Week 3: Assessment of Children

SOCW 6111 Week 3

Week 3: Assessment of Children

It is essential to obtain a strong knowledge base on the relevant assessment tools used specifically with children. Assessment tools historically have been created and tested primarily on adults, more specifically Caucasian adult male subjects. Children, similar to people with disabilities or those from various ethnic backgrounds, are often ignored in research protocols. In turn, the assessment tools used with them tend to be mere replicas of those created and tested for adults. It has become clear in the social work profession as well as other disciplines that we have not paid close enough attention to the unique needs and experiences of children. It is imperative to recognize the importance of using evidence-based assessment tools that are tailored specifically for children. Children quickly develop emotionally, physically, and psychologically, and the assessment tools used with this population must be sensitive to their developmental process. Further, a child’s physical, emotional, personality, and psychological development is strongly impacted by his or her environment. Taking an ecological perspective, understanding a child’s experience within his or her home and surrounding environment, will help to identify the level of support and safety. This knowledge will help guide one’s treatment plan and intervention.

Learning Objectives

Students will: Not a assingment

· Analyze assessment tools for children

· Analyze the importance of using multiple tools for assessment

· Analyze the ecological perspective of assessment

· Analyze the importance of cultural competence in clinical practice

Photo Credit: [kristian sekulic]/[E+]/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Centers for Disease Control and Prevention. (2013). Adverse Childhood Experiences (ACE) Study. Retrieved from http://www.cdc.gov/ace

Woolley, M. E. (2013). Assessment of children. In M. J. Holosko, C. N. Dulmus, & K. M. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions (pp. 1–39). Hoboken, NJ: Wiley.

McCormick, K. M., Stricklin, S., Nowak, T. M., & Rous, B. (2008). Using eco-mapping to understand family strengths and resources. Young Exceptional Children, 11(2), 17–28.

Note: Retrieved from Walden Library databases.

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

· Working With Children and Adolescents: The Case of Claudia (pp. 15–17)

Note: Depending on your concentration, you may not receive a case study book until a later term. Therefore, if you did not receive a copy of Social Work Case Studies: Concentration Year in your previous course, use the linked PDF provided here. If you did receive the book referenced above, you may find the cases there or use the PDF.

Discussion – Week 3 Attachment

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Assessment Tools

Assessments are an integral part of the planned change process. During this part of the process you will accumulate, organize, and review the information you will need to begin the planning and intervention phases of treatment. Content and information are obtained from multiple sources (the child, family members, school personnel, etc.) and in various forms (interviews, records, and observation). It is essential to collect data in a comprehensive manner—understanding the presenting problem from an ecological model that seeks to gain insight into the concern on a micro, mezzo, and macro level. Focusing on a multilevel approach to a client’s concern and taking into account the environmental factors that contribute to the presenting problem distinguishes social work from other disciplines.

1. Answer A, B and C write each one with 2 paragraphs and each paragraph needs 2 citations and references to support all of your written ideas in this answer. Support your posts with specific references to this week’s resources. Be sure to provide full APA citations for your references.

A. a description of the importance of using multiple evidence-based tools (including quantitative, open ended, and ecologically focused) to assess children.

B. Explain how each complements the other in order to gain a comprehensive understanding of the young client’s concerns and situation.

C. Then, describe the use of an eco-map in assessment and explain the different systems you will account for in your assessment of a child.

Support your posts with specific references to this week’s resources. Be sure to provide full APA citations for your references.

Assignment: Cultural Competence

As with all areas of the social work process, cultural competence is essential when engaging and assessing a child’s concerns. Being culturally competent includes understanding the unique needs of your client and asking how those needs can be fulfilled. Using an empowerment perspective treating clients as experts on their lives and their needs is essential. Not only does this establish your commitment to being culturally sensitive and aware, but it will enhance the therapeutic relationship. While it is essential to learn and master social work skills and techniques to be a successful practitioner, another significant indicator of a successful intervention is the relationship a social worker builds with his or her client. Some research suggests that the quality of the therapeutic relationship will account for 30% of the clinical outcome of the treatment (Miller, Duncan, and Hubble, 2005, as stated in Walsh, 2010, p. 7). Exhibiting a dedication to learning about a client’s culture, history, and current environmental factors exemplifies a social worker’s desire to build that client–worker bond.

For this Assignment, read the case study for Claudia and find two to three scholarly articles on social issues surrounding immigrant families.

2. In a 4- to 6-page paper, explain how the literature informs you about Claudia and her family when assessing her situation.

· Describe two social issues related to the course-specific case study for Claudia that inform a culturally competent social worker.

· Describe culturally competent strategies you might use to assess the needs of children.

· Describe the types of data you would collect from Claudia and her family in order to best serve them.

· Identify other resources that may offer you further information about Claudia’s case.

· Create an eco-map to represent Claudia’s situation. Describe how the ecological perspective of assessment influenced how the social worker interacted with Claudia.

· Describe how the social worker in the case used a strengths perspective and multiple tools in her assessment of Claudia. Explain how those factors contributed to the therapeutic relationship with Claudia and her family.

Support your Assignment with specific references to the resources given for this assignment. Be sure to support all your written ideas with proper and full APA citations for your references. Support all your written ideas with APA citation and references

SOCW 6111 week 4

Currently Reading SOCW 6111: Advanced Clinical Practice I | Week 4

Week 4: Assessment of Adolescents

Adolescence is often one of the most difficult stages individuals experience in their lives. Think back to your own teenage years and consider some of the questionable choices you made at that time, or reflect upon some of your responses to situations that may now seem emotionally and hormonally driven. Given the nature of the developmental changes that occur during adolescence, it can be quite challenging for a clinician to assess what a client is actually experiencing. During the adolescent stage, teens will often exhibit behaviors that seem unhealthy, dangerous, and sometimes even pathological. A closer look at the current developmental stage of the client and the familial history may lead to a very different conclusion. Therefore, social workers need to be very thorough when assessing adolescents and take into consideration multiple factors prior to planning and intervening.

Learning Objectives

Students will: not a assingment

· Apply attachment theory to a case study

· Analyze attachment styles in adolescents

· Analyze developmental stages in adolescents

· Apply developmental theory to a case study

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Gutiérrez, L., Oh, H. J., & Gillmore, M. R. (2000). Toward an understanding of (em)power(ment) for HIV/AIDS prevention with adolescent women. Sex Roles, 42(7–8), 581–611.

Note: Retrieved from Walden Library databases.

Springer, D. W., & Powell, T. M. (2013). Assessment of adolescents. In M. J. Holosko, C. N. Dulmus, & K. M. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions (pp. 71–95). Hoboken, NJ: Wiley.

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

· The Bradley Family (pp. 17–19)

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

· Working With Families: The Case of Brady (pp. 26–28)

Required Media

Laureate Education (Producer). (2013a). Bradley family: Episode 2 [Video file]. Retrieved from https://class.waldenu.edu

The Bradley Family Episode 2

Discussion 1: Attachment Theory

The adolescent stage can be described as a time where there is a loss of innocence and a preentry into adulthood. A large part of being an adolescent is beginning that process of stepping out into the world and learning about oneself as a unique and autonomous individual. This movement out into the world is contingent upon the knowledge that this young person will have a safe and secure home to return to at the end of the day. If a traumatic loss or event has occurred in the adolescent’s life, there may be no safe base to which this individual can return. Attachment theory teaches us that a young person’s ability to attach/engage with peers, family, and other potential support systems is an important aspect of the developmental process. During the adolescent stage of development, assessing attachment styles is important because it provides a window into how the adolescent relates to others, which allows the clinician to choose the appropriate intervention.

3. Post a answer and support all of your written ideas with 2 APA citations and references per paragraph. Answer in an application of the attachment theory to the case of either Tiffani or Brady. Discuss the connection between his or her attachment style and the exhibiting behavior. For this Discussion, choose either the program case study for the Bradley family or the course-specific case study for Brady. This answer is for a Masters course not a Bachelors course.

Discussion 2: Developmental Stages

Understanding an adolescent’s behavior can be at times elusive and even frustrating. Due to the multiple aspects of the developmental tasks during these years, it can be at times quite challenging to clearly define the issue(s) at hand. Assessment during this stage will include an evaluation of whether an adolescent’s actions are indicative of unhealthy behavior or merely representative of being an adolescent. A comprehensive assessment that includes an evaluation of the client’s developmental stage is a priority when working with this age group.

4. For this Discussion, choose the opposite case from Discussion 1 and use Erikson’s developmental theory. Post an answer and support all your written I ideas with 2 APA citations per paragraph and references. Write your answer with an assessment of whether the client is mastering the stage of identity. Identify the areas that should be addressed in an intervention based on his or her developmental stage. Describe how you might address those areas. This is for a Masters course not for a Bachelors course

Support your posts with specific references to this week’s resources. Be sure to provide full APA citations for your references.

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Working With Children and Adolescents: The Case of Claudia

Claudia is a 6-year-old, Hispanic female residing with her biological mother and father in an urban area. Claudia was born in the United States 6 months after her mother and father moved to the country from Nicaragua. There is currently no extended family living in the area, but Claudia’s parents have made friends in the neighborhood. Claudia’s family struggles economically and has also struggled to obtain legal residency in this country. Her father inconsistently finds work in manual labor, and her mother recently began working three nights a week at a nail salon. While Claudia is bilingual in Spanish and English, Spanish is the sole language spoken in her household. She is currently enrolled in a large public school, attending kindergarten.

Claudia’s family lives in an impoverished urban neighborhood with a rising crime rate. After Claudia witnessed a mugging in her neighborhood, her mother reported that she became very anxious and “needy.” She cried frequently and refused to be in a room alone without a parent. Claudia made her parents lock the doors after returning home and would ask her parents to check the locks repeatedly. When walking in the neighborhood, Claudia would ask her parents if people passing are “bad” or if an approaching person is going to hurt them. Claudia had difficulty going to bed on nights when her mother worked, often crying when her mother left. Although she was frequently nervous, Claudia was comforted by her parents and has a good relationship with them. Claudia’s nervousness was exhibited throughout the school day as well. She asked her teachers to lock doors and spoke with staff and peers about potential intruders on a daily basis.

Claudia’s mother, Paula, was initially hesitant to seek therapy services for her daughter due to the family’s undocumented status in the country. I met with Claudia’s mother and utilized the initial meeting to explain the nature of services offered at the agency, as well as the policies of confidentiality. Prior to the

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meeting, I translated all relevant forms to Spanish to increase Paula’s comfort. Within several minutes of talking, Paula notice- ably relaxed, openly sharing the family’s history and her concerns regarding Claudia’s “nervousness.” Goals set for Claudia included increasing Claudia’s ability to cope with anxiety and increasing her ability to maintain attention throughout her school day.

Using child-centered and directed play therapy approaches, I began working with Claudia to explore her world. Claudia was intrigued by the sand tray in my office and selected a variety of figures, informing me that each figure was either “good” or “bad.” She would then construct scenes in the sand tray in which she would create protective barriers around the good figures, protecting them from the bad. I reflected upon this theme of good versus bad, and Claudia developed the ability to verbalize her desire to protect good people.

I continued meeting with Claudia once a week, and Claudia continued exploring the theme of good versus bad in the sand tray for 2 months. Utilizing a daily feelings check-in, Claudia developed the ability to engage in affect identification, verbalizing her feelings and often sharing relevant stories. Claudia slowly began asking me questions about people in the building and office, inquiring if they were bad or good, and I supported Claudia in exploring these inquiries. Claudia would frequently discuss her fears about school with me, asking why security guards were present at schools. We would discuss the purpose of security guards in detail, allowing her to ask questions repeatedly, as needed. Claudia and I also practiced a calming song to sing when she experienced fear or anxiety during the school day.

During this time, I regularly met with Paula to track Claudia’s progress through parent reporting. I also utilized psychoeduca- tional techniques during these meetings to review appropriate methods Paula could use to discuss personal safety with Claudia without creating additional anxiety.

By the third month of treatment, Claudia began determining that more and more people in the environment were good. This was reflected in her sand tray scenes as well: the protection of good figures decreased, and Claudia began placing good and bad

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figures next to one another, stating, “They’re okay now.” Paula reported that Claudia no longer questioned her about each indi- vidual that passed them on the street. Claudia began telling her friends in school about good security guards and stopped asking teachers to lock doors during the day. At home, Claudia became more comfortable staying in her bedroom alone, and she signifi- cantly decreased the frequency of asking for doors to be locked.

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7. What local, state, or federal policies could (or did) affect this case?

Chase had an international adoption but it was filed within a specific state, which allowed him and his family to receive services so he could remain with his adopted family. In addi- tion, state laws related to education affected Chase and aided his parents in requesting testing and special educa- tion services. Lastly, state laws related to child abandonment could have affected this family if they chose to relinquish custody to the Department of Family and Children Services (DFCS).

8. How would you advocate for social change to positively affect this case?

Advocacy within the school system for early identification and testing of children like Chase would be helpful.

9. Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?

There was a possibility of legal/ethical issues related to the family’s frustration with Chase. If his parents had resorted to physical abuse, a CPS report would need to be filed. In addi- tion, with a possible relinquishment of Chase, DFCS could decide to look at the children still in the home (Chase’s adopted siblings) and consider removing them as well.

Working With Children and Adolescents: The Case of Claudia 1. What specific intervention strategies (skills, knowledge, etc.)

did you use to address this client situation? Specific intervention skills used were positive verbal support

and encouragement, validation and reflection, and affect identification and exploration. Knowledge of child anxieties/ fear and psychoeducation for the client and her mother were also utilized. Child-centered play therapy was utilized along with sand tray therapy to provide a safe environment for Claudia.

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2. Which theory or theories did you use to guide your practice? I used theoretical bases of child- (client-) centered nondirective

play therapy. 3. What were the identified strengths of the client(s)? Client strengths were a supportive parenting unit, positive peer

interactions, and the ability to engage. 4. What were the identified challenges faced by the client(s)? The client faced environmental challenges. Due to socioeconomic

status, the client resided in a somewhat dangerous neighborhood, adding to her anxiety and fear. The client’s family also lacked an extended support system and struggled to establish legal residency.

5. What were the agreed-upon goals to be met to address the concern?

The goals agreed upon were to increase the client’s ability to cope with anxiety and increase her ability to maintain attention at school.

6. Did you have to address any issues around cultural compe- tence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?

Language barriers existed when working with the client’s mother. I ensured that all agency documents were translated into Spanish. It was also important to understand the family’s cultural isolation. Their current neighborhood and culture is much different than the rural Nicaraguan areas Claudia’s parents grew up in. To learn more about this, I spent time with Paula, learning more about her experience growing up and how this affects her parenting style and desires for her daughter’s future.

7. What local, state, or federal policies could (or did) affect this situation?

The client and her parents are affected by immigration legislation. The client’s family was struggling financially as a result of their inability to obtain documented status in this country. The client’s mother expressed their strong desire to obtain legal status, but stated that lawyer fees, court fees, and overwhelming paperwork hindered their ability to obtain legal residency.

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8. How would you advocate for social change to positively affect this case?

I would advocate for increased availability and funding for legal aid services in the field of immigration.

9. How can evidence-based practice be integrated into this situation?

Evidenced-based practice can be integrated through the use of proven child therapy techniques, such as child-centered nondirective play therapy, along with unconditional positive regard.

10. Describe any additional personal reflections about this case. It can be difficult to work with fears and anxiety when they

are rooted in a client’s environment. It was important to help Claudia cope with her anxiety while still maintaining the family’s vigilance about crime and violence in the neighborhood.

Working With Children and Adolescents: The Case of Noah 1. What specific intervention strategies (skills, knowledge, etc.)

did you use to address this client situation? I utilized structured play therapy and cognitive behavioral

techniques. 2. Which theory or theories did you use to guide your practice? For this case study, I used cognitive behavioral theory. 3. What were the identified strengths of the client(s)? Noah had supportive and loving foster parents who desired to

adopt him. He quickly became acclimated to the foster home and started a friendship with his foster brother. He started to become engaged in extracurricular activities. Noah was an inquisitive and engaging boy who participated in our meetings.

4. What were the identified challenges faced by the client(s)? Noah faced several challenges, most significantly the failure

of his mother to follow through with the reunification plan. He has had an unstable childhood with unclear parental role models. There may be some unreported incidences of abuse and trauma.

Bradley Family Episode 2

Bradley Family Episode 2 Program Transcript

DOCTOR: Tiffany, what are you thinking?

TIFFANY: I was remembering being out on the street. I got in trouble for not make enough money. I don’t want to talk about it.

DOCTOR: That necklace is beautiful.

TIFFANY: Thank you. I think so. You really like it?

DOCTOR: Yeah, I do. I like your shoes, too.

TIFFANY: I like to shop. It makes me forget for a while, you know? You’re asking me to share my feelings about what’s going on, but it’s hard, you know. I’ve got so many feelings.

DOCTOR: Take your time.

TIFFANY: I miss Donald. I know I shouldn’t say that. He loved me, he really did.

DOCTOR: You also told me that he hit you and sold you to another pimp.

TIFFANY: Yes, but you don’t understand. The house where I was growing up, I never felt safe. My mother, she didn’t love me, not really. Like other girls I knew. There were other things, too. Someone in the family, he would abuse me sometimes. Nobody seemed to care, only Donald. He came along and he got me out of there. He was my boyfriend and he protected me.

DOCTOR: So you’re telling me all the positives he did for you, and how you felt safe with him and he loved you. Can we also talk about what you said he did that wasn’t so loving and kind? You were together for two years and there were a lot of things that happened during that time that weren’t very good for you. Can we talk about that?

Bradley Family Episode 2 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

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Working With Families: The Case of Brady

Brady is a 15-year-old, Caucasian male referred to me by his previous social worker for a second evaluation. Brady’s father, Steve, reports that his son is irritable, impulsive, and often in trouble at school; has difficulty concentrating on work (both at home and in school); and uses foul language. He also informed me that his wife, Diane, passed away 3 years ago, although he denies any relationship between Brady’s behavior and the death of his mother.

Brady presented as immature and exhibited below-average intelligence and emotional functioning. He reported feelings of low self-esteem, fear of his father, and no desire to attend school. Steve presented as emotionally deregulated and also emotionally immature. He appeared very nervous and guarded in the sessions with Brady. He verbalized frustration with Brady and feeling overwhelmed trying to take care of his son’s needs.

Brady attended four sessions with me, including both individual and family work. I also met with Steve alone to discuss the state of his own mental health and parenting support needs. In the initial evaluation session I suggested that Brady be tested for learning and emotional disabilities. I provided a referral to a psychiatrist, and I encouraged Steve to have Brady evaluated by the child study team at his school. Steve unequivocally told me he would not follow up with these referrals, telling me, “There is nothing wrong with him. He just doesn’t listen, and he is disrespectful.”

After the initial session, I met individually with Brady and completed a genogram and asked him to discuss each member of his family. He described his father as angry and mean and reported feeling afraid of him. When I inquired what he was afraid of, Brady did not go into detail, simply saying, “getting in trouble.”

In the next follow-up session with both Steve and Brady present, Steve immediately told me about an incident Brady had at school. Steve was clearly frustrated and angry and began to call Brady hurtful names. I asked Steve about his behavior and the words used toward Brady. Brady interjected and told his dad that being

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called these names made him feel afraid of him and further caused him to feel badly about himself. Steve then began to discuss the effects of his wife’s death on him and Brady and verbalized feel- ings of hopelessness. I suggested that Steve follow up with my previous recommendations and, further, that he should strongly consider meeting with a social worker to address his own feelings of grief. Steve agreed to take the referral for the psychiatrist and said he would follow up with the school about an evaluation for Brady, but he denied that he needed treatment.

In the third session, I met initially with Brady to complete his genogram, when he said, “I want to tell you what happens some- times when I get in trouble.” Brady reported that there had been physical altercations between him and his father. I called Steve in and told him what Brady had discussed in the session. Brady confronted his father, telling him how he felt when they fight. He also told Steve that he had become “meaner” after “mommy died.” Steve admitted to physical altercations in the home and an increase in his irritability since the death of his wife. Steve and Brady then hugged. I told them it was my legal obligation to report the accusations of abuse to Child Protective Services (CPS), which would assist with services such as behavior modifica- tion and parenting skills.

Steve asked to speak to me alone and became angry, accusing me of calling him a child abuser. I explained the role of CPS and that the intent of the call was to help put services into place. After our session, I called CPS and reported the incident. At our next session, after the report was made, Steve was again angry and asked me what his legal rights were as a parent. He then told me that he was seeking legal counsel to file a lawsuit against me. I explained my legal obligations as a clinical social worker and mandated reporter. Steve asked me very clearly, “Do you think I am abusing my son?” My answer was, “I cannot be the one to make that determination. I am obligated by law to report.” Steve sighed, rolled his eyes, and called me some names under his breath.

Brady’s case was opened as a child welfare case rather than a child protective case (which would have required his removal

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from the home). CPS initiated behavior modification, parenting skills classes, and a school evaluation. Steve was ordered by the court to seek mental health counseling. One year after I closed this case, Brady called me to thank me, asking that I not let his father know that he called. Brady reported that they continued to be involved with child welfare and that he and his father had not had any physical altercations since the report.

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5. What were the agreed-upon goals to be met to address the concern?

The goal was to find solutions to alleviate their frustrations and the discord in their relationship.

I was aware and sensitive to the fact that they were a gay couple. I was cognizant of the possible biased reactions they might have received from administrators at Jackson’s school and their surrounding community. I inquired into their interactions with the adoption agency and the school to get a sense of any nega- tive interactions that might have impeded service delivery. I also suggested a support group for lesbian and gay couples who adopt.

7. How would you advocate for social change to positively affect this case?

I would advocate for better education for foster and adoptive parents on the resources they may be eligible to receive.

8. How can evidence-based practice be integrated into this situation?

Using weekly scaling questions would be one way in which evidence-based practice could be implemented.

Working With Families: The Case of Brady 1. What specific intervention strategies (skills, knowledge, etc.)

did you use to address this client situation? I used structural family therapy, particularly the use of a geno-

gram. I addressed issues of grief and loss and child development. Finally, I used education to help them learn about services avail- able and crisis intervention.

2. Which theory or theories did you use to guide your practice? I used structural family therapy. 3. What were the identified strengths of the client(s)? Brady’s bravery in disclosing the altercations between himself

and his father showed great motivation and strength.

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4. What were the identified challenges faced by the client(s)? Steve was resistant to his own mental health needs and the effect

on his relationship with Brady. Brady was not receiving proper evaluation and intervention for his presentation of develop- mental delays/disabilities. Brady and Steve were clearly dealing with unresolved grief due to the death of Brady’s mother.

5. What were the agreed-upon goals to be met to address the concern?

The goal was to obtain a second evaluation and then provide suggestions of services to improve Brady’s behavior in the home and at school.

6. What local, state, or federal policies could (or did) affect this situation?

The child abuse reporting laws were relevant to this case. 7. How would you advocate for social change to positively

affect this case? I would advocate for more education and support for children

with developmental disabilities and their parents. It was clear that Brady had an intellectual disability that had not been previ- ously acknowledged nor properly addressed.

8. Were there any legal/ethical issues present in the case? If so, what were they and how were they addressed?

While the reporting laws and ethics for clinicians are very clear in a case like Brady’s, there is always the concern that a parent might file a lawsuit against the social worker for making the report. These are cases in which the clinician’s documentation of the sessions needs to be accurate and thorough to justify the CPS report.

9. Describe any additional personal reflections about this case. I am often asked by students, “Do you find it difficult to make

calls to Child Protective Services and does it get any easier?” My answer to that question is no, I do not find it hard to make calls to CPS because those institutions are there to help. However, I do continue to find it hard to hear stories of abuse from chil- dren. That will never get easier. I have learned a great amount of humility in these cases. If a child (or adult) finds my office space

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safe enough and is able to disclose such complex issues as these to me, I feel honored. It is because a client trusts me enough to tell me these things that I feel responsible to do my job.

Working With Families: The Case of Carol and Joseph 1. What specific intervention strategies (skills, knowledge, etc.)

did you use to address this client situation? This case required extensive use of active and passive listening

and patience to enable the client to become sufficiently comfort- able with me and to arrive at a point where she could work on her issues. Initially she was very angry, hostile, resistant, and very much in denial.

2. Which theory or theories did you use to guide your practice? I work with people in their homes, which is their territory, not

mine. I think it is very important to be aware of how I would feel if I were in their shoes. The person-in-environment perspective and Carl Rogers’ person-centered approach are crucial here.

3. What were the identified strengths of the client(s)? She was smart and had a good support system in her husband

and mother, who were very supportive during her treatment. 4. What were the identified challenges faced by the client(s)? Carol was a severe alcoholic and had a drug problem to a lesser

extent. She had psychological issues as well, including low self- esteem, depression, and anxiety. She also had transportation and legal problems as a result of losing her driver’s license after the DUI.

5. What were the agreed-upon goals to be met to address the concern?

The primary goal was to protect her child by keeping Carol sober and finding the intervention method that would be most appropriate for her to do that. This took time due to the resist- ance to treatment.

6. How would you advocate for social change to positively affect this case?

Treatment options and access to them need to be improved in rural areas. There were not many choices for this client,

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