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(BQ) Part 1 book Fundamentals of case management practice - Skills for the human services has contents: Ethics and other professional responsibilities for human service workers; case management - definition and responsibilities, cultural competence, attitudes and boundaries, asking questions,...and other contents.
www.downloadslide.com www.downloadslide.com This is an electronic version of the print textbook Due to electronic rights restrictions, some third party content may be suppressed Editorial review has deemed that any suppressed content does not materially affect the overall learning experience The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest www.downloadslide.com FOURTH EDITION FUNDAMENTALS OF Case Management Practice Skills for the Human Services Nancy Summers Harrisburg Area Community College Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States www.downloadslide.com Fundamentals of Case Management Practice, Skills for the Human Services, Fourth edition Nancy Summers Publisher/Executive Editor: Linda Schreiber-Ganster Acquisitions Editor: Seth Dobrin © 2012, 2009, 2006 Brooks/Cole, Cengage Learning ALL RIGHTS RESERVED No part of this work covered by the copyright herein may be reproduced, transmitted, stored or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher Assistant Editor: Naomi Dreyer Editorial Assistant: Suzanna Kincaid Technology Project Manager: Elizabeth Momb Marketing Manager: Christine Sosa Marketing Coordinator: Gurpreet Saran Marketing Communications Manager: Tami Strang For product information and technology assistance, contact us at Cengage Learning Customer & Sales Support, 1-800-354-9706 For permission to use material from this text or product, submit all requests online at cengage.com/permissions Further permissions questions can be emailed to permissionrequest@cengage.com Senior Art Director: Jennifer Wahi Library of Congress Control Number: 2011924386 Print Buyer: Rebecca Cross ISBN-13: 978-0-8400-3369-7 Rights Acquisition Specialist (Text): Isabel Saraiva ISBN-10: 0-8400-3369-9 Cover Designer: The Resource Agency Cover Image: Getty Images Production Service: PreMediaGlobal Content Project Management: PreMediaGlobal Brooks/Cole 10 Davis Drive Belmont, CA 94002-3098 USA Cengage Learning is a leading provider of customized learning solutions with office locations around the globe, including Singapore, the United Kingdom, Australia, Mexico, Brazil, and Japan Locate your local office at: international.cengage.com/region Cengage Learning products are represented in Canada by Nelson Education, Ltd For your course and learning solutions, visit academic.cengage.com Purchase any of our products at your local college store or at our preferred online store www.cengagebrain.com Printed in the United States of America 15 14 13 12 11 www.downloadslide.com To my parents, whose humor and wisdom about people and relationships formed the foundation for my work with others www.downloadslide.com Contents Preface Section xiii Foundations for Best Practice in Case Management Chapter Ethics and Other Professional Responsibilities for Human Service Workers Introduction Language and Ethics Dual Relationships Value Conflicts The Rights of Individuals Receiving Services 10 Confidentiality 13 Privacy 17 Health Insurance Portability and Accountability Act 17 Social Networking 20 Privileged Communication 21 When You Can Give Information 21 Diagnostic Labeling 24 Involuntary Commitment 25 Ethical Responsibilities 26 Protecting a Person’s Self-Esteem 27 Stealing from Clients 29 Competence 30 Responsibility to Your Colleagues and the Profession 31 Professional Responsibility 33 Summary 34 Talk it Over 34 Exercises I: Ethics 34 Exercises II: Ethically, What Went Wrong? 37 Exercises III: Decide on the Best Course of Action 41 Exercises IV: What is Wrong Here? 42 Chapter Case Management: Definition and Responsibilities Introduction 43 A History of Case Management 44 Why We Use Case Management 44 Assessment 45 Planning 46 Creating an Individualized Plan 49 Linking 52 iv Contents 43 www.downloadslide.com Monitoring 53 Advocacy 53 Service Coordination 55 Levels of Case Management 57 Separating Case Management from Therapy 59 Case Management in Provider Agencies 60 Managed Care and Case Management 61 Underlying Principles: Hope and Self-Determination 63 Generic Case Management 65 Summary 65 Exercises I: Case Management 66 Exercises II: Decide on the Best Course of Action 69 Chapter Applying the Ecological Model: A Theoretical Foundation for Human Services 71 Introduction 71 Seeking a Balanced View of the Client 72 The Three Levels 74 Looking at What the Person Brings 74 Looking at What the Context Brings 75 Developmental Transitions 76 Developing the Interventions 77 Working with the Generalist Approach 78 Macro Level Interventions are Advocacy 79 Summary 79 Exercises I: Looking at Florence’s Problem on Three Levels 80 Exercises II: Designing Three Levels of Intervention 81 Section Useful Clarifications and Attitudes Chapter Cultural Competence 85 Introduction 85 Culture and Communication 85 Your Ethical Responsibility 86 Where Are the Differences? 86 Strangers 88 Anxiety and Uncertainty 89 Thoughtless versus Thoughtful Communication Dimensions of Culture 94 Obstacles to Understanding 99 Competence 101 Summary 102 Exercises I: Testing Your Cultural Competence 90 103 Chapter Attitudes and Boundaries 107 Introduction 107 Understanding Attitudes 107 Basic Helping Attitudes 108 Reality Check 111 How Clients Are Discouraged 111 Understanding Boundaries 114 Contents v www.downloadslide.com Seeing Yourself and the Client as Completely Separate Individuals 114 Erecting Detrimental Boundaries 116 Transference and Countertransference 116 Summary 117 Exercises I: Demonstrating Warmth, Genuineness, and Empathy 118 Exercises II: Recognizing the Difference—Encouragement or Discouragement 123 Exercises III: Blurred Boundaries 124 Chapter Clarifying Who Owns the Problem 127 Introduction 127 If the Client Owns the Problem 128 If You Own the Problem 131 If You Both Own the Problem 131 Summary 132 Exercises I: Who Owns the Problem? 133 Exercises II: Making the Strategic Decision 135 Section Effective Communication Chapter Identifying Good Responses and Poor Responses Introduction 137 Twelve Roadblocks to Communication 138 Useful Responses 142 Summary 150 Exercises: Identifying Roadblocks 150 Chapter Listening and Responding 153 Introduction 153 Defining Reflective Listening 154 Responding to Feelings 154 Responding to Content 158 Positive Reasons for Reflective Listening 160 Points to Remember 160 Summary 162 Exercises I: How Many Feelings Can You Name? Exercises II: Finding the Right Feeling 162 Exercises III: Reflective Listening 163 Chapter Asking Questions 169 Introduction 169 When Questions Are Important 170 Closed Questions 170 Open Questions 171 Questions That Make the Client Feel Uncomfortable 172 A Formula for Asking Open Questions vi Contents 173 162 137 www.downloadslide.com Summary 175 Exercises I: What Is Wrong with These Questions? 176 Exercises II: Which Question Is Better? 178 Exercises III: Opening Closed Questions 179 Exercises IV: Try Asking Questions 181 Chapter 10 Bringing Up Difficult Issues 183 Introduction 183 When to Use Confrontation 184 The I-Message in Confrontation 185 Asking Permission to Share Ideas 190 Advocacy: Confronting Collaterals 190 On Not Becoming Overbearing 191 Summary 193 Exercises I: What Is Wrong Here? 193 Exercises II: Expressing Your Concern 195 Exercises III: Expressing a Stronger Message 197 Chapter 11 Addressing and Disarming Anger 199 Introduction 199 Common Reasons for Anger 199 Why Disarming Anger Is Important 200 Avoiding the Number-One Mistake 201 Erroneous Expectations for Perfect Communication: Another Reality Check 202 The Four-Step Process 203 What You Do Not Want to Do 205 Look for Useful Information 207 Managing an Angry Outburst 207 Summary 208 Exercises I: Initial Responses to Anger 209 Exercises II: Practicing Disarming 209 Chapter 12 The Effective Combination of Skills 211 Introduction 211 Combining Skills and Attitudes 212 Communication Skills That Facilitate Change 213 Trapping the Client 218 From Adversarial to Collaborative 219 Case Manager Traps 221 Summary 224 Chapter 13 Putting It All Together: Exercises Introduction 227 Exercise I 227 Exercise II 228 Exercise III 231 Exercise IV 233 Exercise V 235 227 Contents vii www.downloadslide.com Section Meeting Clients and Assessing Their Strengths and Needs Chapter 14 Documenting Initial Inquiries 237 Introduction 237 Guidelines for Filling Out Forms 238 Steps for Filling Out the New Referral or Inquiry Form Evaluating the Client’s Motivation and Mood 240 Steps for Preparing the Verification of Appointment Form Summary 243 Exercises I: Intake of a Middle-Aged Adult 243 Exercises II: Intake of a Child 244 Exercises III: Intake of an Infirm, Older Person 244 Chapter 15 The First Interview 245 Introduction 245 Your Role 246 The Client’s Understanding 246 Preparing for the First Interview 246 Your Office 247 Meeting the Client 248 Summary 252 Chapter 16 Social Histories and Assessment Forms 253 Introduction 253 What Is a Social History? 254 Layout of the Social History 254 How to Ask What You Need to Know 255 Who Took the Social History 262 Social Histories in Other Settings 266 Writing Brief Social Histories 266 Using an Assessment Form 270 Taking Social Histories on a Computer 271 The Next Step 272 Summary 272 Exercises I: Practice with Social Histories 273 Exercises II: Assessment of a Middle-Aged Adult 273 Exercises III: Assessment of a Child 274 Exercises IV: Assessment of an Infirm, Older Person 274 Exercises V: Creating a File 275 Chapter 17 Using the DSM 277 Introduction 277 Is DSM Only a Mental Health Tool? Cautions 278 Who Makes the Diagnosis? 279 Background Information 279 Using the DSM 283 Making the Code 288 Additional Information 290 Summary 291 Exercises: Using the DSM 291 viii Contents 278 238 242 www.downloadslide.com Reflective Listening VI Instructions: People communicate words and ideas, and sometimes it seems appropriate to respond to the content of what someone has just said Behind the words, however, lie the feelings Often it is most helpful to respond to the feelings Following are statements made by people with problems For each statement, first identify the feeling; write down the words you think best describe how the person might be feeling Next, write a brief empathic response—a short sentence that includes the feeling Refer to the sample openers provided in Chapter under the heading “Useful Responses.” “I can’t believe I was that intoxicated! I just don’t believe it Their gizmo must have been broken or something I just didn’t drink that much and I wouldn’t be driving if I had!” FEELING: EMPATHIC RESPONSE: “You don’t expect us to take Alfred into our home, you? He is very mentally ill—tore up the house several times I really—well, I know he’s my son, but I just can’t deal with the way he’s been in the past.” FEELING: EMPATHIC RESPONSE: “I can tell you what scares me most It’s being by myself at the house one night and having him come back I don’t know if I can go on living there.” FEELING: EMPATHIC RESPONSE: “I just can’t go to class Not after making a fool of myself the last time I got every answer wrong when the teacher called on me, and people were making fun It was terrible!” FEELING: EMPATHIC RESPONSE: 168 Section Effective Communication www.downloadslide.com CHAPTER Asking Questions Introduction When listening to another person’s difficulties, we might find ourselves asking a lot of questions We usually mean well In part, we this to find out more so a solution can be quickly devised We also this as a way of filling in the gaps when our reflective listening skills are not strong It may be easier for the listener to say “Did you have any money?” or “Where did the man say he lived?” than to simply say, “Tell me about what happened.” Sometimes when we listen, we feel nervous about what the other person expects from us After all, if we are the worker, should we not have all the answers? If we not have an answer just yet, we can stall for time by asking a lot of questions until we Often, however, the client hears these questions as prying You may ask questions at a rate the client is not ready to answer For instance, you may be asking questions further ahead in the story, throwing the client off Clients may feel pushed to reveal more than they intended or be distracted from the line of reasoning they were following They may become defensive and their communication guarded if the questions seem to pry or to imply there is only one way to have handled things Chapter Asking Questions 169 www.downloadslide.com When Questions Are Important Obviously, at times questions need to be asked The three times it is important to ask questions are as follows: When you are opening a case or chart on a person and need identifying information (closed questions) When you are compiling information for assessment and referral purposes and need facts to that properly (closed questions) When you are encouraging the client to talk about his or her situation freely to better understand which aspects of it are important to the client (open questions) Closed Questions A closed question is one that requires a single answer For example: WORKER: CLIENT: WORKER: CLIENT: WORKER: CLIENT: WORKER: CLIENT: WORKER: CLIENT: WORKER: CLIENT: Where you live? 346 Pine Street How long have you lived there? Oh, about years Have you ever been seen here before? Yes, in 2009 And who did you see then? Dr Langley in outpatient Did she prescribe any medication? Yes, she gave me a prescription for Prozac Do you still take that? No, I stopped a few months ago Closed questions are most often used when opening a case or when compiling information for an assessment In both of these instances, however, clients will need to talk about what has brought them into the service, and you will not rely exclusively on closed questions Nevertheless, some closed questions are appropriate here to gather the basic information The client can respond with a simple answer because the questions to not ask for expressions of feelings, descriptions of circumstances, or explanations of problems Remember too, as noted in Chapter 7, asking one closed question after another about a person’s situation or problem can sound as if the case manager is frantically trying to find a solution, rather than trying to understand what concerns the client 170 Section Effective Communication www.downloadslide.com Open Questions Open questions serve the purpose of giving clients more opportunity to talk about what is important to them By asking open questions, you receive more information about a client’s situation In answering open questions, the client can talk about feelings, underlying causes, supporting circumstances, and personal plans Open questions have been shown to put clients at ease Workers using these questions are not perceived as prying but as expressing real interest in other people or a genuine desire to understand their situation You can use open questions to obtain examples or elaboration of the problem and to clarify certain aspects of the other person’s story Often an open question begins with “can” or “could,” but there are other ways to start such questions For example, you might say, “Tell me a little bit more about your divorce.” Typically open questions look something like this: WORKER: Can you tell me about the night your father left? CLIENT: Well, my mother had been arguing with him for some time I could tell he was getting angry I don’t think I really blame her for his leaving He had done many things to her that she had every right to be angry about But I guess for him it was the last straw Anyway, we were having dinner and she began on the same topic of the house He just put down his fork and got up from the table and walked out of the house WORKER: Can you describe your relationship with him after that? CLIENT: Well, he did come back to the house for his things from time to time He got an apartment nearby, and I used to stop there on my way home from school We never stopped seeing each other, and we never talked about my mother I can’t ever remember him asking me how she was or, for that matter, saying anything mean about her Would the worker have gained as much information by conducting the same conversation using closed questions? This example demonstrates that the client would have been much less forthcoming: WORKER: CLIENT: WORKER: CLIENT: WORKER: When did your father leave? Oh, August of 2004 Did your parents argue much before he left? Sure, yeah, a lot of the time Why did he go? CLIENT: Well, they disagreed over money WORKER: After he left, where did he go? CLIENT: WORKER: CLIENT: He got an apartment near us Did you ever see him after that? Yes, pretty much Chapter Asking Questions 171 www.downloadslide.com Would the client have felt investigated with these short closed questions fired at him, one after the other? Did the worker really understand how the client felt about the divorce and the contact with his father? In the second example, in which the worker used closed questions, there was “The First Interview” room for the worker to assume things that might not be true For instance, the worker might have assumed that the client blamed his father for leaving In the first example, in which the worker used open questions, the client’s elaboration on the situation “Developing a demonstrated that this clearly was not the case Service Plan” You can see Keyanna use open questions to learn more about Michelle’s situation by watching “The First Interview” on the DVD that comes with your textbook “Helping Tom Solve Danica uses open questions to work with Alison on her service plan in “Developing a a Personal Problem” Service Plan” and “Helping Tom Solve Personal Problem.” Questions That Make the Client Feel Uncomfortable Avoid the Use of “Why” Questions If you ask someone why they did something or did not something, you imply that you believe the person should have handled things differently • “Why didn’t you call the police?” • “Why did you go there?” • “Why were your children out that late?” Do Not Ask Multiple Questions If you fire off a string of questions, the person can feel interrogated You may sound impatient, and you can confuse the client “Did you see the other person? What did he look like? Did you get a license plate number or some identifying information? How close were you? Did anyone else have information that would identify him? Did the police have any suggestions?” As we saw in Chapter 7, too many closed questions can sound as if you are desperately trying to solve the problem for the client In the example above the worker is getting bits and pieces of information, but probably would have done better to simply have asked, “Tell me about what happened that night?” Do Not Change the Subject If the client is talking about how she learned of her mother’s death, not start asking questions about her mother’s prearranged funeral Let the client continue to talk about her mother’s death until it seems that she wants to turn to the prearranged funeral Never ask about something out of curiosity Do not ask, for example, about the 172 Section Effective Communication www.downloadslide.com prearranged funeral because you are thinking of getting one for your mother and want to know more about it Ask questions that stay on the topic the client has selected If you ask questions on another topic, make sure the topic is relevant and the questions will actually clarify the client’s situation for you Here are some examples of questions that change the subject: • “I heard about the kids before, but where you work?” • “So, she died on Saturday, and now you are seeing a lawyer about the will?” • “That’s real neat about how your car looked before the accident Do you have adequate car insurance?” • “So, your mother died on Saturday, and you’re living in a house by yourself?” Sometimes questions such as these can disrupt the entire discussion Do Not Imply There Is Only One Answer to Your Question You can ask questions in a way that implies there is only one acceptable answer • “Didn’t you go to the police?” • “Did you tell the other person what you heard?” • “Did you see to it that he knew what you were thinking?” Do Not Inflict Your Values on the Client You can also ask questions based on your own value system The client, however, may have other values For example, you may value truthfulness at all costs, whereas your client may come from a group that values group harmony and not hurting another person’s feelings Questions that imply that your value system is better are not useful • “Did you tell her how you felt before you just walked out?” • “Did you tell her the complete truth?” • “Don’t you value truth above everything else in this situation?” Do Not Ask Questions That Make Assumptions You can word questions in such a way that they make it clear you are assuming you already know the answers • “You called the police, right?” • “You wanted to go to the store, didn’t you?” • “He was being a fool, wasn’t he?” A Formula for Asking Open Questions Figure 9.1 contains a formula for asking open questions In the figure, the open question is broken into parts You can interchange the parts, by choosing one part from each column, to construct good open questions that encourage the other person to Chapter Asking Questions 173 www.downloadslide.com FIGURE 9.1 Formula for asking open questions Directives Add-ons/Softeners Object of the Question Can youa share describe explain summarize outline spell out a little bit more about a little bit about a little more about something about the problems with the larger picture your husband your childhood your medication what the move was like the move regarding the move Could youa talk a little more about what your dad said give me tell me a bit more about something more about your illness your job help me understand clarify something about your relationship with your kids the situation © Cengage Learning Openers a bit aIt is fine to leave the “can you” or “could you” out of the questions In this case, you would make a request such as “Share a little bit more about the fire.” feel safe in talking and expressing feelings and opinions Use this formula in the exercises at the end of this chapter to construct effective open questions that invite others to be open and talk freely with you Some Tips for Asking Open Questions Learning to ask open questions takes practice It is easy to ask a closed question, such as “Where you live?” or “How old are you?” When intending to ask an open question, we often start out well and then unwittingly close the question Some examples of what can happen are presented next A Question That Is Not Really Open “Tell me a little bit about how you got here?” “How you got here” is a closed question and the client can answer, “I came over in the car.” To Open That Question Try This “Tell me about getting here.” The client is more inclined to say more, such as “Well, I came over in the car, but it was scary I kept looking in my rearview mirror to see if he was following me.” Words That Snap Questions Closed Are How, Why, What, When, Where You may not be able to avoid using these words in some of your open questions, and using these words in questions is perfectly all right To leave them out might 174 Section Effective Communication www.downloadslide.com mean your question doesn’t make sense However, when our purpose is to draw clients out and make them feel comfortable about talking to us in depth, we want our questions to be as open as possible When you are about to use one of these words—how, why, what, when, or where—see if you can leave it out for a more open question INSTEAD OF : “Tell me a bit about how you found out about your husband’s cheating.” ASK: “Tell me about finding out about your husband.” INSTEAD OF: ASK: “Can you describe leaving him?” INSTEAD OF: ASK: “Can you summarize for me when you left?” “Can you tell me about leaving?” INSTEAD OF: ASK: “Could you tell me a little bit about what the doctor said?” “Could you tell me a little bit about visiting the doctor?” INSTEAD OF: ASK: “Can you describe why you left him?” “Tell me a bit more about where you were that night.” “Tell me a bit more about that night.” If we look at one of those pairs of questions carefully, we can see that the two questions are asking for somewhat different information For example, in responding to the question “Tell me a bit more about where you were that night,” the client might tell you where she was and in addition give you more valuable information beyond that: “I was down by the railroad tracks I thought I could hop a freight or something like that I just wanted to get away.” When you say “Tell me about that night,” you are asking him for much more, and he may be inclined to tell you many more details: “I was feeling terrified I didn’t know who these people were or why they had singled me out I didn’t know what to or where to go so I went down by the railroad tracks I think I thought I could jump a freight or something like that I just wanted to get away I saw it starting to get light No one came, and fi nally I got up and snuck home.” In this last example we know a lot more about the night in question, and we have some idea about the client’s perceptions and feelings as well Summary Asking questions helps us to understand our clients and the issues that are bothering them Asking too many questions, however, can give the impression that we are desperately seeking some sort of solution Keep in mind what you learned about who owns the problem The problems clients bring to us are theirs They need someone to listen to their concerns and sort out the best way to approach a solution We help clients that by listening and asking open questions that encourage them to tell us more about what has brought them to us for help Chapter Asking Questions 175 www.downloadslide.com Combine open questions with active listening to feelings and content in order to create a safe environment for clients to talk to you and begin to work on problem solving Ask closed questions sparingly, but remember that an occasional closed question is perfectly acceptable; confine them to times such as when you are opening a case or you need information to make a proper referral Exercises I: What Is Wrong with These Questions? Instructions: Read the questions that follow and decide what makes them bad questions In writing your criticism, look for questions that assume there is only one answer, inflict values on the client, make the client defensive, make assumptions, cut off discussion, or change the subject A woman is telling a worker why she has come to the shelter tonight Right in the middle of her gripping tale about what was going on at home only a few hours before, the worker says, “How long has this been going on?” A worker has listened to a young mother talk about how she dropped out of school and got pregnant and has no skills Finally the worker interrupts to ask, “Did you have to get pregnant? Didn’t you know about birth control?” A man calls and says he is depressed He has felt depressed for some time and is now thinking of suicide The worker asks, “Where is your wife? Are you divorced?” A man is telling you about the night he witnessed a murder The victim was his brother-in-law, and although he was never very close to him, he feels that maybe he could have stopped his death in some way The worker asks, “Why don’t you just go and ask the police?” 176 Section Effective Communication www.downloadslide.com A woman has come into temporary shelter with a lot of debts She has been out looking for work today and is discouraged about not finding anything yet She sits down tiredly in the worker’s office and talks about what her day was like The worker asks, “Did you have to get so many debts?” A man wants to know if his wife is all right after she has been raped He is sitting with a worker in the waiting room while his wife is being seen in the emergency room The worker answers his question with one of her own: “How much does your wife mean to you?” A patient in a partial hospitalization program for the chronically mentally ill tells the worker that when the group went to the mall, one of the patients took a pair of socks without paying for them The worker asks, “You told someone right away, didn’t you?” A woman is telling about the time her coworkers waste when the supervisors are out at meetings all day The worker responds, “Why don’t you say something?” A woman tells a worker about a long and difficult marriage she has endured She mentions abuse, both verbal and physical, and talks about her own failing health in recent months The worker asks, “Why can’t you just bring yourself to divorce him?” Chapter Asking Questions 177 www.downloadslide.com 10 A man is trying to sort out whether or not to leave his employer He feels that the small company is poorly run and that he could a better job if he went out on his own On the other hand, he likes his employer, and he feels sorry for him and the mess he’s made of his business He knows that if he leaves, things will really fall apart The worker asks, “Don’t you value loyalty?” Exercises II: Which Question Is Better? Instructions: Read the following questions and decide which of them are better than others Place a check mark next to those you think are good questions, and then explain why you think they are better than the ones you did not check The worker to a woman in the hospital waiting room whose baby just died of pneumonia: “How old was your baby?” The worker to a woman who is grieving after her husband died in a hunting accident: “Could you tell me about your husband?” The worker to a teenage boy who is afraid of failing a math course and losing an opportunity to get a scholarship: “Can you tell me a little bit about this math course?” The worker to a young woman who has just discovered her best friend and her boyfriend have been seeing each other behind her back: “Can you tell me something about your best friend?” The worker to an elderly woman whose dog of 15 years has died: “Couldn’t you get another one?” The worker to a man who is requesting food for his family after running out of unemployment compensation and being unable to find a job: “Can you describe the sort of work you would be looking for?” The worker to a woman in a shelter who has been out searching unsuccessfully for a house or apartment for herself and her two children: “Where all did you look?” The worker to a single mother who has been referred for parenting skills training: “Could you tell me something about the problems you have been having with Johnnie?” The worker to a man with developmental disabilities whose mother, with whom he has always lived, died unexpectedly: “What did your mother die of?” 10 The worker to a woman who was accosted and assaulted in her neighborhood and is afraid of calling the police: “Can you tell me a little bit about what happened tonight?” 178 Section Effective Communication www.downloadslide.com Exercises III: Opening Closed Questions Opening Closed Questions I Instructions: Following are some vignettes in which the worker asks closed questions Write an open question you think might work better in each situation, and be prepared to tell why you think the closed question is not useful A human service worker in the emergency room is talking to a man who was hit on the head before he was robbed He seems to be having trouble getting the story out, but he wants to tell the worker everything that happened The worker has been with the man a long time She thinks that it is late and that the man ought to get to bed and rest now The worker cuts off the discussion with, “Aren’t you tired, Mr Jones?” What open question would you have asked Mr Jones to help him wrap up his story? The human service worker is trying to learn what happened that resulted in Mrs Peters being without housing Mrs Peters says she has been “on the street a while now.” The worker asks, “Have you been on the street for years, years?” What open question would you have asked to learn more about what happened to Mrs Peters to make her homeless? The human service worker is on the phone with a woman, the victim of child abuse The woman tells how she has felt recently, how she needed to call, and then sighs and says, “Oh, I don’t know how to begin.” The worker asks, “Did your father this to you?” What open question would you have asked to help the woman start telling the story in her own way? An older man has just lost his job after repeated warnings to come to work sober and seek help for his alcohol addiction He has decided that he should get help now “Too little, too late,” he says with resignation “I should have been here months ago.” The worker asks, “Why did you ever let it get to this?” Chapter Asking Questions 179 www.downloadslide.com A child is talking to a youth worker while he waits for his mother to get a place to stay “We’ve lived in 16 places,” he announces, “and I’m only 7.” The worker says, “What school did you go to last?” What open question would you have asked to help the child talk about what all this moving has been like for him? A man calls a hot line and tells the mental health worker he wants to die The volunteer asks, “Does this have to with being abused as a child?” The man is startled and says, “Why, uh, no Not really.” The worker asks, “Well, what’s the problem?” What open question would you have asked to help the man talk about what was troubling him? Opening Closed Questions II Instructions: Put yourself in the place of the worker in the following vignettes, and decide what question you would ask in each situation Write an open question that you think might work better than the one asked by the worker, and be prepared to tell why you think the closed question is not useful A worker is interviewing a man in the food bank He tells the worker that he and his children have not eaten for 24 hours and that he has spent most of that time getting referred around town until he finally got a voucher to come to you for food The worker asks, “Why don’t you have any food?” What would you ask? A woman is referred to the social service department in a large hospital after having a stroke She is somewhat incapacitated and has had a lot of therapy while hospitalized Now she is going home and needs therapy at home The worker asks, “What kind of therapy you want?” What would you ask? A 16-year-old girl was brought in by her parents after they caught her and some of her friends huffing glue and gasoline The girl is reluctant to talk and seems a little petulant about being brought in The worker asks, “Huffing glue So tell me, you did it to get high, to be one of the crowd, to be smart? What would you ask?” 180 Section Effective Communication www.downloadslide.com A man and woman have been referred by the county Children and Youth Services for parenting skills training They are poor and have had their four children removed from the home They have been told the children will be returned when they complete the course and demonstrate they can use the skills they learned in supervised visitations The worker asks, “Are your children good kids?” What would you ask? An elderly woman has been having trouble caring for herself in her own home Twice now, in the middle of the night, she has called an ambulance and has been taken to the hospital for chest pains When her heart is checked, she is found to be in good health, if a little frail The worker who is looking into what could be going on asks, “Are you afraid to stay at home alone?” What would you ask? A young woman and her baby have been given a voucher for temporary shelter after she lost the apartment in which she was living She was evicted for back rent, and her rent fell into arrears only when she was laid off several months ago She has worked, but she cannot earn quite what she was making before The worker doing the intake interview asks, “What kind of work have you been doing?” What would you ask? Exercises IV: Try Asking Questions Instructions: Look at the case histories that follow and, for each one, write four closed questions and four open questions that you might ask the client Annette came to your office needing her prescription filled She was in Marywood Hospital, a private mental hospital, and was discharged on Tuesday She was given prescriptions, but has no money to fill them She has no job and probably is eligible for prescriptions paid for by the county You open a case on her Your Closed Questions to Open her Case are: Chapter Asking Questions 181 www.downloadslide.com Your Open Questions to Learn More About her are: Marie was a client of a partial hospitalization program She was loud and demanding, but she often felt hurt upon learning that others were afraid of her or reacted to her as if she were angry As a result of an encounter in the partial program, she is sent to you, her new case manager, to see if there are ways to help her that might work better You need to understand more clearly what has happened from her perspective and what sort of program she might fit into Your Closed Questions to Become Acquainted with her Case are: Your Open Questions to Learn More About her Problems and Desires for Treatment are: 182 Section Effective Communication ... little formal training It is important, therefore, to find a method for teaching the actual human service experience at the entry level Fundamentals of Case Management Practice: Skills for the Human. .. Releasing Information 317 Introduction 317 Sending for Information 317 If You Release Information 317 Directions for Using Release Forms 318 Examples of the Release Forms 320 When the Client Wants... Disarming 209 Chapter 12 The Effective Combination of Skills 211 Introduction 211 Combining Skills and Attitudes 212 Communication Skills That Facilitate Change 213 Trapping the Client 218 From Adversarial