social worker needs many skills that focus on the activation of resources, the creation of alliances, and the expansion of opportunities in order to facilitate empowerment.

FAMILY THERAPY MODELS, INTERVENTIONS, AND APPROACHES Key clinical issues include:

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

TECHNIQUES USED TO EVALUATE A CLIENT'S/CLIENT SYSTEM'S PROGRESS

Evaluating progress is a critical part of the problem-solving process. Examining with a client what has occurred and what still needs to occur involves him or her in treatment decisions. Evaluation methods can be simple or complex. They can rely on quantitative information that shows data on reductions in target behaviors, health care improvements, or psychiatric symptom increases, and/or qualitative information in which a client and/or social worker subjectively report on progress made in various areas. When evaluating progress, a social worker and client should gather all needed information and identify factors that helped or hindered progress. Goals outlined in the contract/service plan should be modified, if needed, based upon the outcome of the evaluation. Social workers should assist clients to understand the progress they have made so they can clearly understand and celebrate their accomplishments, as well as identify areas that need attention. This process should ensure that clients understand why progress has happened, as well as include a dialogue about any changes that need to occur in the problem-solving process to facilitate continued growth.

EVIDENCE-BASED PRACTICE

Evidence-based social work practice combines research knowledge, professional/clinical expertise, social work values, and client preferences/circumstances. It is a dynamic and fluid process whereby social workers seek, interpret, use, and evaluate the best available information in an effort to make the best practice decisions. The promotion of evidence-based research within social work is widespread. Evidence-based research gathers evidence that may be informative for clinical practice or clinical decision making. It also involves the process of gathering and synthesizing scientific evidence from various sources and translating it to be applied to practice. The use of evidence-based practice places the well-being of clients at the forefront, desiring to discover and use the best practices available. The use of evidence-based practice requires social workers to only use services and techniques that were found effective by rigorous, scientific, empirical studies—that is, outcome research. Social workers must be willing and able to locate and use evidence-based interventions. In areas in which evidence-based interventions are not available, social workers must still use research to guide practice. Applying knowledge gleaned from research findings will assist social workers in providing services informed by scientific investigation and lead to new interventions that can be evaluated as evidence-based practices. Decisions are based on the use of many sources, ranging from systematic reviews and meta-analyses to less rigorous research designs. Social workers often use "evidence-based practice" to refer to programs that have a proven track record. However, it takes a long time for a program or intervention to be "evidence based." Thus, most interventions in social work need more empirically supported research in order to accurately apply the term. "Evidence-informed practice" may be more appropriate.

Social workers use a variety of techniques to work with families.

Family therapy treats the family as a unified whole—a system of interacting parts in which change in any part affects the functioning of the overall system. The family is the unit of attention for diagnosis and treatment. Social roles and interpersonal interaction are the focus of treatment. Real behaviors and communication that affect current life situations are addressed. The goal is to interrupt the circular pattern of pathological communication and behaviors and replace it with a new pattern that will sustain itself without the dysfunctional aspects of the original pattern.

With all approaches, there are actions that a social worker can take to facilitate effective couples' treatment.

For example, when developing a collaborative alliance with each person, a social worker should validate the experience of each and explore each person's reservations about engaging in couples therapy. In addition, when developing an alliance with the couple as a unit, a social worker can reframe individual problems in relationship terms and support each person's sense of himself or herself as being part of a unit, as well as a separate individual.

GROUP WORK TECHNIQUES AND APPROACHES (E.G., DEVELOPING AND MANAGING GROUP PROCESSES AND COHESION)

Group work is a method of working with two or more people for personal growth, the enhancement of social functioning, and/or for the achievement of socially desirable goals. Social workers use their knowledge of group organization and functioning to affect the performance and adjustment of individuals. Individuals remain the focus of concern and the group is the vehicle of growth and change. When individual problems arise, they should be directed to the group for possible solutions as the group is the agent of change. Social workers must remind group members that confidentiality cannot be guaranteed—though seeing an agreement among group members concerning the preserving the confidentiality of information shared should be an initial goal of any group process. Contraindications for group: client who is in crisis; suicidal; compulsively needy for attention; actively psychotic; and/or paranoid There are different kinds of groups. - Open - Closed - Short-Term - Long-Term

EVIDENCE-BASED PRACTICE Some questions guide the selection of intervention modalities:

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?

There is no universal format for a case presentation in social work practice. However, there are some standard elements, including:

Identifying data (demographics, cultural considerations) History of the presenting problem (family history) Significant medical/psychiatric history (diagnoses) Significant personal and/or social history (legal issues, academic/work problems, crisis/safety concerns) Presenting problem (assessment, mental status, diagnosis) Impressions and summary (interview findings) Recommendations (treatment plan/intervention strategies, goals, theoretical models used) Content areas can be added or eliminated based on the reasons for the case presentation and input sought. Information for a case presentation is usually information that a social worker has obtained directly from a client during an interview and/or observation, as well as that collected from collateral contacts, other professionals, and/or case records.

VERBAL AND NONVERBAL COMMUNICATION TECHNIQUES

In order to facilitate change through the problem-solving process, a social worker must use various verbal and nonverbal communication techniques to assist clients to understand their behavior and feelings. In addition, to ensure clients are honest and forthcoming during this process, social workers must build trusting relationships with clients. These relationships develop through effective verbal and nonverbal communication. Social workers must be adept at using both forms of communication successfully, as well as understanding them, because verbal and nonverbal cues will be used by clients throughout the problem-solving process. Insight into their meaning will produce a higher degree of sensitivity to clients' experiences and a deeper understanding of their problems.

THE PRINCIPLES AND TECHNIQUES OF INTERVIEWING (E.G., SUPPORTING, CLARIFYING, FOCUSING, CONFRONTING, VALIDATING, FEEDBACK, REFLECTING LANGUAGE DIFFERENCES, USE OF INTERPRETERS, REDIRECTING)

In social work, an interview is always purposeful and involves verbal and nonverbal communication between a social worker and client, during which ideas, attitudes, and feelings are exchanged. The actions of a social worker aim to gather important information and keep a client focused on the achievement of the goal. A social work interview is designed to serve the interest of a client; therefore, the actions of a social worker during the interview must be planned and focused. Questions in a social work interview should be tailored to the specifics of a client, not generic, "one size fits all" inquiries. The focus is on the uniqueness of a client and his or her unique situation. The purpose of the social work interview can be informational, diagnostic, or therapeutic. The same interview may serve more than one purpose. Communication during a social work interview is interactive and interrelational. A social worker's questions will result in specific responses by a client that, in turn, lead to other inquiries. The message is formulated by a client, encoded, transmitted, received, processed, and decoded. The importance of words and messages may be implicit (implied) or explicit (evident). A social worker should listen, being nonjudgmental, throughout a social work interview.

Strategic Family Therapy

In strategic family therapy, a social worker initiates what happens during therapy, designs a specific approach for each person's presenting problem, and takes responsibility for directly influencing people. It has roots in structural family therapy and is built on communication theory. It is active, brief, directive, and task-centered. Strategic family therapy is more interested in creating change in behavior than change in understanding. Strategic family therapy is based on the assumption that families are flexible enough to modify solutions that do not work and adjust or develop. There is the assumption that all problems have multiple origins; a presenting problem is viewed as a symptom of and a response to current dysfunction in family interactions. Therapy focuses on problem resolution by altering the feedback cycle or loop that maintains the symptomatic behavior. The social worker's task is to formulate the problem in solvable, behavioral terms and to design an intervention plan to change the dysfunctional family pattern.

Social workers must be proficient in the languages spoken by clients or use qualified interpreters.

It is not appropriate to use family members to interpret or provide services in which social workers are not linguistically competent as valuable information may be missed during social work interviews. When working with interpreters, social workers should face clients and speak directly to them—not the interpreters. Social workers also should never ask for the opinions of the interpreters or have conversations with them as their focus must be on clients.

PSYCHOEDUCATION METHODS (E.G., ACKNOWLEDGING, SUPPORTING, NORMALIZING)

One of the ways that social workers provide information to clients is through psychoeducation. This model allows a social worker to provide clients with information necessary to make informed decisions that will allow them to reach their respective goals. In addition to focusing on clients' education, it also provides support and coping skills development. Psychoeducation is delivered in many service settings and with many types of client populations. It is provided to those who are experiencing some sort of issue or problem with the rationale that, with a clear understanding of the problem, as well as self-knowledge of strengths, community resources, and coping skills, clients are better equipped to deal with problems and to contribute to their emotional well-being. The core psychoeducational principle is that education has a role in emotional and behavioral change. With an improved understanding of the causes and effects of problems, psychoeducation broadens clients' perception and interpretation of them, positively influencing clients' emotions and behavior. In other words, clients feel less helpless about the situation and more in control of themselves.

Open Versus Closed

Open groups are those in which new members can join at any time. Closed groups are those in which all members begin the group at the same time.

Secondary Prevention

Secondary prevention occurs after a disease, injury, or illness has occurred. It aims to slow the progression or limit the long-term impacts. It is often implemented when asymptomatic, but risk factors are present. Secondary prevention also may focus on preventing reinjury. Examples: - Telling those with heart conditions to take daily, low-dose aspirin - Screenings for those with risk factors for illness - Modifying work assignments for injured workers

PERMANENCY PLANNING

Permanency planning is an approach to child welfare that is based on the belief that children need permanence to thrive. Child protection services should focus on getting children into, and maintaining, permanent homes. Permanency planning received a lot of attention in the 1970s. Legislation in the United States, such as the Adoption Assistance and Child Welfare Act of 1980, promotes permanency planning and creates mandates related to child placements. In permanency planning, the first goal is to get children back into their original homes. This 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 getting caregivers services for meeting needs or providing education, if needed, to ensure adequate and quality care. If children cannot 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.

Usually change does not occur easily and there are stages of change that occur. Understanding these stages can help achieve goals.

Precontemplation - Denial, ignorance of the problem Contemplation - Ambivalence, conflicted emotion Preparation - Experimenting with small changes, collecting information about change Action - Taking direct action toward achieving a goal Maintenance - Maintaining a new behavior, avoiding temptation Relapse - Feelings of frustration and failure In order for real change to occur, all intervention steps must occur and change must be understood in these sequential stages.

Strategic Family Therapy Concepts/Techniques

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

THE INDICATORS OF CLIENT/CLIENT SYSTEM READINESS FOR TERMINATION

Readiness for termination may be marked when meetings between a social worker and client seem uneventful and the tone becomes one closer to cordiality rather than challenge, as well as when no new ground has been discovered for several sessions in a row. In termination, a social worker and client (a) evaluate the degree to which a client's goals have been attained, (b) acknowledge and address issues related to the ending of the relationship, and (c) plan for subsequent steps a client may take relevant to the problem that do not involve a social worker (such as seeking out new services, if necessary). The process of evaluation helps a client determine if his or her goals have been met and if the helping relationship was beneficial. As a result of the evaluation process, a social worker can become a more effective practitioner and provide better services. There must always be a method to evaluate the effectiveness of the services received. Evaluation measures, when compared with those taken at baseline, assist in determining the extent of progress and a client's readiness for termination. A social worker helps a client cope with the feelings associated with termination. This process may help a client cope with future terminations. By identifying the changes accomplished and planning how a client is going to cope with challenges in the future, a social worker helps a client maintain these changes.

ANGER MANAGEMENT TECHNIQUES Social workers can assist clients to develop action or treatment plans to change these behaviors. Techniques for assisting clients can include one or more of the following.

Relaxation Exercises - Deep breathing - Meditation or repeating calming words/phrases - Guided imagery - Yoga - Stretching or physical exercise Assisting clients to practice these techniques regularly will result in using them automatically in tense situations. Cognitive Techniques - Replacing destructive thoughts, such as "This is the end of the world" with healthy ones like "This is frustrating, but it will pass" - 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 that one will regret - Listening to what others are saying - Thinking about what to say before speaking - Avoiding defensiveness - Using humor to lighten the situation Environmental Change - Walking away or leaving situation - Avoiding people or situations in the future that evoke anger - Not starting conversations or entering situations that may cause anger when tired or rushed

COUPLES INTERVENTIONS AND TREATMENT APPROACHES There are often reasons that couples experience problems including, but not limited to:

Retriggering emotional trauma and not repairing it An inability to bond or reconnect after hurting or doing damage to one another Lack of skills or knowledge

ROLE MODELING TECHNIQUES

Role modeling emphasizes the importance of learning from observing and imitating and has been used successfully in helping clients acquire new skills, including those associated with assertiveness. Role modeling works well when it is combined with role play and reinforcement to produce lasting change. There are different types of modeling, including live modeling, symbolic modeling, participant modeling, or covert modeling.

THE TECHNIQUE OF ROLE PLAY

Role playing is a teaching strategy that offers several advantages. Role playing in social work practice may be seen between supervisor and supervisee or social worker and client. In all instances, role playing usually raises interest in a topic as clients are not passive recipients in the learning process. In addition, role playing 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. In role playing, participation helps embed concepts. Role playing gives clarity to information that may be abstract or difficult to understand. The use of role playing emphasizes personal concerns, problems, behavior, and active participation. It improves interpersonal and communication skills, and enhances communication.

THE PHASES OF INTERVENTION AND TREATMENT

Social work aims to assist with making change on the micro, mezzo, or macro-levels to enhance well-being. Despite the level of intervention, the steps that a social worker takes are similar. Step 1: Engagement with client, group, or community Step 2: Assessment of strengths and needs to be used in the intervention process Step 3: Planning or design of intervention to address problem Step 4: Intervention aimed at making change Step 5: Evaluation of efforts Step 6: Termination and anticipation of future needs

CONSULTATION APPROACHES (E.G., REFERRALS TO SPECIALISTS)

Social workers are often called upon to seek consultation for a problem related to a client, service, organization, and/or policy. Consultation is the utilization of an "expert" in a specific area to assist with developing a solution to the issue. Consultation is usually time limited and the advice of the consultant can be used by a social worker in the problem-solving process. Although a consultant does not have any formal authority over a social worker, he or she has informal authority as an "expert." However, a social worker is not required to follow the recommendations of a consultant.

METHODS TO TEACH COPING AND OTHER SELF-CARE SKILLS TO CLIENTS/CLIENT SYSTEMS

Social workers assist clients in realizing how their lives can improve and/or how they can learn from mistakes that they have made. The techniques that social workers employ are a form of informal or didactic teaching.

Structural Family Therapy

This approach stresses the importance of family organization for the functioning of the group and the well-being of its members. A social worker "joins" (engages) the family in an effort to restructure it. Family structure is defined as the invisible set of functional demands organizing interaction among family members. Boundaries and rules determining who does what, where, and when are crucial in three ways.

MINDFULNESS AND COMPLEMENTARY THERAPEUTIC APPROACHES

Social workers continue to provide the bulk of mental health services in the United States. A significant number of persons seek services expecting providers to be aware and knowledgeable about alternatives and complements to Western medical approaches for symptom relief and healing when their medical or behavioral health is disrupted and/or compromised. An ever increasing number of people are seeking complementary and alternative medicine (CAM) or integrated health care (IHC) to address health/behavioral health issues. Not only are clients receptive to the use of complementary approaches, they often request diverse approaches that go beyond medications and psychotherapy to address their overall concerns. Thus, social workers must have knowledge mindfulness and complementary therapeutic approaches. Interventions and remedies that some cultures and populations consider conventional others view as alternative, and what some clients assess as successful outcomes, some professionals may not concur. Mindfulness is the practice of paying close attention to what is being experienced in the present, both inside the body and mind and in the external world. It is a conscious effort to be with whatever is going on right now, without judging or criticizing what we find. In each moment, mindfulness invites being awake, aware, and accepting of ourselves. The practice of mindfulness is integral to efforts to reduce stress and to increase capacity to cope. Mindfulness can stand alone as a treatment tool or may be incorporated with other treatment modalities. Most settings where social workers practice would be conducive to mindfulness practice. Social workers and other health/behavioral health providers are increasingly including the practice of mindfulness as a useful tool, not only in building a self-care routine, but also in addressing the needs of their clients. The multitude of complementary approaches to maintaining health are vast and it is unrealistic for social workers to be informed and knowledgeable about all of them, but it is expected that social workers will be aware of the predominant practices and methods being used among the populations they are serving. Just as important, social workers need to be instilled with a respect for clients' authority in determining the best method to treat their problems when there are no indications of harm to self and/or others. Knowing how to integrate empirically tested and validated medical interventions, along with indigenous approaches preserved for generations, is essential to ensuring culturally competent, holistic treatment.

METHODS, TECHNIQUES, AND INSTRUMENTS USED TO EVALUATE SOCIAL WORK PRACTICE

Social workers have an ethical mandate to ensure that they are providing the most efficient and effective services possible. They also must do no harm and ensure that the intervention provided enhances the well-being of clients. These goals require the evaluation of practice. Routine practice evaluation by social workers can enhance treatment outcomes and agency decision making, planning, and accountability. There are two main types of evaluations—formative and summative. Formative evaluations examine the process of delivering services, whereas summative evaluations examine the outcomes.

METHODS TO OBTAIN AND PROVIDE FEEDBACK

Social workers interface with professionals and others in order to achieve the best possible outcomes for clients. Feedback is essential in order to learn what works and what can be done better. There is no single method for social workers to seek feedback. Many factors may impact on how such feedback is solicited and incorporated into practice. However, there are some important principles that social workers should adhere to when obtaining or providing feedback.

METHODS TO ENGAGE AND WORK WITH INVOLUNTARY CLIENTS/CLIENT SYSTEMS

Social workers often find themselves providing services to those who did not choose to receive them, but instead have to do so as mandated by law, including families in the child protection system, people in the criminal justice system, and so on. Working with involuntary clients can be challenging because they may want to have no contact or may only participate because they feel that they have no other choice. Often these situations require social workers to receive peer support or supervision to process struggles encountered, as well as reassert their professionalism, because clients may try to test and exhibit anger at social workers, who represent the mandates placed upon them.

Short-Term Versus Long-Term

Some groups have a very short duration, whereas others meet for a longer duration. A social worker takes on different roles throughout the group process, which has a beginning, middle, and end.

The following are some types of family therapy

Strategic Family Therapy Structural Family Therapy Bowenian Family Therapy

STRESS MANAGEMENT TECHNIQUES

Stress is a psychological and/or physical reaction to life events, with most people experiencing it regularly in their own lives. When a life event is seen as a threat, it signals the release of hormones aimed at generating a response. This process has been labeled the "fight-or-flight" response. Once the threat is gone, clients should return to typical relaxed states, but this may not happen if other threats are presented immediately thereafter. Thus, stress management is important because it provides tools to deal with threats and minimize the impacts of psychological and/or physical reactions. The first step in stress management is for clients to monitor their stress levels and identify their stress triggers. These can be major life events, but also those associated with day-to-day life, such as job pressures, relationship problems, or financial difficulties. Positive life events, such as getting a job promotion, getting married, or having children, also can be stressful. The second step in stress management is to assist clients in identifying what aspects of a situation they can control. Clients can make these changes, as well as benefit from stress-reduction techniques, such as deep breathing, exercise, massage, tai chi, or yoga, to manage those aspects of a situation that cannot be altered. Maintaining a healthy lifestyle is essential to helping manage stress. Stress will always be a part of life, but assisting clients to manage it can increase their ability to cope with challenges and enhance their psychological and/or physical well-being.

Participant modeling

an individual models anxiety-evoking behaviors for a client and then prompts the client to engage in the behavior.

Many treatment techniques are used with individuals that can be adapted in work with couples, including: Behavior modification

Successful couples counseling methods will address and attempt to modify any dysfunctional behavior so that couples can change the way each individual behaves with the other.

Tertiary Prevention

Tertiary prevention focuses on managing complicated, long-term diseases, injuries, or illnesses. The goal is to prevent further deterioration and maximize quality of life because disease is now established and primary prevention activities have been unsuccessful. However, early detection through secondary prevention may have minimized the impact of the disease. Examples: - Pain management groups - Rehabilitation programs - Support groups

Models in any of these forms may be presented as either a coping or a mastery model.

The coping model is shown as initially fearful or incompetent, and then is shown as gradually becoming comfortable and competent performing the feared behavior. The mastery model shows no fear and is competent from the beginning of the demonstration.

Change Strategies 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.

Primary Prevention

The goal is to protect people from developing a disease, experiencing an injury, or engaging in a behavior in the first place. Examples: - Immunizations against disease - Education promoting the use of automobile passenger restraints and bicycle helmets - Screenings for the general public to identify risk factors for illness - Controlling hazards in the workplace and home - Regular exercise and good nutrition - Counseling about the dangers of tobacco and other drugs Since successful primary prevention helps avoid the disease, injury, or behavior and its associated suffering, cost, and burden, it is typically considered the most cost-effective.

Group process End

The group reviews its accomplishments. Feelings associated with the termination of the group are addressed.

Short-Term Interventions

The growing need for time-limited treatment, fueled by the widening influence of managed care in the behavioral health field, has produced a renewed focus on short-term therapy. Short-term interventions vary greatly in their duration. Research has suggested that a social worker's and client's views on the time of treatment are more important than the duration of treatment itself. Sometimes these approaches are used because of organizational or financial constraints. In other instances, clients are choosing them over open-ended approaches. Although some have been wary of the effectiveness of these techniques to instill long-lasting change, they are being used more broadly than ever before. Some short-term interventions include a crisis intervention model and a cognitive behavioral model. Although psychoanalysis is often thought of as long term, this was not the case with Freud's early work, and psychoanalysis did not start out this way. A number of short-term psychodynamic approaches focus on the belief that childhood experiences are the root of adult dysfunction.

THE IMPACT OF OUT-OF-HOME DISPLACEMENT (E.G., NATURAL DISASTER, HOMELESSNESS, IMMIGRATION) ON CLIENTS/CLIENT SYSTEMS

The homes in which clients live are part of their self-definition. They are decorated to reflect likes or dislikes, telling others about their occupants and accommodating interests such as gardening, cooking, and others. Homes are seen as extensions of their residents and distinguish people from each other. Behavior is also cued by the physical environment. Homes remind inhabitants of experiences which took place in the past, as well as what to do in the future. Homes are familiar and are often viewed as safe havens where clients can behave without being judged. Thus, involuntary displacement outside the home due to hospitalization, incarceration, needed safety, or long-term care needs can be traumatic for many reasons. First, such movement may be associated with losses such as those due to health issues, financial concerns, or safety problems. These losses alone can cause depression, anxiety, confusion, and/or other emotional reactions, which are compounded from having to move from the communities or homes in which clients live. In out-of-home placements, clients may have changes in roles, causing them to develop poor self-image. For example, the roles of neighbor, community leader, gardener, and so on, which provided fulfillment and recognition, may be lost and no longer possible. Since there is status attached to these roles, their loss can negatively affect self-image. There also may be a loss of possessions associated with displacement. Precious items that represent a lifetime of memories may have been destroyed, such as by a natural disaster, or sold/given away as there may be no room to keep them in the new settings—especially if they are shared with others. There also may be a cost associated with involuntary displacement. For example, long-term care can drain client assets and make clients feel guilty about spending money on themselves or fearful about running out of funds for sustained care and housing. Out-of-home displacement also often accompanies loss of relationships. Relatives and friends who interfaced with clients in their homes may find it inconvenient or impossible to see them in the new settings. Sometimes the lack of private space in which to visit puts up barriers. Visitors may also be intimidated by the sights and sounds of hospitals, jails, or nursing homes. Clients frequently do not have the same freedom or control that they had when they were at home. In congregate settings, meals, activities, room cleaning, and bathing may be overseen and scheduled for the sake of organization and efficiency, and there are usually numerous rules, policies, and procedures to follow with less individual autonomy and choice.

STRENGTHS-BASED AND EMPOWERMENT STRATEGIES AND INTERVENTIONS

The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty (NASW Code of Ethics, 2008—Preamble). Empowerment aims to ensure a sense of control over well-being and that change is possible. A social worker can help to empower individuals, groups, communities, and institutions. On an individual level, social workers can engage in a process with a client aimed at strengthening his or her self-worth by making a change in life that is based on his or her desires (self-determination).

PROBLEM-SOLVING MODELS AND APPROACHES (E.G., BRIEF, SOLUTION-FOCUSED METHODS OR TECHNIQUES)

The 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. Clients' problem-solving capacities or resources are maladaptive or impaired. The goal of the problem-solving process 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.

TECHNIQUES USED FOR FOLLOW-UP

The standard of practice is that social workers must involve clients and their families (when appropriate) in making their own decisions about follow-up services or aftercare. Involvement must include, at a minimum, discussion of client and family preferences (when appropriate). Follow-up meetings are often important to ensure change maintenance. Many clients continue to progress after termination and follow-up meetings provide opportunities to acknowledge these gains and encourage continuation of such efforts. Follow-up meetings also provide valuable interactions which can mitigate any unanticipated difficulties. Follow-up meetings provide clients with reassurance that they are not alone as they implement what they have learned. They allow for longitudinal evaluation of practice effectiveness. It is important that social workers explain to clients that follow-up meetings may be important in the problem-solving process. Social workers must not be intrusive or send messages that clients cannot function on their own. Clients who have difficulty terminating may use follow-up meetings as ways to prolong social worker-client relationships beyond what is needed. Social workers must set clear boundaries and treat follow-up meetings with professionalism—having clearly stated goals for these sessions. Clients who tell social workers during follow-up about new problems that have arisen should be seen for assessment. Social workers who have already assisted clients resolve issues are often the first ones to which clients disclose new problems which have emerged.

PRIMARY, SECONDARY, AND TERTIARY PREVENTION STRATEGIES

There are three major types of prevention strategies—primary, secondary, and tertiary. Optimally, all three types are needed to create comprehensive strategies of prevention and protection.

Change Strategies

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

There are a number of techniques that a social worker may use during an interview to assist clients.

Universalization—the generalization or normalization of behavior Clarification—reformulate problem in a client's words to make sure that the social worker is on the same wavelength Confrontation—calling attention to something Interpretation—pulling together patterns of behavior to get a new understanding Reframing and relabeling—stating problem in a different way so a client can see possible solutions

Bowenian Family Therapy

Unlike other models of family therapy, the goal of this approach is not symptom reduction. Rather, a Bowenian-trained social worker is interested in improving the intergenerational transmission process. Thus, the focus within this approach is consistent whether a social worker is working with an individual, a couple, or the entire family. It is assumed that improvement in overall functioning will ultimately reduce a family member's symptomatology. Eight major theoretical constructs are essential to understanding Bowen's approach. These concepts are differentiation, emotional system, multigenerational transmission, emotional triangle, nuclear family, family projection process, sibling position, and societal regression. These constructs are interconnected.

THE ELEMENTS OF A CASE PRESENTATION

When a social worker communicates with others in order to ensure comprehensive and complete care for clients, he or she completes a case presentation. Case presentations are also used in professional development and learning to provide input into options for treatment and to ensure services are being delivered effectively and efficiently.

FAMILY THERAPY MODELS, INTERVENTIONS, AND APPROACHES

Working with families has always been central to social work practice. Family interventions require treating not just an individual but all those within a family unit, with the focus of assessment and intervention directed at the interaction of family members.

Formative evaluations

are ongoing processes that allow for feedback to be implemented during service delivery. These types of evaluations allow social workers to make changes as needed to help achieve program goals. Needs assessments can be viewed as one type of formative evaluation.

Covert modeling

clients are asked to use their imagination, visualizing a particular behavior as another describes the imaginary situation in detail.

Symbolic modeling

includes filmed or videotaped models demonstrating the desired behavior. Self-modeling is another form of symbolic modeling in which clients are videotaped performing the target behavior.

Mindfulness

is the practice of paying close attention to what is being experienced in the present, both inside the body and mind and in the external world. It is a conscious effort to be with whatever is going on right now, without judging or criticizing what we find. In each moment, mindfulness invites being awake, aware, and accepting of ourselves.

Summative evaluations

occur at the end of services and provide an overall description of their effectiveness. Summative evaluation examines outcomes to determine whether objectives were met. Summative evaluations enable decisions to be made regarding future service directions that cannot be made during implementation. Impact evaluations and cost-benefit analyses are types of summative evaluations.

Live modeling

refers to watching a real person perform the desired behavior.

There are also specific couples therapy approaches, including the Gottman Method

which is based on the notion that healthy relationships are ones in which individuals know each other's stresses and worries, share fondness and admiration, maintain a sense of positiveness, manage conflicts, trust one another, and are committed to one another. The Gottman Method focuses on conflicting verbal communication in order to increase intimacy, respect, and affection; removes barriers that create a feeling of stagnancy in conflicting situations; and creates a heightened sense of empathy and understanding within relationships.