1. Intervention in Micro and Mezzo Level of Practice
Chapter 8

2. LEARNING OBJECTIVES
Understand that intervention is the time to carry out goals and objective specified in the contract
Understand and apply the basic principles of counseling with individuals and small groups
Understand and apply the basic principles for facilitating information and referral
Understand and apply the basic principles for engagement in crisis intervention, case management, small task group interventions, psychosocial intervention groups, and team work
Understand the basic principles underpinning different intervention modalities at micro and mezzo levels of practice

3. Intervention in Social Work
The Goal:
Empower client systems to interact and engage with their environment in healthy ways
The Means:
Strengthen client’s efficacy when it comes to taking action
Develop client system critical thinking skills
Support client knowledge and skill development
Develop client support systems
Develop client’s ability to take action that leads to change

4. Empowerment
A generative process through which disenfranchised and vulnerable are enabled to:
Mobilize resources
Exercise greater control over their environment
Meet their needs and achieve goals

5. Yes or No… Having a mentally ill friend or neighbor is OK by me.
Homosexuality is normal.
It is OK for educated homeless people to be teachers of children.
Families with homosexual parents should be portrayed in some children's books.
It is OK for homeless people to get legally married, and receive the legal benefits of marriage.
It is OK for mentally ill people to raise children.
It would be OK by me if one or more of my children were developmentally challenged

6. Are you ready to work with…
The mentally ill
The developmentally challenged
The disenfranchised
The poor
The outcast

7. Social Work intervention attempts to empower the client system
Rescuer (Practitioner)
Self Empowered person
Oppressor
Facilitator (Practitioner)
Oppressor
Victim
Social Work & Empowerment (Adams 2003)

8. …Empowering the Mentally Ill
For Example…

9. Empowerment Learning Techniques
Problem-Solving
Educational Drama
Assertiveness Training
Social Skills Training
Client-centered counseling
Group Work

10. Counseling of the Client-Centered Kind
We're seeing a much larger influx here. They're not looking for doctors or lawyer, but for counselors and emotional healing.

11. Counseling
A strengths-based problem-solving process that takes the form of dialogue, questions, actions, and transactions that guide and facilitate:
Resolution and mitigation of problems or issues
Acquisition or strengthening of internal personal resources
Development of affective coping and adaptation
Enhancement of well-being

12. Counseling
Requires:
Broad range of relationship and strengths-based problem solving strategies
Contemporary strategies and techniques used include:
Eco-maps
Sculpting
Genograms
Force-field analysis
Adolescent Grid

13. Eco-maps
Paper-and-pencil assessment tool used to assess specific troubles and plan intervention for clients.
A drawing of the client or client family in its social environment. 
Ecomap
Briefly, the ecomap is a way of mapping the family system in its world.  It provides the family and Children’s Service Worker with a way of actively gathering data about itself and drawing conclusions about that data.  This method of diagramming depicts the family in their dynamic ecological system.  Other important systems that influence the family are included in the ecomap.  Ann Hartman describes the following functions of the ecomap.  The mapping procedure:
Portrays an overview of the family in their ecological situation;
Pictures the important nurturant or conflict-laden connections between the family and the world;
Demonstrates the flow of resources, or lacks and deprivations; and
Highlights the nature of the interfaces and points of conflicts to be mediated, bridges to be built, and resources to be sought and mobilized.

14. Eco-Map Instructions for Ecomapping:
Draw a large circle in the middle of the map.  This represents the members of household. 
Inside the large circle, draw a genogram that describes the makeup of the household.  It is often useful to add names and ages.  Limited space may prevent adding additional descriptive information. Use the symbols that are normally used in genograms (see figure #1).
Inquire into what outside systems influence the family unit and its members.  Examples of these outside systems may include work, extended family, church, school, health care, social welfare, recreation, and friends. Draw smaller circles around the large household circle and label them to represent the outside systems.
The next step is to begin to draw the connections of the family unit and its individuals to the various systems in their environment.  These connections are indicated by drawing lines between the family and the circles representing the outside systems. Some of the connections may be drawn to the family unit as a whole or to the individual members.  This differentiation demonstrates the way the various family members are connected to the environment.
The nature of the connection is described by the type of line that is drawn:
A solid or thick line represents a strong connection;
Three solid lines indicates the strong connection is an intense relationship;
A broken line indicates a tenuous relationship;
A zig-zagged line shows a stressful or conflictual relationship;
Refer to Figure #2 for other variations and examples for diagramming emotional relationships.
Next, indicate the direction of the flow of resources, energy, or interest by drawing arrows along the connecting lines.
Finally, write a word or two beside the connecting lines or smaller circles to further describe, clarify or highlight information drawn on the ecomap.
   Figure 5. Example of Ecomap
It is important for the Children’s Service Worker to study the family's presenting problem and its function within the family system.  The presenting problem is usually the behavior which brought the family to the attention of the Division.  The techniques presented here to assist in this study are:
Time lines; and
Diagramming the sequence of behaviors.
The same type of non-confrontive interviewing techniques that are used when completing genograms and ecomaps should also be applied when completing time lines and behavior sequences.  Use of these methods should come after the completion of the genogram and ecomap.  This should allow the Children’s Service Worker an opportunity to develop rapport with the family.  The family may be more willing to share information about the presenting problem when rapport is established.

16. Force Field Analysis This technique gives you a way of:
Diagnosing a situation
Planning for change
Implementing a change strategy and programme.

17. Restraining forces maintain the status quo. They hinder change.
Driving forces are factors that indicate an openness towards change. They are positive forces for change.
Restraining forces maintain the status quo. They hinder change.
Equilibrium

18. Useful tool when working with clients on goal-setting

19. Information and Referral
Occurs in social work practice when the client system does not have the information or resources necessary for problem resolution

20. Information and Referral
A process in which the generalist social worker :
Clarifies the problem or need for which help is being sought
Gathers information about appropriate and available resources
Provides information to the client system
Discusses options for problem resolution
Examines the means through which client system can gain access to selected service option
Facilitates means of referral
Discusses means for follow-up

21. Referral
Directing clients to another resource for help with an identified problem or need
Successful referral requires:
Clear and concise description of problem
Identification of available resources
Discussion of referral options with client
Planning and contracting with referral sources
Meeting referral source with the client
Monitoring and following up on interaction between client and referral source

22. Making a Referral Questions you are likely to be asked:
Does the client know about the referrals?
Demographics
Physical, Psychological, Behavioral Client Profile
Degree of risk
Family History
Environmental context
Available Supports
Major issues/problems

23. Sample Referrals Forms

24. What a Crisis?
A temporary state of upset and disorganization, characterized by an inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome

25. Crises… Occur in everyone’s lives
Not necessarily pathological, may encourage growth and change
Time limited to a brief period, 4-6 weeks except death
A person’s perception determines the crisis

26. CRISIS INTERVENTION BALANCING FACTORS
Crisis- good outcome
Perception of event realistic
Situational support adequate
Coping mechanism adequate
No crisis
Crisis- development
Perception of event distorted
Situational support inadequate
Coping mechanisms inadequate
Crisis

27. TRIAL & ERROR SOLUTIONS
PHASES OF CRISIS
PERSONALITY DISORGANIZATION (CRISIS)
SEVERE ANXIETY
TRIAL & ERROR SOLUTIONS
USUAL COPING MECHANISMS INEFFECTIVE OR
STRESS
ANXIETY
NEW PROBLEM- SOLVING SOLUTIONS AND SUPPORT
ANXIETY
PRE-CRISIS LEVEL OF FUNCTIONING

28. Crisis Intervention: Assessment
Perception of event:
What happened that prompted you to seek help?; How are you feeling now?; etc.
Coping mechanisms:
Suicidal?; Plans?; What helps you feel better?; etc.
Support systems:
With whom do you live with?; Who is available to help you?; Who is most helpful?; etc
Mental status, previous history
Identify client’s strengths
Self-assessment: Social Worker’s feelings

29. Crisis Intervention
Social workers are frequently called upon to make a rapid and accurate assessment of the magnitude of a client's crisis state.
A single valid crisis assessment instrument with strong psychometric properties does not exist.
See:
There are however, a number of practice and assessment tools however that can help you.

30. Sample Crisis Assessment and Intervention Tools and Plans
Children’s Crisis Intervention Tool

31. Crisis Intervention Goals
Alleviate Stressful Impact
Mobilize Client system strengths and resources
Support client in developing strengths-based problem-solving skills
Assist client in regaining optimal levels of psychosocial functioning
Social
Worker
Client
Resource
System

32. Small Group Intervention
Applying methods in generalist practice to
Meet group member needs
Resolve targeted problems in psychosocial functioning
Complete specified tasks

33. Task Groups
Small collectivities of people drawn together by mutual concerns and interested in accomplishing specific tasks

34. Tasks Groups Intervention with task groups moves through
different phases:
Orientation
Accommodation of groups members to each other
Generation of ideas about needs and solutions
Integrative problem-solving
Task completion

35. Psychosocial Intervention Groups
Focus on enabling members to benefit from the group.
Goals:
Identify issues/problems of concern
Education
Social skills and self-efficacy development
Foster mutual support among group members
Promote strengths
Achievement of personal goals
Change behavior
Develop problem-solving skills

36. Case Management
A process of actions taken by the generalist social worker to mobilize, bring together, and coordinate a continuum of care of client system services.

37. NASW Standards for Case Management

38. Commonly Involves
Referral
Assessment
Action Plan
Intervention
Review

39. Case Management Typically, the process includes:
Assessment of client system needs, assets, strengths, and use of resources in relation to problems or issues
Identification of informal and formal resources
Enabling and empowering the client system by promoting self-determination in making choices and acting
Enabling primary groups in the client system’s environment to expand their care giving capacity
Facilitating effective negotiations for resources between various formal and informal systems of care

40. Case Management Resources
Case Management in Healthcare
Integrated Case Management
Case Management Society of America

41. Teamwork
As a case manager your role will most likely require to bring together a variety of resources to work together in common planning, decision making, and consolidated action.
The result of this is called TEAMWORK
Increasingly, dealing with clients involves coordinated and integrated service delivery across education, health and social services.
This is referred to as multidisciplinary collaboration

42. Team Work A coordinated group service delivery process
across different professional systems. Typically,
effective team work involves:
Obtaining sanctions
Building a supportive team structure
Identifying and maximizing the use of resources
Meeting regularly
Specifying task activities in relation to goals and objectives
Setting up a process of monitoring and evaluation of goal accomplishments
Sharing responsibilities

43. Teamwork Phases Clarify the problem and purpose for organizing
Share data
Agree on goals and a plan for intervention
Assign tasks
Evaluate
Terminate contact

44. Monitoring Intervention
It is important to monitor and document the intervention process

45. Monitoring Intervention
Entails a variety of activities including:
Narrative documentation
Qualitative Assessment
Direct Observation
Consultation
Documentation Review
Phone Calls
Face to Face Interviews
Site Visits

46. Quantified monitoring scale
Convert the observational and narrative accounts you have of your client system intervention to a scale related quantitative measure
-1 = movement away from goal achievement
0 = no movement
1-2 = some progress
3-4 = progress
5 = goals achieved

47. Summary
Counseling, Information and Referral, Crisis Intervention, Small group intervention and case management and teamwork
Can apply more than one of the above in social work practice