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Intervention in Micro and Mezzo Level of Practice. Chapter 8. LEARNING OBJECTIVES. Understand that intervention is the time to carry out goals and objective specified in the contract Understand and apply the basic principles of counseling with individuals and small groups

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learning objectives
LEARNING OBJECTIVES
  • Understand that intervention is the time to carry out goals and objective specified in the contract
  • Understand and apply the basic principles of counseling with individuals and small groups
  • Understand and apply the basic principles for facilitating information and referral
  • Understand and apply the basic principles for engagement in crisis intervention, case management, small task group interventions, psychosocial intervention groups, and team work
  • Understand the basic principles underpinning different intervention modalities at micro and mezzo levels of practice
intervention in social work
Intervention in Social Work
  • The Goal:
    • Empower client systems to interact and engage with their environment in healthy ways
  • The Means:
    • Strengthen client’s efficacy when it comes to taking action
    • Develop client system critical thinking skills
    • Support client knowledge and skill development
    • Develop client support systems
    • Develop client’s ability to take action that leads to change
empowerment
Empowerment
  • A generative process through which disenfranchised and vulnerable are enabled to:
    • Mobilize resources
    • Exercise greater control over their environment
    • Meet their needs and achieve goals
yes or no
Yes or No…
  • Having a mentally ill friend or neighbor is OK by me.
  • Homosexuality is normal.
  • It is OK for educated homeless people to be teachers of children.
  • Families with homosexual parents should be portrayed in some children's books.
  • It is OK for homeless people to get legally married, and receive the legal benefits of marriage.
  • It is OK for mentally ill people to raise children.
  • It would be OK by me if one or more of my children were developmentally challenged
are you ready to work with

Are you ready to work with…

The mentally ill

The developmentally challenged

The disenfranchised

The poor

The outcast

social work intervention attempts to empower the client system
Social Work intervention attempts to empower the client system

Rescuer (Practitioner)

Self Empowered person

Oppressor

Facilitator (Practitioner)

Oppressor

Victim

Social Work & Empowerment (Adams 2003)

empowering the mentally ill
…Empowering the Mentally Ill

http://www.t-mha.org/TheShakenTree.htm

For Example…

empowerment learning techniques
Empowerment Learning Techniques
  • Problem-Solving
  • Educational Drama
  • Assertiveness Training
  • Social Skills Training
  • Client-centered counseling
  • Group Work
counseling of the client centered kind

Counseling of the Client-Centered Kind

We're seeing a much larger influx here. They're not looking for doctors or lawyer, but for counselors and emotional healing.

slide11

Counseling

  • A strengths-based problem-solving process that takes the form of dialogue, questions, actions, and transactions that guide and facilitate:
    • Resolution and mitigation of problems or issues
    • Acquisition or strengthening of internal personal resources
    • Development of affective coping and adaptation
    • Enhancement of well-being
counseling
Counseling
  • Requires:
    • Broad range of relationship and strengths-based problem solving strategies
  • Contemporary strategies and techniques used include:
    • Eco-maps
    • Sculpting
    • Genograms
    • Force-field analysis
    • Adolescent Grid
eco maps
Eco-maps
  • Paper-and-pencil assessment tool used to assess specific troubles and plan intervention for clients.
  • A drawing of the client or client family in its social environment. 
force field analysis
Force Field Analysis
  • This technique gives you a way of:
    • Diagnosing a situation
    • Planning for change
    • Implementing a change strategy and programme.
slide17
Driving forces are factors that indicate an openness towards change. They are positive forces for change.
  • Restraining forces maintain the status quo. They hinder change.

Equilibrium

information and referral

Information and Referral

Occurs in social work practice when the client system does not have the information or resources necessary for problem resolution

slide20

Information and Referral

  • A process in which the generalist social worker :
  • Clarifies the problem or need for which help is being sought
  • Gathers information about appropriate and available resources
  • Provides information to the client system
  • Discusses options for problem resolution
  • Examines the means through which client system can gain access to selected service option
  • Facilitates means of referral
  • Discusses means for follow-up
referral
Referral
  • Directing clients to another resource for help with an identified problem or need
  • Successful referral requires:
    • Clear and concise description of problem
    • Identification of available resources
    • Discussion of referral options with client
    • Planning and contracting with referral sources
    • Meeting referral source with the client
    • Monitoring and following up on interaction between client and referral source
making a referral
Making a Referral
  • Questions you are likely to be asked:
    • Does the client know about the referrals?
    • Demographics
    • Physical, Psychological, Behavioral Client Profile
    • Degree of risk
    • Family History
    • Environmental context
    • Available Supports
    • Major issues/problems
sample referrals forms
Sample Referrals Forms
  • http://www.southwark.gov.uk/Uploads/FILE_9457.pdf
  • http://www.bloorview.ca/pages/documents/outpatientreferralform.doc
  • http://www.togethertrust.org.uk/section_nav/uploads/18949606.pdf
  • http://www.daisyhouse.org/DHreferralform.pdf
  • http://www.nenqayni.com/_images/pdf/fadpintakeassesment.pdf
  • http://www.vch.ca/home_page/mood/docs/MDC_Referral_Form.pdf
what a crisis

What a Crisis?

A temporary state of upset and disorganization, characterized by an inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome

crises
Crises…
  • Occur in everyone’s lives
  • Not necessarily pathological, may encourage growth and change
  • Time limited to a brief period, 4-6 weeks except death
  • A person’s perception determines the crisis
crisis intervention balancing factors
Crisis- good outcome

Perception of event realistic

Situational support adequate

Coping mechanism adequate

No crisis

Crisis- development

Perception of event distorted

Situational support inadequate

Coping mechanisms inadequate

Crisis

CRISIS INTERVENTIONBALANCING FACTORS
phases of crisis
PHASES OF CRISIS

PERSONALITY DISORGANIZATION (CRISIS)

SEVERE ANXIETY

TRIAL & ERROR SOLUTIONS

USUAL COPING MECHANISMS INEFFECTIVE

OR

STRESS

ANXIETY

NEW PROBLEM- SOLVING SOLUTIONS AND SUPPORT

ANXIETY

PRE-CRISIS LEVEL OF FUNCTIONING

crisis intervention assessment
Crisis Intervention: Assessment
  • Perception of event:
    • What happened that prompted you to seek help?; How are you feeling now?; etc.
  • Coping mechanisms:
    • Suicidal?; Plans?; What helps you feel better?; etc.
  • Support systems:
    • With whom do you live with?; Who is available to help you?; Who is most helpful?; etc
  • Mental status, previous history
  • Identify client’s strengths
  • Self-assessment: Social Worker’s feelings
crisis intervention
Crisis Intervention
  • Social workers are frequently called upon to make a rapid and accurate assessment of the magnitude of a client's crisis state.
  • A single valid crisis assessment instrument with strong psychometric properties does not exist.
  • See:
    • http://brief-treatment.oxfordjournals.org/cgi/reprint/1/1/17.pdf
  • There are however, a number of practice and assessment tools however that can help you.
sample crisis assessment and intervention tools and plans
Sample Crisis Assessment and Intervention Tools and Plans
  • http://www.dhh.louisiana.gov/offices/publications/pubs-305/sq06030.pdf
  • http://www.mh.state.oh.us/cmtymh/soqic/manual/i030.pdf
  • Children’s Crisis Intervention Tool
    • http://ibhas.in.gov/Documents/CANS-CAT%20Indiana%20.pdf
crisis intervention goals
Crisis Intervention Goals

Social

Worker

  • Alleviate Stressful Impact
  • Mobilize Client system strengths and resources
  • Support client in developing strengths-based problem-solving skills
  • Assist client in regaining optimal levels of psychosocial functioning

Client

Resource

System

small group intervention

Small Group Intervention

Applying methods in generalist practice to

Meet group member needs

Resolve targeted problems in psychosocial functioning

Complete specified tasks

task groups
Task Groups
  • Small collectivities of people drawn together by mutual concerns and interested in accomplishing specific tasks
tasks groups
Tasks Groups
  • Intervention with task groups moves through
  • different phases:
  • Orientation
  • Accommodation of groups members to each other
  • Generation of ideas about needs and solutions
  • Integrative problem-solving
  • Task completion
psychosocial intervention groups
Psychosocial Intervention Groups
  • Focus on enabling members to benefit from the group.
  • Goals:
    • Identify issues/problems of concern
    • Education
    • Social skills and self-efficacy development
    • Foster mutual support among group members
    • Promote strengths
    • Achievement of personal goals
    • Change behavior
    • Develop problem-solving skills
case management

Case Management

A process of actions taken by the generalist social worker to mobilize, bring together, and coordinate a continuum of care of client system services.

commonly involves
Commonly Involves

Referral

Assessment

Action Plan

Intervention

Review

slide39

Case Management

  • Typically, the process includes:
    • Assessment of client system needs, assets, strengths, and use of resources in relation to problems or issues
    • Identification of informal and formal resources
    • Enabling and empowering the client system by promoting self-determination in making choices and acting
    • Enabling primary groups in the client system’s environment to expand their care giving capacity
    • Facilitating effective negotiations for resources between various formal and informal systems of care
case management resources
Case Management Resources
  • Case Management in Healthcare
    • http://www.sswlhc.org/docs/swbest-practices.doc
  • Integrated Case Management
    • http://www.mcf.gov.bc.ca/icm/pdfs/ICM_quickref_upper_island.pdf
  • Case Management Society of America
    • http://www.cmsa.org/HOME/tabid/67/Default.aspx
teamwork
Teamwork
  • As a case manager your role will most likely require to bring together a variety of resources to work together in common planning, decision making, and consolidated action.
    • The result of this is called TEAMWORK
  • Increasingly, dealing with clients involves coordinated and integrated service delivery across education, health and social services.
    • This is referred to as multidisciplinary collaboration
team work
Obtaining sanctions

Building a supportive team structure

Identifying and maximizing the use of resources

Meeting regularly

Specifying task activities in relation to goals and objectives

Setting up a process of monitoring and evaluation of goal accomplishments

Sharing responsibilities

Team Work

A coordinated group service delivery process

across different professional systems. Typically,

effective team work involves:

teamwork phases
Teamwork Phases
  • Clarify the problem and purpose for organizing
  • Share data
  • Agree on goals and a plan for intervention
  • Assign tasks
  • Evaluate
  • Terminate contact
monitoring intervention

Monitoring Intervention

It is important to monitor and document the intervention process

monitoring intervention45
Monitoring Intervention
  • Entails a variety of activities including:
    • Narrative documentation
    • Qualitative Assessment
    • Direct Observation
    • Consultation
    • Documentation Review
    • Phone Calls
    • Face to Face Interviews
    • Site Visits
quantified monitoring scale
Quantified monitoring scale
  • Convert the observational and narrative accounts you have of your client system intervention to a scale related quantitative measure
  • -1 = movement away from goal achievement
  • 0 = no movement
  • 1-2 = some progress
  • 3-4 = progress
  • 5 = goals achieved
summary
Summary
  • Counseling, Information and Referral, Crisis Intervention, Small group intervention and case management and teamwork
    • Can apply more than one of the above in social work practice