ASSIGNMENT IS ATTACHED ALONG WITH INSTRUCTIONS THANKS In order to understand the helping process holistically, you must understand each piece that contributes to the process. Once you gain an underst

CHAPTER ONE Introducing the Helping Process

I work at an agency that serves adolescent females. The length of stay at our short-term facility varies from 14 to 30 days, depending on their situation. We have kids who are in state custody and need temporary housing, juvenile court placements, homeless, or in crisis. Individual and family therapy, psycho-educational groups, health assessments, and food, clothing, and shelter are provided by the agency.

— A caseworker in St. Louis, MO

There is a variety of helping professions committed to helping those in need. Those professions in settings such as mental health, substance abuse, criminal justice, welfare, education, child and youth services, and legal aid, to name a few, are committed to helping clients address issues that emerge from problems in living. These professionals, committed to viewing clients from a holistic point of view, support client growth in areas such as social, physical, and mental health and financial, spiritual, educational, and vocational issues. The helping process is a fundamental way that professionals reach out to those in need and provide the support and structure necessary to influence their potential to develop and grow in positive ways. In this text we present knowledge and skills that will help you prepare to help others.

This chapter introduces you to a model of helping that guides many professionals who work in human service delivery. Helping is a purposeful undertaking that generally moves through three phases. We say “generally” because people are often unpredictable, problems or situations change, or services are disrupted for other reasons. The three phases of this helping model are not discrete categories with specific time limits. Rather, they illustrate the flow of the helping process that is individualized to each person, situation, or both.

This chapter also introduces the three components of the helping process: case review, documentation and report writing, and client participation. Both a strengths-based approach to the process and the ethical considerations that undergird the process are important parts of this chapter. Focus your reading and study on the following objectives, which you should be able to accomplish after reading the chapter.

Phases of the Helping Process

■ List the three phases of the helping process.
■ Identify the two activities of the assessment phase.
■ Illustrate the role of data gathering in assessment and planning.
■ Describe the helper’s role in implementation.

Three Components of the Helping Process

■ Define case review and list its benefits.
■ Support the need for documentation and report writing.
■ Trace the client’s participation in the three phases of the helping process.

Strengths-Based Approach to the Helping Process

■ Describe this approach as it relates to each phase of the helping process.
■ Discuss the advantages of this approach.

Ethical Considerations

■ List the principles that undergird professional practice.
■ Summarize the limitations of codes of ethics.

At times, learning about a new concept or process is difficult without a concrete example to illustrate what the process looks like in the real world. With this in mind, we would like to introduce you to the phases of the helping process through the experience of Roy Johnson, a client working with several helping professionals to address major difficulties he encounters. Roy’s experience is based upon a client that we know who has been involved in the human service delivery system for years. He has given us permission to adapt his experiences to illustrate the nature of the helping process.

The section that follows introduces the three phases of the helping process. The case of Roy Johnson illustrates each phase.

Phases of the Helping Process

The three phases of the helping process are assessment, planning, and implementation (see Figure 1.1). Each phase will be discussed in detail in later chapters. Human service delivery has become increasingly complex in terms of the number of organizations involved, government regulations, policy guidelines, accountability, and clients with multiple problems. Therefore, the helping professional needs an extensive repertoire of knowledge, skills, techniques, and strategies to serve clients effectively.

Let’s see how these phases occur in three different settings.

I am a case coordinator. My agency has initial responsibility for all children who come through the juvenile court system. We begin each case with an assessment. I gather school and medical records and prior psychological evaluations. Because I want to find out as much as possible about a child, I will visit the home, interview teachers and school counselors, or arrange for an evaluation.

Figure 1.1 The Helping Process

The planning process helps the staff at another agency located in the Bronx, NY, decide how and why to provide services. The agency director says:

It seems like our clients want to do everything all at once but we encourage them to take one day at a time. Steps are very important so that they don’t get overwhelmed and end up failing. This is something we talk with them about and encourage them to do.

A social worker who provides frontline assessments and referrals for emergency admissions at a metropolitan Houston hospital describes patient placements as the implementation phase of his work.

In a nutshell, my job is to figure out what’s going on and where the patient can go. Most of the people I work with come to the emergency room involuntarily, often brought by the police. I do all the paperwork and then I find a placement.

As you can see, the responsibilities at each phase vary, depending on the setting and the helper’s job description. It is important to understand that the three phases represent the flow of the helping process rather than rigidly defined steps to successful case closure. An activity that occurs in the first phase may also appear in the second or third phases of planning and implementation. Other key components appear throughout the process, including case review, report writing and documentation, and client participation. Ultimately, the goal of the helping process is to empower clients to manage their own lives as well as they are able. The case of Roy Johnson shows how this happens.

As stated earlier, Roy Johnson is a real person, but his name and other identifying information have been changed. The case as presented here is an accurate account of Roy’s experience with the human service delivery system. His case exemplifies the three phases of the helping process. The following background information will help you follow his case through assessment, planning, and implementation.

Roy referred himself for services after suffering a back injury at work. He was 29 years old and had been employed for five years as a plumber’s assistant; he hurt his back lifting plumbing materials. After back surgery, he wanted help finding work. Although he had received a settlement, he knew that the money would not last long, especially since he had contracted to have a house built. He heard about the agency from a friend who knew someone who had received services there and was now working. The agency helps people with disabilities that limit the kind of work they can do. An important consideration in accepting a person for services at the agency is determining whether services will enable that person to return to work. Roy’s case was opened at the agency; we will follow it to closure.

Assessment

The assessment phase of the helping process is the diagnostic study of the client and the client’s environment. It involves initial contact with an applicant as well as gathering and assessing information. These two activities focus on evaluating the need or request for services, assessing their appropriateness, and determining eligibility for services. Until eligibility is established, the individual is considered an applicant. When eligibility criteria have been met, the appropriateness of service is determined and the individual is accepted for services, then he or she becomes a client. You will read more about assessment in Chapters Two and Three.

The initial contact is the starting point for gathering and assessing information about the applicant to establish eligibility and evaluate the need for services. In most organizations, the data gathered during the initial contact is basic and demographic: age, marital status, educational level, employment information, and the like. Other information may be obtained to provide detail about aspects of the client’s life, such as medical evaluations, social histories, educational reports, and references from employers.

Roy was self-referred to the agency. He initiated contact by telephoning for an appointment. Fortunately, a helping professional was able to see him that week, so he made an appointment for May 24 at 10:30 A.M. He was sent a brochure about the agency and a confirmation of his appointment. When he arrived at the agency, Roy completed an application for services. The agency believes the applicant should supply the information in this initial information gathering. Roy was able to complete the form without too much trouble, although he wasn’t sure how to answer the question about where he had heard about the agency. He didn’t know the name of his friend’s friend. The receptionist helpfully told him to write in “self-referral.” She suggested that he leave any questions blank if he wasn’t sure about the response. She also asked him not to sign.
Roy had brought a copy of a letter prepared by his orthopedic surgeon, Dr. Alderman, for his attorney a year earlier (see Figure 1.2). Dr. Alderman had expressed the opinion that Roy would be left 10 percent disabled as a result of the injury. Dr. Alderman was also careful to clarify that Roy’s condition did not reflect a preexisting disability, even though he had suffered back problems previously. Tom Chapman, the helper who saw Roy, made a copy of the letter and returned Roy’s copy to him.

During the initial contact, the helper determines who the applicant is, begins to establish a relationship, and takes care of such routine matters as filling out the initial intake form. An important part of getting to know the applicant is learning about the individual’s previous experiences with helping, his or her strengths, his or her perception of the presenting problem, the referral source, and the applicant’s expectations. As these matters are discussed, the helper uses appropriate verbal and nonverbal communication skills to establish rapport with the applicant.

Skillful use of interviewing techniques facilitates the gathering of information and puts the applicant at ease. The helper makes the point at the conference that the client is considered an expert and that self-reported information is very important. By providing information about routine matters, the helper demystifies the process for the applicant and makes him or her more comfortable in the agency setting. Some of the routine matters addressed during the initial meeting are completing forms, gathering insurance information, outlining the purpose and services of the agency, giving assurances of confidentiality, and obtaining information releases.

Documentation records the initial contact. In the agency Roy went to, helpers fill out a Helping Professional’s Page (see Figure 1.3), which describes the initial meeting.

Although Dr. Alderman’s letter provided helpful information about Roy’s presenting problem, agency guidelines stated that all applicants must have a physical examination by a physician on the agency’s approved list. Mr. Chapman also felt that a psychological evaluation would provide important information about Roy’s mental capabilities. He discussed both of these with Roy, who was eager to get started. Mr. Chapman asked Roy to sign a form that permits release of information from the external evaluation. As Roy prepared to leave, Mr. Chapman explained that it would take time to process the forms and review his application for services. He would be in touch with Roy very soon, explaining the next steps.

Figure 1.2 Dr. Alderman’s Letter

If the applicant is accepted for services, the client and the helper will become partners in reaching the goals that are established. Therefore, as they work through the initial information gathering and routine agency matters, it is important that they identify and clarify their respective roles, as well as their expectations for each other and the agency. From the first contact, client participation and service coordination are critical components in the success of the process. The helper must make clear that the client is to be involved in all phases of the process. A skillful helper makes sure that client involvement begins during the initial meeting (see Figure 1.4).

Figure 1.3 Helping Professional’s Page

In Roy’s case, the helper reviewed the application with him. There were some blanks on the application, and they completed them together. Roy had not been sure how to respond to the questions about primary source of support and member of his household. As Roy elaborated on his family situation, the helper completed these items. Roy felt positive about his interactions with Tom Chapman because Tom listened to what he said, accepted his explanations, and showed insight, empathy, and good humor.

Figure 1.4 Tom Chapman’s Memo

In gathering data, the helper must determine what types of information are needed to establish eligibility and to evaluate the need for services. Once the types of information are identified, the helper decides on appropriate sources of information and data-collection methods. His or her next task is making sense of the information and data-collection methods. In these tasks, assessment is involved: The helper addresses the relevance and validity of data and pieces together information about problem identification, eligibility for services, appropriateness of services, plan development, service provision, and outcomes evaluation. During this process the helper checks and rechecks the accuracy of the data, continually asking, “Does the data provide a consistent picture of the client?”

Client participation continues to play an important role throughout the information-gathering and assessment activities. In many cases, the client is the primary source of information, giving historical data, perceptions about the presenting problem, and desired outcomes. The client also participates as an evaluator of information, agreeing with or challenging information from other sources. This participation establishes the atmosphere to foster future client empowerment.

The helper needed other information before a certification of eligibility could be written. In addition to Dr. Alderman’s letter, a general medical examination, and a psychological evaluation, the helper requested a period of vocational evaluation at a regional center that assesses people’s vocational capabilities, interests, and aptitudes. Tom Chapman had worked with all these professionals before, so he followed up the written reports he received with further conversations and consultations. Following a two-week period at the vocational center, the evaluators met with Roy and Mr. Chapman to discuss his performance and make recommendations for vocational objectives. When the report was completed, Mr. Chapman and Roy met several times to review information, identify possibilities, and discuss the choices available to Roy. Mr. Chapman’s knowledge of career counseling served him well as he and Roy discussed the future. Unfortunately, an unforeseen complication occurred, delaying the delivery of services. Tom Chapman changed districts, and another helper, Susan Fields, assumed his caseload. Meanwhile, Roy moved to another town to attend school. Although he was still in the same state, Roy was now about 200 miles from the helping professional with whom he worked. While Roy was attending his first semester at school in January, Ms. Fields completed a certificate of eligibility for him. This meant that he was accepted as a client of the agency and could now receive services. In May, his case was transferred to another helper (his third) in the town where he lived and attended school.

Planning

The second phase of the helping process is planning, which is the process of determining future services in an organized way. When planning begins, the agency has usually accepted the applicant for services. The individual has met the eligibility criteria and is now a client of the agency. During this planning process, the helper and the client turn their attention to developing a service plan and arranging for service delivery. Client participation continues to be important as desired outcomes are identified, services suggested, and the need for additional information determined. The actual plan addresses what services will be provided and how they will be arranged, what outcomes are expected, and how success will be evaluated.

A plan for services may call for the collection of additional information to round out the agency’s knowledge of the client. Some helping professionals suggest that the service-delivery process is like a jigsaw puzzle, with each piece of the information providing another clue to the big picture. During this stage, the helper may realize that a social history, a psychological evaluation, a medical evaluation, or educational information might provide the missing pieces. You will read more about this information in a later chapter. The plan identifies what services are needed, who will provide them, and when they will be given. The helper must then make the appropriate arrangements for the services.

During the assessment phase, Tom Chapman did a comprehensive job of gathering information about Roy. When Roy was accepted for services, the task facing him and his new helper was to develop a plan of services. Clarity and succinctness characterize the service plan, which the helper and the client complete together, emphasizing the client’s input in the process. The plan lists each objective, the services needed to reach that objective, and the method or methods of checking progress.

Suppose that Tom Chapman had believed that a psychological evaluation was unnecessary and had been able to establish eligibility solely on the basis of the medical and vocational evaluations. Susan Fields, the new helper, might find that a psychological evaluation would be beneficial, especially since the agency was contemplating providing tuition and support for training. One objective of the plan would then be to provide a psychological evaluation of the client. This is an example of continuing to gather data during the planning phase, as well as continuing to assess the reliability and validity of the data.

Roy’s plan indicates that he is eligible for services and meets agency criteria. His program objective, business communications, was established as a result of evaluation services, counseling sessions with Mr. Chapman, and Roy’s stated vocational interests (see Figure 1.5). The three stated intermediate objectives will help Roy achieve the program objective.

Figure 1.5 Service Plan

The plan also provides a place to identify the responsibilities of Roy and the agency in carrying out the plan. Many agencies take very seriously the participation of the client in the development of the plan, even asking that the client sign it, as well as the helper.

Once the plan is completed, the helper begins to arrange for the provision of services. He or she must review the established network of service providers. Experienced helpers know who provides what services and who does the best work. Nonetheless, they should continue to develop their networks. For beginning helpers, the challenge is to develop their own networks: identifying their own resources and building their own files of contacts, agencies, and services. A later chapter provides information about developing, maintaining, and evaluating a network of community resources.

Implementation

The third phase of the helping process is implementation, when the service plan is carried out and evaluated. It starts when service delivery begins, and the helper’s task becomes either providing services or overseeing services and assessing the quality of services. He or she addresses the questions of who provides each service, how to monitor implementation, how to work with other professionals, and how to evaluate outcomes.

In general, the approval of a supervisor may be needed before services can be delivered, particularly when funds will be expended. Many agencies, in fact, have a cap (a fee limit) for particular services. In addition, a written rationale is often required to justify the service and the funds. As resources become increasingly limited, agencies redouble their efforts to contain the costs of service delivery. In Roy’s case, the agency’s commitment to pay his training tuition represented a significant expenditure. Susan Fields submitted the plan and a written rationale to the agency’s statewide central office for approval.

Who provides services to clients? The answer to this question often depends on the nature of the agency. Some are full-service operations that offer a client whatever services are needed in-house. For example, the helper might provide counseling, career exploration, or education. As a rule, however, the client does not receive all services from a single helper or agency. It is usually necessary for him or her to go to other agencies or organizations for needed services. This makes it essential for the helper to possess referral skills, knowledge of the client’s capabilities, and information about community resources.

No doubt you remember that Roy’s first helper, Tom Chapman, arranged for a psychological evaluation. Many agencies like Tom’s have so many clients needing psychological evaluations that they hire a staff psychologist to do in-house evaluations of applicants and clients. School systems, for example, employ their own school psychologists. Other agencies simply contract with individuals—in this case, licensed psychological examiners or licensed psychologists—or with other agencies to provide the service. Whatever the situation, the helper’s skills in referral and in framing the evaluation request help determine the quality of the resulting evaluation.

Another task of the helper at this stage is to monitor services as they are delivered. This is important in several respects: for client satisfaction, for the effectiveness of service delivery, and for the development of a network. Monitoring is doubly important because of the personnel changes that constantly occur in human service agencies. Moreover, there may be a need to revise the plan as problems arise and situations change.

The implementation phase also involves working closely with other professionals, whether they are employees of the same agency or another organization. A helper who knows how to work successfully with other professionals is in a better position to make referrals that are beneficial to the client. These skills also contribute to effective communication among professionals about policy limitations and procedures that govern service delivery, the development of new services, and expansion of the service delivery network.

Perhaps there is no other point in service delivery at which the need for flexibility is so pronounced. For example, during the implementation stage it often becomes necessary to revise the service plan, which must be regarded as a dynamic document to be changed as necessary to improve service delivery to the client. Changes in the presenting problem or in the client’s life circumstances, or the development or discovery of other problems, may make plan modification necessary. Such developments may also call for additional data gathering.

In his second semester at school, Roy heard about a course of study that prepared individuals to be interpreters for the deaf. This intrigued him, because he was already proficient in sign language. His mother was severely hearing impaired, and as a child, Roy signed before he talked. He also thought back to the evaluation staff meeting, at which the team discussed the possibility of making interpreter certification a vocational objective for him. Roy liked the interpreting program and the instructors, so he applied to the program. The change in vocational objective made it necessary to modify his plan. His helper (by now, his fourth) revised the plan at the next annual review to include his new vocational objective of educational interpreting.

Three Components of the Helping Process

Case review, report writing and documentation, and client participation appear in all three phases of the helping process; they are discussed in detail in later chapters. Here we introduce the concepts by examining how each applies to Roy’s case.

Case review is the periodic examination of a client’s case. It may occur in meetings between the helper and the client, between the helper and a supervisor, or in an interdisciplinary group of helpers, called a staffing or case conference. A case review may occur at any point in the helping process, but it is most common whenever an assessment of the case takes place. Case review is an integral part of the accountability structure of an organization; its objective is to ensure effective service delivery to the client and to maintain standards of quality care.

Roy’s case was reviewed in several ways. Each time a new helper assumed the case (unfortunately, this was often), a review was conducted. There were also reviews on the occasion of the two professional contacts Roy had per semester. At the end of each semester, his grades were checked—also part of the case review. The staffing related to Roy’s vocational evaluation is an example of case review by a team. In this case, the client was an active participant in the case review. Roy also participated in developing the service plan, which involved a review of the information gathered, the eligibility criteria, and the setting of objectives. The agency serving Roy implemented the important component of case review in various ways at different times throughout the process.

An important part of case review is the documentation of the case. Documentation is the written record of the work with the client, including the initial intake, assessment of information, planning, implementation, evaluation, and termination of the case. It also includes written reports, forms, letters, and other material that furnish additional information and evidence about the client. The particular form of documentation used depends on the nature of the agency, the services offered, the length of the program, and the providers. A record is any information relating to a client’s case, including history, observations, examinations, diagnoses, consultations, and financial and social information. Also important are “all reports pertaining to a client’s care by the provider, reports originating from orders written within the facility for tests completed elsewhere, client instruction sheets, and forms documenting emergency treatment, stabilization, and transfer” (Mitchell, 1991, p. 17). The helper’s professional expertise must include documenting appropriately and in a timely manner and preparing reports and summaries concisely but comprehensively.

Roy’s file includes many different types of documentation. The written record may include computer forms, applications for services, helpers’ notes, medical evaluations, reports, and letters. Other documentation in Roy’s file might be a psychological evaluation, a vocational evaluation, specialized medical reports, and medical updates. In Roy’s case, all this documentation may turn out to be indispensable because, during his time as a client, he worked with five different helpers. For continuity of service, good case documentation is essential.

Client participation means the client takes an active part in the helping process, thereby making service delivery more responsive to client needs and enhancing its effectiveness. In some cases a partnership is formed between the helper and the client; an important result of this partnership is client empowerment. One of the many factors involved in forming a partnership with the client is clear communication, or two-way communication. The helper must explain to the client his or her goals, purposes, and roles as defined by the agency. The helper encourages the client to define his or her goals, priorities, interests, strengths, and desired outcomes. At this point the client also commits to assuming responsibility within the helping process. As client participation continues and the partnership develops, it is helpful to have knowledge of subcultures, deviant groups, reference groups, and ethnic minorities so as to communicate effectively with the client about roles and responsibilities. Other factors can affect client involvement, including the timing, setting, and structure of the helping process. Minimizing interruptions, inconveniences, and distractions enhances client participation.

Encouraging client participation has identifiable components. The first is the initial contact between the client and the helper. It is easier to involve clients who initiate the contact for help, as Roy did, because they usually have a clearer idea of what the problem is and are motivated to do something about it. In Roy’s case, the clarification of roles and responsibilities occurred at three points in the assessment phase. Roy and his helper were able to talk about the agency and the services available, and the helper encouraged Roy to talk about his goals, motivations, and interests. When Roy completed his application, the helper reviewed it with him, especially the statement at the bottom of the second page. On signing the statement, the client voluntarily places himself or herself in the care of the agency. With this agreement come roles and responsibilities for both the client and the helper, which the helper reviews at that point. A second opportunity to clarify roles and responsibilities comes with the completion of a service plan. Both the client and the helper sign the service plan, which designates the responsibility for each task and the time frame for completion of each service.

The final phase of client participation comes at the termination of the case. At this time, the client and the helper together review the problem, the goals, the service plan, the delivery of services, and the outcomes. They may also discuss their roles in the process. Thus, in terms of client participation, termination means more than just closing the case. It is an assessment of the client’s progress toward self-sufficiency, the ultimate goal of client empowerment. Self-sufficiency is defined differently for each client.

Strengths-Based Approach to the Helping Process

A strengths-based approach to helping focuses on the talents, skills, knowledge, interests, and dreams of an individual as a way to empower, motivate, and engage internal and environmental supports (Saleebey, 2008). Helpers use a strengths-based approach during assessment, planning, and implementation as a way to engage the client in the helping process. In this section are exercises that will help you apply the strengths-based approach to the helping process.

Assessment

A strengths-based approach to the assessment phase focuses on the positive characteristics, abilities, and experiences of the client to build upon them in addressing current problems. The counselor identifies these by asking clients to recall how they have solved problems in the past and to describe successes at home, school, work, and in relationships. This discussion is part of the problem-identification phase but shifts the emphasis from problems or deficit thinking to a more positive, client-focused position.

This approach to assessment takes time and calls for patience and facilitation from the helper. There is a dual focus at this point. One is to collect information about the client’s needs and resources; the second is to assess client functioning and the client’s social network, for example. In the strengths-based approach, the helper is most interested in the client’s resources and abilities. To identify these, the client may need prompting to recall past successful behaviors and situations. The following examples of statements or questions encourage this recall: “Tell me about a time when you faced a similar problem.” “What do you consider your most important ability?” “What have you learned from your friends and family?” “What do you enjoy doing?”

Taking time to explore the client’s responses has other benefits. Identifying strengths fosters motivation. For example, focusing on positives rather than negatives empowers the client to believe that change is possible and that he or she has the abilities and resources to make this happen. This positive approach also helps build rapport and the relationship between the client and the helper. The client leaves this session with hope that his or her needs will be met and with confidence in the helper and the relationship.

During this phase, the helper also assesses the client’s readiness for change in the areas the client has identified. Older models of helping depended on the helper to inform the client what to do. The noncompliant client was then labeled as resistant. Strengths-based approaches consider change as a process that begins with two stages. The first is precontemplation, at which point there has been no thought about change, and the second is contemplation, where considering change begins, although probably with some ambivalence (Norcross, Prochaska, & DiClemente, 1994).

There are a number of tools to assist with strengths identification. They include questionnaires, surveys, and forms that may be completed by the client, the family, the helper, or a combination of those involved. Figure 1.6 is an example of a simple strengths-identification form. Guidelines of assessing strengths, detailed in Figure 1.7, help client and helper identify areas of perceived strength. These guidelines are based upon the sources of strengths (Saleebey, 2008). Other approaches are more complex and encompass the following seven domains: living arrangements, leisure/recreational, vocational/educational, health/medical, social support, emotional/behavioral, and financial (Rapp & Goscha, 2006). Whatever the approach during the assessment phase, the goal of the strengths-based approach is the identification of client strengths and resources.

Planning

The second phase of the helping process is planning. An understanding of strengths is essential to effectively plan. The strengths, abilities, and resources of the client become part of the plan development. In addition, all environments contain resources, and these are identified and incorporated into the planning process. These may exist in the home, the extended family, the place of employment, the place of worship, the community, or a mix of several of these. Increasing the number of available resources identified has a direct bearing on the success of the plan: the more resources to support the client’s efforts, the greater the possibilities for change.

During this phase the client–helper collaboration continues and becomes a stronger and more positive force in the helping process. A critical part of this collaboration is client participation in determining both short-term and long-term goals that are compatible with the client’s values and strengths. These goals are formulated realistically given the client’s abilities and available resources. And they are stated positively—again, a basic tenet of the strengths-based approach. Finally, the client provides input about updates based on changes in any conditions that affect the client, the plan, and the process. Assuming this responsibility engenders client participation and is one way that the transfer of helping responsibilities to the client occurs.

Implementation

Several approaches to implementation are grounded in client strengths. Among them are harm reduction, solution-focused intervention, cognitive-behavioral strategies, and motivational interviewing. The hallmark of any strengths-based intervention is choice. Specifically, the client has options in terms of the goals determined during the planning phase, the interventions or methods employed to bring about change, and the context of intervention (e.g., outpatient, inpatient, group, individual). The possibilities available to the client emphasize the values of self-determination and responsibility. The helper maximizes any benefits of these choices by respecting the client’s preferences and choice, further solidifying the relationship and affirming the client’s active role in the helping process.

Figure 1.6 Strengths Identification Form

Figure 1.7 Sources of Strengths

Another critical component of intervention is incorporating the resources that have been identified. These may be community-based resources, such as services provided by other agencies for which the client is eligible, or the resource may be one or more family members who will support the client’s efforts. In fact, the resource may have already been available but not directed to or activated for the client’s benefit. Making use of every available support enhances the client’s chances for success.

Let’s examine a specific intervention to see how it works. Motivational interviewing is a strategy that enhances the client’s desire to change by exploring and resolving ambivalence (Van Wormer & Davis, 2003). Although first used with problem drinkers, its use has expanded to a number of different problems, including smoking, bulimia, and domestic violence, and to a variety of settings such as medical practice, child welfare, and community-based organizations. Its goal is to help clients change by providing a way for them to see themselves and the costs of their behavior and to find the motivation to change the targeted behaviors. Motivational interviewing facilitates client change not by admitting the problem or finding solutions but rather by focusing on identifying what is preventing the client from changing.

The goal of motivational interviewing strategies is to increase motivation, not to get answers. The interview begins by determining the client’s current level of motivation or readiness to change. One way to determine this is to ask, “If on a scale of 1 to 10, 1 is not at all motivated to give up smoking and 10 is 100% motivated to give it up, what number would you give yourself at the moment?” (Van Wormer & Davis, 2003, p. 80). Following up with an inquiry about “why a 4 rather than a 1” will lead to the identification of positive reasons for change. Asking “What would it take for your confidence or motivation to move from a 4 to a 5,” is another way to get the client to think about what he or she needs to increase motivation. These techniques encourage the client to identify values and goals for behavior change and to resolve any ambivalence about changing.

The helper’s role during this process is to be empathic, avoiding judgments and arguments. It is also important for the helper to articulate discrepancies between the client’s words, behaviors, and goals and to direct the client’s attention to an exploration of these discrepancies: “You say you want to quit smoking yet you keep a pack of cigarettes in your car. Tell me about that.” Using the client’s own words makes an impact on the client and prompts the client’s recognition and exploration of the discrepancy. Any resistance or reluctance is a natural part of change and is met with “It is up to you” or “What you do is really your decision.”

This brief overview of motivational interviewing enables you to see how it uses client strengths and client participation in changing. It differs from the traditional approaches or interventions that begin with problem identification, end with resolution, and involve confronting clients or persuading them that they must change. Often, these approaches actually increase resistance.

Ethical Considerations

Permeating the helping process is a commitment to ethical standards. Whatever the profession, whether it be counseling, health, human services, nursing, psychology, or social work, helping behavior is grounded in similar principles that focus on the way helpers work with the recipients of their services. These principles represent commitments to the client’s right to self-determination, to do no harm, to promote fairness and equal access to services, to be responsible to the client, and to be honest.

Codes of ethics, or ethical standards, have been developed by professions to operationalize these commitments in order to provide guidelines for practice. Examples are the Ethical Standards for Psychologists (American Psychological Association), the Ethical Standards for School Counselors (American School Counselor Association), the Code of Ethics for Rehabilitation Counselors (Commission on Rehabilitation Counselor Certification), and the Ethical Standards of Human Service Professionals (National Organization for Human Services). Their purpose is to clarify the helper’s responsibility to clients, employers, and society.

Codes of ethics pose two challenges. First, a profession’s code of ethics is binding only on members of the group that adopts it. Those who are not members are not bound by the code. Second, it is impossible for a code to cover every possible situation that could arise in the helping process. The following quotes present some real ethical dilemmas that helpers encounter:

All the people we work with want everything to be confidential. This is a problem for them and for us when we have to report something.

Settlement House Worker, Bronx, NY

Clients who don’t want our help are challenging. It’s difficult to watch a client fail, especially when there is potential for improvement and stability.

Case Manager, Los Angeles

It’s a difficult situation when the family is against us. For example, we have a client whose family tells her she shouldn’t be on medication. She listens to them but what they tell her isn’t always in her best interest.

Mental Health Professional, Knoxville

As you can see from these quotes, the helping process often requires a delicate balance of consideration to the client, the family, the agency or organization, laws and regulations, and professional codes of ethics. These conflicting interests can create crises that require the helper to make difficult choices. The situations just described reflect some of the tensions helpers face. Because changes occur in laws and regulations, professional practices, and standards of practice, codes of ethics also change, adding complexity and presenting new challenges to professionals. For example, the use of technology has required a rethinking of assuring confidentiality, and the realities of shifting population demographics have created the need for competencies in multicultural counseling.

Ethics in helping professions is a complex issue that is addressed both in courses and throughout curricula and is mandated by academic accrediting bodies and certification and licensure boards. As you read the following chapters about the phases of the helping process, think about the ethical dilemmas that might occur.

CHAPTER SUMMARY

Managing client services is an exciting and challenging responsibility for helping professionals. To assist clients with multiple problems, helping professionals must know the process of helping and be able to use it. The process can be adapted to many different settings, for work with a variety of populations.

The three phases of the helping process—assessment, planning, and implementation—each represent specific responsibilities assumed by the helper. The process of helping is nonlinear; for example, a helper may make some assessments early on and return to conduct assessment during the planning and implementation work with the client. Three components of the helping process appear in all three phases of helping: case review, report writing and documentation, and client participation. Note that the first two components also include interaction with and participation by the client. These components require ongoing evaluation and written documentation of the helping process.

The strengths-based approach differs from older models of helping that are problem-based or deficit-based assessments, followed by planning and implementation that target the problem(s). These older models have less client engagement and participation, are often provider driven, and focus on negative events or characteristics. They may actually lessen the client’s ability to solve his or her own problems and encourage dependency on the helper to define problems and identify strategies to resolve the problem. Both older models and strengths-based approaches attempt to match clients and resources. The strengths-based approach also helps clients become their own helpers, assuming responsibility for themselves and their problems and motivating them to act in their own best interests.

CHAPTER REVIEW

The key terms and the discussion questions will reinforce the knowledge you gained about the helping process.

KEY TERMS

Assessment

Case review

Client empowerment

Client participation

Codes of ethics

Documentation

Implementation

Information gathering

Initial contact

Motivational interviewing

Planning

Record

Strengths-based approach

REVIEWING THE CHAPTER

Distinguish between the terms applicant and client.

What should be accomplished during the assessment phase?

What occurs during the initial contact between the helper and the individual seeking services?

Describe the routine matters that are discussed during the initial contact.

Identify the types of information that are gathered during the initial interview.

Using the case of Roy Johnson, discuss the advantages of a partnership between the helper and the client.

Describe the helper’s activities during the planning phase.

Why is flexibility so important during the implementation phase?

Define case review.

10.

List the three keys to successful case review.

11.

Why is documentation important in service coordination?

12.

How can the helper promote client participation?

13.

Describe how the strengths-based approach applies to assessment, planning, and implementation.

14.

How will a client’s resistance affect his or her participation in the service coordination process?

15.

What is the purpose of a code of ethics or ethical standards?

QUESTIONS FOR DISCUSSION

From your own work and study of helping, what evidence do you have of the importance of assessment and planning?

If you were a helper, what three principles would guide your work? Provide a rationale for your choices.

Describe Roy’s strengths and how they might impact the helping process.

What ethical dilemmas might you encounter in Roy’s case?

REFERENCES

Mitchell, R. W. (1991). Documentation in counseling records. Alexandria, VA: American Association for Counseling and Development.

Norcross, J. C., Prochaska, J. O., & DiClemente, C. C. (1994). Changing for good. NY: Avon.

Rapp, C. A., & Goscha, R. J. (2006). The strengths model: Case management with people with psychiatric disabilities (2nd ed.). Oxford Press: Oxford.

Saleebey, D. (2008). The strengths perspective in social work practice (5th ed.). Boston: Allyn & Bacon.

Van Wormer, K., & Davis, D. R. (2003). Addiction treatment: A strengths perspective. Pacific Grove, CA: Brooks/Cole/Thomson.