Clients with Diverse Needs and Backgrounds
đ´ đľđśđłđ˝
Case Management 
Disability
Multicultural Counselling 
Aged
Gender Issues 
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 đĽ
Problem Solving Approach (PADI)
âşDeveloped by Anthony Yeo
âşPurpose : Identify problem presented by client & help him/her deal with it
Steps
1.Problem Definition : What is the problem ?
2. Attempted Solutions : What has the client tried to do to resolve / cope with the problem ?
3. Desired Changes : What changes does the client want ?
4. Intervention Plan : Design a plan of action to resolve or cope with the problem.
ECADIT Model
Attending Skills
O : Open Posture
L : Lean Forward
V : Vocal qualities (tone / speed / volume)
E : Maintain Eye Contact
N : Address the client by appropriate name
S : Go Slow
T : Touch where and when appropriate
Strategies in counselling the Aged đĽ
Respect & Avoiding Prejudice
â˘Treat the aged as adults. Remember that older people are people.
â˘Modify the attitudes of people within the system in which the aged live.
â˘Use common courtesy and ask how the person wishes to be addressed.
â˘Treat the aged with respect and learn from them.
â˘Help the aged deal with specific, practical and immediate problems.
â˘Confront our own prejudicial attitudes. Avoid stereotyping.
â˘Always speak directly to the older person and not to the person they are with (E.g. carer)
â˘Never assume the person lacks knowledge or are incapable of assimilating information
Empowering Clients
â˘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 âgiven backâ their self-esteem.
â˘Counselors should equip themselves with the knowledge of the ageing process, financial and health programmes, legal provisions and recreational/social activities.
â˘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.
â˘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.
â˘A good way is to model these skills and help older clients practise by rehearsals and role-plays.
Accessing Resources
â˘It is vital that older people are able to access and utilise formal and informal supports.
â˘The counsellor will have to work with the service delivery system and others to help the elders.
â˘This may involve finding a respite care or obtaining Medifund or other information related to financial assistance.
â˘The counsellor should also advocate for the clients, which means helping others become aware of and be responsive to the older peoplesâ needs and instituting appropriate services for them.
Concern definition
â˘To help the client identify specific concerns.
â˘To assess the clientâs situation and concerns.
â˘To encourage the client to express, verbalise and ventilate.
Engagement
â˘To build a trusting relationship.
â˘To get the client to articulate his/her concerns.
â˘To get the client to express his/her feelings.
Attempted solutions
â˘To get the client to talk about previous coping strategies.
â˘To find out what worked or did not work for the client.
Desired outcomes
â˘To identify the goals of the client and the goals of involved parties.
â˘To come to an agreement on the goals to work on
â˘To concretise the goals.
Intervention
â˘To develop the clientâs ability to resolve and/or cope with concerns.
Termination
â˘To sustain outcomes.
â˘To disengage client.
Purpose of Multicultural counselling â
⢠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 đĽ
2. Understanding the worldview of the culturally different client
âşBeing aware of your negative emotional reactions and of the stereotypes and preconceived notions you may hold towards culturally/racially different groups.
âşUnderstand the culture of your client.
âşAcknowledge how culture and race can affect help-seeking behaviour.
âşKnow how culture and race can affect assessment and implementation of interventions.
âşBe actively involved with minorities outside work to gain a deeper insight into their perspectives.
3. Developing appropriate intervention strategies and techniques
âşRespecting clientsâ religious and spiritual beliefs
âşRespect indigenous helping practices and value bilingualism.
âşBeing aware of institutional barriers to minority groups using counselling/coaching services.
âşUnderstanding minority group family structures, hierarchies, and community characteristics and resources.
âşInteracting in a language requested by the client or referring the client to a counsellor/coach who speaks that language.
âşMaking appropriate referrals to a counsellor/coach who is of the same cultural/racial background as the client, if requested.
âşAbility to send and receive verbal and non-verbal communication accurately.
âşTailoring the helping relationship and interventions to the clientsâ stage of cultural/racial identity development.
âşEngaging in a variety of helping roles beyond those perceived as conventional for counsellors/coaches.
1. Awareness of own assumptions, values and biases
âş Know and understand your cultural and racial heritage and how this affects the counselling process.
âş Understand how oppression, racism and discrimination may affect you in your work.
âş Know about the impact of how you communicate with culturally different clients.
âş Recognise limitations of your competence and expertise
Helping goals for women đ¤
â Helping women value themselves on their own terms and be free of sex-role stereotypes.
â Help women be more assertive.
â Help women deal address issues such as domestic violence and sexual harassment.
â Help women seek career opportunities.
Helping Goals for Men đ¤
â Help men address excessive need for success, power and competition.
â Help men deal with restrictive emotionality and restrictive affectionate behaviour.
â Helping men deal with physical violence.
â Helping men manage work-related stress, and overcoming tendencies to treat women as sexual objects.
â Helping men explore and alter their own gender roles due to women redefining their gender roles.
Strategies for Working with Women đĽ
â Women are relational beings and you should gear your approach towards that fact.
â Challenge sex-role stereotypes and patriarchal norms.
â Assertiveness training.
â Encourage a sense of empowerment and self-disclosure.
â Confronting issues of sexism.
â Dealing with the consequences of changing their gender roles.
â Women can also possess masculine values
(Similarly men can also possess feminine values)
Problems Faced by LGBT Community đ
âź Homosexuals, bisexuals and transgender people are often stereotyped and discriminated against.
âź Some of these discomfort may be a holdover from previous times since up until mid-1970s, the DSM considered homosexuality a disorder.
âź These people often have feelings of isolation and stigmatisation, and have trouble with peer relationships, as well as family disruptions.
âź The majority culture has a predominantly negative view of people who do not have heterosexual orientation.
Counselling the LGBT Community đĽ
âź Members of these groups may have many of the same types of problems as those who are heterosexuals.
âź Do not make any assumptions before hearing what the clients have to say.
âź Some fairly frequent issues faced by these groups include âcoming outâ, forming community organisations, following religious practices, coping with AIDS and relationships.
âź âComing outâ â letting others know that one is gay/lesbian/bisexuals/transgender.
âź Rehearsing how one will act or what one will say may be helpful.
âź Cognitive approaches, in regard to modifying the self-talk a person generates may be therapeutic.
âź Gauge and manage societyâs perception about LGBT.
Problems Faced by People with Disability đ
âş Either a physical or mental condition that limits a personâs activities or functioning.
âşThe clientâs manifestations can be physical, emotional, mental and/or behavioural.
âşPeople who have disabilities often encounter others who have misconceptions and biases about their limitations.
âşThis type of treatment may affect the disabled personâs everyday-social interactions, causing them to withdraw from mainstream interaction.
âşPeople with disabilities may suffer from low self-esteem, lack of confidence and social stigma.
Working with Persons With Disability đ
ⲠWork with each person as an individual and not make assumptions about them because of their disability.
ⲠWhen we stereotype, we are seeing the person within the context of a group/category rather than as an individual.
ⲠIt is important that the counsellor see the client with disabilities in the same way as any other clients.
ⲠA major barrier to engaging with people with disabilities occurs when assumptions are made about what the person can or cannot do.
Models of helping the disabled â
⼠Minority model: Assumes that persons with disabilities are a minority group rather than people with pathologies.
⼠Peer Counsellor model: Assumes that people with direct experience with disabilities are best able to help those who have recently acquired disabilities.
Some counselling strategies : đĽ
âş Assess the clientâs current level of functioning and environmental situation that hinders or enhance functionality.
âş Actively look for the channel of communication that the client is using and mirror that.
âş Plan a strategy beforehand of how you intend to communicate with the client.
Working with Persons with Learning Disabilities
âşGo at the clientâs pace.
âşFollow the lead of the client.
âşTry drawing to communicate.
âşLearn from experience.
âşUse short phrases.
âşFind a place which has no distractions.
âşObserve the clientâs body language.
âşHave a positive and caring attitude.
âşAsk open questions.
âşUse objects, photos and pictures.
Working with Persons with ADHD
âşSymptoms include distractibility, impulsivity, disorganisation, and interpersonal problems that persists and may worsen with age.
âşMany facets of the clientâs personality may be shaped by the multiple effects of these disorders.
Give the clients cues in mnemonic form
â˘âS â Sit up straight
â˘âL â Lean forward
â˘âA â Active thinking and Ask questions
â˘âN â Name key information and Nod your head to validate speaker
â˘âT â Track the speaker
The counsellor must đĽ
âşBe versatile.
âşNot only provide services directly but also coordinate services with other professionals.
âşMonitor clientsâ progress in gaining independence and self-control.
âşUse skills from an array of theories and techniques.
âşBe adaptable in shifting professional roles.
Why the need for Case Management ? đ
âşDeinstitutionalisation: Movement of people out of institutional facilities into community-based programs or back home created a major service delivery problem.
âşDecentralisation: 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.
âşService 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.
âşFragmentation: 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.
âşSocial 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.
âşCost containment: 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 đ¤
Components of Case Management đ¤
1.Assessment: â Case managers are involved in assessing the clientâs self-care capacity and human service needs, assessment of clientâs social network and its capacity to respond to clientâs needs, and assessment of human services providers and their capacity to respond to the needs of the client.
2.Case documentation/Record: This refers to any information relating to the clientâs case, including history, observations, reports pertaining to clientâs care by the provider, and financial and social information. The case managerâs professional expertise must include documenting appropriately and in a timely manner and preparing reports concisely but comprehensively.
2.Planning: đ 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 clientâs needs, translate theses needs into service delivery and social support goals, and identify service delivery providers and social support network members.
3.Intervention: đ 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 clientâs needs, increasing the provision of social support.).
4.Monitoring: âť Case managers have to monitor the implementation and accomplishment of the clientâs service plan.
5.Evaluation: â 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 clientâs needs, increasing the provision of social support.).
1.Case review: Periodic examination of the clientâs 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.
3.Client participation: 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 clientâs participation and collaboration.
Roles of Case Managers
â˘Coordinator: Since clients have multiple problems and need multiples services, case managers work with all the professionals involved to ensure services are integrated.
â˘Broker: Linking the client with the needed service, and help the client choose the most appropriate service and negotiate the terms of service delivery.
â˘Advocate: Speaking on behalf of clients when they are unable to do so.
â˘Colleague and collaborator: Establishing and maintaining a good working relationship with other service providers and professionals.
â˘Recordkeeper: It is essential to document assessment, planning, service provision, and evaluation.
â˘Community organiser: 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.
â˘Consultant: Provide expert advice and hep organisations identify problems, study it. And make recommendations.
â˘Counsellor: Maintaining a primary relationship with the client and his/her family.
â˘Evaluator: This is performed to determine the clientâs functioning, assess effectiveness of service plan and service provision.