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EMPOWERING INVOLUNTARY CLIENTS AND DIRECT PRACTITIONERS
Social workers are working increasingly with involuntary client populations, Private and public nonprofit agencies are providing vendor services for large social service organizations, Larger systems often find it more efficient to contract for clinical services with smaller specialized agencies. Such contracting for services presents many questions related to the service delivery process. The first set of questions to be addressed and resolved relates to identifying the client system,
- Is the person or persons referred for services the primary client, or is the organization that contracted services the primary client ie. who does the worker serve and who has the power regarding problem identification? Do the worker and the prospective client have the power to negotiate a viable service contract? Often contracting organizations have already identified the problem or problems to be worked leaving little flexibility in the service process for further problem identification and goal formulation. This can present problems when attempting to formulate a viable contract that the referee can "buy into" as relevant to his/her life situation,
The second set of questions relates directly to the power of provider agencies and their practitioners.
- Is the person or persons referred automatically accepted by the provider agency? Do provider agencies and practitioners have the power to determine the appropriateness of a referral? What are the imagined or real consequences of refusal for the provider agency, the practitioner, the prospective client?
The third set of questions relates to appropriate intervention strategies.
- Is it the expectation of the contracting organization that all intervention will be person centered with the target for change always being the client? What consideration are significant others and environmental systems given in the change process? For example, is there support to work with the family, school, court, DSS or other significant systems and can they be possible targets for intervention? What balance is there between the service agenda (ie. social control) of the contracting organization and the service agenda (ie. therapeutic benefit) of practitioner and client?
Perhaps the single most important element in the helping process with involuntary clients is the avoidance of a corrupt contract and the formulation of a sound
contract that can be accepted by the contracting organization, the provider agency, the practitioner, the client and other significant stake-holders in the helping process. The remainder of this presentation will focus on the important considerations when formulating sound service (helping) contracts.
Contracting is problematic if a marginal working agreement is reached after much difficulty, following which, client and worker fail to achieve positive results in the clinical process.
A common problem in the contracting process is what Seabury refers to as the "corrupt" contract (1976).
Corrupt contracts involve hidden agendas. This is when the worker or client proceeds with the contract without explicitly stating an objective or negotiating that objective.
a. Worker agrees with what the client identifies as the problem with hidden agenda of eventually working on the "real" problem that the referral system or worker has identified. Often leads to confusion, working at cross purposes and treatment failure.
b. Another kind of corrupt contract occurs when there are several persons or systems in the client system and/or several persons or systems in the worker system whose co-operation and sanction are critical to successful contracting. If these relevant persons or systems are not consulted with for the purpose of congruence, the contract is doomed to fail, ie. other family members, significant others, professionals, DSS, court system, etc.
The problem with a corrupt contract is that sooner or later the hidden agenda or contradictions in agreements are discovered and the service process is ruined when parties realize they have been deceived.
Corrupt contracts are often a result of conflict avoidance. There is nothing inherently bad about conflict, and attempts to avoid during contracting are naive. When contracting goes too smoothly, it is often a sign that one side is selling out to the other or has a hidden agenda.
Principle Number 1.
relationships between client and significant others is so poor that sabotage occurs, it is practically impossible for the primary contract between client and worker to succeed.
Principle 4.
Secondary contracts should be purposefully planned with the client's knowledge and negotiated with the client's participation whenever possible.
Collaboration or bypassing to neutralize the influence of significant others is almost always required to establish viable service contracts with clients. Secondary contracts are often more time consuming and difficult to arrange, but pre- requisite to successful service outcome.
The worker who contracts successfully uses his or her professional skill to facilitate the client's participation in the contract process. The worker's professional judgment is shared, but the content of a decision is not as important as the client's participation in that decision. A worker who contracts successfully worries less about exactly which problem is being identified or which procedure is adopted, and is concerned more about who initiates and idea or suggestion, what responsibilities are shared or divided in carrying out a decision, and how involved the client is in the whole process.
One tool that is particularly valuable when working with involuntary clients is Goal Attainment Scaling (GAS).
GAS is a single-case evaluation procedure that is applicable in a wide variety of human service settings. It consists of a set of procedures for measuring success in achieving pre-determined expectations (conditions) in a service delivery plan. The process involves the participation of the client system, the practitioner and other relevant systems:
1. Areas of change are identified. Each area includes rated treatment outcomes according to levels of treatment success.
- The conditions of each area are operationalized and rated in a guide consisting of a 5 point scale that may be numerically weighted, (weights represent subjective interpretations of the importance of each goal)
GAS is not a fixed instrument, but a measurement system that can be applied with a good deal of flexibility to meet the unique requirements of each case situation.
It is empirically based in that the procedure requires observable and measurable specification of each set of goals.
It is empowering for client and worker in that with up to six possible problem areas, it allows for mandated areas as veil as client/worker identified areas reducing the likelihood of corrupt contracting.
It is not ZERO-SUM (dichotomous measurement) in that it allows for degrees of success rather than a success/fail scenario.
Interpretation of outcome scores presents proJblems if used with standardized measures (no correlation/apples and oranges,). One does not £now what specific kinds of interventions were used (therefore the action plan should be clearly specified in order to systematically evaluate the success of a specific intervention).
The main argument for validity is face validity: The goals selected in a given case represent appropriate indicators of success in the case. Jnter-rater agreement is generally acceptable. Goal setting, evaluation and feedback are interrelated operations.
Use of the GAS follow-up grid involves six steps: (a) selection of goal areas, (b) weighting, (c) selection of a follow-up time, (d) statement of expected outcome, (e) completion of the four ancillary scale levels, and (f) follow-up using the scale and calculation of a goal attainment score.
In GAS the score 0 (target goal) is considered a success. A goal attainment score of 50 indicates overall achievement. It is important that the score at intake therefore, be less than
Level at Yes_ Yes_ Yes Yes_ Yes_ Yes Intake No _ No _ No__ No_ No__ (^) No_ Score Scale 1 Scale 2 Scale 3 Scale 4 Scale 5 Scale 6 Level at Follow up
Score _ w= w=^ w= w- w= w= GAS-Goal
