Practice Notes for the Continuing Education Worker
Student name: Justine Example
Group perspective: Rural
Case identifier: Ben
Summary (In two to three sentences describe the focus of your educational presentation).
The Continuing Education workshop focused on how to engage and assess homeless individuals who
have a mental illness. A portion of the workshop centered on wrap-around services as an effective tool
to engage and support mentally ill clients in services.
Outcome: (In two to three sentences describe whether the group utilized the content you provided)
The group considered wrap-around services, but not to the extent I would have hoped. The group’s
attention strayed toward family, family involvement, legal guardianship rules.
Theory assessment:
Identify the theory or theories) that influenced your framing of the educational content.
Ecological and systems theory framed my C.E.U. workshop
For each theory identify the
Strengths: Context is relevant in problem identification; multi-level interactions are
considered in systems; homeostasis allows for the recognition of change as a disruption of balancepractitioners can ask why now, or what has changed; connections to larger systems considered;
interactions of individuals within his/her environment are essential.
Area of focus: interactions of individuals within and across systems
Limitations: May help identify challenges, but theory gives no guidance regarding best
place to begin intervention.
Theories you could use to mitigate the limitations: Crisis intervention, ego psychology,
cognitive psychology, and object relations.
Assessment: (In a paragraph or two assess whether your content was useful to the group coming to a
consensus on the assessment of the client. Consider the theories that influenced you as well as the
theories that seemed to influence other group members. Provide a rationale for your conclusions.)
I was surprised frustrated, and curious as to why the group did not attend to what I saw as a reasonable,
evidence based process in working with mentally ill clients. Why would the group want to focus on
guardianship and family involvement? Was Ben’s money a factor that influenced the group’s attention?
Was family the most pressing concern?
I think the group was influenced by structural family theory. They saw mother and her recent death as
the trigger to Ben’s homelessness. They saw Ben’s resources as a point of conflict with Ben’s sister.
They believed the sister was working to gain power over Ben and his assets.
I was influenced by crisis intervention theory. I saw the death of mother as the precipitating crisis. Ben
was experiencing significant stress and disorganization. I thought his reaching out to the center a
strength. He was looking for ways to find a new balance.
I thought the group missed the boat on this assessment. With a focus on family dynamics the group
ignored a great opportunity to support Ben.
Plan: [Assume the Clinical Supervisor has asked you to provide a follow-up training program. Based on
your assessment of the group, the groups use of theories (same or different than the ones you used) to
conceptualize the case, and the groups apparent openness to new information what will be the focus of
your next workshop. Provide a rationale for your decision. Also, provide an annotated bibliography for
this workshop. You need a minimum of three annotations on topic.]
I would focus on crisis intervention. My original focus on systems was okay as a generic C.E.U.
workshop; however, after reviewing the case study, participating in group discussions, and feeling
frustrated that my group was missing the point I would follow-up with Crisis Intervention.
I would choose crisis intervention because I think Ben would have been served best had the group
filtered his case through a crisis intervention lens. Crisis intervention fits neatly with a systems
perspectives. Further, it allows for a focus on the immediate issue or concerns. Crisis intervention
allows for a new equilibrium to be developed. Finally, in this case scenario, Ben presented with a
chronic situation (mental illness) and a crisis (death of mother). Crisis intervention would allow a quick,
task oriented, focused response leading, perhaps, to an improved state of being. And, crisis intervention
facilitates focus on client desired outcomes.
Annotations
Pollio, D. E., Thompson, S. J., Tobias, L., Reid, D., & Spitznagel, E. (2006). Longitudinal outcomes for
youth receiving runaway/homeless shelter services. Journal of Youth And Adolescence, 35(5),
859-866. doi:10.1007/s10964-006-9098-6:
This article presents results of a study exploring the long-term impact of homeless shelters for youth.
The study suggests that short term gains are significant; however, long term gains are not maintained.
The results of this study highlight the utility of crisis intervention in helping clients finding a new steady
state.*
Thompson, S. J., Pollio, D. E., Constantine, J., Reid, D., & Nebbitt, V. (2002). Short-term outcomes for
youth receiving runaway and homeless shelter services. Research On Social Work Practice,
12(5), 589-603. doi:10.1177/1049731502012005001:
This article presents a study exploring whether crisis intervention with runaway youths are effective.
Results indicate improved outcomes on all measures. Further, the study compared outcomes of crisis
intervention with a day treatment approach. There was no discernible difference in outcome. *
Susser, E., Valencia, E. Conover, S. Felix, A. Wei-Yann, T., & Wyatt, R. (1997). Preventing recurrent
homelessness among mentally ill men: A “Critical Time” intervention after discharge from a
shelter. American Journal of Public Health 87(2), 256-262.
Study reports on the effectiveness of timely follow-up care for clients discharged from a homeless
shelter. Critical timing is an application of crisis intervention with the focus on maintaining a newly
found steady state. *
*You may briefly indicate the type of study (qualitative, quantitative or mixed and the design, e.g.
randomized control trial, quasi-experimental, pilot study, etc.
Practice Notes for the Ethicist
Student name: Justin Example
Group perspective: Rural
Case identifier: Ben
Summary (In two to three sentences describe the ethical standards that frame this case).
The ethical standards that framed the initial reading of this case were:
1.01 Commitment to clients: Our focus must be on Ben. His interests may conflict with the
interests of his family, the accountant, the facility, etc.
1.02 Self determination: Ben is oriented to person, place, and time. He seems capable of
making choices. However, he has a history of mental illness, he has an apparent history of
bad decision-making, and he may be in a crisis with his mother’s illness.
1.03 Informed consent: There are several entities with whom we should interact. We must
ensure the information and records are secured and confidential.
1.07 Privacy and confidentiality: We need to gain information from several sources. We need
to ensure we do not give any more information than is needed
1.14 Clients who lack decision-making capacity: Though it appears Ben can make decisions at
this time, we need be mindful of any changes to his mental status. If his ability to make
decisions becomes impaired we should be ready to safeguard hos interests.
Outcome: (In two to three sentences describe whether the group utilized the ethical content you
provided)
The group adhered to the Code of Ethics. The group was mindful of securing releases and safeguarding
Ben’s interests. The group had a lively discussion on whether Ben was able to make decisions. It was
agreed that based on the information available Ben could make decisions on his own behalf.
Theory assessment:
Identify the theory(ies) that influenced your framing of the ethical content.
Cognitive behavioral and Empowerment
For each theory identify the
Strengths: Empowerment- advocacy, self-determination, social justice
Area of focus: Advocacy, identification of barriers, and validation of experience
Limitations: May be more applicable to social movements than to individuals within
same, may focus on societal barriers to extent that individual strengths are overlooked.
Theories you could use to mitigate the limitations: Critical theory, feminist perspective,
and strengths perspective.
Strengths: Cognitive-behavioral Defines problems behaviors, focuses on how thinking
impacts behavior, & good evidence of effectiveness.
Area of focus: How thinking affects behavior.
Limitations: Problem oriented.
Theories you could use to mitigate the limitations: Critical theory, feminist perspective,
and strengths perspective.
Assessment: (In a paragraph or two assess whether your ethical content was useful to the group coming
to a consensus on the assessment of the client. Consider the theories and ethical provisions that
influenced you as well as the theories and ethical standards that seemed to influence other group
members. Provide a rationale for your conclusions.)
The group attended to the ethical principles I outlined. I do not know whether my contribution kept us
on track or if the group would have maintained its ethical principles without this contribution.
Plan: [Assume the Clinical Supervisor has asked you to provide a follow-up Ethics Seminar. Based on
your assessment of the group, the groups use of theories (same or different than the ones you used) to
conceptualize the case, and the groups assessed openness to ethical information what will be the focus
of your next workshop. Provide a rationale for your decision. Also, provide an annotated bibliography
for this workshop. You need a minimum of three annotations on topic.]
I would focus on the potential challenge of Informed Consent and Client’s with an incapacity to make
decisions. Though we did not decide Ben was unable to make decisions, his presenting problem, and his
history suggested a very real potential dilemma.
Mazur, D. J. (2013). Informed Consent in the Twenty-First Century: What It Is, What It Isn't, and Future
Challenges in Informed Consent and Shared Decision Making. Sociology Compass, 7(9), 762-774.
doi:10.1111/soc4.12067; This article begins with a historical review of informed consent and ends with
current challenges and practices with same. The article will be useful in the development of a workshop
on informed consent.
Talati, E. (2009). When a spoonful of sugar doesn’t help the medicine go down: Informed consent,
mental illness, and moral agency. Indiana Health Law Review 6, pg. 171 et. Seq.
Zinermon v. Burch (1990) United States Supreme Court, 494 U.S. 113.: This Supreme court decision
highlights the importance of protecting an individuals rights when unable due to give informed consent
due to mental illness. In the case, the individual voluntarily signed himself into a psychiatric hospital.
He was not able to have made such a decision,; however, staff encouraged him to sign forms. The court
recognized the staff’s actions as a violation of the individual’s civil rights. Useful case to remind us that
we might need to protect clients from our own efforts to help them.