Case Critical: Applying a Comprehensive Framework

to Direct Social Work Practice

 

By

 

Andrea Remington

 

 For

 Richard Ramsay

 SOWK 479

 

Faculty Social Work, University of Calgary

December 2002

 

 

Note: Original copy. Minor editing/reformatting was carried out.



Introduction

“The case method reflects the general belief that the primary purpose of law school

is not to teach substantive law, but to teach students to think like lawyers.

Law is as much an art as a science” (LSAC, 2002; Italics mine).


While the profession of social work has been largely concerned with distinguishing itself from other professions, strains borrowed (yet perhaps not originating) from related fields have somehow filtered into superficial and deep-rooted aspects of social work (Sheafor, Horejsi & Horejsi, 2000, Heinonen & Spearman, 2001). From methods of practice (i.e., psychological theories) to methods of teaching (i.e., parallels to the case method as practiced in law schools), one constant in social work seems to be change. This appears to be fitting for a profession that aims to effect social change and workers that act as change agents (CASW, 1982). Also fitting is the recent proliferation into the social work curricula (at the University of Calgary) of the inquiry method of teaching and learning. In viewing teaching and learning as a process, the student exercises creativity by becoming involved in the method of learning (Postman & Weingartner, 1969). Appealing to the process of learning seems particularly relevant to notions of integrating theory and practice: the ultimate underlying goal of this paper. In the application of a comprehensive framework to direct social work practice, it is expected that this underlying purpose will be achieved. This paper will not address the timely necessity of embracing a common conceptual framework for social work practice, but rather the merits of using such a model. This paper intends to apply a framework that includes four dimensions (Domain of Practice, Domain of Practitioner, Paradigm of the Profession and Methods of Practice (Ramsay, 2001) to direct practice with an extended focus on the Methods of Practice dimension. Feminist and Aboriginal approaches to social work practice will also be explored and discussed.

Domain of Practice (DOP)

This dimension of the framework encompasses the realm of social work practice. My initial understanding of this piece occurred at an abstract level. Somehow, social work practice was unique by its “unifying and central focus on interacting networks” (Ramsay, 2001). More specifically, I viewed the notion of person-interaction-environment (PIE) as a complex system of subsystems and interactions between the person and the environment, without an exclusive lens that gleaned towards binary thinking. Only in practice at my placement with the Elizabeth Fry Society have I experienced this way of understanding on a practical level. PIE removes the burden of change from strictly the person or the environment and recognizes the interplay and interface of the two. In practice, I have seen how a focus on one or the other reduces the complexity of the person’s problem and therefore does not lend itself well to successful change. Employing PIE in practice facilitates a comprehensive understanding of the client’s life and therefore fits well with successful change.

Just as a person’s life is complex and multifaceted, so too is the PIE concept. Unfolding PIE into its more discrete parts allows me to examine and piece together the client’s life. Furthermore, PIE has been strategically and symbolically designed to break down into four in all of its dimensions so as to provide a mental model that aims to promote understanding through mimicking natural processes (Holosko, 2001). Four components make up this DOP dimension and are represented by one personal element and three environmental elements (Ramsay & Karls, 1999). Identifying these components facilitates a holistic perspective that emphasizes a relationship-centered approach.


Case Critical: Lana’s Story

In my capacity as a counselor in the Theft and Loss Counseling program at the Elizabeth Fry Society, I meet with Lana to explore her theft behavior. Conscious of the fact that I wanted to employ this framework to my direct practice, I guided our initial meeting to making the implicit explicit. More specifically, I wanted to focus on the interactions in her life: “the contextual and relationship nature of  (her) social functioning” (Ramsay & Karls, 1999). I found this perspective to be highly useful in gaining a complete impression of her life. I discovered that Lana’s primary roles are mother, wife, and child. I also found out about Lana’s interpersonal and occupational life. Overall, we discovered that her relationship types were mainly responsibility (in her spouse and mother roles) and isolation (in her child role). The environmental components of this dimension allowed me to isolate Lana’s social functioning in terms of her anibiopscyhosocial health, social supports, resources and beliefs and values. These factors proved to be critical in appreciating Lana’a life and where she was at. For instance, Lana’s belief that in order to be a good wife, she was to put her husband’s needs ahead of her own revealed how this belief shapes and permeates all of her interconnective relationships. An awareness of DOP allowed me in my role as counsellor to pilot our meeting from a relationship-centered approach that acknowledges the external influences on Lana’s life.

Domain of Practitioner

Identified as “the social worker’s own PIE system and its impact on their practice of social work”, the domain of the social worker is viewed as the second dimension of this framework (Holosko, 2001). The most profound aspect of my social work education has been this notion of recognizing what I bring to practice. My understanding of what this includes is everything from my academic experience to my beliefs and values. Having completed my first degree in psychology where the closest I came to acknowledging this influence was the concept of emotional transference, this piece was challenging yet also refreshing. Now, in my last year of the social work program, I cannot imagine not recognizing and validating this domain.

In meeting with Lana and discussing her personal story, I felt like I could relate to her in many ways. I observed that my own experiences with family and the struggles therein facilitated this connection. The environmental components that impact my practice include the agency mandate and principles as well as the feedback I seek out and receive from my co-workers. Fortunately, the agency operates from a framework that utilizes social work principles, so I have found my practice to be highly congruent with their approach as well as the social work faculty.

However, whatever strengths I may bring to practice based on who I am, there are certainly limitations as well. Despite the connection I felt with Lana concerning her struggles with her family life, I was aware that her circumstances are nonetheless difference and unique. Furthermore, respecting that notion is vital as a practitioner to really hear what she was telling me and being attuned to points that she emphasized. Overall, my awareness of my PIE gave me insight into how certain elements influence my practice and therefore insight into how I may strive to achieve a balance between my personal and professional self.

Paradigm of the Profession

This dimension comprises four practice options including: client system, target system, action system and change agent system (Ramsay & Karls, 1999). Perhaps it is this dimension of this framework that makes me realize how connected we all are as agents in the social work profession. The paradigm of the profession acknowledges generalist and specialist practitioners in all their professional activities (i.e., from micro to macro practice) (Ramsay, 2001). Moreover, this model appreciates and accounts for the diversity within practice and thus facilitates working with different clients, theoretical perspectives and systems.

At the Elizabeth Fry Society, my main source of professional feedback has been my supervisor, Juliana West. As one of two social workers at the agency, Juliana has introduced me to the various practice methods she employs in her direct practice. Her primary approach to practice fits well with the agency mandate and principles. Juliana operates from a feminist approach that compliments the agency’s social work foundation. Furthermore, the Elizabeth Fry Society recognizes feminist principles and Aboriginal approaches to practice thereby facilitating a mutual contract between agency and worker. My placement at this agency has provided a context for this dimension and I have been able to observe and participate in discussions around various theories and approaches to practice.


Case Critical: Lana’s Story Continued

Having an initial impression of Lana’s life and her relationships gave me the impetus to begin examining Lana’s problems with theft behavior. The Theft and Loss Counseling program, through which I operate as a one-on-one counselor, aims to reduce or eliminate theft behavior by figuring out the social difficulties underlying the behavior. To this end, Lana and I explored the triggers to her theft as well as reasons she perceived to contribute to this behavior. Based on the nature of Lana’s problem, the client system option within the paradigm of profession dimension seemed to fit well. As this option reflects the “decision to work directly people who request or are willing to be in a client role to address social functioning needs” (Ramsay & Karls, 1999) I focused my efforts on Lana.

Methods of Practice (MOP)

This last dimension of the model “addresses the ability of social workers to use knowledge effectively and skillfully in relation to the other components of the whole model in the best interests of the people they serve” (Ramsay, 2001). My understanding of this dimension involves taking into consideration the other dimensions and viewing the model holistically. As this dimension encompasses all and any practice interventions and activities that serve to effect positive change, viewing this dimension in systematic phases in the common problem-solving process in social work allows for its discrete parts to be delineated. Consequently, the use of PIE as an organizing tool in one phase of the problem-solving process provides a descriptive and comprehensive portrayal of the individuals life. Moreover, the incorporation of PIE eases the communication of why a particular method was selected (Ramsay & Karls, 1999).

As with the other dimensions, the MOP can be broken down into four parts: Factor 1 examines social roles and relationship types while Factor 11 explores social environment institutions and resources. The remaining two factors investigate mental and physical health. This unfolded interconnectiveness depicts isolated parts, yet it is important to remain cognizant of their collective nature.


Case Critical: Lana’s Story Continued

PIE Assessment

Factor I: Social Role Functioning

Familial Roles

Spouse Role
:

                        Problem Type: Responsibility Type

Severity Index: Moderate Severity

Duration Index: One to Five Years

Coping Index: Inadequate

Lana’s primary problem is most definitely in her spouse role. Lana expressed that since the loss of her husband’s job two years ago, her already responsibility type has gone onto overdrive. Lana explored this issue in relation to her theft and discovered that her theft behavior commenced around this time.

Mother Role:

                        Problem Type: Responsibility Type

Severity Index: Low Severity

Duration Index: More than Five Years

Coping Index: Somewhat Inadequate

Lana’s role as a mother to her two children is perceived to be somewhat lacking. Lana expressed deep feelings of responsibility for their happiness, despite the fact that they are both older adults. Lana recognizes that this has taken a toll on her, yet indicated that she is usually able to cope with this issue.

Child Role
:

                        Problem Type: Isolation Type

Severity Index: Low Severity

Duration Index: Six Months to One Year

Coping Index: Somewhat Inadequate

The last identified issue is Lana’s role as a child. Having has a major dispute with her mother. Lana has been estranged from her for a little over half a year. Lana stated that although this bothers her, she feels that it will be resolved soon and that it does not interfere with her functioning.

Other Interpersonal

Friend Role:
                        Problem Type: Mixed Type

Severity Index: Low Severity

Duration Index: Six Months to One Year

                        Coping Index: Adequate

Lana described her relationships with a few of her close friends in mixed terms. On the one hand, Lana feels quite positive about these friendships. However, Lana discussed the impact of certain disagreements as very negative and residual. Overall, Lana indicated adequate coping skills.


Factor II: Environmental Problems

Judicial System

Judicial and Legal Aid:

                        Involvement in the Criminal Justice Process and Probation (Alternative Measures)

Severity Index: Low Severity

Duration Index: One to Six Months

Lana identified having been caught shoplifting as especially traumatic for her, yet expressed some relief that at least now she is getting the help she needs.

Affectional Support System
:


                        Lack of Social Supports

Severity Index: Low Severity

Duration Index: One to Six Months

Lana expressed that she has not confided in anyone regarding her theft behavior nor her involvement in the criminal justice system. Consequently, Lana stated that this process has been difficult for her as she has not been able to access her normally strong support network. However, Lana views this process as somewhat short-term, at least in regards to its intensity.


Factor III
: Mental Health

                       
                        No reported diagnoses or observed problems of mental health concerns.
 
Factor IIII: Physical Health

No reported diagnoses or observed symptoms of physical health concerns.

 

The PIE assessment helped identify the main contributors to Lana’s problems and specifically her issues with theft. Lana expressed that the stress she has been feeling around her relationship with her partner triggered her maladaptive coping theft behavior. Once we were able to establish this connection, we discussed possible alternative healthier coping responses. The PIE assessment aided this process through identification as well as offering a visual caption of Lana’s problems.

Other merits of using PIE as an organizing tool included facilitating the communication between my supervisor and myself. Juliana commented that the incorporation of PIE made it easy for her to understand Lana’s problem as well as understand the chosen course of action. Furthermore, PIE established other area’s of concern to monitor (i.e., her relationships with friends and her mother). Overall, within the client system option, Lana and I decided to continue the one-on-one counseling sessions in the effort to provide a supportive and safe atmosphere in which we could discuss the progress she was making in eliminating her theft behavior. During these sessions, we will work on identifying the triggers to her theft and challenging her thought process in the high-risk moments.

Feminist and Aboriginal Approaches

As with the nature of PIE, both the feminist and Aboriginal approaches can be viewed as holistic and comprehensive (Shriver, 2001). The feminist approach can be seen as one that recognizes “the range of women’s strengths, knowledge, and lived experience” (Heinonen & Spearman, 2001). This evolving approach considers the inequality women confront in all realms of life and focuses on empowerment. While empowerment as a process can take many forms, the Elizabeth Fry Society emphasizes certain elements. In direct practice, these include: breaking down the “expert & learner” roles by deliberate use of space (physical and conversational), honoring each women’s story, appreciating diversity (one example of this is the purposeful placement of each poster in the office), and believing what the client says to be true.

The Aboriginal approach is one that focuses on wholeness as represented by the four corners of the medicine wheel (physical, emotional, mental, and spiritual) (Heinonen & Spearman, 2001). Although this approach recognizes diversity within diversity, certain concepts are central to many of these approaches. Balance, relationships, harmony, growth and healing comprise some of these teachings (Heinonen & Spearman, 2001). The Elizabeth Fry Society honors these teachings in many ways. In direct practice, these include: identifying features of problems that cover all ‘corners’ of the client’s life, facilitating the client’s acceptance of responsibility for their own healing, and appreciating the divergent paths healing may take.

The feminist and Aboriginal approaches compliment each other in theory and in practice. In my direct work with Lana, I have employed these approaches throughout. For example, I have ensured that my office is set up in a manner that facilitates sharing and equality. In our discussions, I have intended to be respectful and open as well as extensive in terms of matters discussed.  With regards to intervention strategies, I have challenged some of Lana’s pre-existing beliefs, yet aimed to be respectful of her boundaries. I have also included her in all of the decision-making from process to progress. Through these approaches and the use of this comprehensive framework, I believe I am operating to promote successful change.


Conclusion

The process of applying a comprehensive framework to a direct practice case using a feminist and Aboriginal approach has been an enlightening one. Not only am I more aware of the utility of PIE as an organizing tool, I also view it in the context of the other dimensions. This holistic way of thinking has promoted an understanding of my own practice as well as a more accurate portrayal of my client’s life. Furthermore, I have been impressed by how straightforward this framework is to use and communicate to other co-workers. This framework, including the Domain of the Profession, the Domain of the Social Worker, the Paradigm of the Profession and the Methods of Practice, facilitates a perspective that is both comprehensive and enriching. Its unfolding nature is reminiscent of all of us, as social workers and client’s – we all have superficial and deep-seated aspects of our (personal and professional) selves. Recognizing and incorporating this quality makes this framework versatile and responsive to change, the characteristic feature of the social work profession.

References

Canadian Association of Social Workers (1983). Social Worker Declaration, Code of Ethics.

Heinonen T, Spearman L (2001). Social Work Practice: Problem Solving and Beyond. Toronto/Vancouver, Canada: Irwin Publishing Ltd, 24-25, 234-238, 284-286.

Holosko M (2001). The History of the Working Definition of Practice. Research on Social Work Practice.

Law School Admissions Council (2002). Legal Education in Canada. Retrieved from the World Wide Web November 8, 2002. <www.lsac.org>

Postman N, Weingartner. (1969). Teaching as a Subversive Activity: The Inquiry Method. New York: Delta Book Publishing, 25-26.

Ramsay R (2001). Revisiting the Working Definition: The Time is Right to Identify a Common Conceptual Framework for Social Work. One of five keynote papers selected for presentation to the Kentucky Conference on Social Work and Education. February 8-10, 2001.

Ramsay RF, Karls JM (1999). Person in Environment Classification System: Adding CD-ROM Options to the Social Work Learning Menu. NTHS 12(3/4), 17-29.

Sheafor B, Horejsi C, Horejsi G (2000). Techniques and Guidelines for Social Work Practice: Fifth Edition. MA: Allyn and Bacon, 3-5.

Shriver J (2001). Human Behavior and the Social Environment: Third Edition. MA: Allyn and Bacon, 86.