CRISIS INTERVENTION AND TASK-CENTERED MODELS IN SOCIAL WORK

• The more successful past problems were dealt with, the more problem-solving strategies will be available, so states of active crisis are less likely. Unsuccessful problem-solving in the past leads to people falling into active crisis often and finding it hard to escape.
• All crisis reach resolution in 6-8 weeks.
• People in crisis are more open to being helped than those who are not. Intervention in crisis is more successful than at other times.
• In ‘reintegration’ after active crisis, people become set in their newly learned ways of solving problems, so learning effective problem-solving during the crisis improves the coping capacity in the future.

STAGES IN CRSIS INTERVENTION: ROBERTS

1. Assess risk and safety of clients and others.
2. Establish rapport and appropriate communication with clients.
3. Identify major problems.
4. Deal with feelings and provide support.
5. Explore possible alternatives.
6. Formulate an action plan.
7. Provide follow-up support.

STEPS IN REINTEGRATION: GOLAN

• Correcting cognitive perception as clients gain a more accurate and complete view of the events which have affected them.
• Managing feelings involves getting the client to release extreme emotion and the worker accepting it (for example, it is acceptable to grieve for a dead relative)
• Developing new coping behaviors.

MODEL OF CRISIS INTEGRATION: GOLAN

BEGINNING PHASE: FORMULATION (1st interview)

A: FOCUS ON CRISIS STATE

• Focus on ‘here and now’
• Get client to express emotional responses as emotions reduce, explore hazardous event
• Discover type and effects of vulnerable state,
• Assess disturbance caused by crisis state

B: EVALUATION

• Decision statement-account of circumstances and priority problems check client’s priorities Decide main problem

C: CONTRACT

• Define goals, tasks, for client and worker

MIDDLE PHASE: IMPLEMENTATION (1st – 6th interviews)

A: DATA COLLECTION

• Check missing data
• Check inconsistencies
• Select main themes (loss, anxiety, challenge)

B: BEHAVIOUR CHANGE

• Check client’s coping mechanisms in problem area
• Set realistic short-term goals
• Set overall tasks
• Jointly workout practical tasks

ENDING PHASE: TERMINATION (7th and 8th, if necessary, interviews)        

A: TERMINATION DECISION

• Check period since referral and remind client
• Propose spacing of contacts and finishing deal with resistance to termination

B: REVIEW PROGRESS

• Summarize progress
• Review main themes
• Reminder of tasks covered, goals reached, changes, incomplete work

C: PLAN FUTURE

• Discuss present problems
• Discuss client’s plans
• Help client feel that process is ended
• Help client feel OK about returning with other problems.

TASK CENTERED CASEWORK: REID & EPSTEIN

Task-centered work is an approach in social work with wich workers resolve problems presented by clients. Therefore, social work theories mainly focus on how problems arise, what they are and how we may deal with them. Brief work with explicit time limits is an essential feature of the approach.

Task-centered work is concerned with problems that;

• Clients acknowledge or accept;
• Can be resolved through actions taken outside contacts with workers;
• Can be defined clearly;
• Come from things that clients want to change in their lives;
• Come from   ‘unsatisfied wants’ of the client rather than being defined outsiders.

PROBLEMS WITH WHICH TASK CENTERED WORK IS EFFECTIVE: REID

• Interpersonal conflict
• Dissatisfaction in social relationships
• Problems with formal organizations
• Difficulty in role performance
• Decision problems
• Reactive emotional stress
• Inadequate resources
• Psychological and behavioral problems not otherwise categorized, but meeting the general definition of problems in the model

POINTS OF LEVERAGE

Beliefs usually guide our actions. They are changed by interactions between the worker, client and others. Such beliefs are called points of leverage. They can be used to change beliefs. Points of leverage are as follows:

• Accuracy, where workers help clients understand how accurate their beliefs are.
• Scope, where workers help clients see the implications or range of beliefs which client thinks are more limited.
• Consistency, where distortions due to dissonance between one belief and another can be removed by the worker.

STEPS IN TASK-CENTERED WORK

1. PROBLEM SEPCIFICATION

It is the first step, taken early on through agreement with clients to undertake a short period of assessment. Doel and Marsh use a newspaper metaphor. We look first at the front page for the main news, then scan headlines, identify the storylines (details of the problems) and client quotations (putting the whole issue in the client’s words). The social context of the problem and others’ responses to it are important. The process presented by Reid is as follows:

1. Identify potential problems by helping clients describe difficulties in their own way. Summarize and test out workers’ perceptions of problems.
2. Reach tentative agreement on how clients see the main problems.
3. Challenge unresolvable or undesirable problem definitions (for example, where the client unreasonably wants a deserted spouse to return).
4. Raise additional problems, having first accepted the client’s definition of priorities, where the client does not understand or accept additional problems.
5. Seek others’ involvement if necessary.
6. Jointly assess the reason for referral if someone else compels the client to attend
7. Get precise details of when and where problems arise.
8. Specify the problem, usually in writing.
9. Identify clear baselines of the level of present problems.
10. Decide desired changes.

2. CONTRACT CREATION

Doel and Marsh call this making an agreement. Here worker and client reac specific agreements on action. The process is as follows:

1. Agree to work on specify one or more client defined problems.
2. Rank the problems in order of priority.
3. Define the desired outcome of treatment.
4. Design the first set of tasks.
5. Agree the amount of contract and time limits

3. TASK PLANNING

It takes place at regular sessions with clients. Tasks are explicitly planned, practicable for clients to do outside the sessions and agreed between worker and client. They may involve mental or physical action (example, to decide this or do that). General tasks set a policy for the treatment process, and operational tasks define what the client will do. Tasks may be unitary, involving just one action or series of actions, or complex, involving two different actions (for example, to seek a new flat and take part in occupational therapy). They may be individual, undertaken only by the client; reciprocal, so that if the client does this, the worker or a relative will do that; or shared, so that the client and another important person will do it together.

The task planning process is as follows:

• Possible alternative tasks are identified, through generating task possibilities.
• An agreement is made, and explicitly secured with the client.
• Implementation is planned;
• The task is summarized.

4. TASK IMPLEMENTATION

• It takes place the sessions between worker and client. This involves the following:
• A recording system is set up, especially where a sequence of or repeated actions are required
• Strategies are identified (for example, a series of increments, setting limits, setting precise targets, mental tasks, use of paradox).
• Incentives for finishing a task are agreed if these are not built in.
• The client’s understanding of the value of the task and how it helps meet the goal is checked.
• Relevant skills are practiced by stimulation (for instance, the worker acts out an employment interview) or by guided practice.(such as helping a person with disabilities try out a new adaptation to her home in a day center). Reid call this ‘session tasks’ because they are work undertaken among clients or between client and worker in the session. They include planning and expressing and dealing with anxiety and other feelings.
• Obstacles are analyzed and removed. These may relate to motivation, understanding, beliefs and emotions such as anxiety or anger and lack of skill.
• The worker’s contribution is planned.

The workers task may involve the following:

Working with people other than the client to help the client to complete their tasks;

Arranging for rewards and incentives for success;

Sharing tasks with clients where they have insufficient skills or resources to do them alone.

5. THE ENDING PHASE

1. Describing the target problem as it was and it is now, including checking whether it was the most important problem.
2. Assessments by the worker, client and others involved of any charges and achievements;
3. Planning for the future and helping clients manage evident future problems;
4. Additional contracts, to extend the process to finish off properly, or to establish new problem and task definitions;
5. An explicit end where (as residential care or continuing supervision of a client subject to legal requirements) contact with the worker or agency continues;
6. Movement to a long term treatment process, or arranging for follow-up to check that progress is maintained;
7. Referral to another agency for additional or alternative help.

CONCLUSION

Both theories represent a trend in social work to clearer, more focused activity than the long term, non-directive, insight giving methods of psychodynamic work. However, they are in the traditional lineage of social work problem-solving, using a conventional social work individualizing relationship with clients who are treated on a medical model with the aim of getting better. Crisis intervention, with its more psychodynamic roots, offers a greater emphasis on emotional responses and irrational or unconscious behavior than task-centered work, which assumes greater rationality on the part of clients.

REFERENCES

1. Payne, M. (1997). Modern Social Work Theory (2nd Edition ed.). Chicago: Lyceum Books, Inc.
2. Roberts, A. (1991). Contemporary Perspectives on Crisis Intervention and Prevention . NJ: Prentice-Hall.