SOWK 486 Week 10 - Planning in Generalist Practice

A presentation at Heritage University in October 2020 by Jacob Campbell and is tagged with BASW Program, Heritage University, SOWK 486w

Location: Online - Zoom Time: Monday’s from 5:30-8:15 Week 10: 10/26/20 Topic and Content Area: Planning Reading Assignment: Hepworth et al. (2017) chapters 12 and 13 Assignments Due: A–02: Asynchronous Class Engagement How I plan due Sunday 11/01/20 at 11:55 PM via flipgrid A–03: Reading Quiz for chapters 12 and 13 is due at 5:30 PM before class via My Heritage Other Important Information: N/A

Watch clip from the office that includes some simple planning Today we are talking about planning.

Information about goals The 8 steps to planning Practice doing the planning process

(Hepworth et al., 2016) There should a link and connection directly following from each of the steps in the planned change process. Assessment Targeted Concerns Goals

Goals often take circuitous path where we are helping the client to reach goal attainment. A part of this process is… Priority Concerns (starting point) Task or Objective (incremental action steps)

There are a number of factors that influence goal development. [Whole Class Activity] Discuss Each what are examples of each of these. Client Participation: Most important. Working harder than your client… influence commitment, self-definition, and self-efficacy Involuntary Status: Difficult to engage Values and Beliefs: client vs. practitioner goals and views Resources and Supports: Personal resources (think cognitive deficit and functioning), involvement of others Environmental Conditions: Complex and multi systemic

There are many types of goals. “With individuals, this focus typically involves intrapersonal subsystems as well as their interaction with the social and physical environment. Goals may initially be expressed in broad terms.” (Hepworth, 2017, p. 319) Cognitive functioning (e.g., increase positive self-talk) Emotional functioning (e.g., manage anger) Behavioral change (e.g., listen to others without interrupting). These goals can be considered: Overt (requires action) Covert (requires change in thought or perception) Shared (common and agreed on with group) Reciprocal (quid pro quo)

The most common types of distortions and negative thinking patterns conceptualized by Beck (1976) have been summarized in the literature (Cormier, Nurius, & Osborn, 2009; Leahy & Holland, 2000; Walsh, 2006) and are as follows: [Whole Class Activity] Discuss each of the thinking errors, what they mean and possible examples of them. Can also look at what the opposite is that you would be trying to encourage in clients. All or nothing thinking Blaming Catastrophizing Discounting positives Emotional reasoning Inability to disconfirm: blocking ideas that don’t confirm beliefs Judgment focus: perception of self / others is based on assessment (focused on quality not description) Jumping to conclusions Mind reading Negative mental filtering: singling out bad events and ignoring positives Overgeneralization or globalization Personalizing: Taking on more responsibility for things then somebody has (i.e. role or actions made it happen) Regret orientation: focused on the past. “Should” statements: self failures Unfair comparisons What ifs [Small Group Activity] Share with a partner about some of the thinking distortions that are present in the media and then some that you have to some degree or the opposite of those.

There are some activities we can do as clinicians to assist in developing goals with involuntary clients. Motivational Congruence: “work on target goals that are personally meaningful to the client and that also satisfy the requirements of the mandate” (Roony 2009 as cited in Hepworth, 2017, p. 322) Agreeable Mandate: Work on bridging differing views through cognitive re-framing and finding common ground. Let’s Make a Deal: Work on negotiating through helping meet their needs. Getting Rid of the Mandate: Focus on getting rid of services.

While the textbook looks at planning related to… The task-centered model The crisis intervention model The cognitive restructuring technique The solution-focused brief treatment model Case management practice I’d like to present a more generalist concept of planning. Step 1: Work with your client (Getting buy in) Step 2: Prioritize Problems (what do we get done first) Step 3: Translate Problems into Needs (What is the need that we are addressing) Step 4: Evaluate Levels of Intervention (Selecting a Strategy) Step 5: Establish Goals (What is our overall goal) Step 6: Specify Objectives (what is our specific objective) Step 7: Specify Action Steps (what do we need to do to accomplish our objective) Step 8: Formalize a Contract (Lets put it down on paper)

Working with your client might sound like the most basic step, and in some regards it is. It is important to involve your client in every part of the intervention process. Creating Buy-in Collaborating with your client develops buy-in for the plan Its easy to think you know what is best for the client but if the client is involved in the planning process they will be motivated in the planned change process. Developing self-efficacy Empowering clients means enhancing their rights to self determination Collaborating with our clients teaches them the skills to be able to plan in the future.

Which Problem Should You Work on First? Many clients have many complex problems on multiple levels. As in the assessment section, we want to limit areas of focus to the following… Contemplating change First its important that the client recognize that the problem exits, ie; a client who denies an alcohol problem. Clearly understandable Second the problem should be clearly understandable terms. Realistic Third the problem should be realistically attainable for your client and something can be done about it.

Initial use by Doran… Doran, G. T. (1981). There’s a S.M.A.R.T. way to write management’s goals and objectives. Management Review. 70(11) 35–36. When I worked at Jubilee, I used to teach the kids on my case load that goals have have to SMART Goals. Pretty standard and discussed everywhere. Used at WISe. Specific Measurable Attainable Relevant Time-bound

Another way to think about choosing priorities is to look at it this way… Identify problems Identify with the client the problems that are most significant to the client. Restate in behavioral terms Restate each problem using clearly stated behavioral terms Evaluate client priorities Prioritize the problems in order of their importance to the client. Remember how you rank the problem could be very different from how your client ranks them. Develop an initial agreement Establish an initial agreement with the client regarding the problem you will attend to first

Again, the following are possible areas of problems Interpersonal conflict Dissatisfaction in social relations Problems with formal organizations Problems in role performance Problems of social transition Psychological and behavior problems Inadequate resources Problems in decision making Cultural and religious conflicts [Small Group Activity] During the class today, we will break up into partners a number of times. I want you to pick a partner, discuss some sort of area that they want to make change in their life. Come up with a specific problem. I’d prefer it to something real (easier to put together), but doesn’t have to be. [Small Group Activity] Prioritize the problem together that you want to make a plan for today.

The Kirst-Ashman and Hull (2015) divides up the needs into three categories. Translating problems into needs allows us to see start the process of determining what intervention is needed. A problem, without understanding the need the person has is not very helpful (i.e. Homeless might mean that the person needs to feel they have a stable place to stay… or …etc) Basic Needs The first need is those that fall into those items that we depend on for survival, which includes food, water, and shelter. Sense of Wellbeing The second need are those items we require in order to maintain a sense of well being, which includes those that help us feel comfortable, and healthy. Fulfillment The third needs are the items you require to achieve a sense of fulfillment in your life. In order to be able to help your client you must translate your clients problems into his or her needs. Instead of focusing on what is wrong, you focus on how what is wrong can be remedied. Your main goal is to satisfy your clients needs.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. http://dx.doi.org/10.1037/h0054346 You may recognize this, and the Kirst-Ashman version is very similar to Maslow’s Hierarchy of Needs. Physiological needs Physiological needs are the physical requirements for human survival. If these requirements are not met, the human body cannot function properly and will ultimately fail. Physiological needs are thought to be the most important; they should be met first. Air, water, and food are metabolic requirements for survival in all animals, including humans. Clothing and shelter provide necessary protection from the elements. While maintaining an adequate birth rate shapes the intensity of the human sexual instinct, sexual competition may also shape said instinct. Safety needs Personal security Financial security Health and well-being Safety net against accidents/illness and their adverse impacts Love and belonging Friendship Intimacy Family Being loved (sexually / non sexually) Esteem Esteem and respect from others Self esteem and self respect Self-actualization The desire to accomplish everything that one can, to become the most that one can be.

The following are some problems that the Kirst-Ashman and Hull (2015) used to be translated into needs. In my practice, I have generally though of needs as feelings (i.e. to feel stable… kind of like the root need) Unemployment -> Employment Homelessness -> Place to live Depression -> Treatment for relief of depression Grief at death of loved one -> Grief Management Poor performance at school -> Improved school performance, motivation, family stability [Small Group Activity] Now work with your partner, for the given problem, translate the problem into a need.

The next step is to select what strategies are needed to follow up. Focus on selected areas Focus on the first need you and the client have selected to work on. Review from levels of interaction Review the need and consider identifying micro, mezzo, and macro alternative strategies to arrive at a solution. Emphasize strengths Emphasize your client’s strengths when established strategies. Strengths provide blocks upon which to build intervention plans. Strengths give you something positive you can use to empower clients. Strengths allow you to give positive feedback, and help build up their confidence. Strengths can be used to show respect to your clients. Strengths allow you to work with and think about something concrete. Evaluate strategies Evaluate the pros and cons of each strategy you have considered with your client. Make a decision Select and pursue the strategy that appears to be most efficient and effective. [Small Group Activity] With you partner select a strategy of intervention.

Establishing goals helps ensure that clients and workers are in agreement about the problem definition and the changes that must occur to produce a suitable change. [Discussion] What are some possible examples of client goals? Goals help validate a clients concerns and definition of the problem. Goals suggest the nature of the intervention. Defined goals lend themselves more easily to evaluation. Evaluation is important because it is tied to the effectiveness of the interventions. We establish goals to clarify the purpose of an intervention. The goal is a broad statement of what you and your client want to achieve. [Small Group Activity] Work with your partner to develop a general goal (big picture statement)

This is breaking the goal down into measurable, and behaviorally specific terms. Example is: The client goal: Get a job paying at least $300 a week. Objective: Gain GED, or complete 6 months of job skills training. Action steps -Apply to get started on GED or for admission to the job skill training. Specific and measurable Objectives should be explicit or specific enough that anyone can tell that they have or have not been achieved. Objectives should be measurable A clearly defined, specific objective helps us evaluate exactly what has been achieved. Clear Clarity is important A clear objective is one that others can restate accurately. Complete Completeness means that enough information can be given about how the objective can be attained. [Small Group Activity] With you partner, develop an objective.

Action steps are the specific steps of who will accomplish what, when Action steps help identify appropriate intervention strategies. The basic formula for delegating responsibility is to specify who will do what by when. Who involves the individual specified for accomplishing a task. What involves the tasks the individual has to complete in order to achieve the goal. When sets a time limit so that the task is not lost in some endless eternity. [Small Group Activity] With your partner develop action steps.

A contract is an agreement between the client and worker. What will occur A contract specifies what will occur during the intervention process. Built with collaboration A contract is established by a worker and client making an agreement together. Contains all of the specifics of the plan A contract generally contains four types of information, including goals, methods, timetables, and mutual obligations. Various formats A contract format can be written, oral, or implied. It clarifies and summarizes who is responsible for completing which task. Contracts identify expectations and help avoid potential misunderstandings. It is not a legal contract, but rather a commitment that can flexible and subject to change.

There are advantages to having clients involved in completing a contract. Helps clients work on their problems because they were active in establishing their goals, objectives, and action steps. Clients feel empowered as they learn they can take charge and make changes. Clients who are disorganized or forgetful will benefit from a contract that reminds them of their agreements and responsibilities. Contracts provide a record of goals and plans that can assist in monitoring and evaluating the planned change effort. A client may only agree upon a contract when a client fully trusts a worker when working with cross cultural relationships.

Contracts can be written and signed, they can involve a verbal agreement, or contracts can be implicit or assumed. Written contracts should state specific objectives and follow the who-will-do-what by-when format. A written contract should be signed by the client, this shows a level of commitment. A copy of the written contract should be put in the clients file. Oral contracts specify the same things as a written contract but orally. Implicit contracts are agreements that are implied or assumed, but not actually articulated. Whenever possible use written or oral contracts.

A intervention contract must always contain information that identifies the client. What does the end RESULT look like? They have specified objectives and action steps. Signatures-all written contracts should be signed. Dates- an intervention contract should have the date the agreement was made. Formats vary-Regardless of the format who is responsible for what task should be clear. Task completion dates should be specified, and objectives should be measurable . Contracts often change over time, because objectives are reached and new objectives are established.

Portrait style photo of Jacob Campbell

Dr. Jacob Campbell

27 slides

Description

Planning is an important part of the process for working with clients. Like the old adage goes, “failing to plan is planning to fail.” There is a lot we can do to help our clients plan, and even the process of teaching them to plan can have positive longterm impacts. Today we are going to spend time looking at goals, cognitive distortions, and practice going through an eight step process for planning.