Transcript Fundamentals of Case Management Practice: Skills for the Human

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Welcome to HN330- Unit 3 Seminar
Competences, Boundaries, and Problem
Ownership
Last week we discussed the ecological model and the 4 Steps of
Assessment. Briefly describe one new thing you learned that you think
you will use in your practice.
CULTURAL COMPETENCE
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Our perceptions and attitudes are influenced by our own culture.
Ethically we have a responsibility to become acquainted with
cultures that differ from our own and with which we have extensive
contact.
The only way to work with people from different cultures is to see
them as unique individuals and make every effort to perceive them
accurately.
Do you know what your cultural values and beliefs are and how
they might influence your work with clients?
WHERE DO OUR DIFFERENCES LIE?
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Cultures - Generally refers to an entire society within a specific
political boundary wherein the citizens share a common
understanding.
Subcultures - Within a society are smaller groups who hold the
dominant culture but also hold specific ideas and beliefs that may
differ from the dominant culture in some ways.
Race and Ethnic Groups - Societies can have different races and
ethic groups within them. Race refers to a group who are
biologically similar while ethnic group refers to a group of people
who share a common cultural heritage.
Do you identify with a particular race or ethnic group? You
don’t have to share this unless you choose to, but please think
about how this might influence your work with clients.
WE-VERSUS-THEM ATTITUDE
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We learn who is in our in-group and who are in the out groups
through our socialization.
In-groups are seen as acceptable. They are seen as being more
like ourselves.
Out-groups are generally groups with whom we do not often interact
and with whom we feel uncomfortable
We often describe in-groups favorably while we are often suspicious
of the motives of out-groups.
We-Versus-Them attitude develops when we use our own culture to
judge the culture of others.
Have you experienced “we-versus-them” and how did it make
you feel?
STRANGERS
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When we meet people who do not think, act, or believe as we do we
often find them strange.
Often their ways of thinking and acting are unfamiliar to us.
It is always the dominant culture that defines who is a stranger.
As the world becomes more global we are likely to encounter people
who are different from ourselves.
It is often up to the human service worker to help immigrants make a
smooth adjustment to a new culture. Immigrants who become
competent in the dominant culture are healthier.
Can immigrants gain competency in their new adopted culture
without giving up their traditional values and beliefs? As
human service workers how can we help with this?
ANXIETY AND UNCERTAINTY
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It is common to feel anxious when we attempt to interact with
individuals from different cultures.
We need to manage those feelings so they do not impede our
communication with others.
In order to feel less anxious we may interpret the stranger’s
behavior or beliefs through our own culture.
The more we can feel the person is like us, the less likely we are to
feel anxious.
What can we do to reduce our anxiety about people from other
cultures?
OBSTACLES TO UNDERSTANDING
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Stereotypes - assumptions about people from a particular group
and we do not question these assumptions.
Ethnocentrism - we use the standards of our own culture to judge
the behavior and culture of other people.
Prejudice - based on a stereotype we avoid or deny certain things
to people from this group.
Conflict - cultural misunderstandings turn into hostility and conflict.
What can you do personally to reduce or eliminate stereotypes
and prejudice?
ATTITUDES
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Attitudes we hold about other people are bound to be communicated
to them one way or the other.
Positive and supportive attitudes foster rapport.
Superior or disdainful attitudes are bound to be communicated to
another no matter how we try to hide them.
If you forgive yourself for your mistakes and troubles and see these
as part of growing, it is easier to understand and support others
through their own mistakes and struggles.
Good attitudes begin with being tolerant of yourself. It you see
yourself as basically okay you will see others in that light as well.
Have you looked at your attitude lately? Try asking someone
you work with or a friend how they would describe your attitude
toward people that are different. What do you think they might
say?
BASIC HELPING ATTITUDES
There are three basic helping attitudes
 Warmth - In your presence clients feel valued, worthy of being
understood.
 Genuineness - you are open, truthful, an authentic person.
 Empathy - you are able to put yourself in another’s shoes; or better
yet imagine what it is like for them to be in their shoes. You can
accurately communicate to clients an understanding of their
underlying emotions.
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Which of these three do you think describes you the best, why?
ON BEING JUDGMENTAL
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Because you are the worker and the clients are clients does not
make you a better person than they right?
Judging people by your own standards is not helpful.
Comparing your life to theirs, your choices to their choices, is again
not helpful and puts you in the “expert” role.
When you sit in judgment of another person you erect a barrier to
real understanding, rapport; and the opportunity to be of real
assistance.
What can you do to reassure a client you are not “judging”
them? Can you name a specific behavior which conveys
understanding and acceptance versus judgment?
REALITY
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All of our clients will not be cooperative and grateful.
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It is unrealistic to expect that clients will be, if everything was
wonderful in their life they would not need our help.
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What are some things human service workers might do that
discourage clients instead of encouraging and empowering
them?
HOW CLIENTS ARE DISCOURAGED
There are many ways clients become discouraged by workers
 Telling clients “how you did it” or “how you succeeded”
 Pushing or shaming a client into working on a goal
 Focusing exclusively on mistakes
 Demanding unrealistic things
 Intimidating the client
 Failing to notice positive change and client strengths
 Not listening or acting bored
 Discouraging clients from trying new things
UNDERSTANDING BOUNDARIES
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There are boundaries between clients and workers that prevent
ethical violations and facilitate the helping relationship.
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It is the worker who is responsible for maintaining boundaries.
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In addition to boundaries human service workers need to
understand the concept of transference and countertransference
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What are some of the ways we might cross boundaries if we
are not careful?
UNDERSTANDING BOUNDARIES
Ways we cross boundaries:
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The client reminds us of ourselves (countertransference).
The client is dealing with a problem we once had (inappropriate
self-disclosure).
We are using our work with clients to resolve our own issues
(inappropriate countertransference).
We want the client to use solutions we used to solve a similar
problem in our own lives (ego power trip).
We want the client to use a solution so that we appear more
effective and competent as workers (unethical and manipulative).
TRANSFERENCE
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Transference is a collection of feelings and attitudes the client holds
about you.
Accept transference when it exists. Transference is neither a good
thing or a bad thing.
Sometimes we remind clients of someone they knew in the past.
Clients may only be dimly aware of that. They just know that you
remind them of someone.
Positive transference occurs when the client likes you.
Negative transference occurs when the client does not.
When clients act in unexpected and somewhat inappropriate ways
do not take it personally.
Reflective listening creates a safe environment.
COUNTERTRANSFERENCE
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Countertransference occurs when the worker projects onto the client
emotions and attitudes.
It occurs because the client reminds us of someone in the past or
because the clients issues remind us of our own.
Countertransference can be negative or positive.
We may give good service to someone who reminds us of a dear
aunt, while giving poor service to someone who reminds us of a
bully.
It is important to be self-aware of our feelings about another. It is
not acceptable to allow them to interfere with our service to others.
Countertransference feelings may signal we have old issues that
need to be resolved.
Case study of the proud case
manager…
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Elana is feeling very proud of herself. She talked to a client who had
many problems a lot of stress this afternoon. Elana put everything
down on paper, while her client sat quietly by the desk and sipped a
coffee. Then Elana decided on the best course of action for this
situation and told her client what they needed to do to feel better.
The client finished their coffee and said “I understand, it looks like
everything will be fine now”; and left Elana’s office.
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What do you think? Were any boundaries blurred here, how
would you have handled this situation?
The case of the excited DV worker…
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Peter was living in a very abusive relationship with a woman he met
in high school. He had been raised by his parents to never hit a
woman, and he often found himself on the receiving end of brutal
emotional attacks by his girlfriend and was victim to several serious
attacks, one with a knife left him seriously injured and scarred for
life. After several years of this violent abuse, he finally went to see a
counselor. His counselor, Mary, specializes in domestic violence, in
fact she was a survivor of domestic violence herself, but finally
escaped and now has a relationship with a peaceful and supportive
man. Mary believes Peter needs to leave right away, and find a new
life just like she did. She shares details of how bad her abusive
relationship was and how wonderful it is now and encourages Peter
to go home today, pack, and leave to start a new life.
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What do you think? Were any boundaries blurred here, how
would you have handled this situation?
Clarifying Who Owns the
Problem…
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When working with a client, it is important to
establish “who owns the problem”.
The person whose NEEDS are NOT being
met owns the problem.
It is not our job as case managers to “fix” our
client’s problems.
Why is it important that we know who owns
the problem?
Why knowing who “owns the
problem” is important…
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You will know who is responsible for solving
the problem.
Meddling is disrespectful
The client loses opportunities to grow.
Keep your clients in a position of authority
over their lives to the greatest extent
possible.
If the CLIENT owns the
problem…
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Listen rather than providing a solution.
Give the client options.
Ask the client for ideas.
Just become someone tells you about the
problem does not mean you must solve it.
When you allow clients to work on their own
issues and problems, you respect their right to
privacy and self-determination and provide them
with a growth opportunity.
It’s a strategic decision…
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How do we decide how involved to get when assisting a
client with a problem?
How does the case management role differ from the
friend role when working with someone to solve a
problem?
Use your knowledge of the client, assess their strengths
and limitations.
Sometimes solving the problem for the client and doing
the footwork for them is easier, but it isn’t always “better”
for the client.
As case managers, we are a great RESOURCE to our
clients.
If YOU own the problem…
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If you are having a problem, that is, your
needs are not being met, you will understand
that the resolution of the problem is ultimately
your responsibility.
What might be an example of a situation
where YOU might own the problem?
You invite the client to assist you in finding a
solution to the problem at hand.
How might you handle it if the client was not
interested in helping arrive at a solution?
If you BOTH own the
problem…
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Sometimes the problem will lie with both the
case manager and the client.
These are opportunities to negotiate.
When you work on a solution collaboratively
with the client, you provide the client with an
important experience in problem solving.
Working on a problem together can help save
rapport and also build trust in the relationship.
Let’s give it a try…Who owns
the problem…
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You work at a victim/witness resource center where you assist the
victims of crime to handle the emotional and technical ramifications
of the crime before they go to court. The husband of a victim, a
woman who was carjacked by a teenager one night, takes you aside
and asks you to persuade his wife to drop the charges. He tells you
confidentially that it would be better for his wife if “she did not have
to go through this”. Who owns the problem?
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A woman you have placed in temporary housing is angered by the
loud music of her neighbors. She appeals to you to do something
about it. Who owns the problem?
Your client consistently arrives 15 minutes late to all of her
appointment. This causes your schedule to be thrown off the rest of
the day. Who owns the problem?
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An exercise in strategy…
Situation: Hannah recently went blind due to an accident
with chemicals at the company where she worked. She is
asking for a service plan that will help her regain some
independence.
Scenario #1: Hannah is a PhD chemist with the corporation
where the accident occurred. She has received a huge
settlement from the corporations insurance company. The
corporation has said she can coem back to work if she can
be retrained in some way, possibly with computers.
Hannah has a supportive husband and many close friends.
How do you help?
An exercise in strategy…
Situation: Hannah recently went blind due to an accident
with chemicals at the company where she worked. She is
asking for a service plan that will help her regain some
independence.
Scenario #2: Hannah is a student working on a chemical
engineering degree. She worked part time to pay her
school expenses at a large chemical corporation. She
wants to remain in school. Her family is supportive of this,
but they live in another state. Hannah’s roommates seem
hesitant about her returning to live with them in their
downtown apartment now that she is blind. How do you
help?
Questions?