The Entire Situation in Families - Case Study Example

Case Work with Family Linda is a 28 year old woman with a family of four. She is having difficulty with her son Jake who is nine years old and she is not sure what to do about it. In the case study it shows that she does not really want to be involved with social service because she is embarrassed about needing the help; at the same time she needs to have something happen positively for her. Linda understands that Jake is having problems dealing with a new baby and probably needs more attention but she feels that her attention and energy should go to the new baby; in the meantime Jakes behaviour is escalating. The family is having financial problems and Linda does not have a strong support system because her two sisters live 20 miles away. She his having to deal with Jake and the reactions of the family to his behaviour while she is attempting to deal with a new baby. She is feeling anxious and is not on prescription anti-depressants because she has a "low mood" when she wakes up in the morning. She feels guilty about not being able to cope with the circumstances. The entire situation has created a strain on the family and put them into a crisis situation. Jake appears always angry and this may be due to the fact that he is not getting attention since the other family members were born. Michael is upset with Jakes behaviour and appears frustrated with the situation. The other children are having to deal with Jake and therefore are uncomfortable in their own home. Without crisis intervention their could be several problems. As an example, Jake could actually hurt someone and this would create more problems for him and for the family. Since the family now seems to be in a state of crisis with previous coping mechanisms failing, it is important to take a look at the crisis and help the family sort things out. The reason why crisis intervention is chosen is because it seems to be the most relevant way to help the family in a step by step manner. One if the things they need are to return to a space before Jake was angry so that they can possibly put together pieces of where he is now and why his behaviour is escalating. At that point the social worker can assist them in finding ways to handle the situation without making it worse. Why This Theory Was Chosen Crisis is a time when many people are ready to start looking for help when their other ways of coping with a situation are not working. In this situation, the family has tried other things and though they are embarrassed they are ready for the social work intervention. A crisis in this situation is defined as " An acute disruption of psychological homeostasis in which ones usual coping mechanisms fail and there exists evidence of distress and functional impairment" (Roberts 778). A crisis often happens because of an outside event like a national disaster, a death in the family or an accident that was particularly stressful or traumatic but it can also be an internal situation. In this case the crisis is within the family unit. Any situation becomes a crisis when an individual or in this case the family upset to the point of causing an inability to cope with usual coping mechanisms. This situation with the family is identified through as a crisis by this definition. In order to help the entire family they will need to be able to work together to resolve the issues. Strengths and Weaknesses of Crisis Intervention Theory Crisis theory suggests that people have to understand that crisis is a natural part of life whether it is predictable or unpredictable. A crisis can become stressful when it is something where the usual coping mechanisms do not work or when an event or situation triggers an unresolved trauma from the past (Hamer 2008). The strengths of this theory are it provides a systematic way for an individual or a family to look at a crisis that they are experiencing in a systematic way. It allows them to step away from the situation they are in and look at it objectively. A crisis intervention approach also can help the individual move forward when they are feeling stagnated and help them follow through on tasks that they have identified. A weakness of this method could be that the social worker gets too involved with the process and has difficulty letting go when they have finished helping the client. Clients can also cling to any support that comes about that is helping them. There can also be issues of transference or countertransferance in which either party may have challenges with the other. In other words, there could be triggers that each would bring out in the other that would make it difficult for them to work together. Application of Theory: The Needs for the Family The family has several needs that are very important to the lowering of the crisis in their lives. The most important needs are: 1. A need to resolve the conflict with Jake. Jake may be in need of counselling to resolve some of his issues. There may be issues of abandonment, attachment and other things that are temporary since they started when the first baby was born. 2. Linda may need help with the baby so that she can balance her time between Jake and the rest of the family easier. 3. The family needs to develop new ways of coping with the situation and how to deal with Jake if he starts to act out again. 4. The family and the other children need to feel safe with Jake in the house. 5. The family needs to have a network of people and/or services that can be used when needed. 6. The family may need family counselling to help them deal with their feelings with Jake. In choosing crisis intervention it is often a good idea to choose a model to work from because it is sometimes easier to have a series of steps. For this paper the Seven Stages of Crisis Intervention created by Roberts will be used: 1. plan and conduct a thorough biopsychosocial and lethality/imminent danger assessment; 2. make psychological contact and rapidly establish the collaborative relationship; 3. identify the major problems, including crisis precipitants; 4. encourage an exploration of feelings and emotions; 5. generate and explore alternatives and new coping strategies; 6. restore functioning through implementation of an action plan; 7. plan follow-up and booster sessions. (Roberts and Otten 332). The reason this model fits is because it allows a systematic way to look at this crisis and help the family get what they need. We would have already completed the first phase once we met with the family the first time. We have already discussed the presenting information and this would be what we would be assessing when we first met with the family. In stage two, it is known that rapport is already created because the family is willing to talk to the social worker and let them help. This means that we would have established eye contact, practiced active listening skills and made sure that the family was comfortable with the social worker before they continued their discussion. In stage three we would outline the challenges for the family as we have done on page two of this report. We would tell the family that this is what we perceived as what they need and then have further discussion about what they thought; it is very important that the family have input with what is going on so they can feel a part of the situation and not as though it is a process that is given to them. Step four is going to be somewhat difficult and it may be easier to separate the family. In stage four we are to look at the emotions and feelings of the family. By this time there is going to be a lot of anger and blaming involved. Jake may sit and say nothing or depending on what his parents say he may act out more. The social worker will have to keep a gentle balance between the emotions and feelings being expressed and "what is real." In other words, the social worker will have to be the checks and balances in the conversation to not allow it to go to far out of hand. In stage five, the social worker will need a large amount of resources with phone numbers and personally a person to contact for any programs that she might suggest to the family. This would create a stronger bond with the social worker and would increase the willingness of the family to use the information. Once the family had chosen some of the resources to start with the social worker could move them into step 5 and help them explore other ways of coping with Jake and help Jake find other ways to get attention. Steps four and five may take several sessions to accomplish but once everyone had some ways to use that were different from the old way, an action plan could be developed in step 6. In the action plan it would be beneficial to the family if they had short term goals to start with that were followed up with in step 7 by the social worker. When people know they are going to be accountable to someone for what they choose to do they are more apt to follow through with the process. Lindsey, Bethany and Sullivan (2009) also suggest a home based mental health program that could be a help to the family in terms of working with Jake. The program is based in Maryland and if it is found that Jake has a disorder that is in need of mental health it could be an alternative to sending him out of the home (as Michael has suggested). In this model, 24 hour attention and assistance is given to the family and it is both community and family based. A mental health "technician" is a part of the process and it is geared towards high end individuals. This could be a solution for the family to keep them together and to keep Jake in the home. It is the opinion of this researcher that Jakes basic problem is due to a lack of attachment and jealous because of the new baby. There would have to be a diagnostic workup to see what is going on for certain. Challenges working with service users In working with this family it would be difficult to walk into the situation without some knowledge of what is going on. It would seem that the family has learned to manipulate their circumstances so that they would naturally attempt to manipulate the social worker into the process of what is going on. There may be a situation where the family tries to get the social worker to take sides with someone in the family. This means that the social worker would have to be focused and would need to have an understanding of family dynamics before they went into the situation. As a social worker the individual would also have to understand that they are providing assistance to the entire family and not get into just caring about one or two individuals within the family unit. The perception of family members about social work and what the social worker is supposed to do is central to the needs of the family. Davis (2008) did a study of service users to see what they suggested as their needs overall. According to her study these are several things that the service users suggested: 1. Service users want to be treated as people instead of as a "case" or as a "problem". They want to know that the service provider is going to address them and their needs as people and not that there is something wrong. 2. They want to be listened to and: ‘Social workers have to find a way..... that allows them to have the space to listen to and act on the stories that people who are struggling tell them.....you will only make a difference if you are tuned in and giving space to service users’. (Davis 3). 3. Social workers must be careful to build trust with the service users so that they know the individual cares about the situation. They want to be treated with dignity no matter what the situation. (Davis 3). These ideas are good ones and will assist service providers in helping their cases. In the case of the current family it would be a good idea for me as their worker to keep this type of information in mind as I went out to see them. The best way to get them to respond is to treat them with dignity and to make sure that I treated everyone well. It would be very important to listen to each family member, including the children to make sure that I received the full story about how what they were feeling about the situation. Thompson (2003) suggests that one of the challenges for social workers is the fact that as they go out into a situation of crisis they are in an unknown situation. They will not know what is going on in a family until they get to the home. There are several ethical dilemmas that may come up for the individual social worker as they enter the home. As an example, in a situation like Jake, a social worker does not know what is happening. Part of the assessment would be to assess whether he was actually harmful to the family or not. It would be necessary to assess whether there were situations in the home that would need immediate attention (Thompson 3). With this in mind I would have to look at values and anti-oppressive practices that are involved with this family. The family is living in Belfast but it does not say whether they are natives of this country or whether they are Americans living there. It would be necessary to understand how the family was working together and whether the children had been brought up as native or as Americans. If they were Irish it would mean that there may be issues that we would have to address about culture. References Davis, A. What service users expect from social work. Conference Paper. International Conference on Social Work Education, Profession and Practice. Tblisi State University, Georgia. 2008. 27 April 2009 from . Hamer, M. Crisis intervention in child and family social work. 2008 Social Work - Another Way Free Tools and Resources for Solution Focused and Goal Oriented Social Work with families, children and parents. 27 April 2009 . Lindsey, M. A., Bethany R. L., and Sullivan F. A. (2009). An in-home intervention program for children with mental health needs. Psychiatric Services, 60(2), 266-7. 28 April 2009. from Research Library database. (Document ID: 1648419171). Roberts, A. R. Bridging the past and present to the future of crisis intervention and crisis management. In A. R. Roberts (Ed.), Crisis intervention handbook: Assessment, treatment, and research (3rd ed., 3–34). New York: Oxford University Press. Roberts, A. R. and Ottens, A. J. The Seven-Stage Crisis Intervention Model: A road map to goal attainment, problem solving, and crisis resolution. Brief treatment and crisis intervention 20055(4):329-339; doi:10.1093/brief-treatment/mhi030. 26 April 2009 from . Thompson, Paul. Devils and deep blue seas: the social worker in-between. 2003 Journal of Social Work Practice 17 (1), p35. 28 April 2009 from EBSCOhost database Academic Search Premier [AN: 10174938]. Read More