Unit 5: Meeting Clients' Needs and Assessing Their Strengths – Craig Owens (Prof C or Craig)

Unit 5 “To-Do” List Project Family violence Website and PBS Rape video (Please note this is an emotional video) Discussions on first interview & crisis interview Seminar Agenda Applying the learning Documentation, documentation, documentation The Unit 5 Project Questions

What was the most significant thing you learned in last week’s discussion about reflective listening or disarming anger? Applying the Learning…

Fundamentals of Case Management Practice: Skills for the Human Services, Third Edition (Select slides chosen by Craig Owens from author’s PPT‘ chapters 14,15, and 16 – some have been modified for this lecture) By Nancy Summers (Adapted by Craig Owens, KU) Published by Brooks Cole Cengage Learning 2009

STEPS FOR FILLING OUT THE NEW REFERRAL OR INQUIRY FORM II The client will either be: a. a self-referral, meaning the person found out about your agency through the phone book or a friend and called in on his own. If that is the case, write “self” on that line. Most calls are self- referrals or b, referred by a doctor or other professional. In that case, place that person’s name on the line. You are asking the client, “Who referred you to our services?” Answers might be Dr. Graham Smith or Attorney William Burns. Under the section marked “Chief Complaint,” always tell why the person called today. Do not say the person called today because her husband is abusing her. The husband may be abusing her, but what made her go to the phone today?

STEPS FOR FILLING OUT THE NEW REFERRAL OR INQUIRY FORM III Under “Previous Treatment,” keep the notes brief—just note when, where (and with whom if you know that), and for what. Keep from being too wordy in this section. The intake is “taken by” you. This is the first place your name is to appear on this form! Put the date of the intake next to your name. Under “Disposition,” note the name of the person to whom you refer the new client for intake and the date of the intake appointment. In many settings, the person who handles the phone inquiries is not the same person who sees the clients when they come in for their first appointments. For training purposes, we will assume that you will be doing both the phone inquiry and the client intake, in which case you would write your own name, along with the date of the intake appointment, on that line.

CAPTURING HIGHLIGHTS OF THE CHIEF COMPLAINT (Reason for visit) Keep the reasons from being too complicated - Do not create clients who are experiencing a psychiatric emergency. Be very specific - Give specific facts of the clients problem (when, where, how often, what is going on currently). Do not use vague general descriptions. Keep the reasons for the call brief - On this form give only the immediate details. Save the detailed background information for the social history you take from the client in person.

EVALUATING THE CLIENT’S MOTIVATION AND MOOD Always end your chief complaint section with a sentence or two about how the client sounded on the phone or how the client seemed to you. Does the client sound animated or depressed? Does the client speak normally or seemed pressured or vague? Does the client seem to want to get help or use the services? Did the client tell you how he is feeling?

What is our role in the first interview? Any ideas?

YOUR ROLE IN THE FIRST INTERVIEW Listen and convey and accurate understanding of clients’ perceptions about themselves and their problems. This is done using reflective listening. Formulate a professional understanding of what it is the client is experiencing and what this person will need while being served by your agency. Strive to establish rapport with clients so that they feel comfortable with you and with your agency.

What can we do to prepare for the first interview before the client arrives or before we arrive at the client’s home?

PREPARING FOR THE FIRST INTERVIEW Look at the intake material; special needs or cultural considerations? Check past agency records or transferred records if available. Look at past mental health or medical history. Keep in mind the material was collected by others who saw the client under very different circumstances. Make sure your meeting area is a comfortable and welcoming and private place in which to confide in another person. Consider where the client will sit and where you will sit.

What are some of the initial things we might want to do when we are meeting a client for the first time?

MEETING THE CLIENT Go out to the waiting room to meet the client. Introduce yourself, full name and how you prefer to be addressed. Make a mental note your first impressions of the client. Make a mental note of the clients reactions to you and the situation. Ask the client how they prefer to be addressed? Be genuinely interest in what the client has to say. Describe the agency and its purpose. Make sure payment arrangements have been explained. Make sure confidentiality limitations and policies have been explained – this is where it is very important to explain mandatory reporting and confidentiality breaks for safety reasons.

WHAT TO DO AS CLIENTS DESCRIBE THEIR ISSUES It is alright to take notes but we should explain why and the types of things we will be writing down. Allow clients to tell the story in their own way. Try and use mostly reflective listening skills initially to ensure the client feels heard. Encourage the client to talk about their issues by using open questions. Can you provide an example of a reflective listening response to a client who seems very nervous? What would be an example of an open-ended question in this situation?

WHAT INFORMATION TO COLLECT Seek to understand why the client is here now as opposed to last week or last month. What happened to bring the client in now. Document: The client’s presenting issue. This is generally what brought them in to the agency. The extent to which the problem has or has not interfered with the client’s ability to function. Client strengths as well as any possible risk areas (safety) The support system the client has or does not have. What the client is expecting as a result of coming to the agency.

WRAPPING UP Ask how this first meeting went and if they have any questions. Verify what they hope to accomplish and what their goals are. Tell them what to expect next in this process. Give the client an appointment card if there is to be a next appointment or information on any referrals they agree to. Offer to escort the client back to the check-out desk. Do not allow clients to leave if you think they are considering harming themselves or someone else. After clients leave do not talk about them except in the privacy of your supervisor’s office if you need to consult on something. I like to close each client session by asking them what they found helpful, if anything, and what they want to work on next time we meet.

Fundamentals of Case Management Practice: Skills for the Human Services, Third Edition Chapter Sixteen Social Histories and Assessment Forms – Modifications by Craig Owens solely for the use of this seminar. By Nancy Summers Published by Brooks Cole Cengage Learning 2009

WHAT IS A SOCIAL HISTORY? What is the purpose of completing a social history with a client?

WHAT IS A SOCIAL HISTORY? A social history: It provides us with a description and history of the presenting problem (the problem that brought the client into the agency). It provides background information on the person’s life. It provides an opportunity to document the worker’s initial impressions and recommendations.

What do you think are some of the categories of information we capture in a social history?

Categories and Layout of a typical Social History (Often called Psychosocial Assessment) Presenting problem Description and history of the presenting problem Background information Family of origin Birth and childhood Marriages and significant relationships Current living arrangements Education Military service Employment history Barriers to health or dignity Medical history Mental health history Legal history Social and recreational interests Religious activities Client successes and strengths Client resources Your assessment Your impressions Your recommendations

HOW TO ASK WHAT YOU NEED TO KNOW It is sometimes difficult for clients to open up to a stranger. Use open questions to soften the interview. Using all closed questions can sound like a grilling. You will use a few closed questions to get information that you need What is an example of an open question you might use at this point? How about a closed question that would be appropriate at this stage?

CAPTURING DETAILS Refrain from using vague descriptions or general information. EXAMPLE: Poor example: Alice is divorced. Better example: Alice was married in 1992 and was divorced in 2008, following her husband’s incarceration for armed robbery.

SOCIAL HISTORIES IN OTHER SETTINGS When agencies have limited funding to serve the client only a short amount of time a brief social history is necessary. A brief social history has three parts: Presenting problem - describe why the client is here. Background to the presenting problem - give additional information on the presenting problem, the history of it, and some relevant background information on the client. Impressions and recommendations - write your thoughts about the client and what the client needs.

WRITING IMPRESSIONS First sentence Begin with the same comprehensive sentence you used to open your social history. EXAMPLE: Marie is a 13 year old girl living with her single mother and currently addicted to crack. Next two or three sentences Write two or three sentences to describe the client’s situation. EXAMPLE: She is currently not attending school and her mother indicates she cannot manage her at present. The girl’s father is not in the picture and mother works 2 jobs to support the daughter and herself.

WRITING IMPRESSIONS Impressions Next state what you observe about the client’s affect (facial expressions), speech, and motivation for change. EXAMPLE: Marie appears somewhat guarded with a flat affect. She speaks in a quiet steady tone, which matches her lack of affect. She shows some insight into her problem and indicates some motivation to change the situation both at home and at school.

WRITING RECOMMENDATIONS Recommendations Finally write your recommendations and say what they are for. EXAMPLE: Recommend 3 weeks intensive inpatient treatment for detox, followed by NA meetings 90 meetings/ 90 days for support in remaining clean, family and individual counseling to develop better family relationships and Marie’s self-esteem. Recommend Marie return to school at the end of inpatient treatment to maintain her academic status and progress.

Unit 5 Project – Helping Blair This week, you will write a five-page research paper on a rape case study. Using information from the textbook and one article from the Kaplan Library on domestic violence, specifically rape, make sure to address: the signs and symptoms of what the client is going through the physical exam with a male doctor how you will interview the client and the interview skills you will use ethical issues you may encounter the legal issues the client will face future interventions for the client Tip: Do not get so caught up in writing about the effects of rape; that you forget to address the last four bullet points in detail. The first bullet; signs and symptoms should not go over 1 to 2 pages of your 5 page paper or you will not have enough detail on the other parts of this assignment.

Questions? Have a great week, remember to breathe...