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WEEK 5 READING 2 - The Intervention Phase: - Coggle Diagram
WEEK 5 READING 2 - The Intervention Phase:
The Intervention Phase formally starts after the family social worker has engaged the family and completed a thorough assessment, goals have been set, and a clear contract has been agreed upon.
MICRO SKILLS / INTERVENTION TECHNIQUES:
Focusing
Observing
Using examples
Confronting
Enacting
Reframing
Externalising the problem
Using metaphor
OBSERVATION:
Enables the social worker to develop a comprehensive understanding of the ways the family experiences the world.
Must listen to both the content and process in the family
The worker may observe subtle issues related to themes of power, authority, and reluctance about seeking or receiving help
By observing the family in their environment, they can do an ecological assessment of the individual, the family and the community. Worker can become aware of the broader environment where the family lives, including access to community services, neighbourhood safety and recreational and cultural opportunities.
Home observation provides opportunities for observing how family members interact in their daily routine. Contributions to individual family member's wellbeing or dysfunction may be noticed and clues obtained for hat assistance is needed.
Seeing the organisation of the home and resources available to meet basic needs allows the worker to understand more about client strengths and coping strategies, resources and limitations imposed by the home environment.
Examples:
Is there plumbing issues, mattresses on the floor
Do the children have stimulating toys to aid development
Are there numerous dogs in a small house
Is the house impoverished
Is the apartment in a high rise with less access to fresh air and outdoor activities
Social workers formulate hypotheses about families and work to validate or refute them.
Cultural and ethnic differences need to be factored into observations of the family.
Information should be obtained in a way that remains sensitive to and respectful of the fact that the worker is a visitor in the home of the family. Such information should not be used to condemn or make value judgements about lifestyles.
SOCIAL FUNCTIONING:
Look at the social roles that family members perform
Individual behaviour and adjustment reflects how well family members perform their social roles.
There are fours areas of role performance both within the family and outside of the family (Geismar & Ayres 1959).
Internal family roles:
Family relationships and family unit
Child care and training
Health practices
Household practices
External family roles:
Use of community resources
Social activities
Economic practices
Relationship of the family to the social worker
FOCUSSING:
Both the worker and family must ensure their time is used productively.
It's important to recognise when clients are shifting topics or steering the discussion elsewhere.
Th worker should develop a list of relevant and promising areas to be explored (however it's sometimes not possible)
The worker should be focussing on:
The client
The main theme or problem
Other people
Mutual issues
Cultural ,environmental and.or contextual issues
USING EXAMPLES:
They help the worker to explain, describe or teach a concept to a family
Generally, examples should be compatible with experiences of the family's life.
They offer reassurance that others have faced the same challenges.
They can illustrate alternative ways of dealing with a difficult situation
They can help clients feel at ease with something that has made them uncomfortable
Interesting stories can be valuable teaching aids because they are likely to be remembered longer than generalised statements.
CONFRONTING:
It can be useful but is hit and miss at it can either be growth-promoting or damaging to a client/family.
It is used to raise awareness by presenting information that the client is overlooking or failing to identify.
The social worker must find a way to make new info palatable or acceptable to the person being confronted.
Without it, family members may persist in behaviour that is self-destructive or harmful to others.
The tone of voice is important when confronting. to ensure it does not come across as demeaning or hostile.
The purpose is to point out discrepant aspects of the client's verbal and nonverbal behaviour, bringing them to awareness.
Although it does not solve the problem, it can motivate the client to work on the problem.
It involves two steps - formulating the confrontation statement and addressing the response of the client.
LEVELS OF CONFRONTATION:
Giving in to the client
Scolding
Describing ineffective behaviour
Identifying negative consequences of behaviour
(levels 3 and 4) + soliciting commitment to change
REFRAMING:
It removes a situation from an old context (set of rules) and places it in a new context (set of rules) that defines it equally well.
Positive interpretations are assigned to problematic behaviours and responses.
When problems are understood in a more positive light, new responses are likely.
Social workers should use reframing selectively because not all issues should be reframed (eg. sexual abuse should never be reframed as the perpetrator's attempt to show affection)
USING METAPHOR:
They provide information in non threatening ways and gives families some distance from a threatening situation.
Eg. To help families understand how a crisis can de-stabilise the family system, the worker may compare the family to a mobile that gets out of balance when objects are added or moved around.
CONTRACTING:
Contracts between family members.
Two kinds: Quid pro quo (QPQ) and good faith.
QPQ -
one person agrees to exchange a behaviour for one desired by another family member.
Good faith -
A person is rewarded after contract conditions are met, it doesn't rely on the behaviour of another member.
SUB-PHASES OF INTERVENTION:
Contracting
Crisis intervention
Ecological intervention
Problem solving
CHOOSING WHICH FAMILY APPROACH:
When the nuances of language the family uses is around....
Feelings -
communicative/experiential approach
Lack of behavioural change -
behavioural approach, problem solving approach, solution-focused approach.
Oppression or powerlessness -
feminist approach
Irrational thinking -
cognitive approach, narrative approach
OLD APPROACH OF FAMILY SOCIAL WORKERS - EXPERT:
Historically, professional helpers have approached families and individual clients from an expert position.
With presumably greater knowledge and experience than clients, they worked with families to solve problems, make decisions, and show parents ways to become more effective.
As an expert, the helping professional carried out this role an as authority, detached from the family.
Families were not considered partners in the change process and power and knowledge were the domain of the professional helper.
The process, the helper gave and the family received - this giving-receiving pattern reflected power imbalances between the two, that interfered with motivation, commitment and goals.
MODERN APPROACH OF FAMILY SOCIAL WORKERS:
The family is not a passive recipient of intervention but is an active partner and participant throughout the entire change process.
The social worker doe snot know better than the family
The family (within parameters determined by society) must define its own needs, set priorities, and state preferences for service.
The social worker is a collaborator, facilitators and negotiator.
Families have both the right and responsibility to identify their special concerns and goals in relation to their family situation and to play an active role in their resolution.
Responsibilities:
Must reject canned expert solutions to predefined problems
Must understand their own family issues and interpersonal relationships in order to develop mutual respect and partnership with the individual families.
Incorporate a belief in family competence into the decision-making and problem-solving process, to shift from an individual to family perspective.
Take a collaborative approach in which you are free to discuss family stories and narratives, their hopes and fears, and resources (rather than fit them into the narrow confines of a diagnostic category or treatment protocol).
ROLES:
Empathetic support
Teacher or trainer
Consultant
Enabler
Mobiliser
Mediator
Advocate
Read chapter for individual details
CRISIS INTERVENTION:
Crises provide opportunities for change because they disrupt family homeostasis and families feel a certain amount of pain and anxiety, making them want to change.
It's important for the worker to help the family to resolve the immediate crisis in order to provide both a safe environment and hope for family change, thus setting the stage for future longer-term family work.
Common Crisis Model: Gilliland & James 1993
Defining the problem
Ensuring client safety
Providing support
Examining alternatives
Making plans
Obtaining a commitment
(See reading for more detail)
PROBLEM-SOLVING INTERVENTION:
Teaches members to negotiate solutions to their problems that are acceptable to do so.
The social worker's role is the facilitator (and consultant), not the expert.
The worker teaches the family to develop solutions to their own problems rather than relying on outside help.
It aims to help families resolve present difficulty as well as teach them strategies for dealing with present and future concerns.
The emphasis is on helping families learn more effective ways of becoming independent and self-reliant.
Problem-solving steps:
Problem definition
Goal selection
Solution generation
Consideration of consequences
Decision-making
Implementation
Evaluation
(See reading for more detail)
ECOLOGICAL INTERVENTION:
The ultimate goal is to help clients learn how to get needs met on their own.
This is dependant on the collaborative development of an eco-map (the blueprint for planned change)
An eco-map removes individual blame for a situation.
The worker should focus on environmental problems first, as it helps family problem-solve around less threatening issues while at the same time build in supports for the family.
The type of ecological intervention used depends on the issues, client skills, and resources available in the community.
Examples of ecological interventions:
Supplementing resources in the home environment
Developing and enhancing support systems
Moving clients to a new environment
Increasing the responsiveness of organisations to people's needs
Enhancing interactions between organisations and institutions
Improving institutional environments
Enhancing agency environemnts
Developing new resources
APPROACHES THAT COMPLEMENT INTERVENTIONS:
Solution-focussed approach
Communication approach
SOLUTION-FOCUSSED APPROACH:
Very useful during family crises when a family wants to develop rapid solutions to problems to help them to move out of the crises and back to a healthier family functioning state.
Major concepts:
1. Focus on solutions -
steers the client away from problem talk to solution talk, based on the assumptions that people have a sincere interest in changing and they already have the skills to solve their problems they just lose sight of this ability.
2. Modest goals -
The concern is only with the client's presented complaint, a small change is usually all that's needed because that change tends to snowball.
3. Brevity -
Keep it brief...?
TECHNIQUES:
Miracle questions -
A miracle happens and the problem is solved, what would this look like?
Exception questions -
During the past and present when the problem wasn't present when it ordinarily would be, what was different?
Scaling questions -
on a scale of 1-10 with 10 being the best you can feel, how far along are you today on your way to 10? What do you need to do to get to the next number?
Coping questions -
How did they cope in the past with difficult situations?
COMMUNICATION/EXPERIENTIAL APPROACH:
Can be useful when the main problem identified by the family is poor communication skills (particularly the communication of feelings in a supportive, caring manner).
The emphasis is on clear, direct, open and honest communication.
Underlying belief is that the expression of honest feelings will lead to personal and family fulfilment - individuals who feel cared for and loved will have a high sense of self-esteem and will act in worthwhile ways.
Major concepts:
Focus on affect or feelings
Family worker as an important change agent
Self-worth
Communication
The marital relationship
(See reading for more detail)
GOALS OF APPROACH:
Growth of family members
Enhancing family "comfortability"
Directive family worker role
TECHNIQUES:
Role-playing
Family sculpting
Body contact and use of touch
Family life chronology
STRUCTURAL FAMILY APPROACH:
Useful when the family is having problems with developing appropriate rules and consequences in the family.
The worker works on changing the structure to allow the family to access their repertoire of underused problem-solving skills.
Major concepts:
Family structure and hierarchies
Subsystems
Boundaries
GOALS:
Define and strengthen individual and subsystem boundaries to allow for individual autonomy.
In disengaged families - to increase closeness and involvement of members with each other.
TECHNIQUES:
Accommodation (to accomodate a helpful working relationships with the family. - see reading for more info
NARRATIVE FAMILY APPROACH:
Useful when a family uses words to describe a problem as a stressor or something that hinders their wellbeing.
Eg family members may refer to being overwhelmed with stress, overwhelmed with nightmares.
Major concepts:
Focus on stories
GOALS:
To establish the problem as the problem, not the person as the problem.
TECHNIQUES:
Beginning the family session....
Externalising the problem
Mapping influence
Re-authorising the story of lives and relationships
Reinforcing the new story
Ask questions