Social Work Practice 1 Final (Slides)

Establishing Rapport

• Genuine care/authenticity​

• Introductions:​

• How much is too much?​

• Self-disclosure​

• Seeking feedback from our client​

• Trauma Informed lens is important here​

• Sympathy vs. empathy ​

• Understanding client motivation to change​

Key principle of social work:​

Starting where the client is

Voluntary

seeking help of their own volition ​

Involuntary

mandated to be there by an outside authority (Parole/Probation, Court Ordered Tx) ​

Hybrid

kids or adolescents, one half of a couple where the other insists on tx

Motivation relates to

past experiences with help​

• Socialization to the helping profession is a smart place to start as it allows for both parties to be on the same page ​

• Sharing information about what to expect, how sessions run, services that can be offered​

• Explaining confidentiality and its limits​

• Exploring boundaries and communication ​

• Social Workers need to clarify client expectations for the work together​

• “Help me understand what you are hoping to accomplish by working with me” ​

• “What would be an ideal outcome of our time together?”​

• “What motivated you to come see me today?”​

Elaboration skills​

• Using open-ended questions​

• Using minimal prompts​

• Seeking concreteness​

• Summarizing​

• Containment​

• Exploring silences​

• Reframing​

• Using open-ended questions​

• Choose questions that invite dialog ​

• Using minimal prompts​

• Brief verbal or non-verbal indications of encouragement ​

• Head nods, small vocalizations, or short phrases all work well here ​

• Accent responses are options as well ​

• Seeking concreteness​

• Helping the client move from the general to the specific as their story unfolds for your benefit and their own ​

• Can be done with open ended questions ​

• Summarizing ​

• A filtering and feedback process designed to check understanding and to elicit more detail ​

• Can also be helpful in finding connections that client might have missed ​

• Using containment ​

• The skill of not jumping in too soon ​

• Holding space for the client ​

• The artful use of silence ​

• Exploring the meaning of silence for the client ​

• Don’t rush to fill it in for them​

• Reframing ​

• Also referred to as relabeling ​

• Recoding something the client sees as negative as a positive instead ​

• Invites the client to see something from a different perspective ​

Demonstrating Empathy

This is necessary to help clients engage in the change process​

• Focused listening​

• Also known as active listening ​

• Concentrating on a specific part of the client’s message ​

• Listening to the verbal and non-verbal messages of the client ​

• Reflective empathy ​

• Reflecting back to the client their message ideally using paraphrasing​

• “Understanding the facts is important but understanding the feelings is essential” (Poulin, 2024, p205)​

• Can provide a second opportunity to get it right also ​

Additive empathy

• Occurs when we make connections to underlying feelings and connects them to something larger​

• “So, I am wondering if the feelings you have now might feel bigger because of the loss you experienced earlier” ​

• Can feel intimidating because it carries a risk with it of being wrong​

Limits to confidentiality​

• Imminent risk to self or others ​

• Reasonable suspicion of abuse or neglect of a child or a vulnerable adult​

• Disclosure of abuse or neglect taken against a child even if the person reporting is now an adult

Physical Abuse

is the physical injury sustained by a minor as a result of cruel or inhumane treatment or as a result of a malicious act under circumstances that indicate that the minor's health or welfare is harmed or threatened by the treatment

Neglect

is the intentional failure to provide necessary assistance and resources for the physical needs or mental health of a minor that creates a substantial risk of harm to the minor's physical health or a substantial risk of mental injury to the minor. Does not include the failure to provide necessary assistance and resources for the physical needs or mental health of a minor when the failure is due solely to the lack of financial resources or homelessness. ​

Sexual Abuse

is an act that involves sexual molestation or exploitation of a minor, whether physical injuries are sustained or not. includes:​

Allowing or encouraging a child to engage in: ​

• obscene photography, films, poses, or similar activity​

• pornographic photography, films, poses, or similar activity​

• Prostitution​

• human trafficking​

• Incest​

• Rape​

• sexual offense in any degree​

• Sodomy​

• unnatural or perverted sexual practices​

Signs of physical abuse could include: ​

• Bruises, welts or broken bones​

• Burns​

• Missing hair​

• Poor hygiene​

• Injuries or redness around the genitals​

• Injuries at different stages of healing​

• Injury or medical condition not properly treated​

• Slowed physical development​

​

Signs of neglect could include:

• Unattended medical or dental needs​

• Nutritional deficiencies​

• Inappropriate dress for weather​

• Consistent hunger​

• Irregular or no attendance at school​

Signs of sexual abuse could include:

• Change in child’s behavior, personality, or activities​

• Stated desire not to be around a particular adult​

• Aggression toward adults or other children​

• Sudden decline in school performance​

• Sexualized play or has a sexual knowledge beyond normal maturity​

• Avoidance of undressing or wearing extra layers of clothes​

• Swelling or bleeding around genitals or mouth​

• Urinary tract infections​

it is helpful to have the following information, but even if you don't - still make a report!​

• Child’s full name and date of birth​

• Child’s home address​

• Name, address, and contact number for the child’s parent/guardian​

• Current whereabouts of the child​

• Nature and extent of the abuse (minimal facts: who and allegation)​

• Any other information that may help investigators to determine the cause of the abuse and identify the person responsible (i.e. Nicknames, relationship to alleged offender, etc.)​

Boundaries

• Refers to the norms of separation that are maintained between the social worker and the client ​

• Intended to prevent conflicts of interest, ensuring the client’s issues are primary focus of the relationship and avoiding social worker’s professionalism from being questioned ​

• Are concerned with avoiding dual relationships where a social worker is called to wear more than one hat at the same time​

• Specifics around physical, sexual and intimate contact with clients​

• New revisions focus on the need for boundaries in digital space as well for client privacy and practitioner safety ​

Boundary Crossing ​

• Contacts with clients that are unplanned, manageable, temporary and transparent​

• This should be addressed in the opening sessions for clarity ​

Boundary Confusion ​

• Can be created by certain practice settings like homes​

• Social workers in rural settings ​

• Social workers who are supposed to wear two competing hats at the same time ​

Perspectives to Keep For Work With Trauma

◦What is considered traumatic is defined by the individual

◦Trauma-related symptoms are a means to cope to, manage or react to previous trauma

◦Sequelae of trauma can dramatically impact the tasks associated with learning (Hoch et al., 2015; Bonanno, Pat-Horenczyk & Noll, 2011)

◦Behavior is a way to adapt to struggles (cutting is a way to relieve pressure, aggression is self-protection)

◦People are doing the best they can in that moment

◦Healing happens in relationship

◦Trauma-informed care

◦The overarching umbrella that provides the filter for everything we do in a way that ensures universal precaution.

Motivational Interviewing

is considered an evidenced-based practice for individuals with trauma histories with its emphasis on starting where the client is and honoring voice/choice

Safety

◦Asking a client, ” looking around my office, are there things here that are triggering for you?”

◦Before issuing consequences to a resident, inquiring about what’s going on for them

◦Using a De-escalation Preferences Form or another tool to understand best ways to help a client when they are in crisis BEFORE you need it

◦Consider conducting individualized “trigger” inventories with clients

◦Debriefing and providing support to staff ( Harris & Fallot, 2001)

◦Ensuring interactions with everyone are welcoming, respectful and engaging (Harris & Fallot, 2001).

◦Conduct a walk-through of your space entering as a first-time client would—look for factors like lighting, color/decoration, configuration of space,  private spaces, signage/written language

◦A doctor asks a patient what can be done during a procedure to help the patient feel more comfortable (SAMSHA, 2020)

Trustworthiness/Transparency

◦Healing happens in relationship so take time to establish a rapport and boundaries

◦Be clear about what your roles are in a client’s care and also the limits to those roles

◦Give your client permission to take time to test your trust (Smyth, 2013)

◦Identifying places in your work where its about compliance vs. impact  (Johnson, 2019)

◦Be intentional about how you describe confidentiality and its limits

◦Be sure clients know when you are unavailable and how they can contact you (or other help in your absence)  (Smyth, 2013)

◦Ensuring interactions and rules are consistent with an emphasis placed on follow-through (Harris & Fallot, 2001).

Collaboration

◦Clients should play a (significant) role in planning and evaluating their care

◦“Talk Less, Listen More, Partner with People, Request Feedback, Ensure Comfort” (Johnson, 2019)

◦Conveying the message that individuals are the experts in their own lives (Harris & Fallot, 2001).

◦Create a referral database of other providers who also operate from a trauma-informed lens—be sure to gather client feedback

◦Join in opportunities for cross-sector collaboration operating from a trauma-informed perspective

◦Take time to cultivate relationships within your milieu—connection as opposed to compliance is correlated with fewer trauma-reactive crises.  Kids will feel more supported and contained (Abblett, nd)

◦Develop information-sharing agreements across agencies to minimize duplication of assessments and intake questions (NSCASW, 2015)

Empowerment

◦process of increasing personal, interpersonal or political power so that individuals can take action to improve their life situations” ( Zastrow, 2016. pg 14)

◦Education is an important component here—teach about trauma, triggers and the mind-body connection (Johnson, 2018)

◦Find ways to promote resiliency in your clients

◦Operate from the Strengths Perspective 

◦Use of strengths-based language that is focused on solutions rather than problems (ITTIC, 2020)

◦Asking a client what are they already doing that is working to further their goals

Honoring Voice and Choice

◦Providing everyone clear and appropriate messages about their rights and responsibilities (Harris & Fallot, 2001)

◦When possible, giving choice about a therapist to work with or specific modalities they are interested in using

◦Client helps to decide what to work on or choice about modalities

Step 2 of the Social Work Change Process

Assessment

Written assessments

include presenting problems, client goals, level of  functioning, comprehensive overview of client history, strengths, and external observations

Ongoing assessments:

dynamic process where client and worker are gathering data, analyzing & synthesizing it to ensure progress is being made and that accurate information is maintained

Interdisciplinary layer:

when social workers function in a setting where multiple disciplines are present, their assessment is just one piece of a larger assessment process.  Which member of the team is in the driver’s seat varies setting to setting but a social worker’s perspective is rich and valuable regardless.

Frameworks to include

Bio-psycho-social-spiritual

Strengths Perspective

Adverse Childhood Experiences Survey (ACES)

Anti-oppressive framework

Risk Assessment (suicide, lethality, self-injurious behavior)

Mini-mental status exam or another cognitive tool

The Bio-Psycho-Social Assessment

­A holistic approach that takes into account the multiple layers of influence that are present in an individual/family’s world

Biological piece

examines existing medical conditions, physical limitations/challenges, genetic pre-dispositions, etc.

Psychological component

­looks at any mental health issues, cognitive functioning, mental status, current or past psychiatric/behavioral health treatment

Spiritual

concentrates on the religious and spiritual beliefs, practices and traditions of a person

Social piece

­takes into account macro influences, environmental problems that might affect the diagnosis, stressors that impact functioning, functioning of relationships, coping skills, strengths/resiliencies, substance use 

The Strengths Perspective

Based on the assumption that clients will be better motivated to achieve positive and lasting change by focusing on and building upon the intrinsic strengths on the client(s) than by focusing on deficits or problems

Also encourages assessors to see the client(s) as their own best expert; no one knows their experiences, thoughts and feeling better than they know themselves

­The scope of assessment is defined by several factors:

­Role of the Social Worker

­Setting of our work

­Needs of the client

­Who is the client actually is

Where does the information come from?

From the client themselves

From appropriate outside informants

Intake & referral forms

Social Worker’s observations

Assessment tools and tests

The Presenting problem

What has brought the client in

What are the most pressing issues according to the client

Try to understand it in as much detail as possible

How is it impacting the client

Where in their world does it show up

Professional Social Work
documentation is:

Timely, accurate, clear

•TIMELY

•Completed in a predictable schedule •As close to client interaction time as possible

•ACCURATE

•Reports facts

•Honestly evaluates/represents the client

•Upholds value of integrity

•Complete “If it isn’t written down, it didn’t happen”

•CLEAR

•Direct

•Free from ambiguous language

•Explains any anacronyms & jargon

Moving Along in the Change Process

•A solid assessment sets us up for the next phase in the Social Work Change Process

•We use a dynamic assessment to write a thoughtful, evidenced-based treatment plan

•Be sure to include the client in this process as well ensuring that their presenting problem shows up in the treatment plan as a priority

Context around Goal Formation

•All behavior is geared at meeting needs (something that is valued, desired, or satisfies a perceived need or obligation according to Hepworth, 2024)

•Some goals are subconscious while others are purposeful and intentional

•Care in developing goals in a sound way helps to facilitate their accomplishment

•Goals that are carefully formulated can be broken down into smaller manageable tasks that help in overall goal attainment

•Setting goals and talking about them to others has a motivating factor to them provided the goal is achievable and realistic

Setting Goals in Social Work

•Helps us to focus on the outcomes that are priority for ourselves and our clients

•Works to ensure there is solid congruency between what we are are working towards and what are clients are invested in

•Program goals focused on the mission of an agency or funding source are framing considerations but not necessarily the focus of the work

•Should be a process that is client-centered and is based on their needs and priorities; social workers can suggest ideas and direction for the work but working in competition of client wishes will likely result in frustration or lack of compliance  

•Strengths Perspective framework helps to keep us centered on the idea of client-centered work here

•We need to navigate this with care for involuntary or mandated clients

SMART

Specific, measurable, Achievable, Realistic, Time-bound

Specific

Focus on one area for improvement

Measurable

Quantify or have progress indicator in your goals

Long-term goals:

use a client’s ambitions to frame what they wish to address over a longer period of time; on their own they might not be motivating without well-framed short-term goals

Short-term goals:

should represent a chunk of a longer-term goal ensuring the SMART parameters are captured

Definition of an emergency petition (EP)

•Maryland's statute allows a violent or suicidal person with a mental disorder to be brought to an emergency facility for rapid evaluation regarding the need for emergency treatment

Who can issue an EP?

•A physician,

•licensed clinical social worker

• licensed clinical professional counselor

•county health officer or designee

• law enforcement officer

Criteria for filling an EP

•Has a mental disorder

•The individual presents a danger to the life or safety of themselves or others.

•

•Note: The criteria to grant an emergency petition for evaluation does not require that the dangerous behavior be “imminent” to the life or safety of the individual or others

How to File an EP

•DURING BUSINESS HOURS REPORT TO NEAREST DISTRICT COURT

•TAKE A LIST OF PRESCRIBED MEDICATIONS IF KNOWN.

•BRING ANY PERTINTNET MEDICAL RECORDS OR NOTES

•DETAILED RESONSES ARE KEY TO PRESENT TO THE JUDGE

Subjective Observations

refers to how the client views the situation or their experience

Objective Observations

Social worker reports things they saw, observed, etc. “client appeared tearful and disheveled”

Assessment

where the social worker lists clinical impressions and diagnostic impressions; “client scored a moderate risk indicator on their Lethality Assessment”

Plan:

social worker indicates next steps; “A consult with be scheduled for medication provider” “client was open to a referral to Springboard for case management”

Micro Interventions example:

Supportive Counseling, education and training, Service linkage, service coordination, service negotiation, resource mobilization

Supportive Counseling

SW occupies the enabler role; provides containment around an issue; purpose is to help resolve concerns, enhance coping and improve functioning

Education & Training

SW takes on role as educator aimed at helping client learn new concepts and skills

Involves an exchange of ideas and information

When it involves learning on an emotional topic, it can also be considered Psychoeducation

Service Linkage

SW occupies the broker role; provides initial connection to a service provider and also care to ensure the connection was made.

Calls for SWs to become solid at making and  maintaining connections in their community of practice 

Service Coordination

Ensures that clients with complex problems are addresses the various issues presented

Works to reduce barriers in service access

Service Negotiation 

SW works to reduce difficulties with  accessing services within the service delivery system

Primary goal of SW is to enhance communication with SW and the systems they need access to

Resource Mobilization

SW focuses on the actual access to needed concrete resources

What Causes Opioid Overdose?

happens when the level of opioids in a person's body render them unresponsive to stimulation or causes their breathing to be come inadequate.

What is Naloxone?

An Opioid Overdose Reversal Medication

How Does Naloxone Work?

•Reverses opioid overdose by restoring breathing

•Has no effect on someone who has not taken opioids

•Safe for children and pregnant women

How Do I Recognize an Opioid Overdose?

Lips/fingertips turn blue

• Loud Snoring

• Pale/grayish skin

•Unresponsive

•A very limp body

• Shallow, slow or stopped breathing

• Slow or stopped heartbeat

Steps to treating an opioid overdose

Check for breathing/responsiveness, call 911, give Naloxone, wait, support breathing, give care

After Using Naloxone

May be Disoriented or Confused, May Become Sick, Encourage Them to Stay with Someone

Relational Dynamics

Change and healing happen in relationship so when the relationship is problematic, effective change is in jeopardy

Conscious and unconscious reactions can be involved

Distrust and fear can be present in involuntary clients or those who aren’t quite ready for change

Social Workers may have a difficult time establishing genuine empathy with certain clients because of bias or appraisal

Burnout, vicarious trauma and compassion fatigue

Reasons progress can be stalled:

Relational dynamics

Social Work behaviors

Unchecked cultural or value-based differences

Attraction to clients

Problematic Social Worker Behavior

Can include lack of empathy, disconnect with Core Values associated with the profession, lack of appreciation for patient autonomy or non-recognition of unconscious factors

Transference

Countertransference

Transference

client unconsciously directing feelings and attitudes towards the therapist, often mirroring past relationships

Countertransference

counselor redirects emotions onto a client, unconscious emotional reaction