Exercises : Designing Three Levels of Intervention
Instructions: Look at the four cases below and decide how you would intervene on three levels: the personal (micro), the contextual or social context immediately surrounding the client (meso/mezzo), and the larger environment (macro).
1. Maria is paralyzed from the waist down following an accident three summers ago in a swimming pool. She is hoping to complete her degree in accounting, but she is complaining of depression and an inability to focus on school. When you see her, she looks anxious and tired. Her affect is flat, and she tells you nothing in¬terests her. At the local college, she has had trouble finding appropriate parking and misses many days of class when the weather is bad because of the parking situation. One of the professors she must work with closely has made remarks about the difficulty of "other people getting around that wheelchair." She believes her boyfriend, who was with her the night the accident happened, has remained with her simply out of pity. When they fight about other things, she throws this up to him, although he vehemently denies it and tells Maria this is a hurtful accusation.
Interventions on the micro level:
Interventions on the mezzo level:
Interventions on the macro level:
2. Mr. Groff is 93 and living alone in his home. He only stopped driving last year. He would like to get out more, perhaps go to the senior citizen center. In addi¬tion, he would like to go to the Lions Club and to participate in a foreign policy club he belonged to for years. He tells you sadly that the members of the foreign policy club always seemed amazed at the reading he had done and the sound opinions he expressed, "as though I should be senile!" Since he stopped driving, he has lost contact with them. Right now he sees no reason to go to a nursing home and feels that if he had transportation he could continue to buy his groceries, prepare his meals, and care for himself generally. He tells you, however, that he would like to find a way to be less lonely.
Interventions on the micro level:
Interventions on the mezzo level:
Interventions on the macro level:
3. Margie is in a sheltered workshop for people with developmental disabilities. She does well at work and has many friends. She lives with her mother, and her mother is not happy with the new level of independence Margie is developing. She often goes out with others from work and the supervisors for dinner on Friday night. She has joined a social group for individuals with disabilities much like hers, and they go bowling and to the movies. Margie has, since she went to the sheltered workshop, learned how to use the phone to make appointments with her doctor and dentist and how to ride the bus to and from both work and the social club, and she has been shopping to buy her own clothes twice with her case manager. Margie's mother complains about all this. She tends to blame Margie for leaving her alone at night and making her unhappy. "Since your father died, you're all I have," she tells Margie. Margie's response to this is to cry and stay home and give up some of her independence. Sometimes she has missed work, hoping to make her absences up to her mother.
Interventions on the micro level:
Interventions on the mezzo level:
Interventions on the macro level:
4. Chris is a single father who is trying to work and raise three small children. His wife was killed 2 years ago in a traffic accident. After the initial shock and out¬pouring of support from friends and neighbors, Chris found himself alone with all the responsibilities and very unsure of himself. He would like to meet other men who have the same problems but cannot find any groups, even though he has been told about several men who are in the same situation. He tells you he is not sure what the best method is for disciplining his children, whom he describes as "good kids." Sometimes he feels he is too lenient with them, and at other times he is afraid he is unnecessarily strict with them. A local women's health center has groups for bereaved single parents, but Chris believes those would not be open to him. "It would be all women, wouldn't it?" he asks. In addition, he is having a hard time at work balancing the responsibilities there with parenting responsibilities at home. "Of course, I want to do a good job and get the promotions so I can support these kids through college, but I need to be home in the evening, or someone does, and I don't think that is always well received at work."
Interventions on the micro level:
Interventions on the mezzo level:
Interventions on the macro level:
Textbook - Fundamentals of case management practice skills for the human services (5th edition)