Clients with Diverse Needs and Backgrounds 👴 👵🐶👳👽 (Disability…
Clients with Diverse Needs and Backgrounds
Why the need for Case Management ?
: Movement of people out of institutional facilities into community-based programs or back home created a major service delivery problem.
: Services provided within community settings are decentralised, with few mechanism existing for the integration of these services or for the coordination of the many agencies whose services are potentially relevant to the clients.
Service populations with multiple needs
: There are many more people with disabilities or problems in social functioning, and they need to receive multiple services and support.
: Many of our human services are organised according to a categorical logic (E.g. age group, function, problem areas), and there is a lack of integration of services across these categories. Thus, a unified system of care is absent.
Social support and social networks
: The growing awareness of the importance of informal system of care (guidance and emotional support from family, friends, or lay helpers). Thus, case management serves to bridge informal and formal systems of care.
: There is a growing concern to contain costs of human services delivery while maximising the impact of service delivery within the constraints of scarce resources.
Functions of Case Management :silhouette:
: :pencil2: Case managers are involved in assessing the client’s self-care capacity and human service needs, assessment of client’s social network and its capacity to respond to client’s needs, and assessment of human services providers and their capacity to respond to the needs of the client.
: :pen: Case managers need to develop comprehensive treatment/service/goal plans that can integrate the services and social support activities of providers and social network members. They will delineate client’s needs, translate theses needs into service delivery and social support goals, and identify service delivery providers and social support network members.
: :unlock: Involves Direct intervention (Teaching the client self-advocacy skills, intervening during period of crisis) and/or Indirect intervention (Linking client to human service providers, brokering services, advocating for responsiveness to client’s needs, increasing the provision of social support.).
: :recycle: Case managers have to monitor the implementation and accomplishment of the client’s service plan.
: :star: Case managers evaluate the impact of the service delivery plan on the client through quantitative and qualitative techniques.: Involves Direct intervention (Teaching the client self-advocacy skills, intervening during period of crisis) and/or Indirect intervention (Linking client to human service providers, brokering services, advocating for responsiveness to client’s needs, increasing the provision of social support.).
Components of Case Management
: This refers to any information relating to the client’s case, including history, observations, reports pertaining to client’s care by the provider, and financial and social information. The case manager’s professional expertise must include documenting appropriately and in a timely manner and preparing reports concisely but comprehensively.
: Periodic examination of the client’s case. Case review is an integral part of the accountability structure of an organisation; its objective is to ensure effective service delivery to the client.
: This is important to the partnership that makes service delivery accountable and effective. A primary goal of client participation is client empowerment. It is always important to encourage client’s participation and collaboration.
Roles of Case Managers
: Since clients have multiple problems and need multiples services, case managers work with all the professionals involved to ensure services are integrated.
: Linking the client with the needed service, and help the client choose the most appropriate service and negotiate the terms of service delivery.
: Speaking on behalf of clients when they are unable to do so.
Colleague and collaborator
: Establishing and maintaining a good working relationship with other service providers and professionals.
: It is essential to document assessment, planning, service provision, and evaluation.
: Facilitate cooperation among agencies to allow professionals who direct services to operate as colleagues and collaborators. Case managers also help agencies work together to assess the needs of the community and plan how the local human service delivery system will meet those needs.
: Provide expert advice and hep organisations identify problems, study it. And make recommendations.
: Maintaining a primary relationship with the client and his/her family.
: This is performed to determine the client’s functioning, assess effectiveness of service plan and service provision.
Problems Faced by People with Disability
► Either a
condition that l
imits a person’s activities or functioning
►The client’s manifestations can be
►People who have disabilities often encounter others who have
misconceptions and biases
about their limitations.
►This type of treatment may affect the disabled person’s everyday-social interactions, causing them to withdraw from mainstream interaction.
►People with disabilities may suffer from l
ow self-esteem, lack of confidence and social stigma
Working with Persons With Disability
▲ Work with each person as an
not make assumptions
about them because of their disability.
▲ When we stereotype, we are seeing the person within the context of a group/category rather than as an individual.
▲ It is important that the counsellor see the client with disabilities in the same way as any other clients.
▲ A major barrier to engaging with people with disabilities occurs when assumptions are made about what the person can or cannot do.
Some counselling strategies
► Assess the client’s
current level of functioning and environmental situation
that hinders or enhance functionality.
► Actively look for the
channel of communication
that the client is using and mirror that.
► Plan a strategy beforehand of how you intend to
communicate with the client
Working with Persons with Learning Disabilities
►Go at the client’s pace.
►Follow the lead of the client.
►Try drawing to communicate.
►Learn from experience.
►Use short phrases.
►Find a place which has no distractions.
►Observe the client’s body language.
►Have a positive and caring attitude.
►Ask open questions.
►Use objects, photos and pictures.
Working with Persons with ADHD
►Symptoms include distractibility, impulsivity, disorganisation, and interpersonal problems that persists and may worsen with age.
►Many facets of the client’s personality may be shaped by the multiple effects of these disorders.
Give the clients cues in mnemonic form
– Sit up straight
– Lean forward
– Active thinking and Ask questions
– Name key information and Nod your head to validate speaker
– Track the speaker
The counsellor must :silhouettes:
►Not only provide services directly but also coordinate services with other professionals.
►Monitor clients’ progress in gaining independence and self-control.
►Use skills from an array of theories and techniques.
►Be adaptable in shifting professional roles.
Models of helping the disabled
: Assumes that persons with disabilities are a minority group rather than people with pathologies.
Peer Counsellor model
: Assumes that people with direct experience with disabilities are best able to help those who have recently acquired disabilities.
Purpose of Multicultural counselling
• Help clients transit, adjust and assimilate from their culture to the new host culture.
• Help clients manage post-traumatic stress disorders caused by their home country.
• Help clients manage intergenerational and cross-cultural relationships.
• Help clients cope with racism, discrimination and inequality.
• Help clients take pride in their race and culture, and to liberate themselves from internalised negative stereotypes.
Multicultural counselling competencies
2. Understanding the worldview of the culturally different client
►Being aware of your negative emotional reactions and of the stereotypes and preconceived notions you may hold towards culturally/racially different groups.
►Understand the culture of your client.
►Acknowledge how culture and race can affect help-seeking behaviour.
►Know how culture and race can affect assessment and implementation of interventions.
►Be actively involved with minorities outside work to gain a deeper insight into their perspectives.
3. Developing appropriate intervention strategies and techniques
►Respecting clients’ religious and spiritual beliefs
►Respect indigenous helping practices and value bilingualism.
►Being aware of institutional barriers to minority groups using counselling/coaching services.
►Understanding minority group family structures, hierarchies, and community characteristics and resources.
►Interacting in a language requested by the client or referring the client to a counsellor/coach who speaks that language.
►Making appropriate referrals to a counsellor/coach who is of the same cultural/racial background as the client, if requested.
►Ability to send and receive verbal and non-verbal communication accurately.
►Tailoring the helping relationship and interventions to the clients’ stage of cultural/racial identity development.
►Engaging in a variety of helping roles beyond those perceived as conventional for counsellors/coaches.
1. Awareness of own assumptions, values and biases
► Know and understand your cultural and racial heritage and how this affects the counselling process.
► Understand how
oppression, racism and discrimination
may affect you in your work.
► Know about the
how you communicate
with culturally different clients.
7 tasks at old age
Adjusting to Physical Changes : eg. reduced physical & cognitive capabilities
Learning to live with spouse in retuirement
Establishing Satisfactory Living Requirements
Adjustment to Retirement and Loss of Income
Adjusting to death of spouse or family
Forming affiliation with aging peers
Adopting flexible social roles
Approaches in counselling the Aged
Problem Solving Approach (PADI)
►Developed by Anthony Yeo
: Identify problem presented by client & help him/her deal with it
: What is the problem ?
: What has the client tried to do to resolve / cope with the problem ?
: What changes does the client want ?
: Design a plan of action to resolve or cope with the problem.
•To help the client identify specific concerns.
•To assess the client’s situation and concerns.
•To encourage the client to express, verbalise and ventilate.
•To build a trusting relationship.
•To get the client to articulate his/her concerns.
•To get the client to express his/her feelings.
•To get the client to talk about previous coping strategies.
•To find out what worked or did not work for the client.
•To identify the goals of the client and the goals of involved parties.
•To come to an agreement on the goals to work on
•To concretise the goals.
•To develop the client’s ability to resolve and/or cope with concerns.
•To sustain outcomes.
•To disengage client.
: Open Posture
: Lean Forward
: Vocal qualities (tone / speed / volume)
: Maintain Eye Contact
: Address the client by appropriate name
: Go Slow
: Touch where and when appropriate
Strategies in counselling the Aged
Respect & Avoiding Prejudice
•Treat the aged as adults. Remember that older people are people.
•Modify the attitudes of people within the system in which the aged live.
•Use common courtesy and ask how the person wishes to be addressed.
•Treat the aged with respect and learn from them.
•Help the aged deal with specific, practical and immediate problems.
•Confront our own prejudicial attitudes. Avoid stereotyping.
•Always speak directly to the older person and not to the person they are with (E.g. carer)
•Never assume the person lacks knowledge or are incapable of assimilating information
•Older people are often in a vulnerable position, and they not only need help, they also need to be made aware of their own strengths and be ‘given back’ their self-esteem.
•Counselors should equip themselves with the knowledge of the ageing process, financial and health programmes, legal provisions and recreational/social activities.
•Counsellors have to assure clients that the society does care about older people and that they have a right to use public services as they have already served their country.
•Counsellors need to impart the necessary skills that the older people may need, such as communication skills so that they can better express their needs and wishes.
•A good way is to model these skills and help older clients practise by rehearsals and role-plays.
•It is vital that older people are able to access and utilise formal and informal supports.
•The counsellor will have to work with the service delivery system and others to help the elders.
•This may involve finding a respite care or obtaining Medifund or other information related to financial assistance.
•The counsellor should also advocate for the clients, which means helping others become aware of and be responsive to the older peoples’ needs and instituting appropriate services for them.
Helping goals for women
♀ Helping women value themselves on their own terms and be free of sex-role stereotypes.
♀ Help women be more
♀ Help women deal address issues such as domestic violence and sexual harassment.
♀ Help women seek career opportunities.
Strategies for Working with Women
♀ Women are
and you should gear your approach towards that fact.
♀ Assertiveness training.
♀ Encourage a sense of empowerment and self-disclosure.
♀ Confronting issues of sexism.
♀ Dealing with the consequences of changing their gender roles.
♀ Women can also possess masculine values
(Similarly men can also possess feminine values)
Helping Goals for Men
♂ Help men address excessive need for success, power and competition.
♂ Help men deal with restrictive emotionality and restrictive affectionate behaviour.
♂ Helping men deal with physical violence.
♂ Helping men manage work-related stress, and overcoming tendencies to treat women as sexual objects.
♂ Helping men explore and alter their own gender roles due to women redefining their gender roles.
Problems Faced by LGBT Community
▼ Homosexuals, bisexuals and transgender people are often stereotyped and discriminated against.
▼ Some of these discomfort may be a holdover from previous times since up until mid-1970s, the DSM considered homosexuality a disorder.
▼ These people often have feelings of isolation and stigmatisation, and have trouble with peer relationships, as well as family disruptions.
▼ The majority culture has a predominantly negative view of people who do not have heterosexual orientation.
Counselling the LGBT Community
▼ Members of these groups may have many of the same types of problems as those who are heterosexuals.
▼ Do not make any assumptions before hearing what the clients have to say.
▼ Some fairly frequent issues faced by these groups include “coming out”, forming community organisations, following religious practices, coping with AIDS and relationships.
▼ “Coming out” – letting others know that one is gay/lesbian/bisexuals/transgender.
▼ Rehearsing how one will act or what one will say may be helpful.
▼ Cognitive approaches, in regard to modifying the self-talk a person generates may be therapeutic.
▼ Gauge and manage society’s perception about LGBT.