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

2. Week 5 Project Family violence video and PBS Rape video Discussions on first interview & crisis interview Seminar Agenda Applying the learning Documentation, documentation, documentation The Unit 5 Project Questions

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

4. 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) By Nancy Summers Published by Brooks Cole Cengage Learning 2009

5. 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?

6. 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.

7. CAPTURING HIGHLIGHTS OF THE CHIEF COMPLAINT 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.

8. 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?

9. 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.

10. PREPARING FOR THE FIRST INTERVIEW Look at the intake material. Check past agency records. Look at past medical history. Keep in mind the material was collected by others who saw the client under very different circumstances. Make sure your office is a comfortable place in which to confide in another person.

11. MEETING THE CLIENT Go out to the waiting room to meet the client. Introduce yourself, using your full name. Make a mental note your first impressions of the client. Make a mental note of the clients reactions to you and the situation Show an interest in what the client has to say. If asked, give your credentials. Point out respectfully, if asked personal questions, that the interview is about the client, not about you. Describe the agency and its purpose. Make sure payment arrangements have been explained. Make sure confidentiality limitations and policies have been explained.

12. WHAT TO DO AS CLIENTS DESCRIBE THEIR ISSUES It is alright to take notes. Note-taking ensures accuracy Allow clients to tell the story in their own way. Encourage the client to talk about their issues by using open questions. EXAMPLE: Tell me a little bit about what’s been happening Avoid judging clients who may have different values or lifestyles from your own. To seek more clarification use open questions. EXAMPLE: Can you tell me more about your sister’s comments that evening? Refrain from using why questions which may sound like prying or ask for a level of understanding the client does not have.

13. 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 problem. This is generally what brought the client to the agency. The extent to which the problem has interfered with the client’s ability to function. The support system the client has or does not have. What the client is expecting as a result of coming to the agency.

14. WRAPPING UP Ask clients if they have any questions they want to ask you. With the client define the problem in language they understand. Verify what the client is expecting. Tell the client what will happen next. Give the client an appointment card if there is to be a next appointment. Rise at the end of the interview to indicate the interview is complete. 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 where other clients can overhear you.

15. Fundamentals of Case Management Practice: Skills for the Human Services, Third Edition Chapter Sixteen Social Histories and Assessment Forms By Nancy Summers Published by Brooks Cole Cengage Learning 2009

16. WHAT IS A SOCIAL HISTORY A social history is: A description and history of the presenting problem (the problem that brought the client into the agency). Background information on the person’s life. The worker’s impressions and recommendations.

17. Layout of the social history: the categories to cover 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 Medical history Legal history Social and recreational interests Religious activities Client successes and strengths Client resources Your assessment Your impressions Your recommendations

18. 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. All closed questions can sound like a grilling. You will use a few closed questions to get information that you need EXAMPLE: How many days a week do you work? Ask questions with respect and a genuine interest in the client. Example: Tell me about the work you do.

19. CAPTURING DETAILS Refrain from using vague descriptions or general information. Make the information you put in the social history specific. Look at the history you wrote to see where you would have questions if you were reading it for the first time. 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.

20. 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: 1. Presenting problem 2. Background to the presenting problem 3. Your impressions and recommendations 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.

21. OTHER WAYS TO TAKE SOCIAL HISTORIES Assessment forms These are used when agencies need a lot of detailed information The form is an outline of what is important. You need to stop and ask open questions as you go through the form. Talk with the client in addition to asking the questions. Taking social histories on the computer: Computers are used so that the history does not have to be typed after you have written it. It is important that you have enough space to write what is important and that you be able to see and fully engage the client.

22. WRITING IMPRESSIONS AND RECOMMENDATIONS 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.

23. WRITING IMPRESSIONS Impressions Next state your impressions. Write about these areas if they are relevant: functioningaffectvegetative functions insightmotivation to changemotivation to accept help EXAMPLE: Marie is somewhat guarded with a flat affect. She shows some insight into her problem and indicated some motivation to change the situation both at home and at school.

24. 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 achievement.

25. Unit 5 Project 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 need ethical issues you may encounter the legal issues the client will face future interventions for the client

26. The Case Study: Helping Blaire You have been sound asleep for over four hours. You think you are dreaming that your phone is ringing but you soon realize that it is. You answer the phone only to find out that it is the local hospital. It is the emergency room doctor on the phone. He is expecting the arrival of a rape victim and is requesting your help in working with her through the physical exam for evidence along with her psychological state as affected by the trauma. You put the phone down and your first thought is, “Now what do I do.” I do not have any forms at home with me. Do I go to the office and pick them up or not? Should I just get dressed and go to the emergency room? Decisions need to be made quickly at this time.

27. Helping Blaire con’t You arrive at the hospital. Dr. Dan is there waiting for you. The rape victim has just arrived by ambulance. You look at the time and see that it is 3:30 am. You cannot help but wonder how long this is going to take because you have to be at work by 8:00 am, which is only a few hours away. Dr. Dan has not seen the patient. The only information he has to give to you is that she is 27 years old, her first name is Blaire, she is Jamaican, and the police are waiting for the evidence. The police were unable to get any information out of her. You look at him wondering why. Dr. Dan finally tells you that he is new to the emergency room procedures for treating a rape victim because he is new to the department. He is looking for your guidance in how to approach the victim of this crime in the best way. You decide that you both will meet with the patient together before any type of examination is done. Dr. Dan agrees with you because he sees you as the professional in this area and he is here to learn from you.

28. Helping Blaire, last page of case study Together you both walk to the small little cubicle to meet with the victim. On your way there you hear her crying and sobbing for help. Your heart is racing and emotionally you are feeling a little helpless. You ask the police to leave the room so that you and the doctor have the chance to talk with the victim. They agree to wait outside of the room. Before entering the room you must put on surgical garbs and gloves. You are feeling so impersonal right now, but this is the procedure so as to not contaminate any evidence. You introduce yourself and slowly begin your interview with the victim and Dr. Dan.

29. Unit 5 Project 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 need ethical issues you may encounter the legal issues the client will face future interventions for the client

30. Have a great week, remember to breathe...