Transcript PowerPoint - National Association of States United for Aging and

Developing Effective
Intervention Plans
Developed by DATA of Rhode Island
Through a special grant from the Rhode Island
Department of Human Services
September 2006
1
Training Overview
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This course focuses on trainees developing
skills to select reasonable goals, negotiating
contracts, and develop intervention/action plans.
These activities are presented as they may
apply to both voluntary and involuntary clients.
The rationale for goals and guidelines for
selecting, defining, and negotiating goals is
delineated in the first part of the training.
The final portion of the training is devoted to the
elements and skills involved in formulating an
intervention plan.
The intervention plan is illustrated with the use of
case examples.
2
Purpose
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The purpose of this training is to provide
participants with the opportunity to
acquire the beginning knowledge and
skills to design and implement -- as
partners with clients -- individualized
intervention plans which address the
needs of individuals experiencing a variety
of problems.
3
Importance of Intervention
Planning
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3 Components of Intervention Planning
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Multi-dimensional Assessment
Developing a Problem List
Assessing Interpersonal & Environmental
System Factors
Negotiating Goals & Formulating
Intervention Plan
4
Multi-dimensional Assessment:
Knowledge & Skills of
Assessment
5
Multidimensionality of Assessment
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Reciprocal interaction between person and external
world
Humans are social creatures
An understanding of interactions between numerous
systems
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Biophysical
Cognitive
Emotional
Cultural
Behavioral
Motivational
Priorities based on:
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Client’s needs
Agency’s purpose and resources
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Assessment
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Both a product and a process
Can be based on legal/programmatic
mandates as well as the needs of the
immediate situation
Seeks to understand problems and needs
Not deficits based
Strengths based
7
Defining Assessment: Process and Product
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What does the client see as his or her primary problems
or concerns?
What (if any) current or impending mandates the client
and helper must consider?
What (if any) potentially serious health or safety
concerns might require the helper worker’s and client’s
immediate attention?
8
Overview: Areas for Attention in
Assessing Strengths and Problems
Problems as seen by potential clients
•Health and safety concerns
•Legal or program mandates
•Culture, race, gender, sexual orientation
and other areas of difference
Problems and
challenges
•Personal and family
coping capacities
•Severity
•Sites of problem
•Duration
Strengths and
resources
Developmental
needs and life
transitions
•Skills
•Values
•Frequency
•Motivations
•Emotional reaction
•Community resources
and support networks
including cultural
supports
•Consequences
•Resource deficits
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Culturally Competent Assessment
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Possibilities for distinguishing individual members of an
ethnic minority
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Degree of commonality between the two cultures (norms,
values, beliefs, and perceptions)
Availability of cultural translators, mediators, and models
Amount and type of feedback provided by each culture
regarding attempts to produce normative behaviors
Conceptual style and problem-solving approach of the
individual and the mesh with the prevalent or valued styles of
the majority culture
Individual’s degree of bilingualism
Degree of dissimilarity in physical appearance from the
majority culture
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Emphasizing Strengths in Assessments
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To emphasize strengths and client empowerment
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Give preeminence to client’s understanding of the facts
Discover the client’s wants
Assess personal and environmental strengths on multiple levels
Commonly overlooked strengths
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Facing problems and seeking help
Risking by sharing problems
Persevering under difficult circumstances
Being resourceful and creative
Seeking to further knowledge, education, and skills
Expressing caring feelings to family and friends
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Emphasizing Strengths (continued)
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Commonly overlooked strengths (continued)
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Asserting one’s rights rather than submitting to injustice
Being responsible in work or financial obligations
Seeking to understand the needs and feelings of others
Having the capacity for introspection
Demonstrating the capacity for self-control
Being able to function effectively in stressful situations
Demonstrating the ability to consider alternative courses of
action and the needs of others when solving problems
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Strengths Perspective
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gives preeminence to client understanding
of the facts
discovers what the client wants
assesses personal and environmental
strengths on multiple levels
13
Principles of the Strengths Perspective
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Every individual, family, group and community
has strengths
Trauma, illness, abuse and struggle may be
injurious but may be sources of challenge and
opportunity
We do not know the upper limits of the capacity
to grow and change, take aspirations seriously
Best serve clients by collaboration
Every environment is full of resources
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Strengths Perspective
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Quadrant 1 Environmental strengths
Quadrant II Client’s personal strengths
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Cognition
Emotion
Motivation
Coping
Quadrant III Environmental challenges
Quadrant IV Personal challenges
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Framework for Strengths Assessment
Strength or Resource
Environmental
Factors (family,
community)
1
2
Individual or
Personal Factors
3
4
Deficit, Obstacle, or Challenge
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Strengths Assessment
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Strengths / Assets
You’ve identified
Strengths / Assets
Identified by Others
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Needs / Vulnerabilities
You’ve Identified
Needs / Vulnerabilities
Identified by Others
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Sources of Information
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Background sheets or other forms that clients complete
Interview with clients
Direct observation of nonverbal behavior
Direct observation of interaction between marital
partners, family members, and other persons
Collateral information from relatives, friends, physicians,
teachers, employers, neighbors and other professionals
Personal experiences of the worker based on direct
interactions with clients
Client self-monitoring and self report
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Questions to Answer in Problem Assessment
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Example list of general questions as a checklist
Identifying the problem, its expressions, and
other critical concerns
The interaction of other people or systems
Assessing developmental needs and wants
Typical wants involved in presenting problems
Stresses associated with life transitions
Severity of the problem
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Questions to Answer (continued)
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Frequency of problematic behaviors
Duration of the problem
Other issues affecting client functioning
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Physical health
Mental health
Substance abuse
Life cycle stage (young adult versus older adult)
Clients’ emotional reactions to problems
Coping efforts and needed skills
Cultural, societal, and social class factors
External resources needed
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Solution-Focused Assessment Questions
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Seeking exceptions
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when is the problem not a problem
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On a scale of 1 to 10 how severe is the problem today?
On a scale of 1 to 10 how severe is the problem today
compared to a month ago
Scaling the problem
Scaling motivation
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On a scale of 1 to 10 how motivated are you to deal with the
problem today?
On a scale of 1 to 10 how motivated are you to deal with the
problem today compared to a month ago?
The miracle question
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Suppose you go to bed tonight and discover tomorrow the
problem that brought you here is resolved. What would be
different? Who would be the 1st person to notice the change?
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Assessment:
Exploration of the problem, concern, need
Common sources of information
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Give examples of the problem
verbal report client and others
direct observation of nonverbal behavior
observation of interaction – naturalistic
assessment
client self-monitoring
collateral sources of information
personal experience based on direct interaction
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Multidimensionality of assessment
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The person – the whole person
The meaning the person derives from the problem or
need
The person in time
Developmental aspects
The problem duration, onset, future
The person in social context
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The relationship of the problem or need in relation to family,
friends, neighbors, social supports
The person in environment
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Resources, opportunities
The physical environment
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Comprehensive Assessment Factors
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Manifestations of the problem
Strengths & obstacles
Ecological perspectives
Developmental & unmet
needs/wants
Severity of the problem
Meanings ascribed to the
problem
Sites of problematic behavior
Time
Frequency
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Duration
Antecedent events
Acute and chronic problems
Reasons for help-seeking
Reason for programmatic
actions
Relationships of substance use
Client’s emotional reactions
Coping efforts and needed
skills
Cultural, societal and ethnic
factors
External resources needed
24
Identifying the Problem
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Involve the client in uncovering the problem
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Why is the client seeking help?
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A deficiency, a need, an excess?
Why now?
Importance
Relation to motivation
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Voluntary
Involuntary
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An Ecological Perspective
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Who are involved?
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Family
Social network
Social institutions
Organizations
In what way?
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Interaction
Benefits and challenges
Does the problem have meaning and history
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Developmental Needs and Wants
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Needs
essential elements of human well-being
that must at least be partially met
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Physical needs
Positive self-concept
Emotional / relational/ belonging
Personal fulfillment
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WANTS
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Wants:
strong desires that motivate behavior and
when satisfied, enhance satisfaction and
well-being
translate complaints and problems into
wants and needs
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Developmental Aspects of
Needs and Wants
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Consider developmental period
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infants
early childhood
childhood
adolescence
young adulthood
adulthood
older adulthood
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Assessing Interpersonal &
Environmental System Factors
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Overview: Areas for Attention in
Assessing Intrapersonal Function
Biophysical Functioning
Physical characteristics and
presentation
Physical health
Assessing Use and Abuse of Medications,
Alcohol and Drugs
Alcohol use and abuse
Use and abuse of other substances
Dual diagnosis: co-morbid addictive and
mental disorders
Assessing Cognitive/Perceptual
Functioning Intellectual functioning
Judgment
Reality testing
Coherence
Cognitive flexibility
Values
Misconceptions
Self-concept
Assessing thought disorders
Assessing Emotional Functioning
Emotional control
Range of emotions
Appropriateness of affect
Assessing affective disorders
Bipolar disorder
Major depressive disorder
Suicidal risk
Depression and suicidal
risk
Assessing Behavioral
Functioning
Assessing Motivation
Assessing Environmental
Systems Physical environment
Social support systems
Spirituality and affiliation with a
faith community
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Biophysical Functioning
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Physical characteristics and presentation
Physical health
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Assessing Use and Abuse of Medications,
Alcohol, and Drugs
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Alcohol use and abuse
Use and abuse of other drugs
Prescribed medication
Other the Counter drugs
Dual diagnosis: Addictive and mental disorders
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Interviewing for Potential Substance Abuse
1.
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Do you, or did you ever, smoke cigarettes? For how long? How many per day?
Do you drink?
What do you drink? (beer, wine, liquor?)
Do you take any prescription medications regularly? How do they make you feel?
Do you use any over-the-counter medications regularly? How do they make you feel?
Have you ever used any illegal drug?
When was the last time you had a drink/used?
How much did you drink/use?
When was the last time before that?
How much did you have?
Do you always drink/use approximately the same amount? If not, is the amount increasing
or decreasing?
(If it is increasing) Does that concern you?
Do most of your friends drink/use?
Do (or did) your parents drink/use?
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Interviewing for Potential Substance Abuse
(continued)
15.
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Have you ever been concerned that you might have a drinking/drug problem?
Has anyone else ever suggested to you that you have (or had) a drinking/drug
problem?
How does drinking/using help you?
Do other people report that you become more careless, or angry, or out of control
when you have been drinking/using?
Do you drink/use to “get away from your troubles?”
What troubles are you trying to get away from?
Are you aware of any way in which drinking/using is interfering with your work?
Are you having difficulties or conflict with your spouse or partner because of
drinking/using?
Are you having financial difficulties? Are they related in any way to your
drinking/using?
Have you ever tried to stop drinking/using? How?
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Assessing Cognitive/Perceptual Functioning
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Intellectual functioning e.g..
Memory, concentration,
attention, problem solving
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Judgment
Reality testing
Coherence
Values
Self-concept
Cognitive Disturbance or thought disorders
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Mental Status Exam
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Appearance
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Reality testing
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How does the client look and act?
Stated age, dress and clothing
Psychomotor movements, tics, facial expressions
Judgment
Dangerous, impulsive behaviors
Insight
Speech
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Volume
Rate of speech
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Mental Status Exam (continued)
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Emotions
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Mood: How the client feels most of the time
Affect: How the client appears to be feeling at this time,
variability, and intensity
Thought
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Content: What the client thinks about
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Delusions: Unreal belief, distortion
Other thought issues: Obsessions, compulsions, phobias, thought
broadcasting, ideas of reference
Homicidal ideation
Suicidal ideation
Process: How the client thinks
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Mental Status Exam (continued)
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Sensory Perceptions
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Illusions
Hallucinations
Mental Capacities
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Orientation: Time, person, place, situation
General intellect
Memory
Concentration
Attitude toward interviewer
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Assessing Emotional Functioning
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Emotional control
Range of emotions
Appropriateness of affect
Affective disorders
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Bipolar disorder
Major depressive disorder
Suicidal risk
Depression and suicidal risk
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More Areas of Assessment
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Assessing behavioral functioning
Assessing motivation
41
Behavioral Patterns
Dimensions of
Behavior
Dysfunctional
Patterns
Functional
Patterns (Strengths)
Power/control
Autocratic, overbearing, aggressive, ruthless,
Democratic, cooperative, assertive,
demanding, domineering, controlling, passive,
includes others in decision making,
submissive; excludes others from decision making.
stands up for own rights.
Nurturance/support
Responsibility
Self-centered, critical, rejecting, withholding,
Caring, approving, giving, empathic,
demeaning, distant, punitive, fault-finding,
encouraging, patient, generous,
self-serving; insensitive or unconcerned
altruistic, warm, accepting, supportive;
about others.
interested in others.
Undependable, erratic; avoids responsibility,
Dependable, steady, consistent, reliable;
places pleasure before responsibility, externalizes
follows through, accepts responsibility,
responsibility for problems, neglects maintenance
owns part in problems, maintains
of personal property.
personal property.
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Behavioral Patterns (continued)
Dimensions of
Behavior
Social skills
Dysfunctional
Patterns
Functional
Patterns (Strengths)
Abrasive, caustic, irritable, insensitive, aloof,
Outgoing, poised, personable, verbally
reclusive, sarcastic, querulous, withdrawn,
fluent, sociable, witty, courteous, engaging,
self-conscious, ingratiating; lacks social delicacy.
cooperative, assertive, spontaneous, respectful
of others, sensitive to feelings of others; has
sense of propriety.
Coping patterns
Rigid, impulsive, rebellious; avoids facing problems,
Flexible; faces problems, considers and weighs
uses alcohol or drugs when under stress, becomes
alternatives, anticipates consequences, maintains
panicky, lashes out at others, sulks.
equilibrium, , seeks growth, consults others for
suggestions, negotiates and compromises.
Personal habits
Disorganized, dilatory, devious, dishonest, compulsive,
Planner, organized, flexible, clean, efficient,
and traits
overly fastidious, impulsive; manifests poor personal
patient, self-disciplined, well-groomed,
hygiene, has irritating
honest, open, sincere, temperate, considerate,
mannerisms.
even-disposition, punctual.
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Behavioral Patterns (continued)
Dimensions of
Behavior
Dysfunctional
Patterns
Functional
Patterns (Strengths)
Communication
Mumbles, complains excessively, nags, talksListens attentively, speaks fluently, expresses
excessively, interrupts others, tunes others out,
views, shares feelings, uses feedback, expresses
stammers, yells when angry, withholds views,
self spontaneously, considers others’
defensive, monotonic, argumentative, taciturn,
viewpoints, speaks audibly and within
verbally abusive.
tolerable limits.
Accomplishment/
Unmotivated, aimless, nonproductive, easily
Ambitious, industrious, self-starting,
independence
discouraged, easily distracted, underachieving;
independent, resourceful, persevering,
lacks initiative, seldom completes endeavors,
successful in endeavors, seeks to advance
workaholic, slave to work.
or to improve situations.
Unaffectionate, reserved, distant, sexually
Warm, loving, affectionate, demonstrative,
inhibited, promiscuous, lacking sexual desire,
sexually responsive (appropriately).
Affectionate/sexual
engages in deviant sexual behavior.
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Assessing Environmental Systems
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Basic needs
Physical environment
Social support systems
Spirituality and affiliation with a faith community
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Diagram of Ecological and Social Systems
Schools
Recreational
programs
Friends
Family
physician
Governmental
organizations
Work
associates
Child
welfare
Nurses, health
Members of
Rehabilitation
care providers
church
programs
Economic
Parents
Landlord
Clan
Barber or
(income
Siblings
members
Employment
hairdresser
maintenance)
Bartender
Aunts and
Mate
systems
uncles
Grandparents
Social club
Neighbors
Correctional
Individual
members
systems
Other close
Student
Judicial
Children
Stepsiblings
associates
Pastor, relatives Intimate
system
Family
priest,
Parents
Cousins
friends
mechanic
rabbi,
in-law
Social
Other
bishop
Cultural
worker or
organizations
Distant
reference
counselor
Family
Political
relatives
group
dentist
party
Municipal
services
Action groups
Law
enforcement
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What’s an Intervention Plan?
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This is usually written document that lists and
describes the problems or needs, the anticipated
goals and all the services a client will receive to
achieve these goals.
Intervention plans are based on information
about a client’s strengths, problems, history, and
needs.
The intervention plan also includes information
on aftercare or continued care, which are
services or supports are recommended for the
continued maintenance of a client.
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Goals
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Factors influencing goal development
The purpose of goals
Program objectives and goals
Types of goals
Guidelines for selecting and defining goals
The process of negotiating goals
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Purpose of Goals
1.
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5.
Ensure that helpers and clients are in agreement,
where possible, about objectives to be achieved.
Provide direction and continuity to the helping process
and prevent needless wandering.
Facilitate the development and selection of appropriate
strategies and interventions.
Assist helpers and clients in monitoring their progress.
Serve as outcome criteria in evaluating the
effectiveness of specific interventions and of the
helping process.
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Linkage Between Target Concern & Goals
Assessment Summary
Target Concern
Margaret, age 87, feels unable
to remain in her home
because of concerns for her
safety. She has expressed an
interest in moving into an
assisted living apartment
complex and she wants to
maintain her independence.
Margaret is concerned
about safety in her home.
Goals
Maintain maximal safe
independence.
Explore assisted living.
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Guidelines for Selecting and Defining
Goals
1.
2.
3.
4.
5.
6.
7.
8.
Goals must relate to the desired results sought by
voluntary clients or negotiated between client and
provider.
Goals for involuntary clients should include
motivational considerations
Goals should be defined in explicit and measurable
terms
Goals must be feasible
Goals should be commensurate with the
knowledge and skills of the helper
Goals should be stated in positive terms
Avoid agreeing to goals about which you have
major reservations
Goals must be consistent within the functions of
your agency
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Process of Negotiating Goals
1.
2.
3.
4.
5.
6.
7.
8.
Determine clients’ readiness [stage of change]
Explain the purpose and function of goals
Negotiating goals with clients
Jointly select appropriate goals
Define the goals explicitly
Determine the feasibility of goals and discuss their
potential risks, benefits and consequences
Assist clients to make a choice about committing
themselves to specific goals
Rank goals according to clients’ priorities
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Stages of Change
Maintenance
Precontemplation
Relapse
Action
Contemplation
Preparation Determination
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Stages of Change & Helper’s Tasks
Client’s Stage
1.
Precontemplation
2.
Contemplation
3.
Preparation
4.
Action
5.
6.
Therapist’s Motivational Task
1.
2.
Raise Doubt- increase client’s perception or risk &
problems with current behavior
Tip the balance – evoke reasons to change, risks of
not changing, strengthen client’s self-efficacy for
change of current behavior
3.
Help client determine the best course of action to
take in seeking change
4.
Help client take steps toward change
Maintenance
5.
Help client identify & use strategies to prevent
relapse
Relapse
6.
Help client to renew process of contemplation,
preparation & action without becoming stuck or
demoralized because of relapse
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Case Progress Notes
Client/Family:
Helper:
GOAL STATEMENT:
GOAL #
GENERAL TASKS:
Identify Strengths/Resources:
TASKS/STEPS-Client:
Date:
Identify Barriers/Obstacles:
TASKS/STEPS-Helper:
Progress Notes:
GOAL STATUS SUMMARY: [ ] C (completed)
Staff
[ ] P (partially completed)
[ ] NC (not completed)
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Case Progress Notes (continued)
CASE PROGRESS NOTES
CONCERN/PROBLEM STATEMENT:
GOAL STATEMENT
GOAL #________
Identify strengths/resources
Identify potential barriers/obstacles
STEPS/TASKS
Family/Client
Date
GOAL STATUS SUMMARY:
Helper
PROGRESS NOTES
[ ] C (completed)
[ ] P (partially completed)
[ ] NC (not completed)
Participant Name/Signature:__________________________________
Helper Name/Signature:_______________________________________
Date:______________
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Examples of Goals and General Tasks
GOALS
1.
Gain increased control over
emotions.
2.
Improve social relations.
3.
Enhance interactions with social
environment.
4.
Enhance self-confidence.
5.
Improve parenting skills.
6.
Increase social participation in a
group context.
GENERAL TASKS
1.
Reduce frequency of anger outbursts by being aware of
cues that elicit anger. Increase use of internal dialogue to
decrease anger.
2.
Approach others and initiate and maintain conversation by
employing listening skills and furthering responses.
3.
Explore living arrangements in a center for elderly persons
that provides outside activities.
4.
Focus on strengths and positive attributes, qualities;
express self-approval.
5.
Demonstrate competence in planning and preparing
nutritious meals, and maintaining adequate sanitary and
hygienic conditions.
6.
Resolve fears about fitting in, initiate discussion of personal
views, ask questions, participate in group discussions.
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Examples of Goals and General Tasks
(continued)
GOALS
GENERAL TASKS
7.
Improve marital communication.
7.
8.
Resolve conflict when interacting
with peers.
Listen without interrupting and check out meaning and
increase frequency of positive messages.
8.
Express anger in a constructive
manner.
Learn methods of problem-solving skills that
contribute to conflict resolution.
9.
Practice alternative productive ways of expressing
anger.
9.
10. Complete job training skills
assessment.
10. Contact vocational-technical program.
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Examples of Negative and Positive Goal
Statements
Negative
1.
Reduce the incidence of criticism among
family members.
2.
Eliminate conflict between marital partners.
3.
Prevent coalitions and non-participatory
behavior by group members.
4.
Discontinue the frequency of drinking
binges.
5.
Refrain from running away from home.
6.
Decrease the use of physical punishment.
7.
Reduce explosive outbursts of anger.
Positive
1.
Increase the family members’ awareness of each
other’s strengths and increase the frequency of
positive messages.
2.
Communicate specific disagreements promptly and
address them in a constructive manner.
3.
To unite efforts of group in working collectively and
to draw each member into participation.
4.
To achieve ever-increasing periods of sobriety,
taking one day at a time.
5.
Identify alternative options to running away from
home.
6.
Consistently apply new ways of disciplining
children, such as utilizing “time out” and increase
positive feedback.
7.
Increase use of alternative non-abusive ways of
expressing anger.
59
Definition - Goal

Goal: A brief, general statement of
the condition expected to change in
the course of the intervention.
Should be directed toward
improvement over or resolution of
problem/need area.
60
Examples - Goals



“The client will learn the skills necessary
to maintain a sober lifestyle” Vs. “The
client will stop drinking.”
“The client will develop a healthy diet
and begin gaining weight.”
“The client will learn to share positive
feelings with others.”
61
Definition- Objective

A concrete, observable behavior -- a
specific skill -- the client must
acquire to achieve a goal. They
must be measurable and have time
limits.
62
Examples - Objectives



“The client will make a list of the activities
necessary for recovery by March 15.”
“The client will role-play in group three real-life
situations where she would like to use
assertiveness more effectively.”
“The client will present to his counselor the
circumstances related to two times he was
able to abstain from using substances by the
following individual session.”
63
Creating Well Formed Intervention
Goals





The intention is for clients to reach their goals.
Before any goal can be achieved, it must first be
clearly defined and well formed.
When goals are well formed the client and
helper will know they have been reached
These goals are co-created by the client and the
helper.
As Alice found out in Alice in Wonderland “if you
do not know where you are bound, it might just
not be where you wanted to go”.
64
Well-formed goals are:






Relevant to the
client
Smaller rather than
larger
Realistic
Doable
Achievable
Start of something






Presence of
something
Concrete
Specific
Contextual
Behavioral
Measurable
65
MOAB




Measurable
Objective
Achievable
Behavioral
66
Elements of a Healthy Life






Safe and decent housing
Education about and
access to good nutrition
Access to appropriate and
adequate medical and
health care
Freedom from fear of
bodily harm
Appropriate clothing for
warm and cold weather
Opportunities for
educational experiences





Opportunities for
vocational experiences
that recognize talents
Access to legal support
when needed
Opportunities for
entertainment and to
enjoy beautiful things
Clean air and water;
enough rest and
exercise
Opportunities to
develop and cultivate
natural support
67
networks
Sample Goal & Task Form
Name:________________________________________
Statement of Problem/Condition to be
Changed:________________________________________________________
__________________________________________________________________
Goal Statement:_____________________________________________________________________________
General
Tasks:___________________________________________________________________________________
________________________________________________________________________________
___
Potential Barriers: _________ __________ __________ __________
Benefits:
_________ __________ __________ __________
Specific Tasks
(steps to be taken to achieve goal):
Completion Date
Review Date
Outcome Code
1.__________________________
______________
_____________
___________
2.__________________________
______________
_____________
___________
3.__________________________
______________
_____________
___________
Outcome Codes
Tasks & Goal Status
[ ] C (completed)
[ ] P (partially completed)
[ ] NC (not completed)
68
Sample of Self-Anchored Anxiety Scale
1
Least anxious
(calm,
relaxed,
serene)
2
3
4
Moderately
anxious
(tense, uptight
but still
functioning
with effort)
5
6
7
Most anxious
(muscles taut,
can’t concentrate
or sit still; could
climb the wall)
69
Intervention Plans



The rationale for intervention plans
Types of intervention plans
Developing intervention plans








Goals to be accomplished
Roles of participants
Interventions or techniques to be employed
Time frame and frequency and length of sessions
Third party involvement
Means of monitoring progress
Stipulations for renegotiating the intervention plan
Housekeeping items
70
Questions on Intervention Planning


What are the benefits of intervention
planning with clients?
What are the difficulties of intervention
planning with clients?
71
Case Questions
1.
2.
3.
4.
5.
6.
7.
What is the overall problem?
What is the “change desired”?
What’s the target behavior?
Who thinks this is a problem?
What has already been done about the
problem?
When, if ever, was the problem not a problem
or not as much of a problem? (Exceptions to
the problem)
Who else, if anyone, has been involved in the
problem or attempting to resolve the problem?
72
Case Questions (continued)
8.
9.
10.
11.
12.
13.
If this is an on-going problem, what has been
done about the problem in the past and how
well has it worked?
What would your client like to see change?
What would others like to see change?
What would you like to see change?
What are the discrepancies between the client’s
values and their behavior with regards to the
problem?
What kind of resistance have you encountered
in dealing with the problem?
73
Case Situation 1

Winston and Clarita need assistance in finding
affordable housing. Currently they are living in
transitional housing with their two children.
Finding housing has been difficult, because they
have two prior evictions and landlords are
reluctant to rent to “high-risk individuals.” Their
eviction from their last apartment was,
according to them, related to a relative who was
living with them at the time. The relative had
damaged their apartment. Also, the police had
been called on numerous times. After the last
time, they asked him to leave, but it was too
late. The landlord posted an eviction notice on
their door, and refused to accept rent for the
next month.
74
Case Situation 1 (continued)

To make matters worse, Clarita lost her job when they
moved into transitional housing because of absenteeism.
In the old apartment, she could walk to work. Winston
works as a cook in a suburban restaurant. Transportation
is an issue because there is limited bus service from the
city to his place of employment. As a result, he leaves
home early, and returns home late. Despite their
difficulties, their children appear to be well cared for, and
the couple reports that their relationship is okay, now
that the relative is out of their lives. Both are, however,
despondent over their circumstances. They have 60 days
in which they can remain in transitional housing. The
couple is concerned about finding housing they can
afford. Clarita is looking for another job during the hours
that the children are in school because child-care in not
available at the housing shelter. Their old child-care
provider lived in their previous neighborhood. Clarita
may be able to get her old job back once they are
settled
75
Case Situation 2
Sherry recently had moved back into the community.
She had lived in Olneyville several times previously
and she considered it home more than any
other place she could remember. Upon returning
to the community, she had sought assistance from
the Good News Mission Shelter.

Sherry, a 47-year-old single woman, had been
unsettled for much of her adult life. She had been
highly mobile, often to the point of being transient.
Although she had experienced some difficulty
controlling her temper and getting along with others
in the past, she now recognized that she needed
assistance to escape from her perpetual hand-to-mouth
existence.

She also had become more realistic about
her troubles maintaining regular employment,
and was willing to take responsibility for her past
and to be more tolerant of the terms with which
help was offered. Sherry knew that she would
have to “make her own breaks” if her life was
going to improve. She was a hard worker and
usually did not have too much difficulty finding
employment.

76
Case Situation 2 (continued)
Sherry quickly got a job at a supermarket that
had just opened in town. She hoped to remain
there and “get herself together.” Because of her
positive work performance and management experience,
she was offered a position as an assistant
manager for the evening shift, the only position in
the store that paid more than minimum wage.
Sherry liked her job and realized that it represented
a rare opportunity for her to earn a livable
income in this rural community.

Sherry had been staying at the shelter for
several weeks before she had found employment.
Fred, the shelter director, was very supportive of
her job search and was delighted with her new
position—until he learned it was an evening job.
Because the shelter’s policy required that all
residents attend the Bible-study support group
each evening, Fred told Sherry she would have to
change her work schedule to the day shift immediately
or be terminated from the program. For
Fred, involvement in the study was a nonnegotiable
requirement.

77
Case Situation 2 (continued)
Without the higher pay and the no-cost housing,
Sherry did not know how she would ever save
enough to pay deposits on an apartment and utilities.
She was angry and discouraged, and it seemed
that the world was collapsing on her. Fred’s inflexibility
regarding attendance at the Bible-study
group was the primary cause of her confusion—he
had strongly encouraged her to find work, but now
he was forcing her to quit the job or leave the shelter.
She had been aware of the Bible-study support
group requirement when she entered the shelter
and, before obtaining her job, she had attended all
the Bible-study meetings without objection.

78
Case Situation 2 (continued)



Determined to find a solution, Sherry contacted her
manager and asked if there was any possibility that she
could move to another shift. But the manager needed
Sherry on the second shift, stating that he understood
her dilemma but was unable to accommodate the
request.
The manager called the landlords he knew and any
churches that might be willing to help. But there were no
funds to subsidize rent, no one willing to defer deposits,
and no one to step forward to offer Sherry temporary
shelter in their home.
But with no income or family support, Sherry’s situation
was becoming desperate.
79
Case Exercise





Each group is attempt to answer the
questions posed on slides 72 & 73 to
complete assessment phase
Each group is to develop a problem list
Each group is to develop a strengths list
Each group is to develop an intervention
plan for you client(s)
Each group will present their case to the
class
80
Questions?
81
Closing Exercise
1.
Something I liked?
2.
Something I’ll use?
3.
This training will help me?
4.
Something more I wanted more of?
82
Suggested Articles or Readings
Boyle, S., Hull, G., Mather, J., Smith, L., & Farley, O.
(2005) Direct Practice in Social Work. Boston, MA:
Allyn & Bacon. [Chapter 7 “Knowledge and Skills of
Intervention”]
Hepworth, D. H., Rooney, R. H. & Larsen, J. A.. (2006).
Direct Social Work Practice: Theory and Skills,
Seventh Edition. Pacific Grove, CA: Brooks-Cole.
Sevel, J., Cummins, L. & Madrigal, C. (1999). Social
Work Skills Demonstrated. Needham Heights, MA:
Allyn & Bacon.
Strom-Gottfried, K (1999) Social work Practice, Cases,
Activities, and Exercises. Thousand Oaks: Pine
Forge Press.
83
Suggested Websites

Center for SA Treatment (CSAT)


SAMHSA/CSAT Treatment Improvement Protocols
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hs
tat5.part.22441
The Center for Mental Health Services
(CMHS), Substance Abuse and Mental Health
Services Administration (SAMHSA)

http://www.mentalhealth.samhsa.gov/publications
/browse.asp
84