Intervention Processes and Techniques Flashcards
What are some interview techniques?
Universalization: The generalization or normalization of behaviour
Clarification: reformulate problem in a client’s words to make sure that the SW is understanding (paraphrasing?)
Confrontation: calling attention to something
Interpretation: Pulling together patterns of behaviour to get a new understanding
Reframing & Relabelling: stating a problem in a different way so a client can see possible solutions
How should a SW use interpreters?
- Not appropriate to use family to interpret as valuable information may be missed
- SW should speak direclty to client not interpreters
What are the 6 steps of problem solving (EAPIET?)
- Engagement
- Assessment
- Planning
- Intervention
- Evaluation
- Termination
What is done during the engagement phase?
SW should be involved in determining why treatment was sought, what has precipitated the desire to change, the parameters of the helping relationship (defining roles), and expectations for treatment (what will happen and when)
What is done during the assessment phase?
Client is source of info to define problem & solutions as well as identifying collateral sources
What is done in the planning phase?
○ Must develop common understanding of client’s preferred lifestyle, this is where goals come from
Specific action plans are developed & agreed upon to specify who does what, what and how resources will be needed and used, and timelines for implementation and review
What is done in the Intervention phase?
○ Client involved in mobilizing support network & must bring up issues that threaten goal attainment
Progress based on client reports must be tracked, plans adjusted accordingly
What is done in the evaluation phase?
○ Subjective reports of client + objective indicators used to determine whether goals have been met & new ones should be set
Client self-monitoring is a good way to help a client see and track their progress
What is done in the termination phase?
○ Client should reflect on what has been achieved and have supports in place if problem arises again
Still requires active involvement even though it’s the last step
What cultural considerations should an intervention plan include?
- Should include: identification of cross-cultural barriers which may hinder a client’s engagement/progress in treatment
- Also an ethical mandate to take info learned when working with individual clients and adapt agency resources to meet others who may have similar cultural considerations/language needs
What culture provide/influence in the assessment/intervention processes?
- Should understand & validate each client’s cultural norms, beliefs and values, areas that can be greatly influenced:
○ Identification of strengths & problems
○ Goals & objectives
○ Modalities of treatment- Culture can provide strengths in the intervention process:
○ Supportive family & community relations
○ Community and cultural events and activities
○ Faith & spiritual/religious beliefs
○ Multilingual capabilities
○ Healing practices & beliefs
○ Participation in rituals *religious, cultural, familial, spiritual, community
- Dreams & aspirations
- Culture can provide strengths in the intervention process:
How can culture affect intervention?
- Client must feel safe to explore their problems within their cultural context, intervention will also be most effective in this situation
- The following should be considered given their cultural appropriateness:
○ Individual vs. group treatment
○ Alternative treatment approaches (yoga, aromatherapy, music, writing)
○ Medication (western, traditional, alternative)
○ Family involvement
○ Location/duration of intervention - Different cultures & communities exhibit/explain symptoms in various ways - important to be aware of relevant contextual info stemming from client’s cultures, races, ethnicities, religious affiliations/geographical origins to more accurately diagnose & treat problems
- Specific diagnostic criteria changed in DSM 5 to better apply across diverse cultures
Cultural Formulation Interview Guide included to help SW assess cultural factors influencing client’s perspectives
- The following should be considered given their cultural appropriateness:
Criteria used in selecting intervention/treatment modalities
- Client/Client System, Abilities, Culture, Life stage
- Intervention plan is developed by consulting the relevant practice research and flexibly implementing an approach to fit a client’s needs and circumstances
○ Driven by assessment data
○ Theories inform SW about what skills, techniques and strategies must be used - which are then outlined in an intervention plan
An intervention plan should be reviewed during intervention, at termination and if possible after termination to make adjustments, ensure progress, and determine sustainability of change after treatment
- Intervention plan is developed by consulting the relevant practice research and flexibly implementing an approach to fit a client’s needs and circumstances
Components of Intervention, Treatment, & Service Plans
- Goals of intervention and means to achieve them are incorporated in a contractual agreement between client & SW
- Can be informal or written
- Contract (intervention plan) specifies problem(s) to be worked on, goals to reduce problems, clients & SW roles, interventions or techniques to be employed, means of monitoring progress, stipulations for renegotiating the contract, time, place, fee, and frequency of meetings
- Can be informal or written
What are psychotherapies, what do they do + examples
- Aims to treat clients with mental disorders/problems by helping them understand their illness or situation
- Use verbal techniques to teach clients strategies to deal with stress, unhealthy thoughts, and dysfunctional behaviours
- Should not use a one size fits all approach
- Some have been tested more than others for particular disorders
○ CBT used for depression, anxiety & other disorders
- DBT developed to treat people with suicidal thoughts and actions - now used for BPD as well
What is the impact of immigration, refugee, or undocumented status on service delivery?
- Immigration law is complex and changes often, quite exclusionary at the moment & has turned to conflating criminality with undocumented status (US mostly but not exclusively)
- Federal jurisdiction
- Professional SW standards support immigration & refugee policies that uphold and support equity and human rights - can cause dilemmas for SW working within restrictive policies
- Important to understand legal & political as well as psychological and social issues surrounding immigration
What are some reasons discharge may occur?
○ Client may have met their goals & no longer needs services
○ Decides to not continue with a particular SW or in general
- Requires a different level of care
What should be considered around termination according to the NASW?
○ Should terminate services to clients & professional relationships when no longer required or no longer serve client needs or interests
○ Should take reasonable steps to avoid abandoning clients who are still in need of services - should withdraw services precipitously only in unusual circumstances and after considering all factors. Appropriate arrangements for continuation of services should be made when necessary
○ SW in fee-for-service settings may terminate services who are not paying an overdue balance if financial contractual obligation has been made clear, if they don’t pose imminent danger to self or others, and if clinical consequences of current nonpayments have been addressed and discussed
○ Should not terminate services to pursue a social, financial, or sexual relationship with the client
○ SW who anticipate the termination or interruption of services hsould notify clients promptly and seek the transfer, referral or continuation of services and benefits
§ It is unethical to continue to treat clients when services are no longer needed or in their best interests
○ SW should make reasonable efforts to ensure continuity of services in the event services are interrupted by unavailability, relocation, illness, disability, or death
○ Must involve clients & their families (when appropriate) in making decisions about follow up services/aftercare - at minimum a discussion of preferences
- Quick return of clients suggests that they did not receive needed follow up or services were inadequate, termination may have occurred prematurely
- Those are risk of developing problems after services have ended should receive regular assessments after discharge to determine whether services are needed or discharge plans are being implemented as planned
What are the stages of change? (Transtheoretical Model)
- Precontemplation - denial ignorance
- Contemplation - ambivalence, conflicted emotion
- Preparation - experimenting with small changes, collecting info about change
- Action - taking direct action toward achieving goal
- Maintenance - maintaining a new behaviour, avoiding temptation
- Relapse - feelings of frustration & failure
What is the core of the helping process?
The relationship between SW and client. Expressed through interaction both verbally and non-verbally
What are some techniques of building and maintaining a helping relationship
- Helping is based on acceptance of a client’s situation and ability of them to make changes if desired
- SW is to assist in this process and influence them in further autonomy, understanding, effectiveness and skill- SW cannot be useful in helping others unless they understand and are willing to accept the difficulties that all human beings encounter in trying to meet their needs
- The potential for all the weakness and strength known to humanity exists at some level in every person
- Recognize the + & - aspects of each client and how that will influence change & goal attainment
- Both a client and social worker have objectives as well as their own thoughts, feelings and attitudes – both have power to influence the situation
What does the process of engagement include?
- During engagement, limits to confidentiality must be explicitly stated at the start
- SW must explain their roles & how they can assist clients in addressing their problems
- It is important to consider how a client feels about coming for help & to deal with negative client feelings - must be willing to discuss these openly because very little can be changed until negative feelings are addressed
- A working alliance between SW & client should be established
- SW should express hopefulness that change can occur
- Resistance may occur during this stage, if clients are resistant to engage, SW should clarify the process or specify that will happen and discuss this ambivalence
What is the client’s role in the problem solving process?
- Client’s often feel that their problems are unique and that no one could understand them
○ May even enjoy this, as a defense against exploring their fears of being like others- Some concerns over whether SW can really be trusted - generally afraid of what others may think of them and can stem from childhood experiences
- Client may only be looking for sympathy, support, and or empathy rather than searching for a new way to solve difficulties - may not seen that change needs to occur
- When a SW points out how the client contributes to their problems - they have stopped listening. Solving the problem often requires a client to uncover some aspects that they have avoided thinking about
What is the problem solving model?
- Problem-Solving approach is based on the belief that an inability to cope with a problem is due to some lack of motivation, capacity, or opportunity to solve problems in an appropriate way
○ Client’s problem-solving capacities or resources are maladaptive or impaired
- Goal is to enhance client mental, emotional, and action capacities for coping with problems and/or making accessible the opportunities and resources necessary to generate solutions to problems
What are short term interventions + examples
- Vary greatly in duration
- Research suggests that SW & client’s views on time of treatment is more important than duration of treatment itself
- Ex:
○ Crisis intervention
○ Cognitive behavioural model
Psychoanalysis started out short term - can be short or long
How does a SW engage & motivate clients?
- Want to create doubt that everything is okay and help client’s recognize consequences of current behaviours of conditions that contribute to dissatisfaction
- Sometimes clients are incapacitated by conditions that need to be addressed first (depression for ex.)
- Role is to create an atmosphere that is conducive to change and to increase client’s intrinsic motivation so that change arises from within instead of being imposed externally
- Sometimes clients are incapacitated by conditions that need to be addressed first (depression for ex.)
Engagement & Motivation techniques?
○ Clearly identifying the problem or risk area
○ Explaining why change is important
○ Advocating for specific change
○ Identifying barriers and working to remove them
○ Finding the best course of action
○ Setting goals
○ Taking steps toward change
○ Preventing relapse
- EmpathyHow do SW engage/motivate involuntary clients?
- Ex. Families in child protection system, those in CJS
- May want no contact or only participate because they feel like they have no choice
- Often requires SW to have peer support or supervision to process struggles & reassert themselves because clients may test or direct anger at SW
- May want no contact or only participate because they feel like they have no choice
What are some methods to engage/motivate involuntary clients?
○ Acknowledging clients’ circumstances and understanding how they came about given clients’ histories
○ Listening to clients’ experiences in order to try to understand how they feel about intervention
○ Engaging in clear communication because involuntary clients struggle to understand what is happening to them
○ Making clear what the purpose of the intervention is, what clients have control over and what they do not, what is going to happen next, and what the likely consequences will be if they do not participate
○ Assisting at an appropriate pace as progress may be slow
○ Building trust, even on the smallest scale, by consistently being honest and up-front about the situation and why a social worker is involved
○ Giving clients practical assistance when needed to help them fight for their rights
○ Paying attention to what is positive in clients’ behavior and celebrating achievements
- Showing empathy and viewing clients as more than the problems that brought them into services
What are 10 methods to obtain & provide feedback?
- Feedback may be verbal or nonverbal so SW must try to see what clients are trying to convey verbally or via their behaviour and nonverbal cues in order to see whether interventions should be altered
- When SW involve consultants or others in the feedback process related to client care, clients should provide consent
- SW should ask for feedback in difficult circumstances - not just in neutral/positive ones. Difficult feedback should be talked through with supervision as well
- Feedback is especially critical at key decision points (when transferring/closing cases)
- Important to guard against influencing people to respond in a particular way - can be unintentional due to power/influence of SW over client
- Confidentiality should be respected when informant wants it
- Always be clear about why feedback is needed and what will be done with the information
- Documentation of feedback is essential
- Be aware that feedback may be very different depending upon when it is solicited - critical to realize how recent events may influence information - multiple different times may be helpful
- SW must make sure that the communication method is appropriate - online for younger, face to face for older, jargon free and language, culture, disability may affect the ways in which people both understand and react to requests for feedback
What are principles of Active Listening & Observation?
- Can be achieved by showing interest in client’s words - communication will be more open
- Speaking using mirroring techniques to paraphrase and reflect back to clients what has been said
- In macro intervention - with key policy influences, community members etc.
- As an observer - SW can take many roles - complete participant (living experience), participant as observer (removed from activity)
What are some verbal & nonverbal communication techniques?
- Active Listening
- Silence
- Questioning
- Reflecting/validating
- Paraphrasing/Clarifying
- Reframing
- Empathy
Define Active Listening
body language, sitting straight, leaning in, relaxed and open (not crossed legs/arms), commenting on statements, asking open ended questions, making statements
Define Silence
by social workers, can show acceptance of clients’ feelings and promotes introspection or time to think about what has been learned (very effective when used with a client who is displaying a high degree of emotion).
Define Questioning
using open- and closed-ended formats to get relevant information in a non-judgmental manner.
Define Reflecting/Validating
to show empathetic understanding of clients’ problems. These techniques can also assist clients in understanding negative thought patterns.
Define Paraphrasing/Clarifying
social workers rephrase what clients are saying in order to join together information. Clarification uses questioning, paraphrasing, and restating to ensure full
understanding of clients’ ideas and thoughts.
Define Reframing
social workers show clients that there are different perspectives and ideas that can help to change negative thinking patterns and promote change.
Define Empathy
denotes understanding the ideas expressed as well as the feelings of a client
○ Differs from sympathy in that sympathy denotes pity or feeling bad for a client
○ To be empathetic, a SW must accurately perceive a client’s situation, perspective and feelings as well as communicate this understanding in a helpful way
Establishing boundaries to create a safe environment for change
What are 2 of the other core conditions?
Genuineness: needed in order to establish a therapeutic relationship - involves listening and communicating without distorting messages, being clear and concrete
Unconditional Positive Regard: ability to view a client as being worthy of caring about and as someone who has strengths and achievement potential. Built on respect and usually communicated nonverbally.
Listening, Attending, Suspending Value Judgements, and Helping
What are some limit setting techniques?
- Facilitative as clients DO NOT feel safe or accepted in a completely permissive environment
- Compassion is important but so is maintaining the relationship, understanding and maintaining boundaries is essential
What is Role Play?
- Teaching strategy that can happen between supervisor and supervisee or SW & client
- Usually raises interest in a topic as clients are not passive recipients
- Teaches empathy and understanding of different perspectives as clients take on the role of another, learning and acting as that individual would in the specified setting
- Helps embed concepts, gives clarity
- Emphasizes personal concerns, problems, behaviour and active participation
- Improves interpersonal communication skills
What new skill has role modelling been helpful with?
Assertiveness
What does role modelling do?
- Emphasizes importance of learning from observing and imitating and has been used successfully in helping clients acquire new skills
- Works well when combined with role play & reinforcement
What are some types of role modelling?
○ live modeling: watching a real person perform the desired behaviour
○ symbolic modeling: filmed or videotaped models demonstrating the desired behaviour. Self-modeling is another form in which clients are videotaped performing the target behaviour
○ Participant modeling: individual models anxiety-evoking behaviours for a client and then prompts client to engage in the behaviour
- Covert modeling: clients are asked to use their imagination, visualizing a particular behaviour as another describes the imaginary situation in detail
What are the two different categories of role modelling?
- Can be presented as coping or mastery models
○ Coping model is shown as initially fearful or incompetent and then gradually becomes comfortable/competent
- Mastery model shows no fear and is competent from the beginning of the demonstration
What are some methods to obtain sensitive information?
- Start with open ended, nonthreatening questions to gather background and get a client used to talking about their situation before disclosing sensitive material
- Gives client time to “test the waters” w/ SW & gauge their reaction
- Trust often needed before complete honesty
- Be aware of verbal & non-verbal cues - may avoid eye contact, fail to answer a question, look down when speaking, laugh nervously when anxious
- SW may want to repeat question/probe further into this area to see if something undisclosed is causing this behaviour
- Client engaged in couple/family/group treatment may worry about the confidentiality of revealing sensitive information as well as reactions of others to such disclosure - explore individual treatment
- SW may want to review the professional mandate for confidentiality & what info will be stored in the file
- Client may be reluctant to reveal sensitive info if they think there could be negative repercussions or lack of security
- Much more likely to disclose if SW reacts to disclosures with acceptance and a neutral stance rather than judgement, and not interrupting
