Generalist Intervention Model

1 1: Generalist Intervention Model (GIM): The generalist intervention model is a holistic approach to treating a variety of clients who present with a variety of issues. It considers multiple dimensions of human functioning, such as biological, social, and psychological factors, among others. There are 7 phases, which are engagement, assessment, planning, implementation, evaluation, termination, and follow-up. The engagement phase refers to strategies of rapport development and exploring clients' problems by eliciting comprehensive data about the person, the problem, including forces influencing the referral for contact. The assessment phase involves formulating a multidimensional assessment of the problem, identifying systems that play a significant role in the difficulties, and identifying relevant resources that can be tapped or must be developed. The planning stage involves mutually negotiating goals to be accomplished in remedying or alleviating problems, as well as formulating a contract. The implementation stage involves generating action to facilitate change. The social worker and client combine their efforts in working toward the goal assigned highest priority, and implementing the established interventions. The evaluation stage determines the effectiveness of implemented interventions and if goals are being attained as expected. The termination phase occurs when assessment of client goals that have been attained, helping the client develop strategies that maintain change following termination, and successfully terminating the helping relationship. The follow-up occurs when the social worker ensures the client has access to necessary services to continue maintenance of growth. (Emily Burt, Group 1, Hepworth Chapter 3) 2. Empathy: Empathetic communication involves the ability of the social worker to perceive accurately and sensitively the inner feelings of the client and to communicate his or her understanding of those feelings in language attuned to the client's experiencing of the moment. (Emily Burt, Group 1, Hepworth Chapter 5) 3. Empathy One More Time: The first stage of empathy is empathic recognition, meaning demonstration through accurate reflection of feelings that the social worker comprehends the client's inner experiencing. The second is empathetic responding, which involves the social worker's verbalizations to client's statements by responding with reflective and empathetic comments. Empathetic communication plays a vital role in nurturing and sustaining the helping relationship and in providing the vehicle through which the social worker becomes emotionally significant and influential in the client's life. In mandated circumstances, clients are not actively seeking a helping relationship, so conveying empathetic understanding reduces the level of threat perceived by the client and mitigates his or her defensiveness, conveys interest and helpful intent, and creates an atmosphere conducive to behavioral change. (Emily Burt, Group 1, Hepworth Chapter 5) 4. Verbal following (tracking): Verbal following skills include furthering responses, reflection responses, closed & open-ended responses, seeking concreteness, providing/maintaining focus, and summarizing. The social worker should use furthering responses to ensure that they are actively listening and as well as to encourage the client to verbalize. Reflections can be used to respond to the content of the client’s message as well as the effect. There are different types of reflections that can be used to emphasize the client’s messages and help them identify certain feelings from that message. Close-ended questions allow the social worker to define topics and get a direct response. Open-ended questions allow for the client to use their expression and expand on what is relevant to them. Seeking concreteness is used when a client uses terms that can be vague or that lead you to not fully understand their message. Providing and maintaining focus is important in verbal skills to value the time that one has with their client by staying on key topics. Summarizing responses is an important verbal following skill because 2 it highlights the problems already discussed, and can connect additional concerns and/or strengths before moving forward. (Samantha Collins, group 1) 5. Rubric for active listening dialogues: An outline for active listening includes the following: ● body contact (eye contact, body language, verbal tone, and distance from client) ● verbal following (open/closed questions, encouragement, paraphrasing, summarizing) ● Empathetic responses (compliment, natural empathy, feeling responses, feeling responses (Samantha Collins, group 1) 6. Problem focused vs. solution focused theory: This is a social theory from a psychological (problems) and a sociological (solution) view. Problems theory pulls from medical models, the DSM, and uses labels. Solution-focused perspective uses a social model and avoids labeling clients. Problems perspective focuses on the deficits a client may face, where solution-focused relies on the strengths of the client. The problem focused perspective relies on the client on a personal level and their familial interactions compared to the solution approach that puts emphasis on all of their social levels. Problem focused relies heavily on the social worker and evidence as the expert, but solution focused perspective allows the client to be the expert of their own experience and for their own resources. (Samantha Collins, group 1) 7. Solution focused interviewing: Most often a brief, therapeutic process, without a formal assessment. Solution focused starts with the problem BUT then focuses on the client’s understanding of the problem (as opposed to problem solving interviewing which focuses on “what’s wrong”). Small goals and exceptions to the problem are emphasized. -Olivia Goza, Group 1 8. Client or social worker emphasis: In solution-focused interviewing, the client is emphasized as the “expert” on their life (not the social worker). -Olivia Goza, Group 1 9. Exploring for exceptions: The social worker helps the client identify examples of previous successes, also their strengths. Exceptions are used as motivation tools and direction towards the future. -Olivia Goza, Group 1 10. End-of-session feedback: An element of solution-focused interviewing that consists of messages given to clients, including compliments and suggestions, in order to assist the client in determining what they should do more of, given their specific frame of reference. Feedback should be structured as giving a compliment (highlighting the client’s successes, strengths, and/or exceptions), creating a bridge between the compliment and the suggestion (a statement that connects the compliment to a related solution), and sharing a suggestion (discussing exceptions and appropriate behavioral suggestions). An example of end-of-session feedback might be, “It’s impressive that you manage to cook dinner for your family every night and finish your schoolwork on time. I agree with you that it can be overwhelming to have so many responsibilities at home, therefore I suggest that you and your husband discuss sharing some of the household chores.” (Melissa Joiner, Group 1, De Jong & Berg - Chapter 7) 11. Exceptions: Random or deliberate instances in which the client’s problem did not occur, despite the client expecting it to. Understanding the ways in which an exception occurred (the “how” of the exception) can build toward solutions through boosting the client’s confidence 3 and/or allowing the client to perceive the specifics of a situation in which the problem does not occur. (Melissa Joiner, Group 1, De Jong & Berg - Chapter 6) 12. Content and process: These two components consist of the textual (i.e., literal) meaning of what the client is saying, as well as the way in which the information is expressed (the client’s affect). It is important for the interviewer to consider the content and process of the client’s messages, in order to address these discrepancies with the client. For example, if the client says, “Yeah, I got the promotion I was hoping for,” while frowning and looking down, the social worker might address the difference between the client’s content (getting a desired promotion) and process (seeming disappointed about the news). (Melissa Joiner, Group 1, De Jong & Berg - Chapter 3) 13. Affirming client’s perceptions is a technique used in the interviewing process. The clinician, by nodding, saying “Yes” or “Sure”, validates how the client is perceiving the situation. It is important to affirm not only the client’s feelings, but also his/her thoughts, attitudes, beliefs and past behaviors. In the case of extreme perceptions, such as suicide or abuse, it’s important to get the client’s perception in relationship to others. – (Connie Borromeo, Group 1, de Jong & Berg Ch. 3, ppts, slide 31, 32) 14. Keeping the focus on the client – Clients may act powerless, feeling that it’s up to someone else to solve the problem. The clinician should respectfully maintain the focus on the client, not on others. The clinician’s interaction is an invitation to work together with the client and to facilitate the client’s self-empowerment. – (Connie Borromeo, Group 1, de Jong & Berg, Ch. 3, ppts, slide 35) 15. Complimenting is a technique in empathetic interviewing. Compliments provide feedback about a client’s efforts, are based in reality, focus on the client’s strengths and successes and on what is important to the client. Compliments can direct, indirect, or be a response to a client’s self-compliment. An example of a direct complement might be “I see you’ve made significant changes to reduce the number of angry outbursts when speaking to your children.” An example of an indirect compliment might be “How have you managed to juggle all the demands on your time?” An example of a self-compliment would be to notice what the client says, “I decided to stop eating a pound of chocolate every day,” and then comment on that, “How do you find a way to do that?” – (Connie Borromeo, Group 1, de Jong & Berg, Ch. 3, ppts, slide 30 also in Empathy in Interviewing) 16. Contrast between solution focused and problem-solving interviewing – Solution focused and problem-solving interviewing are two different ways to approach a client’s problem. A problem-solving approach is evidenced based, focuses on what is wrong (deficits), and is based on a medical model which assigns labels and looks to the past. The social worker is the expert. By contrast, a solution-focused approach, stresses strengths; as initiated by the client, who is the expert of his/her own experience. The approach looks to the present for exceptions (where the client has demonstrated success), for opportunities for future change. It is most often a brief therapeutic approach. – (Connie Borromeo, Group 1, Strengths vs Problems F1 and F2, also in F2 Lecture: weeks 1 and 2) 17. SOLUTION FOCUSED LEADERSHIP 4 -“ The client constructs his or her own solution based on his or her own resources and successes.” Not a formal assessment, small goals are emphasized and successes are used as motivation tools to create goals. Get the details and client meaning, and affirm client perceptions throughout the interview. Lead from a step behind. (Michelle Nguyen, Group 2) 18. CLIENT SAYS SOMEONE ELSE SHOULD CHANGE -Client does not see self as part of the solution and is powerless to change without the other person. The social worker should be respectful and work toward shifting towards any role the client may play toward change. “What could you do differently” (Michelle Nguyen, Group 2) 19. RESISTANCE -Often non voluntary or mandated, clients usually are resistant to talk solutions at the beginning. The social worker should be curious and respectful about; ● ● ● ● ● -clients’ perceptions/understandings about themselves and circumstances clients’ perceptions about what they might want (influenced by HOW client got to social worker) - WHO is the real client? Collaterals (as parents, teachers, etc. ) - Resistance, lack of control by client, motivation low - Need for a JOINT view of the problem (Michelle Nguyen, Group 2) 20. GENERALIST SOCIAL WORK -Having broad-based knowledge and skills of social work that can be used in a wide range of practice settings at multiple levels, a foundation for social work practice to be enabled. Ex: explaining confidentiality and limitations to the practice before the session begins, asking a basic question at the beginning of assessment/interview, genuine desire to help others. (Michelle Nguyen, Group 2) 21. Multiple Choice: SOLUTION FOCUSED (STRENGTH PERSPECTIVE) ASSESSMENT ● A strengths-based assessment is a way for a social worker to gather information about a client in a way that focuses on potential solutions rather than framing client problems in a deficit perspective. Areas of the assessment include: the presenting problem, problem history, personal history, substance abuse history, family history, employment/education, summary and treatment recommendations. (Allison May, Group 2) 22. Multiple Choice: SOCIAL CLASS DEFINITION -Social class is a combination of income, education, wealth, and occupation. (Darian McCluskey, Group 2) 23. Multiple Choice: SOCIAL CLASS AND HEALTH -Those in a higher socioeconomic class are more likely to live longer, better quality lives. Social class affects one’s health because it influences the resources available to that person. Resources affecting health include education, access to medical care, and access to adequate nutrition. Quality medical care in the United States is disproportionately given to those with 5 better education, more money, better jobs, and better social connections. (Darian McCluskey, Group 2) 24. Multiple Choice: GOALS ● Setting goals is a way to help clients toward change and solutions. Goals should be concrete and focused on starting with small changes. (Allison May, Group 2) 25. Multiple Choice: SCALING QUESTIONS -Using a scaling question allows for a client to gauge where they feel they are in their current situation or problem. For a scaling question, the scale usually should be from 0 to 10. Being at a “0” would be the worst the problem has ever been while being at a “10” would be the best it has ever been. Scaling questions can be used to form goals and monitor progress. (Darian McCluskey, Group 2) -from Interviewing for Solutions Powerpoint 26. Multiple Choice: SAFETY ISSUES - Crisis Intervention - Steps to take to ensure client’s safety as well as others. Verbally or Physically deescalating client’s behavior that may cause physical or psychological harm. (Michelle Meloon, Group 2) 27. Multiple Choice: BETTER? WORSE? THE SAME? Questions in follow-up sessions; What’s better for the client now? What’s worse for the client in regards to issues; what has remained the same. (Michelle Meloon, Group 2) 28. Multiple Choice: CLIENT PERCEPTIONS The client’s awareness or comprehension of how therapy should be; what should happen; its effectiveness; and outcomes. (Michelle Meloon, Group 2) Content found in "Interviewing for Solutions Dejung & Berg Powerpoint" - Ch.8 Later Sessions: Finding, Amplifying and Measuring Client Progress (Slides 84 - 87) (Riley Henderson 'Khoury', Group 2) 29. Multiple Choice: EARS (Riley Henderson, Group 2) ● Eliciting, Amplifying, Reinforcing and Start again ● This process may be difficult for a client ● Tracking: Help client through process ● Start again - “What else is better?” ● Also notice that client perceptions change over time ● Paraphrase/summarize exceptions as needed ● Use relationship questions as a way to sustain discussion ● How to get exceptions to occur again: DO MORE OF THE SAME 30. Multiple Choice: EARS, "E" (Riley Henderson, Group 2) ● Eliciting the exception ● Most of the later session is taken up with exceptions and goal formulation/refinement, scaling for progress 6 ● For latter sessions 31. Multiple Choice: EARS: "A" (Riley Henderson, Group 2) ● Amplifying exception ● Do not explicitly ask clients how they have followed through on suggestions 32. Multiple Choice: EARS: "R" (Riley Henderson, Group 2) ● Reinforcing successes and strengths exception represents ● Problems are not necessarily connected to solutions ● Avoid awkward situations ● Client often goes beyond limit of suggestions 33. Multiple Choice: EARS: "S" (Riley Henderson, Group 2) ● Start again - "What else is better?" ● This question is looking for exceptions ● Elicit Success 33. Multiple Choice: TERMINATION ● Four Primary tasks of termination 1. Evaluating service and goals 2. Determining when to implement termination 3. Mutually resolving emotional reactions experienced during process of ending 4. Planning to maintain gains achieved and to achieve continued growth ● Process of ending the client-worker relationship (TERMINATE) 1. When goals have been met 2. Transfer 3. Time limited to end sessions 4. Client or social worker ends helping relationship ● Introduce that there will be an ending at the beginning so that client can prepare ● Can be unplanned (50% of population will drop out) or planned (having unsuccessful outcomes or have reached all goals and achieved symptom relief) (Allison May group 2) (Dominque Torrence - Group 3 Questions 41-43: Unit 1 Case management 2020 // Practice 1 powerpoints) 34. Multiple Choice: CLIENT SETBACKS, RELAPSES Clients’ not meeting set goals in therapy or repeating old behaviors. (Michelle Meloon, Group 2) 7 35) Goal Formation: (Lucy Owen - Group 3 - q's 35-37) Once the problem has been identified by the client, goals can be formed. The client is going to have most of the responsibility of creating the goal with the guidance of the social worker. During the termination process, these goals will be reviewed and the progress made towards these goals (Hepworth chp 1-4 pp). Goals are created as a strategy for achieving outcomes. Goals must be linked to the target outcomes. They also have to be measurable in regard to the progress you are trying to achieve. When you create goals they need to be a part of the contract that is also created between the social worker and client. The most important part of creating a goal is to make sure that it is directly related to the client and their problem. They must involve the client as it provides a sense of empowerment. They can go from broad to very specific, with broad goals being broken down into smaller goals. This makes them more measurable and realistic to achieve. All goals must be SMART (Specific, Measurable, Action-oriented, Realistic, Timely). Lucy Owen Group 3 36) Resistance - Who is in charge? When a client is resistant it is important to not play tug of war with the client but to remain respectful. Social workers need to hold their client accountable and ask the correct questions to hold them accountable. The social worker needs to be curious about the client and the clients perceptions/understandings about themselves and the circumstances, as well as the clients perceptions about what they might want. Resistance typically occurs when the client has low motivation and has lack of control. This requires a JOINT view of the problem, by both the Social worker and the client. Lucy Owen Group 3 37) Aspect of Solution Focused Interviewing: Solution focused interviewing can help to create changes within a client by using small changes to create larger ones over time. Solutionfocused interviewing also focuses on the present, this can help to empower the client to find a creative solution to the problem. This style of interviewing focuses more on the solutions rather than the problems which can be beneficial in working towards a positive mindset. There are four main techniques to solution-focused interviewing; seek exceptions to the problem, scale the problem, scale motivation, and miracle questions. Lucy Owen Group 3 38. End of Session Feedback: (Abby Rand- Group 3) - Shows that we value client's input - Helps to determine what direction the client would like to go in. - Client's needs and reactions - Feedback to a client compliments on what the client is doing well on and affirms what is important to the client and their successes and strengths. - Create HOPE - Re-evaluate if clients do not find this meaningful or accurate. - Solutions built around client's goals Bridge: Links compliment to suggestion "I agree with you that... Therefore I suggest that...." 39. Suggestion Follow Up: (Abby Rand- Group 3) Exceptions: When client is not clear about their goals, and not motivated. The hardest part: What type of suggestion to give? 8 Does the client want something? Do not explicitly ask if they followed up on your suggestions. Avoid awkward situations and ask about if improvement has occurred. 40. Suggestions: (Abby Rand- Group 3) Client thinks he/she needs to change: behavioral suggestion. Others need to change or don't know what to do: observational suggestion ("For next time pay attention to what's happening in your life that tells you this problem can be solved".) No change needed: no suggestion/compliments only. Are there wellformed goals? Do not push for closure too early. Give individual feedback if clients are at different places. Are there exceptions? Are they random or deliberate? If random, give observational suggestions only. BE CONSERVATIVE when given behavioral or observational suggestions. Less is more. 41) A client who doesn’t want a solution Signs that client may not want a solution: -- States that someone else has the problem -- Often non-voluntary or mandated -- May be multi-problem, long term Case Tips to working with client who doesn’t want solution: -- suggest client continues to do what he/she is doing (clients who don’t want anything at all) -- Avoid tug of war; be respectful -- Hold clients accountable for their perceptions (“What is happening that tells you….?”) 42) Mandated clients Mandated Clients are required to fulfill a legal obligation to services as a result of their actions. Tips for Mandated: ● “Let’s make a deal.” ● Get rid of the mandate together. -- Work on mandates but also goals that clients desire. 9 ● In some cases, “Let’s work to get them off your back.” -- Need to JOIN with the client. Negotiating goals with involuntary clients. Mandated court orders may be vague, poorly worded or stated in negative terms. Clients may feel confused, angry, anxious, defeated. Explain intent, give clients some control over the process. 43) Involuntary and mandated cases Involuntary Client: One who feels forced or pressured into meeting with a professional Tips for working with Involuntary Clients: ● Begin by assuming the client probably does not want anything from you as past professionals have failed. ● Responding to Anger and Negativity -- Do NOT take personally ● LISTEN As you listen involuntary clients may come to seem like voluntary clients because you LISTEN. -- Accept client perceptions and get the details in a respectful manner -- Listen for who and what are important ● When incorporating non negotiable requirements -- Give information; DO NOT CONFRONT -- Continue with a “not knowing” stance ● Give control to clients -- “Tell me more” -- “What is your understanding of your situation?” 10 ● REFRAME problem into the direction of the SOLUTION. -- Motivation must be fueled by client’s self interest Wood: 44) Solution Focused relabelling of Resistance- many clients are resistant to solution focused talk. Bring focus back to the client periodically, “What is happening that tells you the problem might be solved?” -“How were you hoping I would be useful to you” -“What are the chances of finding a solution on a scale from 0 to 10?” -Ask a coping question, scale from 0 to 10 When clients seem resistant to changing remember: -Client does not have the problem -Someone else has the problem -Often non-voluntary or mandated -May be multi-problem, long term case -Avoid tug of war; be respectful -Hold clients accountable for their perceptions, “What is happening that tells you….?” Be curious about -clients’ perceptions/understandings about themselves and circumstances -clients’ perceptions about what they might want (influenced by HOW client got to social worker) -WHO is the real client? Collaterals (as parents, teachers, etc. ) -Resistance, lack of control by client, motivation low -Need for a JOINT view of the problem 11 45) Dyads- a group of two people, the smallest possible social group to work with. A dyad can be lined to romantic interest, family relation, coworkers, partners, friends, etc. 46) Voluntary vs Involuntary Clients Solution Building with a voluntary client ● Engage clients by using empathy and listening skills ● Problem Solving ● Assumes clients have chosen to get help and are motivated to solve their problems ● Emphasis has been on confronting antisocial comments/ behaviors in context of positive comments. Try to get clients to participate in activities. Involuntary Client- a client who feels forced or pressured into meeting with a professional. Solution Building with an involuntary client- assume that the client probably does not want anything from you. ● ● Responding to anger and negativity: ○ -Do not take anything personally ○ -Accept client perceptions and get every detail in a respectful manner Listen for who and what are important -Involuntary clients may come to seem like voluntary clients as they notice you listen ● Use relationship questions to address context ● Incorporating non negotiable requirements -Always give information and do not confront -Continue with a not knowing stance because the client is the expert on their life ● Give control to clients - “Tell me more” ○ “What is your understanding of your situation” 47) Keys to working with involuntary clients - Involuntary clients are individuals who are not attending therapy by choice but rather are compelled to come due to some outside force ( courts, parents, spouse, etc.) Involuntary clients will often be less motivated to engage in therapeutic treatment. Listed below are the 4 main keys to working with these clients: -Motivational Congruence- Help the client craft goals that are personally meaningful to the client and that satisfy the requirements of any mandate 12 -Agreeable Mandate- Search for common ground to bridge the gap between the clients perception of an issue and the courts perception of any issues -Let's make a deal- a strategy to combine the private concerns of the involuntary client with the problem that led to the mandate referral -Getting Rid of the Mandate- Use the clients desire to be rid of the court mandate as the motivating factor to participate in therapy. This strategy is generally employed when the previous strategies listed prove unhelpful. (Nathan Derrickson) 48) Children as Clients- Any individual below the age of 18 is considered a child. Strategies for working with children can vary greatly depending on that child’s age, level of maturity, developmental issues, and whether that child is mandated or voluntary. In the same way as adults, children respond well to clearly defined therapeutic goals. When creating goals with children emphasize the following : 1. The expected behavioral change 2. Define the conditions in which the behavioral change will occur 3. Clarify the level of goal performance and timeline. Goals should be broken down into smaller steps so that minors can better understand the therapists expectations. Therapy sessions may also need to be structured differently when working with kids. It is suggested that the therapist use games, stories, metaphors, and visual aids to help develop goals. ( Nathan Derrickson) 49) Answering “I don’t know responses”- I don’t know responses occur when the client does not wish to answer a social worker's question. These types of responses occur most often with mandated clients. Before a client has established trust with the social worker they may try to create a boundary by responding with I don’t know. When faced with an “I don’t know response” it is important that the social worker not become hostile. The client may use this response due to shame/embarrassment or because they are hostile toward the mandated treatment. In order to move past I don’t know statements social workers should ask what others ( mother, judge, etc.) may think about a given situation. Try to probe the client about past successes that may relate to the given problem. If the client still remains hostile, compliment them on knowing their mind and ask them if they believe their current actions can help them to be successful in overcoming the issue at hand. Social workers should also embrace silence with these clients ( sometimes these clients will start to open up to fill that silence). (Nathan Derrickson) 50) Mandated clients and court orders- Mandated clients must attend therapy due to a court order. The social workers first task when working with these clients is to educate the client about the purpose of goal creation. This will hopefully foster discussion between the client and social worker. Social workers need to carefully review the court mandate so they know what is expected of the client both in session and out of session. For example the client may be required to attend anger management. Be sure to understand the client's view of the situation and involve the client in creating goals. By including the client in the goal creation process they may take more agency over their therapeutic treatment. The social worker must also be sure to measure goals as to know the effectiveness of treatment. (Nathan Derrickson)