Chapter 13: Planning & Implementing Change-Oriented Strategies

Benefits of a crisis

**only for adults 1. Promote growth 2. Increase self-efficacy, spirituality, faith in people, and community closeness 3. Client view the situation through multiple lenses 4. Construct interventions that recognize and strengthen the benefits and increase successful outcomes

Reassessment at fixed intervals

- Formal or informal - Completed at fixed intervals - Information father can also determine the level of change since the initial assessment

Solution-focused brief treatment

- Post-modern, constructivist approach - Goal is to release a client's unconscious resources, thereby shifting from a problem-oriented perspective to one that is more solution based - Integrates aspects of cognitive restructuring - Based on the premise that change can occur over a brief period of time

Cognitive distortions

- Problems occur when thoughts are consistently distorted because of a client's ingrained beliefs and faulty reasoning - Distortions maintain negative thinking & reinforce negative emotions 1. All or nothing thinking - seeing the glass as half empty 2. Blaming - perceives others as the source of negative feelings & avoid taking responsibility 3. Catastrophizing - if a certain event occurs, the results would be unbearable 4. Discounting positives - treats a positive as a negative 5. Emotional reasoning - based on how you feel rather than on reality 6. Inability to disconfirm - unable to accept any information that is inconsistent with your beliefs or negative thoughts 7. Judgment focus - perception of self & others or an assessment of events as good or bad 8. Jumping to conclusions - assumes the negative when there may be limited supporting evidence 9. Mind reading - assumes that you know that people will think, do , respond 10. Negative (mental) filtering - results in mentally singling out bad events 11. Overgeneralization or globalization - involve perceiving isolated events and using the to reach broad conclusions 12. Personalizing - you had a role in or that you are responsible for a negative situation 13. Regret orientation - focused on the past 14. "Should" statements - self-failure or judgments about others relative to how things should be 15. Unfair comparisons - measure self against others believed to have desirable attributes 16. What ifs - refers to tendency for people to continually question themselves about the potential for events

Cognitive restructuring

1. A therapeutic process derived from cognitive behavioral therapy 2. Assumption that people often manifest cognitive distortions which in turn affects their emotions and actions

Case Management Functions

1. Access & Outreach 2. Intake & Screening 3. Multidimensional Assessment 4. Goal Setting 5. Planning Intervention and linking to resources 6. Monitoring the progress and adequacy of services 7. Reassessment at fixed intervals 8. Outcomes evaluation/termination

Tenets of the crisis intervention equilibrium model

1. Action oriented, with the central intent being to reduce the intensity of a client's emotional, mental, physical, and behavioral reactions to a crisis and to restore client functioning to the pre crisis state 2. Promptness of response - during acute period 3. Procedure involves assessing the nature of the crisis, identifying priority concerns, and developing limited goals

Social worker role in solution-focused treatment

1. Active in helping clients to question self-defeating constructions 2. Assisting them to construct "new & more productive perspectives

4. End-of-session feedback

1. Aim is to compliment and reinforce what client has already done to solve the problem 2. Clients are asked what they should do more or less of in order to accomplish a goal

Change-oriented approaches

1. Aim is to facilitate the attainment of goals or respond to a mandate in the case of involuntary clients 2. Approaches are organized around the systematic interpersonal & structural elements of the helping process and follow the distinct phases of engagement, assessment, goal planning, intervention, and termination 3. Emphasize mobilizing individuals, families, & groups toward positive action 4. Approaches are: task-centered model, crisis intervention model, the cognitive restructuring technique, the solution-focused brief treatment model, case management practice

Rehearse or practice behaviors involved in tasks

1. Aimed at assisting clients that may lack skills or behaviors with which they have had little or no experience to gain experience and mastery in performing skills or behaviors essential to task accomplishment 2. Enhance clients' sense of self-efficacy so as to increase their potential for successful task completion

Help the client to assess the rationality of beliefs & self-statements

1. Ask how a client has reached certain conclusions 2. Elicit evidence that supports the client's perceptions or beliefs 3. Explore the logic of beliefs, that have magnified the feared consequences of certain actions

Developing specific tasks

1. Assessing client readiness to engage in an agreed upon task 2. Brainstorming alternative tasks - involves a process in which you and the client mutually focus on generating a broad range of possible task options from which the individual, family or group may chose 3. Establishing a reward of an incentive - specify the time frame & conditions under which the task is to be performed - with collaboration with the client, identify the reward to be earned as well as establish a method for tracking the progress of task completion - identify relationship rewards - provide a bonus for consistent achievements of tasks over an extended period of time - encourage task completion by providing consistent & positive feedback

Procedures of cognitive restructuring

1. Assisting clients in accepting that their self statements, assumptions, and beliefs determine their emotional reactions to life's event (tool: explanation & treatment rationale) 2. Assist clients in identifying dysfunctional self-statements, beliefs, and thought patterns that underlie their problem (tool: self-monitoring) 3. Assist clients in identifying situations that engender dysfunctional cognitions 4. Assist clients in replacing dysfunctional cognitions with functional self-statements 5. Assist clients in identifying rewards and incentives for successful coping efforts

Reasons related to the target problem

1. Attributed not acknowledged problems -beginning by acknowledging this view of the situation, respecting the client's reactions, and exploring incentives that might encourage him to complete tasks 2. Conflicting wants/needs - flexibility is called until the competing concern is resolved 3. Client unaware of consequences 4. Little hope for change - help the client by calling attention to his past successes, boost confidence

Application of crisis intervention with diverse groups

1. Believed to be applicable to different population 2. Calls for multicultural helping that includes the social worker's sensitivity to difference & worldviews, self-knowledge, & awareness of his bias 3. Important to understand the meaning of the crisis to the client & his preference for resolution 4. Attention should be given to inequality, faith & social justice

Step 5: Make Plans

1. Client & social worker agree on specific action steps or tasks 2. Social worker solicit client's views on what she believed would help her to function at a level of precrisis equilibrium 3. Safety was identified as a priority and related tasks were developed

Step 4: Examine Alternatives

1. Client & social worker select and prioritize available options 2. Alternative should be realistic & are considered to the extent that they are: - situational supports - coping mechanisms that represent actions, behaviors, or environmental resources - positive and constructive thinking patterns that effectively alter how a client views the problem

Step 6: Obtain Commitment

1. Client and social worker committed to collaboratively engage in specific intention land positive tasks designed to restore her to a level of pre-crisis functioning

Procedures of the task-centered model

1. Client identifying & prioritizing a target problem 2. Goals are agreed upon, and general and specific tasks to achieve goal attainment are developed 3. Monitoring progress - identified goal is monitored and reviewed in each session as the client moves towards termination

Evidence of the approach

1. Considered evidence-based practice particularly for clients who have histories of trauma 2. Should not harm clients - at best leave survivors better off than when they first sought help

Duration of contact & focus

1. Crisis work is time limited, spanning 4 to 8 weeks 2. Focus of the intervention is on the here and now 3. Goals are limited to alleviating distress & assisting clients to regain equilibrium 4. Task are identified, and task performance is intended to help clients achieve a new state of equilibrium

Solution-focused procedures

1. Description of the problem 2. Developing well-formed goals 3. Exploring exceptions 4. End-of-session feedback 5. Evaluating progress

Step 1: Define the problem

1. Determine the unique meaning of the crisis and the severity of the situation to the client 2. Assess and alleviate emotional distress - listen & respond empathically, able to gain an understanding of the magnitude of distress in relationship to her problem within her culture 3. Elicit the client's definition of the problem

Case plan

1. Determining the eligibility criteria of each provider 2. The provider's ability to meet the plan's goals and the case review and monitoring process 3. Once you are satisfied with a fit between the client's needs and the service provisions of each provider, server agreements are developed with each

Applying cognitive restructuring with diverse groups

1. Differences in reality, history, and context can influence cognitive development and processes 2. Examining the context of distortions or negative thought patterns before concluding that a client's cognition and thought patterns are irrational 3. Cognitive restructuring as supportive counseling for immigrants with their maladaptive thoughts & increase their coping skills in intercultural situations 4. Supports the status quo of mainstream society 5. Research is limited

Tenets of the Task-Centered Approach

1. Direction with regard to goal attainment is both systematic and efficient 2. Clients are capable of solving their own problems & that it is important to work on problems that are identified by the client 3. Client's identification of prior concerns & collaborative relationships - empowering aspects

Strengths of crisis intervention

1. Diverse populations - include an understanding that the definition of a crisis is influenced by culture 2. perceptions of crisis vary based on associated threats, client cognitions, ego strengths, coping capacity, and problem-solving skills 3. Retains the assumptions of a crisis as an episodic, time-limited event 4. Consistent with generalist practice

Is the approach compatible with the basic values and ethics of social work?

1. Does the approach safeguard the client's right to self-determination ? 2. Does the approach safeguard the client's right to informed consent?

Limitations of cognitive restructuring

1. Doesn't always equip clients with the skills required to perform those new behaviors 2. Presence of external factors such as oppressions or rejection - social control for diverse clients 3. Dysfunctions may be produced by numerous biophysical problems

Theoretical framework of crisis intervention

1. Early crisis intervention theory spanned the life course to include grief & loss reactions, role transitions, traumatic events, and maturational or biopsychosocial crisis at various developmental stage 2. psychoanalytic paradigm - Erikson

Standards of Case Management Practice

1. Educational & Licensing requirements for case managers 2. Utilizing a comprehensive assessment to determine the biopsychosocial functioning and care needs of clients, including their strengths & resources 3. A client-centric, shared decision-making collaborative relationship between the client and case manager 4. Planning & implementing services that address & are responsive to the unique needs of the client 5. Adhering to professional values & principles 6. The primacy of the obligation to he client 7. Monitoring progress and the evaluation of the achievement of targeted outcomes 8. Utilizing the best evidence available to inform case management practice with specific populations, conditions & needs

Tenets of solution-focused brief treatment

1. Emphasizes identifying solutions rather than resolving problems 2. Draws on people's strengths and capacities with the intent of empowering them to create solutions 3. The analysis of a problem doesn't necessarily predict a client's ability to problem-solve 4. Solutions & problems are not necessarily connected 5. Oriented towards the future - asserts that clients have a right to determine their desired outcomes 6. Clients are categorized

Task implementation sequence

1. Enhance the client's commitment to carry out tasks 2. Plan the details of carrying out tasks 3. Analyze and resolve barriers & obstacles 4. Rehearse or practice behaviors involved in tasks 5. Summarize the task plan

Does the approach safeguard the client's right to informed consent?

1. Ensuring that clients understand and consent to an approach is essential to ethical & collaborative practice 2. Explain the approach in language that is easily understood, presenting information about the benefits, risks, & evident of the approach's effectiveness with their problem Does the client understand the proposed approach? Is the client in agreement with the proposed approach? Does the client have concerns about the procedures and effectiveness of an intervention, strengths, and limitation related to her particular problem? Is the client satisfied with the manner in which his progress would be monitored and measured? - Answer to the questions provide assurance that the client understands & is able to make an informed decision, and is subsequently able to give or withhold consent

Case management

1. Entails work that interfaces between the client and her environment 2. Designed to coordinate the provision of services from multiple source for the benefit of the individual client

Am I sufficiently knowledgeable and skilled enough in this approach to use it with others?

1. Ethically obligated to have the requisite knowledge, skills, training, and competence to use an approach to resolve a particular client problem 2. Are you competent enough to make use of the techniques of another approach with the one that you have selected?

Step 2: Ensure Client Safety

1. First & foremost concern 2. Safety involves deliberate steps to minimize the physical and psychological danger to the client or other 3. Evaluate affective, cognitive, and behavioral domains - evaluate the extent of adaptability and coping capacities and family resources

Using cognitive restructuring with minors

1. Found that distorted thinking can affect the social & interpersonal skills of minors 2. Can increase self-efficacy & reduce social anxiety in adolescence 3. Assess the context in which the minor's behavior occurs 4. Negative thought patterns and self-talk of minors were linked to harsh punishment and excessive criticism in their home life 5. Procedure more effective with older adolescents 6. Importance of family & school involvement and discussed cognitive restructuring as effective when age-appropriate strategies were used

Assist clients in identifying dysfunctional self-statements, beliefs, and thought patterns that underlie their problem

1. Help the client identify the associated thoughts and beliefs relevant to his difficulties 2. Requires a detailed exploration of events related to problematic situations and antecedents with particular emphasis on conditions pertinent to the distressing emotions 3. Focus on the problematic events that occurred during the preceding week or on events surrounding a problem the client has targeted for change 4. The aim is to identify self-statements and beliefs related to an event and to increase the client's awareness of the way in which automatic thoughts and beliefs are powerful determinants of behavior 5. To elicit self-statements, ask the client to recreate the situation as it unfolded, recalling exactly what he thought, felt and did 6. Exploration of self-statement during events often reveal that thoughts maintain self-defeating feelings and behaviors and drastically reduce personal effectiveness 7. A client's thoughts & feelings after an event can have an impact on his subsequent behaviors - after listening you can further highlight the mediating function of cognitions 8. Be prepared to challenge or dispute the validity of irrational beliefs by emphasizing the disadvantages associated with counterproductive beliefs 9. Identifying patterns of misconceptions - direct efforts to the theme common in all of them

Strengths of Task-Centered Model

1. Honors self-determinations, strengths, and empowerment by allowing clients to define the problem, develop goals and tasks, and participate in monitoring progress 2. Increases self-efficacy and opportunity for mastery by identifying and resolving obstacles to task completion & goal attainment 3. Empirical evidence in multiple settings & demonstrated in worldwide practice 4. Emphasis on taking action on problems acknowledged by clients - appeal to racial & ethnic minorities

Interview question that facilitate a client's capacity to think about the future and to identify solutions

1. How can I help? - engagement session 2. What's better? 3. How will you know when you problem is solved? 4. What will be different when the problem is solved? - goal development 5. What signs will indicate to you that you don't have to see me any longer? - before & during termination 6. Can you describe what will be different in terms of your behavior, thoughts, & feelings? 7. What signs will indicate to you that there involved in this situation are behaving, thinking, or feeling differently?

Case managers

1. Human interaction between clients and various systems 2. Type of setting will also determine whether your involvement is brief or time-limited, targeted, ongoing or open-ended 3. Case management begins with assessed need rather than a service

Assist clients in replacing dysfunctional cognitions with functional self-statements

1. Important to not ignore the struggle as client shirts from habitual & ingrained patterns of thinking to adopting new behavioral patterns 2. Coping self-statements are intended to support the transition to risking new behavior 3. Social worker explains the rationale for developing new self-statements 4. After, social worker models coping self-statemtn so that client can use as substitute for his thoughts & beliefs - reflect the client's actual experience - empathy for & understanding of a client's struggle 5. Appropriate to encourage the client to practice the behavior - close their eyes and picture the moment before exact situation 6. Continue to practice & coach them until they feel relatively comfortable in their ability to develop new self-statements 7. Shift to self-statements during the exact situation - modeling again 8. Social worker ask client to describe his feelings about what had happened so far 9. Self-monitoring is essential 10. Another technique: encouraging them, upon their first awareness of such thought to nip them in the bud

Informed consent & minors

1. Informed by developmental stage & cognitive & reasoning ability 2. Presumes that clients not only understand a proposed approach but also are able to weigh potential outcomes 3. Unable to give consent, they can nonetheless be provided with information about the approach and ask whether they assent; that is they can give an affirmative agreement

Plan the details of carrying out tasks

1. Intended to prepare client for all of the actions involved in a task 2. The practitioner's role in task planning - assumes responsibility for some tasks & accompany the client (support system) 3. Conditions for task completion - the details of tasks should specify when, as well as, the conditions or circumstance of the action that is to occur 4. Start with a structured first task that is easy and within the individual's capacity to achieve

Enhance the client's commitment to carry out tasks

1. Involves clarifying the significance of task for reaching the goal and identifying the potential benefits 2. Exploring apprehension, discomfort, & uncertainty is especially critical when a client's motivation to carry out a given task is questionable 3. Ask client to identify benefits they will gain by successfully accomplishing the task

Strengths of solution focused

1. Involves practical procedures and questions that can be readily learned and applied in many practice situations 2. Efficacy with diverse populations & variate of problems 3. Success with involuntary clients 4. Commitment to empowerment and focus on client's competence, strengths, and capacities

Trauma in client with a diagnosis of serious and persistent mental health problems

1. Is interpersonal and intentional in nature: prolonged, repeated, and serious 2. Involves emotional, sexual, or physical abuse, serious neglect, witnessing violence, repeated abandonment, or a sudden and traumatic event 3. Occurs in childhood or adolescence and may extend over a client's life span

Tenets of case management

1. Is not a change-oriented intervention strategy - involve the procedural elements similar to the intervention approaches 2. Linking individuals or families to a range of services based on their assessed needs 3. The method can make use of theories and intervention tactics or techniques that are appropriate to. clients' situations

5. Evaluating progress

1. Monitoring is ongoing & is specific to evaluating the client's level of satisfaction with reaching a solution 2. After client has rate her ratification level, you work with her to identify what needs to occur so that the problem is resolved

Intervening with minors

1. More vulnerable and at greater risk when a crisis event occurs 2. Disrupt biological, social, and cognitive development

Does the approach safeguard the client's right to self-determination ?

1. Nature of decision, age, and stage of development, and the capacity to understand the consequences of a decision 2. Focus should be on the client's capacity rather than limitations 3. Encourage self-direction with such clients and emphasizing the ways in which they can exercise their rights and regain control over their situation should be discussed

Limitation of solution focused

1. Not collaborative - assignments decided by practitioner 2. Limited attention to behaviors 3. Too simple & practical of questions - ignore relational dynamics between the client & social worker

Failure to complete tasks - reasons related to the specific task

1. Occurrence of an emergency or crisis - empathetically respond to the emotional state of the client & focus on the more urgent difficulty and develop a goal & yaks related to the unexpected situation 2. Lack of Commitment - covert unwillingness to own one's part of a problem (blaming others & wait for others to initiate corrective actions); need to use ethical confrontation 3. Lack of Skills/Resource - ensure they have what they need to complete agreed-upon action 4. Task Inadequately Specified - task should be specific, be stated in positive terms, and indicate what action is expected within a specified time frame 5. Adverse Beliefs - Being sensitive to and respecting different beliefs is important 6. Lack of Support - Relevant individuals should be involved in supporting task accomplishment 7. Environmental Factors - Support for completing tasks can also be related to family or environmental factors 8. Reactions to the Practitioner - Negative reactions to the social worker, both verbal & nonverbal, can affect a client's ability to complete tasks 9. Inadequate Preparation - Better for clients not to attempt a task than for them to make an attempt & fail because they are unprepared

Monitoring progress in task-centered model

1. Once tasks have been identified and agreed upon, devote time in each session to a review of progress 2. During review process, if tasks have not been completed or have not had the intended effect on the target problem, explore barriers and obstacles and the reasons for low task performance 3. Discuss with the client details about the conditions, actions, or behaviors that facilitated completion of the task 4. Ongoing in-session review of progress gives immediate feedback of gains as well as alerting you and the client to where adjustments need to be made

Need for a trauma-informed service approach

1. Paradigm shift 2. Person centered

Self-determination & Minors

1. Parents or legal guardians act as their proxies 2. Developmental stage, reasoning, and cognitive capacity are also significant factors that influence a minor's capacity for decision making and self-direction 3. Task is to provide the opportunity for them to participate in intervention planning, which includes your explaining the benefits and potential risks using words that they understand

Bandura: people receive information about self-efficacy from 4 sources

1. Performance accomplishments - assisting people to master essential behaviors through modeling, behavior rehearsal, and guide practice 2. Vicarious experience - observing others demonstrate certain behaviors or observing the performance of a behavior without experiencing adverse consequences 3. Verbal persuasion - talking to clients about their capacity to perform can be somewhat effective & also raise outcome expectations 4. Emotional arousal - perceived self-competence can reduce emotional arousal

Generalist-electic practice

1. Person & environment focus that is informed by ecological theory 2. An emphasis on establishing a positive helping relationship and empowerment as well as a holistic multilevel assessment, including a focus on diversity, oppression, and strengths 3. A problem-solving model that provides structure and guidelines for work with clients 4. Flexibility in the use of problem-solving methods that allows a choice among a range of theories and techniques based on their compatibility with each client's situation

Cognitive schemas

1. Positive or negative, the memory patterns that a client uses to organize information 2. Determine the context & the type of situation that triggers and maintains problematic behavior 3. Assess whether external and internal stimuli that led to cognitive errors are actual distortions or a client's misunderstanding of his experiences

Theoretical framework of the task-centered model

1. Problem-solving activities occurred within a limited time frame 2. Focused on the challenging problem in the daily living and psychosocial factors that were observed to be common among a majority of social work constituents 3. Use of task - self-efficacy, enhancing the clients sense that through his efforts, he can be successful agent in solving problems 4. Designed to be eclectic

Strengths of case management

1. Problem-solving practice method that is designed to link the needs of client to arrange of service providers 2. As a stand alone or integrated with another treatment - has demonstrated its effectiveness in addressing a range of needs & problems with specific populations

Strengths of cognitive restructuring

1. Procedure to be particularly useful in altering perceptions, distorted beliefs, and thought patterns that result in negative or self-defeating behaviors 2. Compatible with crisis intervention, the task-centered system, and solution-focused treatment 3. Intended to remove cognitive barriers to change and foster a wellness to risk new behaviors

Assisting clients in accepting that their self statements, assumptions, and beliefs determine their emotional reactions to life's event

1. Provide clients with an explanation and your rationale for selecting cognitive restructuring as an intervention procedure 2. May be advisable to use self as an example to explain the technique - highlights how thoughts and beliefs can cause difficulties and the manner in which cognitive restructuring facilitates the development of other thoughts that are realistic and consistent with his goals

3. Exploring exceptions

1. Questions focused on those times in her life when the problem was not an issue or was less of a concern 2. Followed by questions relating to what could happen that would decrease the concern and make exception possible

Empirical evidence of case management

1. Reducing number of hospitalizations for children 2. Effectiveness in school-based approach 3. Positive outcomes for people with substance abuse treatment

Empirical evidence & uses of cognitive restructuring

1. Relevant for treating problems associated with low self-esteem, distorted perceptions in interpersonal relations, unrealistic expectations of self, others, and life in general; irrational fears, panic, anxiety, and depression, control of anger and other impulses; and lack of assertiveness 2. Effective in the treatment of PTSD, social phobia, & anxiety, spousal caregiver support groups, and in crisis or trauma situation 3. Often blended with other interventions

Application of solution-focused approach with diverse groups

1. Responsive to diverse groups b/c its basic threat recognizes the expertness of the narrative and language of the client 2. The basic tenets of the approach are consistent with competent multicultural practice with clients in social service agencies

Utilization with minors

1. Results show successful, specific, solution-focused therapy explore feelings, develops behavioral goals, and encourages positive behaviors 2. Positive outcomes were reported for improving client social skills and managing school-related behavioral problems

Key principles of a trauma-informed approach & trauma-informed care

1. Safety 2. Trustworthiness & transparency 3. Peer support and mutual help 4. Collaboration and mutuality 5. Empowerment, voice, and choice 6. Cultural, historical, and gender issue

Questions that guide the engagement, the formation of goals, & solution-building process

1. Scaling question 2. Coping questions 3. Exception questions 4. Miracle questions

Assist clients in identifying situations that engender dysfunctional cognitions

1. Self-monitoring between sessions is a concrete way for a client to monitor and recognize cognitions related to difficulties around problematic efforts - focuses a client's efforts between sessions, clarifies the connection between cognition and feelings, and appraises information refrain the prevalence and intensity of thoughts, images, and feelings - note recurring situations or themes

Assist clients in identifying rewards and incentives for successful coping efforts

1. Should reinforce their accomplishment by coaching to observe and credit success 2. When a person is hesitant about the exercise, empathic understanding and encouragement on your part will usually prompt them to try this exercise

Theoretical framework for solution-focused treatment

1. Social constructivists' perspective that people use language to create their reality 2. Reality is constructed by culture & context as well as perceptions and life experiences

Step 3: Provide support

1. Social supports - family, friends, and institutional programs that care about the client and can provide comfort & compassion 2. Included in safety plan

Assessment in the crisis situation - Triage assessment system

1. The severity of the crisis 2. Current emotional status and level of mobility/immobility 3. Alternaives, coping mechanisms, support systems, and other available resources 4. The client's level of lethality - Provides a framework for social workers to asses the client's affective, behavioral and emotional functioning; assess the severity of the situation; and plan the appropriate intervention strategy

Trauma-sepcfic interventions support & recognize

1. The survivors' needs to be respected, informed, connected, and hopeful regarding their own recovery 2. The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression and anxiety 3. The need to work in a collaborative way with survivors, family and friends of the survivor and other human services agencies in a manner that will empower survivors and consumers

Basic tenets of CBT

1. Thinking - primary determinant of behavior & involves statements that people say to or about themselves - must clearly differentiate thinking from feelings 2. Cognitions - affects behaviors, which is manifested in behavioral responses - cognitive distortions or faulty thinking can be monitored and changed 3. Behavioral change - involves assisting clients to make constructive change by focusing on their misconceptions and the extent to which they produce or contribute to their problems

Is the approach appropriate for addressing the problem & the service goals?

1. To achieve a desired goal, the change strategy must be directed to the problem specified by the client or a mandate, as well as to the systems or environmental issues that are implicated in the problem 2. Take into account, developmental age and stage and the family life cycle, the latter of which can become exaggerated as a result of stressful transitions 3. Culture & race are requisite factors to be considered 4. Does the approach acknowledge & allow for the integration of environmental factors? 5. Are modifications to the approach indicated so that it is responsive to diverse individuals, families, and minors? 6. Is the approach flexible enough that it respects and can be adapted to specific cultural beliefs, values, and a different worldview?

Trauma-informed approach can

1. Validate a part of people and a history that often has been dismissed or denied 2. Create a safe place where people come for help, restoration and motivation to continue 3. Increase the effectiveness of services designed to empower clients in transition periods 4. Provide opportunity to plant seeds of hope, demonstrate that someone in tis world care about them and show clients that they matter

Broker role

1. Vital to facilitating interagency coordination and cooperation 2. Helping people gain access to amiable resources may require negotiating with the various service providers 3. Advocacy at the systems level may be necessary to ensure that clients have access to resources to which they are entitled 4. mediating between a client & various systems is required

Involuntary clients - questions

1. Whose idea was it that you needed to come here? 2. What is your understanding of why you're here? 3. What makes the mandating authority believe that you needed to see me? 4. What is the difference between your point of view and that of the persona who required that you come here?

What empirical or conceptual evidence supports the effectiveness of the approach?

1. With whom did it work? 2. Under what circumstances? 3. What were the results? 4. The evidence should specify the approach's effectiveness with respect to client problem or status, developmental stage, and cognitive ability, as well as its compatibility with diverse cultural values and beliefs

Analyze and resolve barriers & obstacles

1. You and the client deliberately anticipate and subsequently prepare for obstacles that can affect or stall task accomplishment 2. Inquire about the practical economic resources needed for completing the tasks 3. Tasks that involve changes in patterns of interpersonal relationships tend to be multifaceted & require developing subtasks as a prerequisite 4. Psychological barreies to task performance leading to goal attainment are often encountered regardless of the nature of the task 5. Examine the problematic emotions, helping the client to identify the cognitive source and to align his thoughts and feelings with reality 6. Time & effort invested in overcoming & resolving barriers & obstacles are likely to result in a higher rate of success in accomplishing tasks

The effects of trauma

1. biological, psychological, social, and spiritual in nature 2. Impact is associated with change in brain neurobiology; social, emotional, and cognitive impairment; and the adoption of health risk behaviors as coping mechanisms (childhood trauma too) 3. Behavioral effects include reactions & symptoms that persist into adulthood, including a decreased ability to concentrate, disturbed sleep patterns, and disruptive behavior when an individual is in a situation that reminds him of the traumatic experience 4. PTSD higher among racial & ethnic minorities 5. Gender differences

Initial intervention phase has 3 strategic objectives

1. relieve the client's emotional distress 2. complete an assessment of the client's cognitive, behavioral, & emotional functioning 3. plan the strategy of intervention, focusing on relevant tasks the client is able to perform

Crisis

A perception of an event of situation as an intolerable difficulty that exceeds the resources or coping mechanisms of the person

Visitor

A person who is willing to be minimally or peripherally involved but is not invested in the change effort

Trauma-informed care

A person-centered and strengths-based service delivery approach in recognition of the prevalence of trauma among clients across settings and human services systems - understands and is responsive to the impact of trauma and emphasizes the physical, psychological, and emotional safety of providers and survivors, and creates opportunities to rebuild a sense of control and empowerment in their lives

Labeling

Another form of overgeneralizing in which a negative label is attached to self or others based on a single incident

Crisis reaction

Any event or situation that upsets the client's normal psychic balance to the extent that his sense of equilibrium is severely diminished

Anticipatory Guidance

Assisting clients to anticipate future crisis situations and to plan coping strategies that will prepare them to face future stressors - involves a discussion of scenarios of potential or future stressors

Limitations of crisis intervention

Because of time limit it is not practical for individuals who have ongoing difficulties in their daily lives, people who are exposed to a chronic and constant state of vulnerability in their environment - wouldn't be feasible nor realistic

Intake & Screening

Before assessment - initial step in determining eligibility for services - Preliminary plan may be developed

Technical eclecticism

Blending generalist practice - must consider whether this is appropriate for the problem or situation at the time

Outcomes evaluation/termination

Brief situations - goals have been achieved & leads to termination Longer-term situations - reassessment & evaluation of outcomes are ongoing

Theoretical Framework

CBT considers the behavior of clients to originate from their processing of both internal and external information - most social & behavioral problems or dysfunctions are directly related to the misconceptions that people hold about themselves, other people, and various life situations - understanding of the reciprocal relationship of cognition, affect, and behavior is considered central - classical & operant conditioning

Targeted case management

Certain beneficiary groups are considered to be primary recipients of targeted case management services

Planning goal attainment strategies

Choose an intervention that makes sense to both you and the client and is also relevant to the client's situation 1. Is the approach appropriate for addressing the problem & the service goals? 2. What empirical or conceptual evidence supports the effectiveness of the approach? 3. Is the approach compatible with the basic values and ethics of social work? 4. Am I sufficiently knowledgeable and skilled enough in this approach to use it with others?

Role play

Client is able to rehearse a desired behavior or outcome - a client can build on his existing skills, as well as identify potential barriers or obstacles

Restructuring

Cognitive procedural technique that aims to change a client's thoughts, feelings, or overt behaviors that contribute to and maintain problem behavior

Exception question

Considered the core of the intervention - Assist a client to describe life when current difficult didn't exist - Advances the client's ability to externalize or separate self from the problem by highlighting strengths and resources

Developing general tasks

Consist of discrete actions to be undertaken by the client and by sometimes the social worker - each has specific tasks tat direct the incremental action steps to achieve goals

Intervention techniques in CBT

Designed to help client modify their beliefs, fault thought patterns or perceptions, and destructive verbalizations, thereby leading to changes in behavior

Miracle question

Draw the client's attention to what would be different once a desired outcome is achieved

Interactive trauma/grief-focused model

Emphasizes a developmental ecological framework as another approach to crisis work with minors - the developmental stages and the environment within which the minor operates are interrelated 1. Characteristics of the stressors: include the perception of threat related to the event, physical proximity to the event, duration, and intensity 2. Characteristics of the minor: developmental stage, gender, and vulnerability play a significant role in how a minor experiences a threat, as do psychological or behavioral problems that existed prior to the threat 3. The minor's efforts to cope: good communication skills, a sense of self, internal locus of control, and average intelligence 4. Characteristics of the post-disaster environment: social support from significant others & resources

Amplification (integrated into the process of asking questions)

Encourage clients to elaborate on the "What's different" - can inform goals and tasks related to the miracle question

2. Developing well-formed goals

Encouraging the client to think about what will be different once the problem no longer exists

Goal Setting

Goals & objectives are developed based on assessed needs in collaboration with the client - based on the client's perception of needs and may be structured as long or short term

Empirical evidence and uses of solution-focused strategies

Has been utilized in a variety of settings and with diverse populations, including person with mental illness & involuntary clients

Complainants

Individuals who identify a concern but don't see themselves as part of the problem or solution

Customers

Individuals who willingly make a commitment to change

Multidimensional Assessment

Information is collected about the client's physical, mental, social, and psychological functioning and the physical environment, including strengths and resources - guides the development of the case plan

Coping question

Intended to highlight and reinforce a client's resources & strengths - Credit the client's prior efforts to manage a difficulty and reenergize her strengths and capacities

Behavioral rehearsal

Intended to reduce anxieties and help clients practice new behaviors or coping patterns - include citations in which a client feels threatened, feels inadequately prepared to face a situation, or is anxious or overwhelmed by the prospects of engaging in a given task

Planning Intervention and linking to resources

Interdependent functions - Both formal & informal resources and the approbate service providers are identified - The specific services as well as the frequency and duration of contact with the service provider are specified

Type 1 - minors reaction

Involves a single, distinct crisis experience in which symptoms and signs are manifested

Guided practice

Involves your observing the client as he engages in a task related to a target behavior. Afterward, you provide immediate feedback and also coach the client as he attempts to gain mastery toward task completion - enables you to clarify what is occurring as well as coach clients in engaging in more productive behavior

Access & Outreach

Outreach or case finding identifies people who are likely to need case management services

Bridging (integrated into the process of asking questions)

Part of feedback, clarifying goals, exceptions, or strengths

Covert interactions - microaggressions

People are treated differently based on their race, ethnicity, sexual orientation, ability, or socioeconomic status - conditions that affect cognitive, physical, & psychological functioning are extraordinary stressors

Compliments (integrated into the process of asking questions)

Provide feedback about a client's efforts and reinforce strengths and successes

The crisis intervention model

Referred to as equilibrium model - based on the basic crisis theory

Task-centered model

Specific focus on problems of concern identified by the client and its emphasis on task and the collaborative responsibilities between the client & the social worker

Crisis reaction stages

Stage 1: The initial tension is accompanied by shock and perhaps even denial of the crisis-provoking event Stage 2: To reduce the tension, the client attempts to utilize her usual emergency problem-solving skills - if fail the stress level will become heightened Stage 3: The client experiences severe tension, feels confused, overwhelmed, helpless, angry, or perhaps acutely depressed - patterns of behavior associated with stages are disorganization, recovery & reorganization

Procedures of crisis intervention

Step 1: Define the problem Step 2: Ensure Client Safety Step 3: Provide support Step 4: Examine Alternatives Step 5: Make Plans Step 6: Obtain Commitment

Summarize the task plan

Takes place at the conclusion of a session, consists of a review of the actions or behaviors that a client has agreed to do in order to accomplish a task - need to document in case record or SOAP notes

Trauma-informed approach

The delivery of services and includes an understanding and awareness of the impact and consequences of trauma exposure and of a history across settings and populations - Trauma viewed through an ecological and cultural lens, specifically, the importance of context and the client perception and processing of traumatic events

Essential organizational & professional characteristics

The treatment: 1. Recognizes the prevalence of trauma and understand the potential for recovery 2. Recognizes the signs and symptoms of trauma in clients and how trauma affects all clients involved with the service delivery system, including its own workforce 3. Responds by integrating the knowledge about trauma into practice, policies, and procedures 4. Actively avoids practice and polices that can result in retraumatization

Application of the task-centered model with diverse groups

Thought to be sensitive to the experience of diverse individuals & families because of the emphasis on the rights of clients to identify concerns, including clients who are involuntary - accommodates different worldviews

Monitoring the progress and adequacy of services

Vital & ongoing process 3 sources of information are indicated: - regular contact with service providers to determine if services responsive - monitoring progress toward the stated goals - client's observations regarding the level of progress & satisfaction with the providers

1. Description of the problem

While listening to clients' description of the problem, you are looking for ways in which you can guide them toward a solution

Behavioral responses

a function of the cognitive process of attention, retention, production, and motivation, as well as of rewarding or unrewarding consequences

Crisis Intervention Teams

emphasize the effectiveness of the approach in improving interactions between police & persons who are mentally ill

Prevalence of trauma

high incidence of trauma in the general population, including youth and young adults

Type 3 trauma

involves multiple pervasive violent events, often taking place in childhood and continuing into adulthood - suffer persistent psychological effects requiring different treatment strategies

Type 2 trauma

involves repetitive and prolonged exposure to a traumatic event or experience, resulting in intense psychological and physical reactions

Trauma

single event, multiple events or a set of circumstances that tis experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual's social, emotional, and spiritual well-being

Type 2 - minors reaction

the result of longstanding, repeated trauma whose cumulative effects result in the minor's psyche developing defensive coping strategies, anxiety, depression, or acting out behavior

Type 1 trauma

trauma in which the individual retain complete memory of the experience

Scaling questions

using a scale of 1 to 10, solicit a client's level of willingness and confidence in moving toward developing a solution and are subsequently used to observe progress