Case Studies in Social Work Practice E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 882

Veröffentlichungsjahr: 2014

Beschreibung

A practical approach to understanding social work concepts in action that integrates theory and practice

In this updated edition of the classic social work text, students and instructors have access to real-world demonstrations of how social work theories and concepts can be applied in practice. The case studies in this book bridge the gap between the classroom and the field by allowing students to discover the when, why, and how of social work principles. Brief but comprehensive topic overviews are brought to life by case studies that apply general theories to the work of social work.

• Each of the book's nine sections cover an essential area of social work, encompassing the micro, mezzo, and macro levels
• Highly readable explanations are followed by 3-5 case studies relating theory to the living practice of real social workers
• Topics include Generalist Practice; Family Therapy, Treatment of Adults; and Diversity

Approaching each topic from a variety of different theoretical bases, this essential text allow students to learn by concrete example, experiencing social work concepts as they are applied in the profession today.

Leseprobe

Contents

Cover

Title Page

Copyright

Dedication

Educational Policy and Accreditation Standards (EPAS) and Case Studies Crosswalk

Case Study Topic Areas Matrix

Preface

FOR STUDENTS

FOR INSTRUCTORS—HOW TO USE THIS BOOK

THE THIRD EDITION

Acknowledgments

About the Editor

Contributors

Part I: Case Studies in Generalist Practice

REFERENCES

Case Study 1-1

USING THE ECOLOGICAL MODEL TO GUIDE PRACTICE: A TEAM APPROACH

CONCLUSIONS

REFERENCES

Case Study 1-2

REFERENCES

Case Study 1-3

WHEN WE ONLY LOOK AT THE PROBLEMS

WE MISS SEEING THE STRENGTHS

THE COMMUNITY CONTEXT

SANDSTONE NEIGHBORHOOD PROJECT—FIRST CONTACT

THE FIRST 6 MONTHS

THE SECOND 6 MONTHS

A SELF-ACTUALIZING COMMUNITY

LOOKING BACK: JASMINE'S STORY

SUMMARY

REFERENCES

Part II: Case Studies in Integrating Theory and Practice

REFERENCES

Case Study 2-1

THEORETICAL PERSPECTIVE

PRACTICE PRINCIPLES AND GUIDELINES

REFERENCES

Case Study 2-2

SOCIAL LEARNING THEORY IN THE TREATMENT OF PHOBIC DISORDERS

CONCEPTUAL FRAMEWORK

THE TREATMENT PROCESS

CONCLUSIONS

REFERENCES

Case Study 2-3

RELATIONAL THEORY

REFERENCES

Case Study 2-4

THE FAMILY

THE PRESENTING SITUATION

JOINING THE FAMILY SYSTEM

CONCLUSION

REFERENCES

Part III: Case Studies in Child and Family Welfare

REFERENCES

Case Study 3-1

CRISIS OF DISCLOSURE

BACKGROUND

TEAM TREATMENT GOALS AND INTERVENTIONS

ROLE OF THE SOCIAL WORKER

FAMILY INTERVENTIONS

CONCLUSIONS

Case Study 3-2

REFERENCES

Case Study 3-3

THE THREE FUNCTIONS OF SOCIAL WORK SUPERVISION

CHILD WELFARE SUPERVISION

CASE STUDY

REFERENCES

Case Study 3-4

A SURPRISE CALL

CHALLENGING THE FAMILY'S VALUES

PHASE TWO

OTHER SYSTEMS

TRANSGENERATIONAL ISSUES

CONCLUSION

Part IV: Case Studies in Family Therapy

REFERENCES

Case Study 4-1

CASE OVERVIEW

INTERVENTION

CONCLUSIONS

REFERENCES

Case Study 4-2

CONCLUSIONS

REFERENCES

Case Study 4-3

Part V: Case Studies in Treating Adult Problems

REFERENCE

Case Study 5-1

CONCLUSIONS

Case Study 5-2

OVERVIEW OF THE INTERVENTION

THE COURSE OF THERAPY

CONCLUSIONS

REFERENCES

Case Study 5-3

DEALING WITH A DIAGNOSIS

FORMING A PARTNERSHIP

HELPING WITH DEPRESSION

MAKING PROGRESS

CONCLUSIONS

Case Study 5-4

LEARNING THE HARD WAY

MENTAL GYMNASTICS

POWER STRUGGLE

MAMA'S LITTLE GIRL GROWS UP

WALKING TALL

MAKING IT HAPPEN

Case Study 5-5

SUMMARY OF ASSESSMENT

INTRODUCTION TO MINDFULNESS-BASED INTERVENTIONS AND MINDFULNESS-ORIENTED RECOVERY ENHANCEMENT

COURSE OF TREATMENT WITH CHARLES

SUMMARY

CONCLUSION

REFERENCES

Part VI: Case Studies in Preventing Problems and Developing Resourcefulness

REFERENCE

Case Study 6-1

ASSESSMENT

GROUP SESSIONS

CONCLUSIONS

REFERENCES

Case Study 6-2

A CASE BEGINS: THE FACILITATED SETTLEMENT CONFERENCE OF JENNIFER K.

ISSUES DURING THE PENDING OF THE CASE: REUNIFICATION AT RISK FOR JENNIFER K.

NEAR THE ENDING OF A CASE

CONCLUSION

Case Study 6-3

REFERENCES

Case Study 6-4

BACKGROUND

OVERVIEW OF THE INTERVENTIONS: CLINICAL CASE MANAGEMENT AND PROBLEM-SOLVING TREATMENT

THE COURSE OF THERAPY

SOCIAL WORKER REFLECTIONS

CONCLUSIONS

REFERENCES

Case Study 6-5

AN OVERVIEW OF THE PROGRAM

WEEK 1: BEING A GIRL IN TODAY'S SOCIETY

WEEK 2: ESTABLISHING A POSITIVE SELF-IMAGE

WEEK 3: ESTABLISHING INDEPENDENCE

WEEK 4: MAKING AND KEEPING FRIENDS

WEEK 5: WHEN IT ALL SEEMS LIKE TOO MUCH

WEEK 6: PLANNING FOR THE FUTURE

CONDUCTING A SESSION: A CLOSER LOOK

CONCLUSIONS

REFERENCES

Part VII: Case Studies in Group Work

REFERENCE

Case Study 7-1

THE FIRST SESSION: THE BEGINNING PHASE

THE FOURTH SESSION: THE TRANSITION TO THE MIDDLE (WORK) PHASE

THE FINAL SESSIONS: THE ENDING AND TRANSITION PHASE

REFERENCES

Case Study 7-2

FORMING A GROUP FOR RELATIVES AND FRIENDS

PHASES OF WORK AND STRESSORS-IN-LIVING

INITIAL PHASE

ONGOING PHASE

TRANSITION AND ENDING PHASE

CONCLUSION

REFERENCES

Case Study 7-3

TEACHING SOCIAL SKILLS

STARTING THE GROUP

AN EXAMINATION OF THE TRAINING PROCESS

GROUP PROCESS ILLUSTRATED

PRACTICING SOCIAL SKILLS IN THE NATURAL ENVIRONMENT

CONCLUSION

REFERENCES

Case Study 7-4

CONCLUSION

REFERENCES

Part VIII: Case Studies in Diversity

REFERENCE

Case Study 8-1

THE ACCIDENT AND HOSPITALIZATION

NURSING HOME PLACEMENT

SOCIAL WORK ENGAGEMENT AND ASSESSMENT

SOCIAL WORK INTERVENTION

POSTLUDE

REFERENCES

Case Study 8-2

REFERENCES

Case Study 8-3

CONCLUSION

REFERENCES

Case Study 8-4

THE CASE OF MAI

DISCUSSION

REFERENCES

Part IX: Case Studies in Using Practice Evaluation

REFERENCES

Case Study 9-1

INTERVENTION

RESULTS

DISCUSSION

CONCLUSION

REFERENCES

Case Study 9-2

THE FAMILY AND THE FAMILY'S PROBLEMS

OVERVIEW OF TREATMENT TECHNIQUES

THE TREATMENT PROCESS

TERMINATION AND FOLLOW-UP

REFERENCES

Case Study 9-3

SCENARIO 1: ONGOING TREATMENT AND CASE MANAGEMENT

SCENARIO 2: LIMITED-CONTACT INTERVENTION

SCENARIO 3: CASE ACUITY AND HIGH-RISK ASSESSMENT

CONCLUSION

REFERENCES

READING LIST

Case Study 9-4

THE RESEARCH–PRACTICE GAP

GETTING ON THE SAME PAGE

IDENTIFYING CURRENT PRACTICES

STARTING SOMEWHERE

EXAMINING THE EVIDENCE

IMPLEMENTATION

LEARNING FROM THE EFFORT

REFERENCES

Key Words

Index

Cover Design: Wiley Cover Illustration: © Lisa Stokes/Getty Images

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Library of Congress Cataloging-in-Publication Data:

LeCroy, Craig W. Case studies in social work practice/Craig Winston LeCroy. — 3rd Edition. 1 online resource. Includes bibliographical references and index. Description based on print version record and CIP data provided by publisher; resource not viewed. ISBN 978-1-118-41899-4 (ebk.) — ISBN 978-1-118-41622-8 (ebk.) — ISBN 978-1-118-12834-3 (pbk.) 1. Social service—United States—Case studies. I. Title. HV91 361.3′20973—dc23

2013032295

To Kerry B. Milligan and the social workers of the world

Educational Policy and Accreditation Standards (EPAS) and Case Studies Crosswalk

The Council on Social Work Education’s EPAS has set forth recommendations for students of social work to master 10 competencies. Within each competency are practice behaviors that further define the core competencies. Case Studies in Social Work Practice addresses the 10 competencies within the various case studies presented in the book. The following table lists the competencies and the case studies that reflect the competency most directly. This may be helpful to both instructor and student in relating the educational material in the book to the core competencies for effective social work practice.

Educational Policy 2.1.1: Identify as a professional social worker and conduct oneself accordingly.

Educational Policy 2.1.2: Apply social work ethical principles to guide professional practice.

Educational Policy 2.1.3: Apply critical thinking to inform and communicate professional judgments.

Educational Policy 2.1.4: Engage diversity and difference in practice.

Educational Policy 2.1.5: Advance human rights and social and economic justice.

Educational Policy 2.1.6: Engage in research-informed practice and practice-informed research.

Educational Policy 2.1.7: Apply knowledge of human behavior and the social environment.

Educational Policy 2.1.8: Engage in policy practice to advance social and economic well-being and to deliver effective social work services.

Educational Policy 2.1.9: Respond to contexts that shape practice.

Educational Policy 2.1.10: Engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities.

Case Study Topic Areas Matrix

Preface

This book provides a different format to learn about social work practice than is currently available in traditional social work textbooks. My intent is to provide students with an accordingly different educational experience, which results from reading and thinking about case studies.

Case studies are an action-oriented educational tool because they provide students with an opportunity to vicariously participate in the process of doing social work practice. It is critical to provide an interesting educational atmosphere for effective adult education.

In order to achieve this goal, I have asked many different people, primarily teachers and social workers, to write case studies that reflect their experiences. More than 45 people helped contribute to this book. The people chosen to write case studies reflect the diversity of social work practice. As a result, each case study is unique in approach, content, and writing style.

I have always told my students that doing social work is much more exciting and gratifying than reading about social work practice. Because the case study method of teaching allows students to participate in social work, there is a corresponding increase in interest and motivation for learning.

The objective of Case Studies in Social Work Practice is teaching students about the process of doing social work. The book is appropriate to many classes at the undergraduate and graduate levels. At the undergraduate level, it may be used to teach students about the range and diversity of the social work profession. In this context, the emphasis is on the various fields of practice, the organizational setting, and the variety of roles that social workers embrace. At the graduate level, it may be used as the primary text or as a supplement to a more theoretical textbook, with the emphasis on understanding the complex variables involved in delivering social work services.

Case Studies in Social Work Practice is also designed to be useful as a textbook for field seminars. Here the focus is to help students learn to discuss cases within a social work frame of reference. The instructor can use the case material and emphasize the practice principles relevant for the particular class and level of the student.

FOR STUDENTS

This book was designed to make learning about social work interesting and exciting. In it you will find fascinating experiences that social work practitioners have shared about their work. The focus is on what social workers actually do as professionals—a picture of their day-to-day lives. As you read these case studies, think about being confronted with each situation yourself. How would you feel? What do you notice? What would you do? By doing this, you can vicariously participate in social work practice. This will give you important clues about whether this is the profession for you and where your interests are in the various fields of practice.

The purpose of this book is to help you learn to integrate theory and practice by studying how practitioners have applied general social work principles to real-world case situations. In order to facilitate learning, each case study begins with a series of questions. These questions are designed to stimulate critical thinking and promote class discussion.

Classroom discussions about the case studies will investigate judgments made by the practitioners, answer questions you have about social work practice, and reveal the limitations of textbook generalizations. In many instances, information in the case studies may be incomplete, and students’ opinions may be divided about the manner in which to intervene.

FOR INSTRUCTORS—HOW TO USE THIS BOOK

This book can be used in a variety of ways to teach students about social work practice. The book is designed to be used in a flexible manner, depending on your needs and the objectives of the particular course. Some suggestions for how this book might be used include:

Having students think about what they might have done differently and whyHaving students write out treatment plans based on the information presentedUsing the case studies to discuss the range of roles and skills needed by social workers in a variety of settingsHaving students describe and analyze policies, organizational factors, and community implications inherent in the case studiesHaving students gather theoretical and empirical studies that could have been useful to the social worker in the different case situations

With this kind of book, it is important for you to decide how you can best use the case material. In my experience, I have found some of the following ways of using case studies helpful:

The case studies can be used to get students to think like social workers. By reading the cases, students learn about the different environments that social workers must perform in, the decisions that social workers must make, and the importance of complex and competing factors in making those decisions. By vicariously participating in the practice of social work, students develop an understanding of how social work is performed, the social work environment, and human behavior in the social environment.Use the case studies to help students develop a social work frame of reference. Each chapter is an opportunity for students to explore the various aspects and roles of social work: advocacy, case management, community organization, clinical counseling, referral, resource development, mediation, evaluation, and so on. As a result of reading the case studies, students will develop skills in approaching various social work problems and an understanding of the function social workers perform.In order to stimulate student thinking and class discussions, each case study is preceded with a series of questions. The questions are designed to promote critical thinking and act as a catalyst for class discussion.The case studies can be used for class discussion with many positive benefits. With a group of students, many perspectives about the case will develop. Within this context, the instructor can examine with students their underlying theories and assumptions about human behavior and social work practice. The natural interaction and exchange of ideas and information will promote an atmosphere for critical discussion. Too often, students accept any approach to a case without critique and analysis. Group discussion of the cases can be a safe environment to teach students more critical problem-solving skills.Teach students to examine the facts and opinions in a case. Encourage students to take on the case situation and decide what they would do in some of the practice situations. Stimulate students to develop alternatives and choose the most effective course of action. Although each case contains its own particular approach to resolving a practice problem, each case also contains new problems to be addressed and new decision points that can be brought out in a class discussion.You may also wish to use the case material to conduct role-plays with the students. Students can be selected to act out the characters involved in the case study. As they take turns playing the social work practitioner, they will grapple with the real situations that social workers face in a variety of circumstances. You can provide students with feedback on skills and alternative courses of action. With experimentation you will find Case Studies in Social Work Practice to be an effective format for teaching social work practice.The case studies will stimulate students to think critically, analytically, and objectively about social work practice. Clear thinking skills are a necessity in social work, and the cases should be used to promote such skills. As students move from one case to the next, they will begin to develop an accumulation of experience in thinking and reasoning as applied to the very different problem configurations presented.

THE THIRD EDITION

It is very exciting to have a third edition of the Case Studies in Social Work Practice book! The overall organization of the text remains consistent with the first edition. The major changes include updating the case material and adding new cases. In particular, new material has been added that reflects newer changes in the field. For example, case studies have been added in areas such as mindfulness treatment, family systems approach, family drug courts, the use of supervision, multisensory interventions, geriatric depression, and the use of evidence-based practice. These changes, in addition to changes from the second edition, should have a broader appeal to social work students: undergraduates, foundation MSW students, and advanced MSW students. The book still maintains case material that represents both generalist practice and more specialized practice, both of which are needed in social work education. The goal of Case Studies in Social Work Practice continues to be the provision of case study material that is interesting and enlightening about the day-to-day practice of social work—material that is too often ignored in social work textbooks.

Acknowledgments

This book is the result of the many authors who agreed to graciously contribute a case study. Without them there would be no book, and I sincerely appreciate their efforts. Many people helped to make this a successful project. Emily Furrier and Molly Madeline Gebler were my research assistants, and they provided critical support in organizing and managing this project. Arizona State University, School of Social Work, provided the needed institutional support. The staff and editors at Wiley are to be thanked for their persistence in helping me get this material into the format of a publishable book. My longtime association with Peggy Alexander provided the impetus for this project, Rachel Livsey worked with me as the acquisition editor for this book, and Amanda Orenstein made sure the project was brought to completion. Lisa Gebo, now deceased, was responsible for making the second edition become a reality. Her vision and confidence in the case study approach to teaching social work is greatly appreciated.

About the Editor

CRAIG WINSTON LECROY is a professor in the School of Social Work at Arizona State University. He also holds appointments at the University of Arizona in the John & Doris Norton School of Family and Consumer Sciences, Family Studies and Human Development division, and the University of Arizona College of Medicine, Department of Pediatrics. He has been a visiting professor at the University of Canterbury, New Zealand; the Zellerbach Visiting Professor at the University of California at Berkeley; and a senior Fulbright specialist.

Professor LeCroy has published 10 books previously, including Parenting Mentally Ill Children: Faith, Hope, Support, and Surviving the System; First Person Accounts of Mental Illness and Recovery, Handbook of Evidence-Based Treatment Manuals for Children and Adolescents; Handbook of Prevention and Intervention Program for Adolescent Girls; The Call to Social Work: Life Stories, Case Studies in Child, Adolescent, and Family Treatment; Case Studies in Social Work Practice; Empowering Adolescent Girls: Examining the Present and Building Skills for the Future with the “Go Grrrls” Program; Go Grrrls Workbook; Human Behavior and the Social Environment; and Social Skills Training for Children and Adolescents.

Professor LeCroy has published more than 100 articles and book chapters on a wide range of topics, including mental health, the social work profession, home visitation, and research methodology. He is the recipient of numerous grants, including (as principal investigator or co-principal investigator) interventions for risk reduction and avoidance in youth (NIH), Go Grrrls Teen Pregnancy Prevention Program, evaluation of Healthy Families (a child abuse prevention program), a mental health training grant for improving service delivery to severely emotionally disturbed children and adolescents (NIMH), and Youth Plus: Positive Socialization for Youth (CSAP).

Contributors

Danie Beaulieu, PhD

Author of Impact Techniques

for Psychotherapists (Routledge)

and Eye Movement Integration

Therapy(EMI) (Crown House

Publishing)

Jennifer L. Bellamy, PhD

Assistant Professor

School of Social Service Administration

University of Chicago

Chicago, IL

Larry Bennett, PhD, LCSW

Professor

Jane Addams College of Social Work

University of Illinois at Chicago

Chicago, IL

Kia J. Bentley, PhD

Professor

School of Social Work

Virginia Commonwealth University

Richmond, VA

Betty Blythe, PhD

Professor

Graduate School of Social Work

Boston College

Chestnut Hill, MA

Charlotte Booth, MSW

Executive Director

Institute for Family Development Federal Way, WA

Yesenia Campos

Recovery Support Specialist

Pima County Family Drug Court

Tucson, AZ

Jeannine K. Chapelle, MAA

Associate Director of Community Initiatives

La Frontera Arizona, Inc.

Tucson, AZ

Kevin Corcoran, PhD

Professor

School of Social Work

Portland State University

Portland, OR

Martha Morrison Dore, PhD

Director of Research and Evaluation

Division of Child and Family Services

The Guidance Center/Riverside Community Care

and

Research Associate

Cambridge Health Alliance

Department of Psychiatry

Harvard University School of Medicine

Cambridge, MA

David R. Eddy, PhD

Clinical Director

Family Therapy Associates

Rockville, MD

Eric Garland, PhD, LCSW

Assistant Professor, College of Social Work

Assistant Director, Trinity Institute for the Addictions

Florida State University

Tallahassee, FL

Brent B. Geary, PhD

Director of Training

The Milton H. Erickson Foundation

Private Practice

Phoenix, AZ

Alex Gitterman, EdD, MSW

Zachs Professor of Social Work

Director of Doctoral Program

School of Social Work

University of Connecticut

Storrs, CT

Nancy Gladow, MA

Social Worker

Public Health

Seattle & King County

Seattle, WA

Kristen A. Gustavson, LCSW, PhD

Assistant Professor

School of Social Work

College of Public Programs, Arizona State University

Phoenix, AZ

Jan Jess, MSW

University of Kansas

School of Social Welfare

Lawrence, KS

Amber Kelly, LCSW

Private Practice

Gainesville, FL

Steven Krugman, PhD

Psychotherapy, Consultation,

and Coaching

Boston and Newton, MA

Jay Lappin, MSW, LCSW

Family Therapy Director

Centra PC

Marlton, NJ

Craig W. LeCroy, PhD, LCSW

Professor

School of Social Work

Arizona State University

Tucson, AZ

Cynthia A. Lietz, PhD, LCSW

Associate Professor

School of Social Work

Arizona State University

Tucson, AZ

Kathie Lortie, MSW

School Social Worker

Tucson Unified School District

Tucson, AZ

Randy H. Magen, PhD

Associate Dean, College of Health

Professor, School of Social Work

University of Alaska

Anchorage, AK

Deana F. Morrow, PhD, LPC, LCSW, LISW-CP, ACSW

Department Chair and Professor

Department of Social Work

Winthrop University

Rock Hill, SC

Paula S. Nurius, PhD

Grace Beals-Ferguson Scholar and Professor

Director, Prevention Research Training Program

School of Social Work

University of Washington

Seattle, WA

Carl Oekerman, MS

Instructor, Psychology/Communications

Bellingham Technical College

Bellingham, WA

Myrtle Parnell, MSW

Warwick, NY

Susan K. Parnell, LCSW

Court Mediator

Pima County Juvenile Court Center

Tucson, AZ

Shirley L. Patterson, PhD

Emeritus Professor

School of Social Work

Arizona State University

Tempe, AZ

Peter J. Pecora, PhD

Managing Director of Research Services,

Casey Family Programs

Professor, School of Social Work

University of Washington

Seattle, WA

Catherine Sammons, LCSW, PhD

Private Practice

Los Angeles, CA

Lawrence Shulman, MSW, EdD

Emeritus Professor and Dean

School of Social Work

University at Buffalo

Buffalo, NY

Christine Swenson-Smith, MSW

Division Director

Pima County Juvenile Court

Tucson, AZ

Frances E. Tack, MS, LPC, LCAS, CCS

Program Chair

Substance Abuse Program

Central Piedmont Community College

Charlotte, NC

Barbra Teater, PhD

Senior Lecturer in Social Work

University of Bristol, UK

Bruce A. Thyer, PhD, LCSW

Professor of Social Work

Florida State University

Tallahassee, FL

Richard M. Tolman, PhD

Professor

School of Social Work

University of Michigan

Ann Arbor, MI

Jo Vanderkloot, LCSW

Private Practice

Warwick, NY

Joseph Walsh, PhD, LCSW

Professor of Social Work

School of Social Work

Virginia Commonwealth University

Richmond, VA

PART I

Case Studies in Generalist Practice

The idea of generalist practice is an old one. The origins of the generalist concept are as deep as the social work profession itself. Social work pioneers such as Mary Richmond and Jane Addams have stressed the importance of understanding people in relation to their environment. The social workers’ long-standing commitment of a dual focus on the individual and on the society supports the fundamental notions of generalist practice.

Although the notions of generalist practice are old, the emphasis of a generalist perspective in social work reemerged as social work programs began to offer Baccalaureate of Social Work (BSW) degrees. The BSW programs, as stipulated by the Council on Social Work Education, required education from a generalist perspective. Currently, most BSW programs focus their curricula on generalist practice, and MSW programs use the first year, or foundation year, for education on the generalist approach to practice. As Landon (1995, p. 1102) concludes, “in the quest for a theory for this broad practice base, social work education adopted notions from general and social systems theories and ecological thinking to undergird the foundation for all practice.”

Generalist practice has reemerged as central to social work education. But what exactly is generalist practice? How is it defined? Not surprisingly, there is no one definition of generalist practice. However, important themes emerge in the various definitions.

Several generalist social work practice books describe generalist practice as beginning with a decision as to what the unit of attention should be—an individual, a family, a small group, an agency or organization, or a community (Johnson & Yanca, 2009; Krist-Ashman & Hull, 2008). The generalist model promotes a multimethod and multilevel approach, an eclectic theory base, and the dual perspective of social work. Schatz, Jenkins, and Sheafor (1990) generated a three-level model of generalist practice:

1. The generic or foundation level of knowledge necessary for all social workers, regardless of later specialization, includes the purposes, values, focus, and knowledge base of the profession.

2. The initial generalist level includes competency in direct and indirect practice based on multilevel assessment and the capacity to intervene on multiple levels, perform various practice roles, and evaluate practice ability.

3. Generalist practice at the advanced level delineates knowledge needed for practice in greater depth and in relation to more complex and technical issues.

Lastly, any discussion of the generalist perspective would be remiss to omit a discussion of the ecological perspective. The underlying theory of social work is rooted in social systems theory, particularly ecological-systems theory. Gitterman and Germain (2008, p. 20) describe the theoretical underpinnings of an ecological perspective, or what they refer to as the life model:

Ecology is a science concerned with the relations between living organisms—in this case, human beings and all the elements of their environments. It is concerned with how organisms and environments achieve a goodness-of-fit or adaptive balance and equally important, how and why they sometimes fail to do so.

Ecological-systems theory provides an understanding of the person-in-environment perspective, stressing how critical interactions occur between individuals and their environments. This model directs social work practice at the interface of these systems and helps social work practice maintain a dual emphasis. Social workers assess an individual in relation to the opportunities and obstacles that exist in one'S environment.

In this chapter you will read three case studies that explicitly address a generalist perspective in social work practice. The first case study by Patterson, Jess, and LeCroy describes an ecological perspective and shows why it is considered the cornerstone of good generalist practice. It takes the fundamental concepts from ecological theory and illustrates how they can be used in direct social work practice. The case study demonstrates how the notions of ecological theory are tantamount to generalist social work practice.

The case study by Lortie presents a complex situation for a social worker in a hospital setting. It elucidates how generalist practice with a person-in-environment perspective must consider the resources available to a person. It is an excellent example of how critical good case management can be and shows that case management services represent social work at the interface of the person and the environment. A lot of social work practice revolves around helping individuals cope with a difficult environment. In addition to helping them cope on an individual basis, we must help bring services to bear on their problems.

The last case by Chapelle extends the generalist model to community-based work. Too often, social work is focused narrowly on the individual. As this case demonstrates, good social work practice can take place at the community level. Using basic concepts of community practice, this case shows how a social worker can approach large-scale change in a community.

Together these cases represent a sample of how direct-line practitioners view generalist practice. It should give you a good, practical feeling for what it means to do generalist practice. Also, it should alert you to the difficulties and complexities of doing good social work. When our attention is focused on personal problems and social concerns, multilevel methods, and ecological understandings, we are faced with drawing on a broad range of skills and abilities. Social work practice offers a challenge for those who want to tackle social problems but need a large toolkit.

REFERENCES

Gitterman, A., & Germain, C. B. (2008). The life model of social work practice: Advances in theory and practice (3rd ed.). New York, NY: Columbia University Press.

Johnson, L. C., & Yanca, S. J. (2009). Social work practice: A generalist approach (10th ed.). New York, NY: Pearson.

Krist-Ashman, K. K., & Hull, G. H. (2008). Understanding generalist practice. Pacific Grove, CA: Brooks Cole.

Landon, P. S. (1995). Generalist and advanced generalist practice. In R. L. Edwards (Ed.), Encyclopedia of social work (19th ed., pp. 1101–1108). Washington, DC: National Association of Social Workers.

Schatz, M., Jenkins, L., & Sheafor, B. (1990). Milford redefined: A model of initial and advanced generalist social work. Journal of Social Work Education, 26, 217–231.

Case Study 1-1

Using the Ecological Model in Generalist Practice: Life Transitions in Late Adulthood

SHIRLEY PATTERSON, JAN JESS, AND CRAIG WINSTON LECROY

This case uses the ecological perspective as a guide to generalist practice. This perspective offers a framework for how the social worker organizes her work and helps the client cope with a serious life transition.

Questions

1. Why is the ecological perspective considered a good framework for generalist practice?

2. What were the essential skills and abilities the social worker used in this approach?

3. How were ecological concepts used to help the social worker?

4. How was the concept of person and environmental fit used in this case?

I met Mrs. Lilly Goodman at the medical center in Kansas City on the long-term care unit where I work. She is a 77-year-old woman who is thin, small in stature, with straggly gray hair, who peers at you above her glasses, which keep slipping down her nose. When I met her for the first time, I was struck by her sad demeanor. However, as I got to know her, I came to love her wry sense of humor that is often masked to those who do not know her well.

Mrs. Lilly Goodman has been a hard-working laborer all of her life. She grew up in poverty—living in apartments and moving frequently as her father sought new work opportunities. She was not encouraged to go to school and, in fact, quit school after completing a fifth-grade education. Despite this, she is a well-spoken woman who is articulate, well-read, and has seized new learning opportunities all of her life.

Mrs. Lilly Goodman began work as a “cleaning lady” at 12 years old and has been doing it ever since, until she became too frail to continue. She recounts the very day she could not work anymore: “It was about half past noon when I bent over to put fresh sheets on the bed. As I tried to straighten up, my back experienced sharp shooting pains and I knew that I could not work any longer.” As she tells me about her life, I can sense the confident, proud woman that she is. As she talks, you quickly get to know that one of her greatest achievements and joys is her home. She bought and paid for her own home, and she is very proud of having accomplished this goal. Also, her home is a central source of comfort: “I have lived in my home now for 30 years. I have one of the neighborhood'S best gardens. My neighbors stop by to see me on a regular basis.”

I try to think back to what life must have been like for her prior to landing in the hospital. I can see her getting up early in the morning to tend to her flowers, sitting and reading in an old overstuffed chair, and having a few old friends over for afternoon tea. Everything is different now. Her independence has come to an end, and she has not had much time to prepare for it. After suffering two strokes, one right after the other, and developing crippling and painful arthritis, I know that her life must have changed dramatically.

She, however, has not accepted these changes. Mrs. Goodman has consistently told the hospital staff that she plans to return home to live as soon as she gets out of the hospital. Because staff were unsure about the possibility of her returning to home, I was brought in as the long-term care social worker. Mrs. Lilly Goodman did not directly ask for help, but she willingly accepted my offer for help, proffered help—I was reaching out to her.

An ecological perspective was used in thinking about and guiding my approach to practice (Gitterman, 2009; Gitterman & Germain, 2008). From an ecological perspective, Mrs. Lilly Goodman is best understood as someone who is in a life transition. She is at a place in her life where she is facing a major transition—from an independent person who took care of herself to a person who is dependent and needs some assistance. There are three aspects of her life transition that help in thinking about how to offer her help:

Her developmental stage

Her change in status and roles

The crises she faces

Mrs. Lilly Goodman is in the final stages of growth. The developmental stage that confronts her has a biological base, and the associated tasks of this stage of development arise out of biological pressures and the social and physical environment. In other words, her residency in long-term care is not of her own choosing; rather, it is a result of illness, limited resources, and lack of family support.

Mrs. Lilly Goodman is also being thrust into some very new statuses, none of which she is particularly happy about. These include being:

A resident of a nursing home

A displaced homeowner

A dependent person

An older adult with fairly limiting health problems, which are difficult for her to accept

In addition to new statuses, Mrs. Lilly Goodman has new roles that she must adapt to, including being:

A lucid, ambulatory resident among many residents who are neither

A protected mother (and mother-in-law) in a sheltered environment

A welfare recipient, who receives Medicaid to supplement her social security that pays for her care in the long-term care unit

These roles are a striking contrast to the Mrs. Lilly Goodman of only a few months ago—someone who lived independently, tended her garden, cared for her home, and shared tea in the afternoon with friends.

As the team of workers at the hospital staffed this case, they recognized that Mrs. Lilly Goodman faces several life stressors. They are considered critical life stressors because they are situations that exceed the personal and environmental resources she has for managing them. The critical life stressors she faces include:

Loss of health

Denial of the limitations her strokes have caused

The threat of losing her home

Her daughter'S poor health, which prevents her from providing her mother with support

Client strengths are an important part of the ecological model (Gitterman & Germain, 2008). As I thought about Mrs. Lilly Goodman, I needed to be aware that there is an innate strength in her—toward health, continued growth, and the development of new potentials. Although many of the people on the team exclusively discussed her limitations and what she could not do, I was always quick to point out her strengths—what she could do. As a social worker focused on helping Mrs. Lilly Goodman obtain self-determination, I empathized with her desire for discharge in order to live in her own house. Out of respect for her, I wanted to honor her wishes. Also, I knew that health could not be easily separated from obtaining satisfaction and meaning in life.

USING THE ECOLOGICAL MODEL TO GUIDE PRACTICE: A TEAM APPROACH

As the team members began to get to know Mrs. Lilly Goodman, they could see a determined woman who really did deserve an opportunity to try to return home. The team agreed that this was a reasonable goal that everyone could help her achieve. We set about a specific set of actions to make this happen.

Being in the long-term care unit had taken an emotional toll on Mrs. Goodman. Over time she had become increasingly despondent. The first goal was to rejuvenate her passion to seek a more meaningful life. To do this, we agreed to provide her with our support to supplement the limited support she received from her daughter in her wish to return home. We spent time talking with Mrs. Goodman about her home—getting her to tell us what it was like and to describe what her priorities would be when she returned. One team member who is an amateur artist sat down with Mrs. Goodman and drew a picture of her house—the outside and inside. You could observe an instant impact from this intervention. This helped shift her focus away from being a “patient” and helped her focus on what she wanted to achieve.

The team knew that to release Mrs. Lilly Goodman back to her home, they would have to be confident that she could function independently. This called for an assessment of the feasibility of discharge. To conduct this assessment, different team members took on separate tasks.

The occupational therapist conducted a cooking evaluation with Mrs. Goodman. This was done in the hospital occupational therapy kitchen. The assessment did not focus on her skills of cooking but on her stamina in cooking for herself. Mrs. Goodman rather enjoyed this challenge. Trying these tasks gave her an opportunity to show others what she could do. Each team member was instructed to help emphasize the positive competencies that she was able to demonstrate. Indeed, Mrs. Goodman did have the necessary stamina for cooking.

The nurse set out to help Mrs. Goodman plan daily activities while she was still on the long-term care unit. This was done to help her develop the stamina to live alone and care for herself. Mrs. Goodman was encouraged to take on increasing amounts of daily living activities. Also, to improve her physical stamina, the nurse worked with her to increase the amount of walking she could do.

As the social worker on the unit, I helped Mrs. Goodman assess what resources and support she would need when she returned home. I talked with her about the kinds of resources other older persons I had helped found useful, such as homemakers, visiting nurses, meals-on-wheels, transportation, telephone reassurance, neighborly support, and the kinds of supplemental income she might be eligible for when she returns home. I also helped Mrs. Goodman realize that she was facing new changes in her life and that she had a lot of adaptations to make. I wanted her to become more accepting of her new challenges. I tried to help her see that she could face these new challenges with new solutions. Although adaptations had to be made, some resources could help make those adaptations easier.

Our work culminated when we decided to take Mrs. Lilly Goodman to her home for a visit. This allowed the team to make further assessments to bolster our confidence that she would be able to go home. In particular, we wanted to assess her physical environment. How easy was it for her to manage her home environment? Was her cooking stove easy to operate? Would she be able to run a bath for herself? How would she get the laundry done? We also examined the outside environment. How easy would it be for her to take the trash out? What kind of neighbors did she have? Would they be able and interested in helping her occasionally? We wanted to know what kind of support was available to her in her social environment. As we assessed the daily skills needed to operate a home, we could see how difficult it was for someone like her—with two strokes and painful arthritis.

Lastly, the team brought Mrs. Goodman and her daughter together for discussion of the home assessment and to provide specific information about finances, the daughter and son-in-law'S support, and how the daughter felt about her mother'S wish to go home. The team wanted to assess the quality of Mrs. Goodman'S interpersonal interactions.

These assessments were focused on action, which takes place in physical, social, and interpersonal environments. The team approach operationalized the notion of treating Mrs. Lilly Goodman as a whole person. We were attempting to deal with all aspects of her life in order to facilitate a smooth life transition. From an ecological perspective, when habitats are rich in resources required for growth and development, then human beings thrive. However, when habitats are deficient in vital resources, then physical, social, and emotional functioning are adversely affected.

The primary function of the social worker in addressing life transitions is to help people move through stressful life transitions—to help them adapt and cope. The social worker acts simultaneously as an enabler, facilitator, and teacher. Our work with Mrs. Lilly Goodman certainly sought to enable her by embracing her desire to return home as an important way to help her cope with her life transitions. We helped her develop a plan to return home and helped her assess that plan realistically. We sought to empower her as an individual.

Overall, the team acted as facilitators by serving several different functions. The team supported Mrs. Lilly Goodman'S competence through building her skills. We set realistic and measurable goals. For example, we made a contract with her to take more walks in the long-term care unit and assume responsibility for her medication. This aided her stamina and gave her renewed confidence in her own abilities.

We mobilized environmental supports by encouraging Mrs. Lilly Goodman'S participation in an organized group in the hospital that was discussing discharge planning. We helped shift her focus from “patient” to consumer. In so doing, we helped her recognize that resources are available to her and that they can be used to help her meet her goals. She became more active and involved in working with us.

We also actively sought to help her develop a sense of self-direction. We knew that to empower her, she would have to take some degree of control over her life and accept increasing responsibility for her decisions and actions. Making age- and health-appropriate decisions and taking purposeful action was key to helping her fulfill her wish to return home. Team members facilitated this by setting up problems that she had to solve. For example, when it was decided that we should visit her home, she had to make the arrangements with her daughter to secure the house key. Although these actions were small, together they combined to create a new sense of self-direction.

Teaching was an important function in helping Mrs. Lilly Goodman. I took a major role in teaching her several critical skills. For example, I provided pertinent information about how she could manage following discharge from the hospital. This included not only talking about community resources but also teaching her exactly how to use these resources: where to find them, how to contact them, what to say to them, and how to follow up on contacts made. I knew from past experience that too often social workers only talk about resources rather than teach clients how to use resources.

Although ultimately Mrs. Goodman decided that she did want to return home, I provided a great deal of education concerning other alternatives that would be available to her. I helped her learn about the range of available options, such as assisted living, boarding homes, and the like. Although none of these alternatives were what she wanted, it helped her see that when you are facing difficult life decisions, resources are available to help you find the best fit for your circumstances.

My teaching also included helping her restructure her perceptions about certain issues. In particular, her reliance on her daughter'S moral support and her own continued insistence that she could still care for herself as she had always done in the past. Lastly, the team members taught her the importance of systematic problem solving, which takes into consideration the individual abilities of the person and the resources available to the person. The problem-solving process was highlighted when we asked Mrs. Goodman and her daughter to meet with us to discuss what needed to be considered for a feasible and safe discharge.

CONCLUSIONS

This case study described the elements of the ecological perspective in recognizing and dealing with an older adult'S life transition. The approach included understanding the developmental stage, the changes in status and roles, and the life stressors present in Mrs. Goodman'S final stage of growth and development. The social worker—in conjunction with a team of professionals—worked to enable, teach, and facilitate discharge planning for the client. Of course, the unanswered question is: Did Mrs. Lilly Goodman go home?

She did not. After all the planning and work, she decided that the obstacles were too many and the support insufficient. In effect, there was not a good enough fit between her individual abilities and the resources and support in the environment. In the end, it was her decision, which made her subsequent adaptation much easier. Mrs. Lilly Goodman benefitted tremendously from the work the team had done. She made progress toward adaptation and learning to cope with her nursing home “home.” She still is not completely satisfied, but now when she talks about going home, she adds, “I’d like to, but I’m not sure I can. I’m not the same person I used to be.”

Further adaptation occurred for Mrs. Goodman a year later when she assumed a resident leadership role by assisting the long-term care professional team in designing an outdoor space for the residents to enjoy, spring through fall. Materials and labor for this project were donated by a local construction company, a concrete company, and a landscape nursery. The outdoor living space consisted of lovely tree and shrub plants, picnic tables and benches, comfortable seating areas, and a raised garden bed that accommodated wheelchairs. The latter, of course, was Mrs. Goodman'S idea. As I look from my office window, I often see her tending her own flowers and helping other residents tend theirs.

REFERENCES

Gitterman, A. (2009). The life model. In A. Roberts (Ed.), The social workers’ desk reference (2nd ed., pp. 231–234). New York, NY: Oxford University Press.

Gitterman, A., & Germain, C. B. (2008). The life model of social work practice: Advances in theory and practice (3rd ed.). New York, NY: Columbia University Press.

Case Study 1-2

Finding Resources: Case Management With Childhood Chronic Illness

KATHY L. LORTIE

Finding resources for families is one of the most important functions for social workers. This case study describes the social worker'S effort to find resources for a family with a very sick child.

Questions

1. What were the social worker'S goals in this case?

2. What resources were identified for this family?

3. How could the family have been helped to better use the resources that were available?

4. Why were resources critical to the success of this case?

Today, Jeffrey asked me to have lunch with him. It'S been so long since a guy asked me to lunch that I was startled for a moment, but then I accepted, especially since I was kind of down and Jeffrey is a bright 12-year-old with cystic fibrosis who has spent the past week in the hospital where I am a pediatric social worker. Every day he has been stopping by my office to borrow the Game Boy or ask for candy, and today he said, “So, do you eat lunch?”

“Yes, I do.”

“Do you like to eat here in the hospital cafeteria?”

“Usually that'S all I have time for.”

“I have a cafeteria pass. I’ve been eating in the cafeteria.”

“I saw you there yesterday with your grandmother.”

“When are you going to eat lunch today?”

“When I finish these phone calls.”

“Would you like to eat with me, in the cafeteria?”

How could I say no? So we went to lunch, and he forgot to bring his medicines that he has to take before every meal to help with his digestion. I had to call his nurse, who said she would give the medicines to me if I came back to the floor for them. So I climbed the stairs, got the medicines, and rushed back to the cafeteria, collected Jeffrey from a table he had chosen that had no seats left for me, and we sat down to lunch.

During our conversation, he asked, “So what do you do?” And I tried to explain to a 12-year-old my job of hospital social worker, which coincidentally had earlier that week involved having a letter sent to his school asking that he be encouraged to remember to take his medicines every day before lunch. I briefly explained how, in addition to working with upset families, dealing with crisis situations, and contracting with children to take their medicines, I help people get things they need, solve problems, and find resources. And Jeffrey looked at me seriously and said, “That'S easy. You have an easy job. You just help people get stuff.”

I didn’t mention the long hours of overtime for which I do not get paid, or the doctors who ask me to do the impossible for their patients and then fail to call me back when I page them, or seeing the sad eyes of parents whose babies die. And I didn’t mention how the long hours are worth it when the doctors tell me I’m awesome, or when a child who was near death in our pediatric intensive care unit walks back into the hospital for a visit and gives me a hug. So just for you, Jeffrey—though you may not understand it all—because you asked and because the job sounds so easy, here'S a story about what I do to help people “get stuff.”

Late in the work day, I usually check with the inpatient units to see if there are any last-minute problems before I leave for the day. On this particular day about eight months ago, I went to the infant and toddler unit about 4:30 p.m. One of the pediatric doctors approached me and said, “Sometimes you seem to be able to work miracles with patients, and we have a family coming in that sure could use one. They are, to put it mildly, a social disaster. The patient is a 7-month-old baby boy who needs a liver transplant. The family has just moved to town to place the baby on the transplant list and wait for a liver. We think Child Protective Services (CPS) is involved with the family for noncompliance with medical care. The baby is very sick, the father is unsupportive, and the mother is not with it. If they can’t get their act together, the baby will have to be taken away from them in order to qualify for the transplant. We were hoping you could help us out.”

The next morning, I met the family. One of my colleagues, the social worker for the liver transplant team, had completed a psychosocial assessment, and she gave me a copy. Her job was to assess the family and recommend whether they met the criteria to be placed on the transplant list. In this case, the family was intact and consisted of the parents, Joe and Rosa, and their four children. In addition to the baby, Nathan, they had three girls aged 5, 7, and 9. Joe worked construction and Rosa took care of the children. Joe'S family lived in a city about two hours away. Joe and Rosa had recently left that city to be closer to the hospital for the liver transplant. They had a small two-bedroom apartment and one old car. One of baby Nathan'S problems was “failure to thrive,” meaning that his height and weight were below the fifth percentile for his age. The transplant team'S assessment was that Nathan needed to improve his nutritional status and gain weight before he would be eligible for the transplant. I decided my job was to do what I could to help the family meet those criteria.

I spent a lot of time that morning talking to Rosa about her problems in caring for Nathan. She explained, “This is so hard. I have to do it all myself. Joe doesn’t help. Nathan cries all day to be held. I have three other children to take care of. I have to cook, clean, wash clothes, shop, and carry Nathan around all day. Joe comes home at night and wants to know what I did all day. Why is the apartment so dirty? Why isn’t dinner ready? Joe'S family lives 2 hours away, but no one will come and help. They didn’t even help when we lived there. Everyone thinks I should be able to do this on my own. But I am just so tired.”

Then I talked to Joe, who said, “I have to work in order to make money to provide a home and food for my family. If I don’t work, I don’t get paid. Then where do we live, what do we eat? I work hard all day, sometimes 10 to 12 hours. I come home, the apartment is dirty, there'S nothing to eat, the baby is crying. My wife should be able to take care of the home while I work. I’m so tired when I get home.”

After talking to them, I realized this was a story I hear all the time from families of chronically ill children. Caring for a child with complicated medical needs takes so much time and energy that there can be little left for the basic necessities of life. Caring for a sick child places added stress on a family, especially when that family is already stressed from inadequate resources, poor finances, and isolation. The problem is even worse for a single parent. How does a single parent work and meet the health needs of the child? How does a single parent find a childcare worker who can administer medication, perform treatments, recognize emergency situations, and not cost more than the parent earns at work?

In talking with parents of chronically ill children, I have often brought up the subject of counseling. Rosa gave the common response to this suggestion: “I’ve had counseling. The counselor says, ‘Tell me all your problems.’ So I do. Then the counselor says, ‘Now don’t you feel better?’ Well, I don’t. I don’t need to talk about my problems, I need to do something about them. I don’t need someone to talk to, I need someone to hold this baby so I can cook dinner.” Rosa'S experience with her chronically ill child is similar to that of parents with other disabled children (King & Meyer, 2006). Moersch (1978) observes:

Parents need the understanding of professionals, but they also need concrete services to help them in managing and living with the . . . child. Some parents . . . have reported that they always had plenty of people to talk with them about their feelings . . . but it was very hard to find someone who could tell them what to do with feeding, toileting, or behavior problems.

It is even harder to find someone to help do those things with the child.

A social worker is in a unique position to help the family find whatever resources are available to help the family cope. In working with chronically ill children and their families, the use of social work does not change the course of the disease, but it does help families address the cumulative impact of the challenges they face. A central role for the social worker is in linking services to the needs of the child and family—with a focus on not just the child but the entire family facing the crisis.

My first task was to assess the family'S current resources. They had a place to live, the baby had the state'S healthcare insurance, the father had a job, and the baby was receiving Supplemental Security Income ($484 per month), which is available to families caring for a chronically ill, disabled child. In their hometown, the state'S health insurance plan had assigned a case manager to the family to help with resources. After meeting this overwhelmed family, however, that case manager had called Child Protective Services (CPS). The CPS worker concluded that the family was doing the best they could under the circumstances. CPS offered the mother a parent aide, but then the family moved to our city and CPS closed the case. The family was very angry at the insurance case worker. I usually try not to get CPS involved when a family is apparently doing their best with what they have. In these situations, I involve CPS only as a last resort when all else has failed. Calling CPS, as this case illustrates, risks alienating the family from the healthcare team. Joe asked for a new case worker from the insurance company.

After investigating all of the above, I assessed that the following services might be available to this family:

A local children'S shelter provides volunteer parent aides to visit families who are at risk once a week. I called this service, and they were willing to move Nathan'S family to the top of the waiting list and assign a parent aide immediately.Being diagnosed as “failure to thrive” placed the baby at risk of developmental delay and made him eligible for Department of Developmental Disabilities (DDD) services. These services include home visits by a developmental specialist, case management, and respite care in the home. I made a referral and asked them to expedite the intake procedure.The state provides long-term care benefits to patients with chronic illness and disability. These benefits include home nursing, physical therapy, occupational therapy, and respite services. I started the application process.When parents are in the hospital with a sick child and spend most of their day with that child, they often have to eat in our hospital cafeteria. This expense can add up over time. I give families a meal ticket to eat in our cafeteria when they have no money, are from out of town, and sometimes when I just can’t think of anything else I can do for them. I gave Nathan'S parents a meal ticket for lunch in the cafeteria about once a week.

The baby was discharged home. I thought the family now had some concrete resources to help them meet their child'S healthcare needs. However, things did not turn out as I had planned. Rosa contacted the parent aide program and decided that because the aide would only come out and talk to her and not hold the baby while she cooked, she did not need this service. Rosa failed to return the calls of the DDD intake worker and never set up an appointment. Rosa tried to keep her appointment with the long-term care office but got lost on the way and never found the office. Joe lost his job and had to go on unemployment. Nathan missed two doctor appointments because Rosa forgot one and didn’t have transportation for the other.

The baby was then readmitted to the hospital, still losing weight, and started on tube feedings through his nose into his stomach. The doctors were now very concerned about the family'S ability to cope with these tube feedings at home. I began to worry about the family'S ability to properly care for the baby. Families can be overwhelmed, but they still must find a way to meet the needs of the child, or that child may be in danger.