Discussion: Planning and Implementing Treatment Goals with Clients

You are a social worker at an out-patient mental health facility. Your new client presents with a diagnosis of bipolar disorder and noncompliance with her medications. To deal with the mood swings, she has been abusing painkillers and alcohol daily. Currently homeless, she has been sleeping on her friends' couches. Her boyfriend is emotionally and verbally abusive and has just taken her last twenty dollars. She works at a local gas station, but she has to depend on friends for rides to work. As a result, she missed several work shifts. Her boss, who was understanding until now, recently told her she could not miss any more days, due to a lack of transportation. There are many short, intermediate, and long-term problems the client could address in this scenario. How do you choose which problem to tackle first?

One trap for social workers is thinking that they know which problem or concern should take priority and what is best for the client. Rather, what the client feels is the priority is what should take precedence. In this scenario, how would you start the GIM planning process with the client? As her social worker, you might feel that going into drug and alcohol rehab is a priority. However, she might feel that keeping her job, and therefore getting a car, is much more of a priority. If you disregard her goals and instead refer her to an inpatient rehab program, how successful will she be at completing that goal?

For this Discussion, review this week's Resources. Select either the course-specific case study for John or Debra and consider how the social worker applied the GIM in the case study. Also, think about any cultural competence techniques the social worker might have explicitly or implicitly used in the case. Then reflect on why working collaboratively with that client is vital to the treatment planning process. Then, select three of the eight planning steps discussed in the course text and think about how you might utilize those planning steps to foster empowerment during that process. Finally, reflect on the skills you might use to ensure the treatment planning process is mutually agreed upon by you and the client and consider how the treatment planning process affects implementation of treatment.

Post a description of how the social worker in the course-specific case study you selected applied the GIM.

Include in your post an explanation of any cultural competence techniques the social worker might have explicitly or implicitly used in the case.

Explain why working collaboratively with the client is vital to the treatment planning process.

Then, describe the three planning steps you selected and explain how you might utilize those planning steps to foster empowerment during that process.

Finally, explain one practice behavior skill you might use to ensure the treatment planning process is mutually agreed upon for you and the client and further explain how use of that skill might affect implementation of treatment.

Support your posts and responses with specific references to the Resources. Be sure to provide full APA citations for your references.

References

Kirst-Ashman, K. K., & Hull, G. H., Jr. (2015). Understanding generalist practice (6th ed.). Stamford, CT: Cengage Learning.
Chapter 1, "Introducing Generalist Practice: The Generalist Intervention Model" (pp. 1-52)

Chapter 6, "Planning in Generalist Practice" (pp. 207-236)
Kirst-Ashman, K. K., & Hull, G. H., Jr. (2015). Understanding generalist practice (6th ed.). Stamford, CT: Cengage Learning.

Chapter 3, "Practice Skills for Working with Groups"(pp. 94-126)
Kirst-Ashman, K. K., & Hull, G. H., Jr. (2015). Understanding generalist practice (6th ed.). Stamford, CT: Cengage Learning.

Chapter 7, "Implementation Applications" (pp. 237-288)
Scarborough, M. K., Lewis C. M., & Kulkarni, S. (2010). Enhancing adolescent brain development through goal-setting activities. Social Work, 55(3), 276-278.

Working With Survivors of Domestic Violence: The Case of Debra

Debra is a 38-year-old, heterosexual, Chinese American female. She is a stay-at-home mother with 15- and 7-year-old daughters and an 8-year-old son. Her husband of 21 years, Tim, works as an insurance broker at a local insurance agency. Debra has been prescribed Xanax® from her primary physician for anxiety. While at the doctor's office, she noticed a poster about the local domestic abuse center. She wrote down the number but did not call. Then, after being hit one night, she decided to call.

Debra called the center's hotline a few times before deciding to come in for services. She came in to address her children's behavior, which she believed stemmed from her husband's anger problem; her eldest daughter had started yelling at Debra and the two younger children, and her son had begun to kick and hit more than normal. Debra had previously attributed these behaviors, as well as her anxiety, to her husband's stress level. Debra had turned to her mother for help with the children, but her mother had told her, "It is your family, take care of it."

Debra had been trying to appease her husband's anger by having the house clean, dinner ready, and the children in bed by the time he got home. Although Debra was used to his occasional outbursts, the night before she first called he hit her in the face and threatened to take the kids away because she "was a terrible mother."

While discussing her marriage, Debra did not want to label his behavior as abusive or unhealthy. She told me that he was just doing his duty as head of household to provide for his family, and it was her job to keep the family together. After a few sessions, she disclosed that she had been unhappy for years but that her family would disown her if she were to get a divorce.

Debra began individual counseling with the intent to learn about how to keep herself and her children safe from his outbursts and how to manage her children's behavior. She told me she was not comfortable joining a group at this point. Debra also said that she would like to work on regaining support from her family members. Debra discussed her childhood, describing the way she was brought up in a traditional Chinese family where her mother stayed at home with her and her sister. Her father was the bread-winner and had the final say on any household matters.

During our sessions, I learned about Chinese cultural values related to marriage and family. I discovered that if Debra were to leave Tim, she would dishonor her family and lose any support system they did provide. Debra did not see divorce as a viable option for herself but wanted to try to prevent her husband's outbursts.

We met once a week and worked on creating a safety plan for her and her children. The children were old enough to be a part of the safety planning process. Debra was open to having the children come in to the agency to discuss their concerns about their father and mother. The children supported their mother and her ideas to help keep their family safe. We worked on creating and maintaining healthy boundaries for herself and her children.

After 3 months, Debra decided that she did not need to come weekly, but rather on an as-needed basis, to change her safety plan. She felt comfortable with her decision to stay and felt that her husband was respecting the new boundaries that she and the children had put up. Her husband has now enrolled in private counseling.