Case Management

using the phrase I understand

"I understand" - often sounds superficial and trite. "I understand how you feel" - Most of us can never know exactly how a client feels. "I understand how you feel, but..." - the "but" tends to negate the client's very real feelings and push the worker's perspective instead. Avoid using the phrase "I understand".

why listening is healing

"the attentive listening of a concerned and interested healer can, and often does have a compelling effect on the sufferer. The sufferer often enough responds by telling more about himself, by revealing more .... The relationship is deepened - more is said, more is heard, more is understood, more of a sense of being understood is experienced" Dr. Stanley W. Jackson (1992) American Journal of Psychiatry

reflective listening has three purposes

1. Lets people know you have heard their concerns and feelings accurately. 2. Creates an opportunity for you to correct any misperceptions. 3. Illustrates your acceptance of where the person is at that moment.

five points to remember about reflective listening

1. Listen reflectively long enough. Do not cut short this important part of healing. 2. Solutions come later. Don't rush to give advice before you have listened or if you must give imformation at first to help the client relax, go back and use reflective listening. 3. Reflective listening does not mean you agree. It simply means that you are where the client is at the moment. 4. You could be wrong. Let the client correct your perceptions if need be. 5. Mind your body language. Lean toward the client. Make eye contact. Look interested.

Assessment

A case manager's assessment is meant to be comprehensive and thorough. Assessment covers many different aspects of the client's life in an attempt to develop an accurate profile of the client and the client's problem.

Informed Consent

A client always has the right to consent to or withdraw from services. The client has the right to be informed about: ◦Side effects, adverse effects, or negative consequences that could occur as a result of treatment, medication, or procedures ◦Any risks that might occur if the client elects not to follow through with treatment or services ◦What is being offered, including what the treatment is, what will be included, and potential risks and benefits ◦Any alternative treatments or procedures available

Assessment of Needs

A discussion of the problem uncovers what the client needs. What does the client need to bring stability to his or her life? What would be the best way to resolve the problems the client faces?

Dual Relationships

A dual relationship occurs when you and a client to whom you are giving services have more than one relationship. Make every effort to a avoid dual relationships. Your position gives you a position of power. It is possible to exploit or give the impression of exploiting this power. When in a situation where a dual relationship cannot be avoided, give the client a choice about continuing services with you.

Planning

A good plan looks at a variety of resources: ◦Formal agencies Agencies set up to deal with specific problems ◦Generic resources Entities everyone can use such as clinics, recreational programs, or social groups like Lions Club ◦Other established community resources Seminars and support groups which are often free of charge ◦Peer support Individuals who previously had the same problem helping those who need support ◦Informal and folk support systems Neighbors, churches, family, and others in the client's life or likely to be available in the client's life to support the client

Impaired workers

A social service worker is considered impaired when he or she is unable to function effectively due to substance abuse, mental illness or personal problems. If a co-worker becomes impaired: ◦Start by talking to the worker ◦If need be, talk to your supervisor ◦Do not allow clients to become endangered

Reality Check

All of our clients will not be cooperative and grateful. It is unrealistic to expect that clients will be. We are trained to deal with people who are dissatisfied, confused, overwhelmed, have difficulty expressing themselves or are unduly sensitive. Just because clients present difficulties is not an excuse to provide poor service.

Mandated Reporting

All states have laws requiring professionals to report the abuse or neglect of children. Some states have laws requiring professionals to report the abuse, neglect, or exploitation of older people. What does your state require? Even where there are no laws mandating that you report elder abuse, ethically you have an obligation to do so.

Dealing with an MCO

An MCO is a managed care organization Makes money available for the care of specific populations An MCO can be a private insurance company or one that deals with public money Case managers often need to seek permission from MCOs to obtain money for treatments and services for their clients

showing appreciation for what has been said

Appreciate it when clients bring up their concerns. This makes it safe to discuss issues the client may have with you or the agency. EXAMPLES: I really appreciate your telling me about this. It is helpful to know. Thanks for bringing this up. I appreciate your bringing this issue to my attention.

Individualistic Culture

Are more vertical - people are expected to stand out from others Value freedom Promote self-fulfillment Emphasize individual initiative and achievement Emphasize the need and goals of individuals over the group In-group influence is specific to time and place and not general Support unique individual beliefs Maximize individual outcomes

The Four Case Management Tasks

Assessment Planning Linking Monitoring

Attitudes

Attitudes we hold about other people are bound to be communicated to them one way or the other. Positive and supportive attitudes foster rapport. Superior or disdainful attitudes are bound to be communicated to another no matter how we try to hide them.

Dimensions of Culture

Basically most cultures fall into either an individualistic culture or a collectivistic culture. Individualistic cultures tend to place an emphasis on the individual. Collectivistic cultures tend to place more emphasis on the group. Many researchers believe communication can be better facilitated if we know whether the person with whom we are meeting comes from an individualistic culture or a collectivistic culture.

avoiding value conflicts

Be respectful of attitudes and lifestyles that differ from your own. Never practice prejudice toward minorities, those with disabilities, or those with differing sexual preferences. Always give your best service to your client, even when you disagree with the person. Never attempt to change a client's values to coincide with your own.

On being Judgmental

Because you are the worker and the clients are clients does not make you a better person than they are. Judging people by your own standards is not helpful. Comparing your life to theirs, your choices to their choices clouds your objectivity. Being wary and distrustful of clients implies that clients are sneaky, untrustworthy, or devious. When you sit in judgment of another person you erect a barrier to real understanding, rapport. and the opportunity to be of real assistance.

What the Person brings to the situation

Biological Characteristics Neurological development Reflexes Genetic makeup Degenerative processes Illness (chronic, terminal, temporary) Physical health Nutrition Psychological Characteristics Early shaping experiences Perception Personality Affect Cognition Nurturance Life transitions/position in the life cycle Motivation

What constitutes consent in three parts

Capacity ◦The client has the ability or capacity to make clear, competent decisions in his or her own behalf. Comprehension of Information ◦The client clearly understands what is being told to him or her. To make sure that this is so give the information carefully and check to see if the client understands what you have told him or her. Voluntariness ◦The client gives his or her consent freely with no coercion or pressure from the agency or the professional offering the service.

Using strengths, preventing problems

Case management does not focus on just one problem but on the many issues, strengths and concerns the client brings. The client's strengths and needs are used to improve the overall situation. Case management seeks ways to prevent current problems from growing worse.

Why We Use Case Management

Case management is a method for determining an individualized plan for each client, then monitoring that plan to be sure it is effective for the client. Case management is a process used to ensure that the money being spent for the client's services is being spent wisely and in the most efficient manner on behalf of the client.

Case Management

Case management is a process for assessing the client's total situation and addressing the needs and problems found. Case management seeks to improve the quality of life for the client.

Case Management is not Therapy

Case management is therapeutic in that it benefits clients Case managers do not do clinical therapy for long-standing emotional problems or pervasive affective disorders Only those specifically trained to do therapy should act as therapists

How clients are discouraged

Case managers can do things that discourage clients from moving forward confidently Asking people to compete Shaming, forcing or pushing a person toward a goal Focusing on mistakes the client has made Demanding unrealistic outcomes or perfection Giving only negative feedback Failing to note strengths or give positive feedback. These are all ways to discourage clients.

Self- Determination

Clients have the right to self-determination. ◦This includes: The right to research their diagnosis and treatment and ask questions about it The right to make mistakes The right to decide when and for how long they will use the services of an agency or engage in treatment Government and other funding sources are asking case managers to talk to clients about what clients envision for themselves in the future beyond grappling with social and emotional problems.

closed and open questions

Closed Questions These are used to get facts and information. They require a single answer. They are not used often in discussions that involve problems and feelings. EXAMPLES: What is your address? How many children were in your family. Open Questions These are used to solicit more information. They allow clients to bring out the details that are important to them. EXAMPLES: Can you tell me a little bit about your mother? Tell me about that night.

closed questions

Closed questions are good for gathering basic information. Closed questions require a single answer. EXAMPLE: Worker: Where do you live? Client: 348 Pine Street. Worker: How long have you lived there? Client: Oh, about 8 years. Worker: Does anyone else live there with you? Client: Yes. I have a daughter and my mother lives with us. Worker: How old is your daughter? Client: She will be 15.

Countertransference

Countertransferece occurs when the worker projects onto the client emotions and attitudes. It occurs because the client reminds us of someone in the past or because the clients issues remind us of our own. Countertransferencec can be negative or positive. We may give good service to someone who reminds us of a dear aunt, while giving poor service to someone who reminds us of a bully. It is important to be self-aware of our feelings about another. It is not acceptable to allow them to interfere with our service to others. Countertransference feelings may signal we have old issues that need to be resolved.

Involuntary Commitment Criteria

Criteria for committing someone against his or her will are: ◦The person poses a danger to himself or others and one of more of the following: Severe mental illness or severe mental illness that is acute Unable to function and thus unable to provide self-care Has refused to sign a voluntary commitment There are known treatments that can be applied once the person is committed The commitment adheres to the principle of least restrictive treatment setting

Where do our differences lie?

Cultures - Generally refers to an entire society within a specific political boundary wherein the citizens share a common understanding. Subcultures - Within a society are smaller groups who hold the dominant culture but also hold specific ideas and beliefs that may differ from the dominant culture in some ways. Race and Ethnic Groups - Societies can have different races and ethic groups within them. Race refers to a group who are biologically similar while ethnic group refers to a group of people who share a common cultural heritage.

Ethical Responsibility to the Client

DON'T burden clients with your problems or tell clients worse has happened to you. DON'T ask a client to meet your needs ◦Asking them to buy Avon from you, buy insurance from a friend starting an insurance business DON'T insist that the client do what you think the client should do. Don't insist that your solutions are the only solutions. DON'T continue to treat the client as being in need of your services when the client has grown beyond needing these services.

The Individualized Plan

Each client receives a plan that is unique to that client. Each client's plan should include: ◦Elements that take advantage of the client's strengths and supports. ◦A means to address the most immediate and pressing problems for that client. ◦Elements that take advantage of the client's social supports, such as family, friends, teachers, or synagogue. ◦An understanding of the client's goals and preferences.

Responding to feelings

Empathy is the ability to hear accurately the underlying feelings and emotions the person is experiencing. First, listen to what the individual is telling you. Next, identify the predominant feeling you are hearing. Finally, construct a single statement that includes that feeling. To the person whose mother was just hospitalized with kidney failure: Correct: You must be so worried about her right now. Incorrect: Don't worry. We have great doctors here. Does she have insurance?

Empathy

Empathy practiced well makes it safe for others to talk about their deepest concerns and problems Many see empathy as related to compassion. One gains empathy for another through compassion for what the other is facing and experiencing. Carl Rogers raised concerns that the extent to which a person feels empathy and is engaged with another the boundary between the helper and the client can become blurred. Carl Rogers cautions against losing the "as if" quality of the relationship. The helper is fully attuned to the feelings and perspective of the other "as if" these were his own.

Erecting detrimental boundaries

Expecting that people who look like me will act and think like I do. Expecting that people who do not look like me will not be like me at all, but will be very different. Points about these boundaries: A person of another race or culture may have similar values and circumstances to your own. A person from your own race or culture may hold very different views and have very different circumstances. Our beliefs about other people stem from our stereotypes, even when we are not entirely aware of it.

Addressing the Presenting problem

First, the case manager assesses the initial or presenting problem. ◦Does the problem interfere with the client's functioning at work or socially or interfere with self-care? ◦What is the background to this problem? ◦How long has this problem gone on? ◦Are there other social, emotional or medical problems that exacerbate the presenting problem?

What is ethical

Generally represented in ethical codes Developed for specific professions Often required to maintain professional status Violations result in sanctions and loss of privileges

HIPPA

Health Insurance Portability and Accountability Act Passed in 1996 Requires agencies to inform clients of the agency's privacy and confidentiality procedures Security: Requires agencies to protect health information from inappropriate access by others Privacy: The client's right to keep certain information private Stipulates what must be stipulated on a release-of-information form PHI or Identifiable health information: Clients have the right to ask that this information be restricted. Clients have the right to access their files, make copies of their records, and make corrections or additions to their files if these are accurate.

examples of collaboration

I'm thinking that perhaps we can look at the different clinics in your area and see if there is one where you could get the treatment. What do you think? I'm wondering what you would think of this. We could go over to the court house and get a copy of the records and begin to piece it together from there. What are your thoughts? Always ask the other person for their feedback on your suggestions. EXAMPLES: What do you think? What are your thoughts about this? How do you see it?

Accepting the Gift

If you accept a gift from a client: ◦Document the offer and how you responded in the client's chart. ◦Always attempt to accept the gift on behalf of the entire agency rather than as a personal gift to you. ◦Acceptance can pose a conflict of interest

If you become impaired

If you become impaired: ◦Take steps to resolve personal problems promptly ◦Do not work with clients if you are not able to function effectively

Forgiving yourself

If you forgive yourself for your mistakes and troubles and see these as part of growing, it is easier to understand and support others through their own mistakes and struggles. Good attitudes begin with being tolerant of yourself. If you see yourself as basically okay you will see others in that light as well.

collaboration

In order to move toward change there needs to be collaboration. Even when clients will do most of the work the word "we" can create more of a team approach. Clients can trust your intention to be supportive without taking over Start tentatively: "I'm wondering if... End with an invitation to collaborate. " Maybe we can work on this together."

Recent Case Management History

In the 1960s, individuals once housed in institutions came into the community to live and needed intense monitoring to adjust. In the 1980s, the term caseworker became case manager and case managers took on more responsibility to give support and find innovative solutions. Today, case managers are a significant part of most social service settings.

Early Case Management History

In the late 1800s, there was a need to formally organize services given to people in need. The Charity Organization Society took over control of this approach and developed case work as a useful means of tracking progress of clients.

Larger Interventions on the Macro level

In your work you will see groups of individuals who have been harmed by one or more of the larger social systems ◦You have an ethical obligation to speak to the needs of the less advantaged in our society to the larger society where the changes need to be made. ◦You will also see areas of service that need to be developed or better supported. ◦You are in a unique position to bring these needs to the community that funds the services.

Sexual or romantic relationships

Sexual or romantic relationships with clients are almost always illegal and always completely unethical. For clients, the respectful and concerned relationship they form with a case manager may be the first time they have experienced such a relationship. For a case manager who is facing difficulties in his or her own life, a sensitive and concerned client is appealing.

Assessment of the Client

Is the client able to think clearly and understand options? How would you characterize the person's general mood? What strengths or impediments will you have to work with in the client's environment? The information from the assessment helps us to formulate a plan for the client.

Gifts from Clients

It is best to avoid accepting gifts from clients. Sometimes clients give gifts with the expectation of receiving special consideration in the future. Sometimes, however, they are given out of gratitude and a need to stop always being on the receiving end.

Anxiety and uncertainty

It is common to feel anxious when we attempt to interact with individuals from different cultures. We need to manage those feelings so they do not impede our communication with others. In order to feel less anxious we may interpret the stranger's behavior or beliefs through our own culture. The more we can feel the person is like us, the less likely we are to feel anxious.

Who is responsible

It is the case manager's job to make sure that sexual or romantic relationships do not develop! Relationships with clients are exploitive, can add to client's emotional burdens, and will always involve a power differential. ◦One person is the helper with all the answers and resources while the other is the person with all the problems.

Monitoring

It is the case manager's responsibility to monitor the services being given. When you monitor a client's service or treatment plan, you do so to: ◦Be certain the treatment or service you authorized for this client is in fact the treatment or service that is being given. ◦Keep track of the client's progress toward the goals you developed with the client. ◦Be aware of the times when modifications and revisions are necessary.

Referral

Linking the person to services is often referred to as a referral. You indicate on your referral the amount of time you expect the service to take to complete the client's goal and what service you are seeking for your client.

what is legal

May embody moral and ethical codes We are talking about the law Violations are violations of the law - a criminal offense Courts make decisions about the consequences of illegal behavior

The Three Levels

Micro Level ◦Focus is on the client's personality, motivation, affect, and other personal attributes Meso or Mezzo Level ◦Focus is on the context immediately surrounding the client (family, church group, close friends, and work group) Macro Level ◦Focus is on the larger society's characteristics and the way the client experiences these or the way these are brought to bear on the client's situation Institutions and organizations such as the political system, social stratification, educational system, the economy

What is moral?

Moral choices have to do with culture and socialization What we feel is right Often tied to religion We generally feel guilt when we violate our own moral code

Twelve roadblocks to communication

Ordering, directing, commanding Warning, admonishing, threatening Exhorting, moralizing, preaching Advising, giving solutions Lecturing, teaching, logical arguments Judging, criticizing, disagreeing blaming Praising, agreeing Name-calling, ridiculing, shaming Interpreting, analyzing, diagnosing Reassuring, sympathizing, consoling, supporting Probing, questioning, interrogating Withdrawing, distracting, humoring, diverting

Cultural Competence

Our perceptions and attitudes are influenced by our own culture. Ethically we have a responsibility to become acquainted with cultures that differ from our own and with which we have extensive contact. The only way to work with people from different cultures is to see them as unique individuals and make every effort to perceive them accurately.

Collectivists Culture

People are not expected to stand out A value is placed on equality Cooperation occurs with in-group members In-group members look out for each other Require that people fit into the group Emphasize belonging Group goals are emphasized There are shared group beliefs Tend to apply different value standards to members of the in-group as compared with members of out-groups

Continued Planning

Planning with clients is ongoing: ◦Clients improve and may need an advanced level of planning. ◦Clients' situations may interfere with progress. ◦Circumstances in the client's life or the community change. ◦Crises can occur that need to be addressed before continuing the plan.

When the client owns the problem

Points about when the client owns the problem: It is not uncaring to allow clients to resolve all or part of their problems. Instead, it presents an opportunity for them to grow. It is a strategic decision as to the extent to which you will help solve the client's problem based on the client's capabilities. Be a resource and a collaborator with the client in resolving the client's problem.

false praise vs positive feedback

Praise does not give the client information the client can use. Feedback contains information about the client the client can rely on in future problems. Feedback generally identifies traits that might be useful to the client in the future. EXAMPLES OF PRAISE: You did a great job with that. You should feel proud of what you accomplished. EXAMPLE OF FEEDBACK: When you spoke to the people in admissions you had all the information on the courses you wanted to take. You were well-prepared and organized.

Privileged Communication

Privileged communication is a legal concept. Protecting the right of the client to withhold information in a court proceeding

some problems with questions

Questions are often poorly used to try to quickly find a solution. Questions can be used in a flawed attempt to fill in the gaps when our reflective listening skills are not very strong. When we feel that the other person is expecting that we will have all the answers we stall for time by asking a lot of questions. The client can hear questions as prying and may cause the client to become guarded or defensive. Questions can take the client off track. Too many questions can leave clients feeling they revealed more than they had intended to.

Disarming Anger

Questions to begin disarming These questions show a genuine interest in what the client is saying. Do not ask too many questions. One or two are enough. EXAMPLES: Can you tell me how I offended you? Did this happen often? Ways to agree when disarming Look for a kernel of truth in what the person is saying. Refrain from sounding defensive. EXAMPLES: I think we probably don't know how this inconveniences you. It is very possible we overlooked this.

defining reflective listening

Reflective listening is a therapeutic method of listening and responding. Reflective listening involves listening to content and listening to feelings. Reflective listening does not include advice or solutions. Reflective listening does not judge the feelings or the message

responding to feelings and content

Responding to feelings: Identify the feeling and say that back to the other person. Do so in a single sentence. Do not confuse the person with more than one feeling or by adding more. EXAMPLES: You must feel sad about this. You must have been very proud of her. Responding to content: A response to indicate that you heard accurately what the client has said. Confirms for the client that the details of his or her story are important to you. EXAMPLES: So you stood waiting for about 2 hours and no one ever came. When you were ready you wanted to leave but he blocked your path.

useful responses

Responding to other people in friendships and other familiar relationships is not the same as responding professionally to clients. You are responsible for creating an environment in which the client feels safe enough to be open. You are in charge of creating an environment that builds rapport and collaboration in regard to the client's problems.

Social Networking

Social networking is a way to connect with those who share our experiences at work. Away from the work site, it helps to be able to talk frankly and about what happened. Social networking sites are not secure. Comments made can be read by others and misconstrued. It is unethical to talk about clients in any forum where confidentiality is not guaranteed.

The Ecological Model

Sometimes referred to as the person-in-situation or person-in-environment We use the ecological model to: ◦Develop a broad understanding of each individual client ◦See the client in the context in which the client lives and functions ◦See how the client has interacted and is interacting with the environment ◦See how the environment influences the client's choices

If you both own the problem

Sometimes you and the client have a problem with each other. This should not be viewed as a win-lose situation. This is an opportunity to negotiate and collaborate on a solution. This provides the client with experience in problem-solving.

Obstacles to Understanding

Stereotypes - assumptions about people from a particular group and we do not question these assumptions. Ethnocentrism - we use the standards of our own culture to judge the behavior and culture of other people. Prejudice - based on a stereotype we avoid or deny certain things to people from this group. Conflict - cultural misunderstandings turn into hostility and conflict.

The Generalist Approach

The ability to recognize and address issues on all three levels When the case manager looks at how people and systems on each of the three levels affects the client's problems, the case manager has correctly made a multilevel assessment. The generalist approach has as its goal better functioning and increased competence of all parties. This becomes the foundation for solid and long-lasting change.

Linking

The client is linked to the services and supports that will best meet the client's needs. Once there is a plan, the case manager links the client to the service or persons who will carry out the plan. The case manager does not carry out the plan, but monitors the plan to be sure others are carrying it out.

If the client owns the problem

The client may own a problem with something you have done. You need to decide to what extent you are willing to change. The client may own a personal problem apart from you. You need to decide to what extent you will become involved in the solution.

Who owns the problem

The person who owns the problem is the person whose needs are not met. A person may be creating disturbances for others but find that perfectly acceptable. It is the person who is distressed by that disturbance who owns the problem. Knowing who owns the problem means: We know who is responsible for solving the problem. We will not meddle in the problems of others. We will support an opportunity for the person to grow and learn.

if you own the problem

The resolution of the problem is ultimately your responsibility. It is your responsibility to bring up the problem. Don't expect others to guess that you have a problem. Just as you decide how involved to become in the client's problem, the other person may not choose to become involved in helping you solve your problem.

Four Reasons clients are mistreated

There are 4 reasons clients are often mistreated: ◦The worker is unpleasant with everyone. ◦The worker needs to feel superior and to have power over the client. ◦The worker has no supervisory support and feels isolated with unpredictable behavior or unfamiliar problems and develops an us-vs.-clients attitude. ◦The worker is trying to control unpredictable behavior with verbal or physical aggression because the worker lacks training and support in other ways to handle the behavior.

Understanding Boundaries

There are boundaries between clients and workers that prevent ethical violations and facilitate the helping relationship. It is the worker who is responsible for maintaining boundaries. Ways we cross boundaries The client reminds us of ourselves. The client is dealing with a problem we once had. We are using our work with clients to resolve our own issues. We want the client to use solutions we used to solve a similar problem in our own lives. We want the client to use a specific solution so that we appear more effective and competent as workers.

Transference

Transference is a collection of feelings and attitudes the client holds about you. Accept transference when it exists. Transference is neither a good thing or a bad thing. Sometimes we remind clients of someone they knew in the past. Clients may only be dimly aware of that. They just know that you remind them of someone. Transference occurs when you remind the client of someone the person liked or did not like Positive transference occurs when the client likes you because you remind him or her of someone they liked. Negative transference occurs when the client dislikes you because you remind him or her of someone they liked.. When clients act in unexpected and somewhat inappropriate ways do not take it personally. Reflective listening creates a safe environment.

Basic Helping Attitudes

There are three basic helping attitudes Warmth - In your presence clients feel valued, worthy of being understood. Genuineness - you are open, truthful, an authentic person. Empathy - you are able to put yourself in another's shoes. You can accurately communicate to clients an understanding of their underlying emotions.

Three Major Problems

There are three major problems that can occur when communicating with others: You cannot wait to pass judgment - rather than listening the worker is judging what the client is saying and what the client has done. These workers are preoccupied with what they want to say and can't wait to pass along an authoritative judgment. You ignore the client's feelings - The client expresses emotion but the worker does not notice and focuses instead on the facts and a solution. You cannot wait to offer a solution - the worker rushes to a solution without establishing rapport or letting the client know that the underlying feelings were heard.

Two minor problems

There are two minor problems that can occur when communicating with others: You assess your client's feelings incorrectly Here the client may correct you giving you more accurate information. She tells you she did not feel angry but rather she was disappointed. This is helpful to know. Your mind wanders - your mind on occasion will wander away from the conversation. Practicing good body language, showing interest in what the client is saying will prevent these momentary shifts in focus from becoming real problems.

Developmental Transitions

These are normal life changes. These events move a person from one phase of life to another. These changes require an adjustment to new circumstances. Many are part of the normal development from birth to death. Some people find it harder to adjust than others. Starting kindergarten or first grade Going to high school Going out on a first date Leaving home for the first time Losing one's job Experiencing a disaster Large mortgage or debt Large financial losses Children leaving home Birth of a grandchild Starting a new job Getting married Buying a first home Ill health Losing a spouse through death Divorce Losing a physical capacity Considerable financial gains Children marrying Death of a child

Confidentiality

This is both an ethical principle and legal right. Ask clients for their permission before sharing their case with colleagues unless this sharing takes place in normal supervision and agency planning. If asked on the phone about a client, request a release-of-information form and indicate you will see if the client is known to your agency when the form is received. Do not discuss your cases with relatives or friends, even when leaving out the names.

Strangers

When we meet people who do not think, act, or believe as we do we often find them strange. Often their ways of thinking and acting are unfamiliar to us. It is always the dominant culture that defines who is a stranger. As the world becomes more global we are likely to encounter people who are different from ourselves. It is often up to the social service worker to help immigrants make a smooth adjustment to a new culture. Immigrants who become competent in the dominant culture are healthier.

Minimum Necessary Rule

Use the Minimum Necessary rule: ◦Only release the minimum amount of information needed for the other agency to fulfill their responsibility to the client.

Developing Interventions

Use two-pronged interventions that address maladaptive interactions between the person and the environment. Choose interventions that strengthen the person to handle the environment. Find interventions that alter the environment to better accommodate the person. Note those parts of the environment that are positive and useful.

Protecting the Clients Self-Esteem

When you diminish another person's self-esteem, you are stealing what feelings of confidence and self-worth they may have. Some workers think they can justify mistreatment of clients because the clients are difficult, don't follow through, call too often, etc. Many clients already feel unsure, vulnerable, and awkward over needing help. We have a responsibility never to diminish another person's sense of self-esteem or self-worth.

Thoughtful vs Thoughtless communication

Ways we can make our communication more thoughtful: Recognize our tendency to categorize - look at how we might stereotype a person. Look for exceptions - seek exceptions to our stereotypes Check our attributions - Do we see negative behavior in others as being part of their poor character while our negative behavior is blamed on circumstances? Evaluate our scripts - People from different cultures may not have the same scripts we do and thus we misunderstand their actions. Check our perceptions - Check with the other person to see if your perceptions are correct. Allow for differences - Recognize there is a lot you don't know and be open to finding out more.

Changing attitudes

We can change our attitudes toward strangers and members of out-groups. Contact, especially contact around substantive issues, is helpful Stress cooperation rather than competition. Learn to see members of other groups as individuals rather than as representatives of our own biases and stereotypes. Remain open to learn more. Confirm to others that they are valuable to you as individuals, that their experiences and concerns are important, and that you are willing to become involved to help them resolve their problems.

we vs them attitude

We learn who is in our in-group and who is in the out groups through our socialization. In-groups are seen as acceptable. They are seen as being more like ourselves. Out-groups are generally groups with whom we do not often interact and with whom we feel uncomfortable We often describe in-groups favorably while we are often suspicious of the motives of out-groups. We-Versus-Them attitude develops when we use our own culture to judge the culture of others.

How we steal a clients self esteem

We steal a client's self-esteem by: ◦Being rude, brusque or demeaning ◦Ignoring the client ◦Refusing to return calls or acknowledge the clients concerns ◦Denigrating, ridiculing, or demeaning the client ◦Forcing clients to perform actions the client is not capable of performing

legal, ethical, moral may overlap

What you find to be immoral may not be embodied in any ethical or legal code Behaviors deemed unethical in your professional code may be behaviors you never considered either immoral or illegal Some behaviors are prohibited in both ethical and legal codes and may be obviously immoral to you

When you can break confidentiality

When you must warn others of possible harm by the client When the client needs professional services and cannot obtain these voluntarily When protecting clients from harming themselves When you are attempting to obtain payment for services When obtaining a professional consultation from your regular supervisor in the course of regular supervision

Workers who are culturally competent

Workers who are culturally competent are: Adaptable to situations. Flexible in choosing how to respond to situations. Have a commitment to give high-quality service to every person who comes for assistance. Lets others know they have been heard and their concerns are significant. Are respectful of others regardless of culture.

When you can reveal information

You can reveal information about a client in a court proceeding when: ◦You are acting in a court-appointed capacity such guardian or payee ◦A child under 16 is believed to be the victim of a crime such as sexual or physical abuse ◦You determine the client needs to be hospitalized ◦The client has told you of his intention to commit a crime or harm himself or another