Chapter 12 - Developing Goals and Formulating a Contract PDF

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Notes from Professor Georgena Haranis's class on developing goals and formulating a contract....

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Chapter 12 - Developing Goals and Formulating a Contract ● Goals ○ Central to achieving outcomes and working in systematic, process-oriented approaches such as the helping process ○ Prominent in task-centered/crisis intervention models, cognitive restructuring, solution-focused brief treatment, case management ○ Goal statement - agreement that becomes focus of the work to be completed by the social worker and client ○ The purpose and function of goals ■ Attainment of goal is a process ■ Priority concern - starting point (Point A) ■ Point B, goal attainment, desired outcome ■ Tasks or objectives - represent incremental action steps taken toward desired outcome and within a designated time frame ■ SMART goals - ensure clients can travel successfully from Point A to B; provide focus and direction to work to be completed by SW/client ● Specific ● Measurable ● Action-oriented ● Realistic ● Timely ■ Setting goals also ● Ensures you and client are in agreement, where possible, about outcomes to be achieved ● Provides direction, focus, and continuity to helping process and prevents wandering off course ● Facilitates development and selection of appropriate strategies and interventions ● Assists you and client in monitoring progress ● Establishes criteria for evaluating effectiveness of specific intervention and of helping process ○ Linking goals to target concerns ■ Evolve from concerns or problems presented by clients ■ Listening to clients tell stories helps you obtain useful information for developing preliminary goals ■ Link between goals and target concerns ■ There will be times when achieving a goal will require accessing resources of another agency ○ Distinguishing program objectives and client goals ■ Program objectives flow from mission statements and inform how organizational resources are utilized to target need/population ■ May be directly related to outcomes sought by funders or purchase of service agreement (POS) ■ Client goals and objectives are often used interchangeably to articulate

expected outcomes for service recipients Program objectives - general statements regarding outcomes that are expected for all service recipients involved with agency’s program ○ Factors influencing goal development ■ Client participation ■ Involuntary status ■ Values and beliefs ● YAVIS - young, articulate, verbal, intelligent, successful ■ Resources and supports ■ Environmental conditions ○ Types of goals ■ Systems or subsystems that will be focus for change will determine type of goal to be developed ■ Examples: ● Change in cognitive functioning ○ Increase positive self-talk ● Change in emotional functioning ○ Manage anger ● Behavioral change ○ Listen to others without interrupting ■ Overt goal - requires action ■ Covert goal - involves changing thoughts or feeling ■ Shared goals - held in common and agreed upon by members of system ■ Reciprocal goals - have some elements of shared goal (also developed in conjunction with all parties involved) ● But all involved agree upon exchanges of different behavior and to act or respond to each other in a different manner ● May be precursor to developing other goals Guidelines for selecting and defining goals ○ Because goals guide work to be completed between SW and client, important that a goal be selected and defined with care ○ Goals must relate to desired results sought by voluntary clients ○ Goals for involuntary clients should include motivational congruence ■ Strategies for developing goals with involuntary clients ● Motivational congruence - as a SW you work on target goals that are personally meaningful to client and that also satisfy requirements of the mandate ● Agreeable mandate - search for common ground, bridges differing views of involuntary client and court; may involve reframing definition of problem to address concerns of mandate and of client ● Let’s make a deal - bargaining strategy; private concerns of client combined with problem that precipitated mandate/referral ● Getting rid of the mandate - appeal client’s desire to be free of restraints imposed by mandate/referral source ■

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Goals should be defined in explicit and measurable terms ■ Partializing goals - helps with empowerment/efficacy of client ● Partialized - made into manageable parts so clients are better able to develop discrete corrective/problem-solving actions ■ Goals and general tasks ● General tasks - developed as instrumental strategies to further partialized goals; serve as basis for subsequent development of objectives, steps of specific tasks ○ Essential function is to indicate particular action steps to be taken to achieve goals ● Discrete general tasks - consist of one-time actions or changes that resolve or ameliorate problems ● Ongoing (continuous) general tasks - actions that are repetitive and rely on incremental progress toward ultimate/global goal

goals

General tasks

Pursue a SW degree

Submit applications for admission

Provide appropriate supervision for children each time mother goes out for evening

Arrange for childcare

Live in safe environment

Visit assisted living facilities

Lose 20 pounds

Join a health club

Learn to plan/prepare nutritious meals

Prepare meals that include foods from five food groups

Improve listening skills in classroom

Listen without interrupting others in classroom

Minimize conflict with peers during recess

Learn conflict resolution skills

Express anger in constructive manner

Learn alternative ways of expressing anger

Attend school on time on a regular basis

Make preparations for getting to school on time

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Goals must be feasible ■ Ethical persuasion - conversation of mutual respect between SW and client so alternative goals can be explored ● Advantages and disadvantages of goal decision reviewed ■ Feasibility of involuntary clients’ mandated case plans ● Specific goal focus clarifies change specifically required for particular client ● Assessing feasibility of both “kitchen sink” and “cookie cutter” goals especially important because they add to tension/distress

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Goals should be commensurate with knowledge and skills of practitioner ■ Secondary supervision - used in instances when you may lack competence or agency supervision for dealing with situation ● Can provide you with access to qualified professional, making it possible for you to contract for goals beyond your scope under professional’s guidance ● Generally restricted to specific case ■ When secondary supervision is not an option ● Proceed to work with client with approval/guidance of supervisor under restricted conditions ○ Explain to client the limitations of competence with regard to their goal; advising them allows them to decide on informed basis whether to continue contact with you ○ Evaluate whether developing goals in area where you lack expertise places clients/others at risk Goals should be stated in positive terms that emphasize growth Avoid agreeing to goals about which you have major reservations ■ Negative and positive goal statements ● Negative ○ Understand inability to manage stress/anger when disciplining children ○ Never leave children home alone ○ Prevent formation of coalitions and nonparticipatory behaviors by group members ○ Discontinue frequency of drinking binges ○ Refrain from running away from home ○ Reduce incidents of abusive behavior ● Positive ○ Learn alternative ways to discipline children ○ Arrange for care of children when you plan to be away for evening ○ Unite efforts of group in working collectively, encouraging each member to participate ○ Increase periods of sobriety each day ○ Discuss curfew with parents as alternative option to running away from home ○ Walk away from situation when you’re angry to avoid hitting your wife ■ Professional values and goal transitions ● Clients’ goals may be incompatible with your values ● Use ethical principles to guide work and frame professional nature ■ Referrals as a resource ● Ethical practice may demand you refer client to another professional or agency

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Ethical and legal tensions ● There may be times you may decline to assist client with particular goal for legal and ethical reasons ○ Goals should be consistent with function of agency Applying goal selection and development guidelines with minors ○ Eliciting minors’ understanding of the goal and point of view of the problem and using this information to assist them to develop goals ○ Is the minor voluntary or involuntary? ■ Can make a difference in dynamics of goal development with minors ■ Involuntary clients may be hesitant to participate and set goals ■ Minor’s feelings should be recognized as valid ○ Definition and specifications of the behavior to be changed ■ Criteria for developing clear goals with minors ● 1. Emphasize the change in behavior that is expected (waiting your turn to speak) ● 2. Define conditions in which behavior change is observed (in the classroom) ● 3. Clarify expected level of goal performance within a specific timeline (listen without interrupting while others are talking) ■ Goals with minors tend to work best when they provide ● Sense of self direction, particularly with adolescents who tend to react to being told what to do and how to act ● Incentives linked to goals (something they want for themselves) ● Sense of their ability to achieve goals ● Involvement in establishing evaluative measures ● Regular feedback about performance that honors their progress ● Praise for their efforts as well as goal attainment ● Opportunity to talk about how they accomplished a goal and their level of satisfaction with performance ● Opportunities for them to measure their progress and praise themselves ● Strengths and protective factors (support of family or significant others in their lives) The process of negotiating goals ○ Determine clients’ readiness for goal negotiation (for both voluntary/involuntary) ■ Readiness of involuntary clients ● The mandate ● Specificity ● Level of freedom ● Client’s viewpoint ● Involving client in setting goals ● Measuring progress ○ Explain purpose and function of goals ○ Jointly select appropriate goals

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○ Define goals explicitly and specify level of change ○ Determine potential barriers to goal attainment and discuss benefits and risks ○ Assist clients in making clear choice about committing themselves to goals ○ Rank goals according to client priorities Monitoring progress and evaluation ○ Essential components of helping process ○ Methods of monitoring and evaluating progress ■ Identifying specific problem/behavior to be changed ■ Specifying measurable and feasible goals ■ Matching goal and measurement procedures ■ Maintaining a systematic record of relevant information ■ Evaluating intermediate and final outcomes ○ Involving clients in monitoring and evaluating progress ■ Feedback from clients regarding progress/satisfaction with services and rationale for inclusion as partners in monitoring/evaluating progress ● 1. By eliciting clients’ views, you maintain focus on goals and enhance continuity of change efforts ● 2. Clients gain perspective in determining where they stand in relation not only to ultimate goals but also to pretreatment levels ● 3. Observing incremental progress toward goals tends to sustain motivation and to enhance confidence in helping process/SW ● 4. Eliciting clients’ feelings about progress can help you address feelings/behaviors that can impede future progress ● 5. Clients can provide feedback on efficacy of a goal or intervention strategy and whether approach has yielded results ● 6. Indications of progress toward goal alert you to when clients might be ready to shift focus to another goal or terminate ○ Quantitative measurements ■ Quantitative evaluation - use of procedures that measure frequency and/or severity of target problems ■ Baseline measures - measurements taken before implementing changeoriented interventions ● Provide baseline against which measures of progress and measures at termination/follow-up can be compared ■ Single-subject design - can be used in variety of settings; can be adapted so you can integrate evaluation as key element in practice ■ Measuring overt behaviors ● Reactive effects - effects of self monitoring on target behavior; source of contamination that confounds effects of interventions ■ Retrospective estimates of baseline behaviors ■ Self-anchored scales ● Denote various levels of an internal state ● Useful when goals involve altering feelings (anger, depression, loneliness, anxiety)

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Ask client to imagine experiencing the extreme degrees of the given internal state and describe what they experience ■ Guidelines for obtaining baseline measures ● 1. Define target of measurement in clear and operational terms ● 2. Be sure your measures relate directly and specifically to goals targeted for change ● 3. Use multiple measures and instruments when necessary ● 4. Measures should be obtained under relatively consistent conditions ● 5. Baseline measures are not relevant when clients present with discrete goals ■ Measuring with self-administered scales ● Useful for obtaining evaluative data ■ Monitoring progress with quantitative measurements ● Measures establish indicators; tells client and SW when goals have been accomplished, when relationship can be terminated ■ Receptivity of clients to measurement ● Clients generally receptive to formal evaluation procedures ○ Qualitative measures ■ Informative events or critical incidences ● Informative event - critical incidence, qualitative method that seeks to determine whether intended/unintended gains can be attributed to a particular event/action ○ These events referred to as therapeutic effects, turning points, or logical analysis effects that are significant to goal attainment ○ Combining measures for measuring and evaluating ○ Evaluating your practice ■ Regardless of method you should be able to answer questions like ● Is the client making progress toward a goal? ● Is what I am doing with the client working, and if not, what changes do I need to make? ● Do I need to consult with a supervisor? ● Is my practice consistent with the ethical standards and principles of the profession of social work? Contracts ○ Contracts are tools that detail agreement between you and the client ○ May also be referred to as service agreements, behavioral contracts, or case/treatment plans ○ Child safety plan - specifies that a parent call a relative when their frustration reaches a point at which potential for hitting child exists ○ Contingency contract - identifies desired behavior change on part of all parties involved ■ Fulfillment contingent on each individual’s behavior in response to other

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parties’ behavior Good-faith contract - parties involved agree to change their behavior independently of one another ■ May be used in a social-behavioral skills group or behavioral parenting training group The rationale for contracts ■ Identifies work to be accomplished through the change-oriented strategies by which goals will be attained Formal and informal contracts ■ Written contracts - provide space for entering concerns/problems of a client situation and for listing the expected intervention outcomes ■ Service agreements - some private agencies prefer these to contracts because contracts are too formal/administrative in nature ■ Oral contracts - include same provisions but lack formality, sterility, and finality of a written contract ● Questions may arise later with regard to informed consent ■ Partially oral and partially written contract is another option Developing contracts ■ Goals to be accomplished ■ Roles of participants ■ Interventions or techniques to be employed ■ Time frame, frequency, and length of sessions ■ Frequency and duration of sessions ■ Means of monitoring progress ■ Stipulations for renegotiating the contract ■ Housekeeping items ● Talking with clients about provisions for canceling/changing scheduled sessions and financial arrangements Sample contracts...