Advanced Clinical Discussion
Advanced Clinical Discussion
Knowing that clients might react negatively to your work with them may cause anxiety, frustration, and even anger. It is inevitable that you will work with a client who expresses anger or disappointment over working with you. This does happen in the social work field and is to be expected over time. Understanding how you might react to allegations of incompetence or anger over incomplete goals is essential to managing this type of exchange. While a negative interaction may be justified if either person did not fulfill responsibilities, often it is a result of the client’s personal reaction to the situation. The best response is to use these interactions to build the therapeutic bond and to assist clients in learning more about themselves. Stepping back to analyze why the client is reacting and addressing the concern will help you and the client learn from the experience. Advanced Clinical Discussion
For this Discussion, review the program case study for the Petrakis family.
BY DAY 4
Post a description of ways, as Helen’s social worker, you might address Helen’s anger and accusations against you. How might you feel at that moment, and how would you maintain a professional demeanor? Finally, how might you use self-disclosure as a strategy in working with Helen?
Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.
SESSIONS Case Histories Editors Sara-Beth Plummer Sara Makris Sally Margaret Brocksen Published by Laureate International Universities Publishing, Inc. 7080 Samuel Morse Drive Columbia, MD 21046 www.laureate.net Director, Program Design: Lauren Mason Carris Content Development Manager: Jason Jones Content Development Specialist: Sandra Shon Production Services: Absolute Service, Inc. Editorial Services: Christina Myers Copyright © 2014 by Laureate International Universities Publishing, Inc. All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, any information storage and retrieval systems, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncom mercial uses permitted by copyright law. For permission requests, write to the publisher, addressed “Attention: Content Development Specialist,” at the address above. Editors Sara-Beth Plummer, PhD, MSW Walden University Sara Makris, PhD Laureate Education, Inc. Sally Margaret Brocksen, PhD, MSW Walden University Contributors Marlene Coach, EdD, MSW, ACSW, LSW Walden University Eileen V. Frishman, MSW, ACSW, LCSW-R, CH Mary E. Larscheid, PhD, MSW, LICSW Walden University Vanessa Norris, MSW, LCSW West Chester University Sara-Beth Plummer, PhD, MSW Walden University Stephanie C. Sanger, MA, MSS, LSW Assistant Director, RHD, Tri-County Supportive Housing Eric Youn, PhD, LMSW Walden University iii Contents Introduction 1 Part 1: Foundation Year 2 The Hernandez Family 3 The Parker Family 6 The Logan Family 9 The Johnson Family 11 Part 2: Concentration Year 14 The Levy Family 15 The Bradley Family 17 The Petrakis Family 20 The Cortez Family 23 Appendix 26 Reflection Questions 27 The Hernandez Family 27 The Parker Family 28 The Logan Family 30 The Johnson Family 31 The Levy Family 32 The Bradley Family 33 The Petrakis Family 35 The Cortez Family 36 Trademarks and Disclaimers 38 iv Introduction T he following eight cases are based on the true experiences of social workers in the field, although names and other identifying circumstances have been changed. The narratives in this book, combined with filmed repre sentations of scenes inspired by the cases, provide you an opportunity to use true-to-life cases as an experiential learning tool. Whereas some academic programs, professors, or instructors may offer an occasional glimpse into past social work experiences, this book and these cases weave through multiple courses in your foundation and concentration year. Like in true-to-life practice, you will follow these cases through a variety of circumstances, prac tice behaviors, and learning opportunities. This unique format for a social work program enables you to integrate and connect the expected learning outcomes for each course. Each case either explicitly or implicitly offers content on practice skills, research, human behavior theory, and policy. Further, you will see that each family’s concerns can be addressed across all levels of practice, from micro to mezzo to macro. Approach this book as a series of cases to which you have been assigned during your first professional experi ence in social work. Advanced Clinical Discussion
We encourage you to use a critical eye to analyze the approaches provided. Remember that each practitioner has his or her own lens or perspective that guides his or her practice and these cases, written in the voices of each individual social worker, offer you authentic, varied perspectives. As you review and dissect these cases, consider your own lens and perspective as a future social worker. The families described in these cases have been connected to social work services in myriad ways. Look closely at how each family member is introduced to the social worker and at the services and interventions that follow. Through reading these cases and then watching them come to life on video, you will see the skills used by social work practi tioners. Carefully identify for yourself how the social worker engages, assesses, and intervenes with his or her client. The social workers who provided these cases offer some of their own personal thoughts about these cases as a series of reflection questions. Use the answers to the questions, posed to the social workers as they wrote these stories, to gain additional insight into the decisions they made to address their clients’ concerns. Reflect on the ques tions and answers as a way to consider whether you would have addressed the client or clients in the same manner. Imagine your first day of practice, preparing for your first client meeting. On your desk is a folder with the last name of the client on the tab. You open the folder to find a case history for your client—perhaps it details family background, medical history, or an accounting of interactions with other agencies. This book is like that folder, preparing you for the client you will soon meet. 1 PART 1: FOUNDATION YEAR 2 The Hernandez Family J uan Hernandez (27) and Elena Hernandez (25) are a married Latino couple who were referred to the New York City Administration for Children Services (ACS) for abuse allegations. They have an 8-year-old son, Juan Jr., and a 6-year-old son, Alberto. They were married 7 years ago, soon after Juan Jr. was born. Juan and Elena were both born in Puerto Rico and raised in Queens, New York. They rent a two-bedroom apartment in an apartment complex where they have lived for 7 years. Elena works as babysitter for a family that lives nearby, and Juan works at the airport in the baggage department. Overall, their physical health is good, although Elena was diagnosed with diabetes this past year and Juan has some lower back issues from loading and unloading bags. Both drink socially with friends and family. Juan goes out with friends on the weekends sometimes to “blow off steam,” having six to eight beers, and Elena drinks sparingly, only one or two drinks a month. Both deny any drug use at all. While they do not attend church regularly, both identify as being Catholic and observe all religious holidays. Juan was arrested once as a juvenile for petty theft, but that has been expunged from his file. Elena has no criminal history. They have a large support network of friends and family who live nearby, and both Elena’s and Juan’s parents live within blocks of their apartment and visit frequently. Juan and Elena both enjoy playing cards with family and friends on the weekends and taking the boys out to the park and beach near their home. Advanced Clinical Discussion
ACS was contacted by the school social worker from Juan Jr.’s school after he described a punishment his parents used when he talked back to them. He told her that his parents made him kneel for hours while holding two encyclo pedias (one in each hand) and that this was a punishment used on multiple occasions. The ACS worker deemed this a credible concern and made a visit to the home. During the visit, the parents admitted to using this particular form of punishment with their children when they misbehaved. In turn, the social worker from ACS mandated the family to attend weekly family sessions and complete a parenting group at their local community mental health agency. In her report sent to the mental health agency, the ACS social worker indicated that the form of punishment used by the parents was deemed abusive and that the parents needed to learn new and appropriate parenting skills. She also suggested they receive education about child development because she believed they had unrealistic expectations of how children at their developmental stage should behave. This was a particular concern with Juan Sr., who repeat edly stated that if the boys listened, stayed quiet, and followed all of their rules they would not be punished. There was a sense from the ACS worker that Juan Sr. treated his sons, especially Juan Jr., as adults and not as children. This was exhibited, she believed, by a clear lack of patience and understanding on his part when the boys did not follow all of his directions perfectly or when they played in the home. She mandated family sessions along with the parenting classes to address these issues. During the intake session, when I met the family for the first time, both Juan and Elena were clearly angry that they had been referred to parenting classes and family sessions. They both felt they had done nothing wrong, and they stated that they were only punishing their children as they were punished as children in Puerto Rico. They said that their parents made them hold heavy books or other objects as they kneeled and they both stressed that at times the consequences for not behaving had been much worse. Both Juan and Elena were “beaten” (their term) by their parents. Elena’s parents used a switch, and Juan’s parents used a belt. As a result, they feel they are actually quite lenient with their children, and they said they never hit them and they never would. Both stated that they love their children very much and struggle to give them a good life. They both stated that the boys are very active and don’t always follow the rules and the kneeling punishment is the only thing that works when they “don’t want to listen.” They both admitted that they made the boys hold two large encyclopedias for up to two hours while kneeling when they did something wrong. They stated the boys are “hyperactive” and “need a lot of attention.” Advanced Clinical Discussion
They said they punish Juan Jr. more often because he is particularly defiant and does not listen and also because he is older and should know better. They see him as a role model for his younger brother and feel he should take that respon sibility to heart. His misbehavior indicates to them that he is not taking that duty seriously and therefore he should be punished, both to learn his lesson and to show his younger brother what could happen if he does not behave. During the intake meeting, Juan Sr. stated several times that he puts in overtime any time he can because money is “tight.” He expressed great concern about having to attend the parenting classes and family sessions, as it would interfere with that overtime. Elena appeared anxious during the initial meeting and repeatedly asked if they were going to lose the boys. I told her I could not assure her that they would not, but I could assist her and her husband through this process by making sure we had a plan that satisfied the ACS worker’s requirements. I told them it 3 SESSIONS: CASE HISTORIES • THE HERNANDEZ FAMILY would be up to them to complete those plans successfully. I offered The Hernandez Family my support through this process and conveyed empathy around their response to the situation. Juan Hernandez: father, 27 Together we discussed the plan for treatment, following the Elena Hernandez: mother, 25 requirements of ACS; they would attend a 12-week Positive Parenting Juan Hernandez Jr.: son, 8 Program (PPP) along with weekly family sessions. In an effort to reduce some of the financial burden of attending multiple meetings Alberto Hernandez: son, 6 at the agency, I offered to meet with the family either just before or immediately after the PPP so that they did not have to come to the agency more than once a week. They agreed that this would be helpful because they did not have money for multiple trips to the agency, although Juan Sr. stated that this would still affect his ability to work overtime on that day. I asked if they had any goals they wanted to work toward during our sessions. Initially they were reluctant to share anything, and then Elena suggested that a discussion on money management would be helpful. I told them I would be their primary contact at the agency—meeting with them for the family sessions and co-facilitating the PPP group with an intern. I explained my limitations around confidentiality, and they signed a form acknowledging that I was required to share information about our sessions with the ACS worker. I informed them that the PPP is an evidenced-based program and explained its meaning. I informed them that there is a pre- and post-test administered along with the program and specific guidelines about missed classes. Advanced Clinical Discussion
They were informed that if they missed more than three classes, their participation would be deemed incomplete and they would not get their PPP certification. Initially, when the couple attended parenting sessions and family sessions, Juan Sr. expressed feelings of anger and resentment for being mandated to attend services at the agency. Several times he either refused to participate by remaining quiet or spoke to the social worker and intern in a demeaning manner. He did this by questioning our ability to teach the PPP and the effectiveness of the program itself, wanting to know how this was going to make him a better parent. He also reiterated his belief that his form of discipline worked and that it was exactly what his family members used for years on him and his relatives. He asked, “If it worked for them, why can’t that form of punishment work for me and my children?” He emphasized that these were his children. He maintained throughout the sessions that he never hit his children and never would. Both he and Elena often talked about their love for their children and the devastation they would feel if they were ever taken away from them. Treatment consisted of weekly parenting classes with the goal of teaching them effective and safe discipline skills (such as setting limits through the use of time-out and taking away privileges). Further, the classes emphasized the importance of recognizing age-appropriate behavior. We spent sessions reviewing child development techniques to help boost their children’s self-esteem and sense of confidence. We also talked about managing one’s frustration (such as when to take a break when angry) and helping their children to do the same. Family sessions were built around helping the family members express themselves in a safe environment. The parents and the children were asked to talk about how they felt about each other and the reason they were mandated to treatment. They were asked to share how they felt while at home interacting with one another. I thought it was of particular importance to have them talk about their feelings related to the call to ACS, as I was unsure how Juan Sr. felt about Juan Jr.’s report to the social worker. It was necessary to assist them with processing this situation so that there were no residual negative feelings between father and son. I asked them to role-play—having each member act like another member of the household. This was very effective in helping Juan Sr. see how his boys view him and his behavior toward them when he comes home from work. As a result of this exercise, he verbalized his newfound clarity around how the boys have been seeing him as a very angry and negative father. I also used sessions to explore the parents’ backgrounds. Using a genogram, we identified patterns among their family members that have continued through generations. Advanced Clinical Discussion
These patterns included the use of discipline to maintain order in the home and the potentially unrealistic expectations the elders had for their children and grandchildren. Elena stated that she was treated like an adult and had the responsibilities of a person much older than herself while she was still very young. Juan Sr. said he felt responsible for bringing money into the home at an early age. He was forced by his parents to get working papers as soon as he turned 14. His paychecks were then taken by his parents each week and used to pay for groceries and other bills. He expressed anger at his parents for encouraging him to drop out of high school so that he could get more than one job to help out with the finances. Other sessions focused on the burden they felt related to their finances and how that burden might be felt by the boys, just as Juan Sr. might have felt growing up. In one session, Juan Jr. expressed his fears of being evicted and the lights being turned off, because his father often talked of not having money for bills. Both boys expressed sadness over the amount of time their father spent at work and stressed their desire to do more things with him at night and on the weekends. Both parents stated they did not realize the boys understood their anxieties around 4 SESSIONS: CASE HISTORIES • THE HERNANDEZ FAMILY paying bills and felt sad that they worried about these issues. We also Key to Acronyms took a couple of sessions to address money management. We worked together to create a budget and identify unnecessary expenses that ACS: Administration for might be eliminated. Children Services It was clear that this was a family that loved each other very much. PPP: Positive Parenting Program Juan Sr. and Elena were often affectionate with each other and their sons. Once the initial anger subsided, both Juan Sr. and Elena fully engaged in both the family sessions and the PPP. We assessed their progress monthly and highlighted that progress. I also was aware that it was important to learn about the Hernandez family history and culture in order to under stand their perspective and emotions around the ACS referral. I asked them many questions about their beliefs, customs, and culture to learn about how they view parenthood, marriage roles, and children’s behaviors. They were always open to these questions and seemed pleased that I asked about these things rather than assumed I knew the answers. Advanced Clinical Discussion
During the course of treatment they missed a total of four PPP classes. I received a call from Elena each time letting me know that Juan Sr. had to work overtime and they would miss the class. She was always apologetic and would tell me she would like to know what they missed in the class so that she could review it on her own. During a call after the fourth missed parenting class, I reminded Elena that in order to obtain the certificate of completion, they were expected to attend a minimum of nine classes. By missing this last class, I explained, they were not going to get the certificate. Elena expressed fear about this and asked if there was any way they could still receive it. She explained that they only had one car and that she had to miss the classes when Juan Sr. could not go because she had no way of getting to the agency on her own. I told her that I did not have the authority to change the rules around the number of classes missed and that I understood how disappointed she was to hear they would not get the certificate. When I told her I had to call the ACS worker and let her know, Elena got very quiet and started to cry. I spoke with her for a while, and we talked about the possible repercussions. I met with my supervisor and informed her of what had occurred. I knew I had to tell the ACS worker that they would not receive the certificate of completion this round, and I felt bad for the situation Juan Sr. and Elena and their boys were now in. I had been meeting with them for family sessions and parenting classes for almost three months by this point and had built a strong rapport. I feared that once I called the ACS worker, that rapport would be broken and they would no longer want to work with me. I saw them as loving and caring parents who were trying the best they could to provide for their family. They had been making progress, particularly Juan Sr., and I did not want their work to be in vain. I also questioned whether the parenting and family sessions were really necessary for their situation. I felt there was a lack of cultural competence on the part of the ACS worker—she had made some rather judgmental and insensitive comments on the phone to me during t…
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