Decision Tree

Introduction to the Text and the
Decision Tree
Navigating Direct and Indirect
Competency In Generalist
• To increase competency in generalist practice, this
text provides a theory and evidence-based guide
to decision-making.
• Six scenarios, focused on client systems of
different sizes, are presented to illustrate the
decision-making process. See text.
• The decision tree is used to prioritize assessment
foci and guide consideration of more than one
method or theory of intervention based on the
complexity of the case at hand.
Competency in Generalist
• Skill sets consistent with different sizes of client
systems are necessary for competent practice;
thus the text presents content on clinical social
work and social work practice in policy, advocacy,
management and community practice in
alternating chapters.
• All practice methods, empirical evidence, and
competing theories must be assessed for cultural
Overarching Cultural Principles
The overarching cultural principles presented in this
text are consistent with the Standards of Cultural
Competence in Social Work (NASW, 2000).
• All actions must conform to the NASW Code of
• Practitioners must be cognizant of the distinction
between personal, professional, and client values.
• Practitioners must be able to engage in ethical
analysis and decision making.
Cultural Principles
Standard 1: Ethics and Values
• Clinicians must be aware of the ideological
and value premises of clinical theories.
• Macro practitioners must be aware of
competing ideological and value premises
when determining the desired end-goals of
policies, programs and reform efforts.
• Tactical means to achieve desired-end goals
must be ethical.
Standard 1: Ethics and Values
• Clinicians must conform to licensing regulations
and practice within the law.
• Macro practitioners must (1) follow standard
accounting procedures, (2) recruit, hire, and fire
within the laws regulating employment, (3) refrain
from malfeasance while in administrative office.
• Community practitioners must practice within a
fair and equitable democratic political process.
Standards 2 & 8
Self Awareness- Professional Education
• Professional education must include content that
leads to practitioner self-awareness.
• All social workers must develop an understanding
of their own personal and cultural values and
• Each practitioner must recognize the relativity,
rather than the universality of, his/her own cultural
Standards 2 & 8
Self Awareness- Professional Education
• Everyone is exposed to different degrees of
privilege and discrimination based on race,
ethnicity, religion, gender, sexual orientation, and
health status.
• Clinical practice: cultural missteps in the helping
process must be recognized and corrected.
• Macro practice: practitioners must be cognizant
of the toxic social forces that necessitate social
policies and programs e.g. poverty, violence,
inequality & political under-representation.
Standards 3 & 8
Cross Cultural Knowledge
• Professional education must provide the student
with cross-cultural knowledge and skills.
• Practitioners must possess descriptive knowledge
(cultural sensitivity) of diverse client populations;
especially those client groups with whom they
• Within group differences as well as between
group differences must be taken into account in
order to counter the tendency to reduce cultural
complexity to cultural stereotypes.
Standards: 3 & 8
Cross Cultural Knowledge
• Clinical practitioners must take into account how
culture shapes family life, individual identity,
priorities, and help seeking behavior.
• Clinical practitioners must be cognizant of how
diverse cultural groups conceptualize or construct
health and illness. Practitioners must be alert to
assessment bias –mistaking difference for
pathology must be monitored.
• Clinical practitioners must recognize & draw upon
the cultural strengths of diverse client groups.
Standards: 3 & 8
Cross Cultural Knowledge
• All practitioners, clinical and macro, must
examine their theories and the empirical evidence
they cite for bias.
• Macro practitioners must examine desired end
goals for value and ideological assumptions.
• Macro practitioners must be aware of and support
the cultural relevance of an agency, policy,
program, planning, or change effort.
Standards: 4, 5, 10
Skills, Language, Leadership
All students/practitioners should:
Principle 4: possess skills in cross-cultural social
work practice able to work with diverse
client groups.
Principle 5: be cognizant of the importance of
language when working with diverse client groups.
Principle 10: exhibit tolerance for difference and
dissent; all are required to engage in effective &
ethical leadership.
Standards: 4, 5, 10
Skills, Language, Leadership
• should be skilled in ethnographic interviewing
techniques and should acquire competency in the
utilization of appropriate ethno-psychotherapies
or refer clients to clinicians with such competency
• should refer clients to same-language clinicians
or used trained translators.
• take into account cultural values and preferences
when forming a collaborative worker-client
partnership and treatment approach.
Standards: 4, 5, 10
Skills, Language, Leadership
Macro practitioners should:
• Possess skills in group dynamics in order to
manage competition and conflict within and
between diverse racial and ethnic groups.
• Possess skills that promote tolerance for
difference and dissent.
• Possess skills in ethical and effective
leadership and follower-ship.
Standards: 5 & 7
Service Delivery/Workforce
Must recognize & take into account issues of racism
(and other isms) that may exist within the agency &
between the agency, worker and client systems.
Macro Practitioners
Must take into account social work’s equity goal.
Are policies, programs, and services reaching highly
vulnerable client populations in need of services?
Standards: 5 & 7
Service Delivery/Workforce
• Management: Management practitioners
must recruit and hire bi-lingual, bi-cultural
and racially diverse personnel.
Standard 6:
Practitioners need to assess power (who has it, who
does not).
• Practitioners need to assess how each theory,
practice model, or method constructs power.
• Practitioners must assess their own alliance with
• Practitioners should possess skills in both case and
class advocacy.
• Practitioners should use their power to benefit
Basic Premises of the Text
• Scientific process (explanation-predictionprescription) is necessary for competent practice.
• Explanation allows for prediction (cause-effect)
and subsequently prescription (prevention or
• Empirical evidence is critical in determining the
efficacy of one intervention over another.
• As part of cumulative knowledge, theory is
critical to the enactment of treatment/intervention.
Basic Premises Of the Text
• Logic and philosophical proof is valued in
addition to empirical evidence.
• Postmodern perspectives are included as part of
open assessment and treatment choice.
• All theories (scientific as well as philosophical
theories of social justice) and all empirical
evidence, requires screening for cultural
Basic Premises-Continued
• Generalist practice, because of its commitment to
open assessment and method and theory choice,
promotes competent practice.
• Normative policy and social goals advocacy need
to be screened using comparative value analysis
and overarching ethical principles.
• In addition to scientific knowledge, social work
practice requires knowledge of economics as well
as knowledge of political & legislative processes.
Aims of the Book
• To teach students two skill sets; one for clinical
social work (direct practice) and another for
policy, advocacy, administrative and community
practice (indirect practice) i.e. competency in
diverse skills is needed for Generalist Practice.
• To promote critical thinking through theory
choice and evidence-based decision making
• To enhance the teaching, learning, and practice
application of complex and often polarizing social
work content
Book Format
Direct and Indirect Practice
• The book is formatted to teach clinical
social work skills and skills in policy,
advocacy, management, and community
practice in alternating chapters.
• The decision tree guides the practitioner in
both direct practice and indirect practice.
in Generalist Practice
• Requires open assessment of all system sizes
• Requires selective use of one or more practice
theories and methods for the same case
• Requires evaluation of treatment/program options
according to existing empirical evidence
• Requires that theories and empirical evidence be
screened for cultural relevance
• Requires value (ethical) analysis of theories and
evidence relevant to the case or situation at hand.
Evidence-Based Practice
Best Practices
Evidence-based practice requires appraisal of the
empirical literature to determine the efficacy of
one treatment intervention over another.
Best practices is defined as the conscientious,
explicit, and judicious selection of an effective
(evidence-based) and appropriate intervention
strategy for a specific client or situation ( Sakett,
Richardson, and Rosenberg, 1997).
Two Tools to Teach Theory
• The Case Scenario: Teaches students how to
apply a major theory to selected facts of the case
in order to guide intervention consistent with that
• Decision Tree: Teaches students how to ascertain
a range of information relevant to the case at
hand through open assessment and prompts the
practitioner in the prioritized selection of one or
more methods and theories (model building)
based on open assessment of the case at hand.
Decision Tree
• The Decision Tree is a conceptual tool that
uses a systematic and exhaustive process to
organize thinking consistent with existing
knowledge and empirical evidence in order
to reach a treatment decision consistent with
best practices.
• The Decision Tree prioritizes and navigates
existing knowledge and empirical evidence.
What the Decision Tree Does
• Helps the practitioner systematically and logically
navigate what is known in order to produce
prescriptions that are case or situation specific
• Cues practitioners to ask all relevant questions,
identify all relevant variables, consider all
possibilities (theories) and evaluate all evidence
(whether positive or negative) in a proper
sequence before arriving at a treatment decision.
• It provides proof of process in arriving at a
treatment decision. It does not create new
How the Decision Tree Works
Seven Steps
• The Decision Tree prompts the practitioner to
engage in open assessment (all seven steps) to
ascertain the facts relevant to the case at hand.
• It then orders (steps 1-7) the obtained
information beginning with those facts of the case
that have life-threatening and survival relevance.
• The tree prompts practitioners to review all
methods, theories, and empirical evidence at each
decision point
Step One:Assure Safety
The Fiduciary Model
• Step one guides the practitioner in the
execution of his/her fiduciary duties in
order to assure client safety and the safety
of others.
• Chapter two (The Legal Aspects of Social
Work Practice) elaborates on the fiduciary
model of practice for all social workers.
Step Two- Crisis Intervention
• Step two guides the practitioner in the application
of crisis intervention or crisis management.
• Chapter 8: three models of clinical crisis
intervention: (1) basic on-site intervention, (2)
advanced clinical crisis intervention, (3) domainspecific crisis intervention.
• Chapter 9 crisis management: disaster preparedness & recovery in the disaster after-math. Policy,
advocacy, management & community techniques
are applied to domestic & international crises.
Step Three: Urgent Need
Clinical Case Management
• Step three guides the practitioner in the direct
face-to face provision of concrete services to
individuals and families in need of immediate or
timely resources.
• Chapter 10: elaborates upon two direct practice
models of clinical case management:
(1) system driven (traditional)
(2) consumer-driven (empowerment).
• Chapter 3 : elaborates on indirect practice as the
policy and program context of direct practice.
Step Four
Case Advocacy
• Step four (chapter 11) guides the practitioner in
the use of case and class advocacy skills.
• Case advocacy: (advocacy to benefit individuals)
(1) The Broker Model
(2) The Adversarial Model
• Class advocacy (advocacy to benefit populations).
(1) Policy advocacy
(2) Rights Advocacy.
Step Five
Social Work with Individuals
Step five guides the practitioner in the selection of
clinical methods, theories and skills needed to work
with individuals.
• Chapter 4: clinical interviewing skills
• Chapter 6: use of self in a clinical therapeutic
• Chapter 12: practice theories/individuals
• Chapter 13: applies the decision tree to an
individual case.
Step Six:
Work With Families
• Step six guides the practitioner in work with
• Chapter 14: Family therapy methods:
(1) Family Life Cycle. (2) Systems Theory
(3) Bowenian Therapy, (4) Structural-Strategic
• Chapter 15: Family and child welfare
(1) Work with impoverished families
(2) Protective services
Step Seven
Use of Group Method
Step seven of the decision tree has four branches:
(1) the use of groups in clinical practice
(2) the use of groups in administrative
(3) the use of groups in advocacy practice
to achieve social goals
(4) the use of groups to build community
Use of Groups in Clinical
Chapter 16:
• Addresses group dynamics –curative and antigroup dynamics are discussed.
• Clinical groups are categorized as: self-help,
psycho-educational, recreational, normative
(social conformity), skilled-based, analytic and the
context of social milieu in day programs and
residential living.
• Therapeutic groups are distinguished from
analytic therapy groups
Use of Groups in Administrative
Chapter 17: Group method informs the use of
groups in administrative practice:
(1) boards and councils, (2) committees, (3) task
groups, (4) project teams, (5) deliberative meetings
and (6) the organization as a whole.
Includes presentation of social exchange theory and
The Coverdale model for managing the dynamics of
task groups.
Use of Groups in Social Goals
• Step seven guides the practitioner in the use of
groups for the purpose of social goals advocacy
(structural change) and for the purpose of policy
advocacy (legislative and regulatory change).
• Chapter 17 elaborates on the theories, methods
and skills needed for direct action organizing for
large scale change (movements) and for local
change (issue campaigns, election campaigns, and
fund raising).
Groups in
Community Practice
• Step Seven: Groups in Community Practice
• Chapter 17: The macro branch of community
practice attempts to balance the rights of the
community as a whole with the rights of
individuals and minorities while regulating inter(between) group tensions.
• The clinical branch attempts to deliver face-toface mental health services to clients with chronic
diminished capacities who reside in the
community- Tertiary Community Mental Health
Special Features of the Text
• In addition to the features already described, the
text offers non-clinical communication skills for
practitioners in policy, advocacy, administration
and community practice. See chapter five.
• In contrast to the use of self in clinical practice,
chapter seven focuses on the macro practitioner’s
use of self in terms of leadership. The chapter
includes theories, empirical evidence, and skills
relevant to leadership.
The Decision Tree
• See exhibit 1.1 at the end of this chapter.
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