ASWB: Notes on Direct and Indirect Practice

Approaches to social work practice
The major approaches to social work practice are the following:
Psychosocial
Functional
Problem-solving
Behavior modification
Cognitive therapy
Crisis intervention
Task centered and competency-based treatment
Life model (ecological treatment)
Family therapy
Narrative therapy
Play therapy
Geriatric social work
Trauma treatment

Views of changes in clients
The following are three different ways to view how change occurs (in clients), as seen in the varied approaches to social work:
Psychological (e.g., psychodynamic, behavioral, cognitive, etc.)
Sphere of change (e.g. individual, couple, family, social system, etc.)
Goal of change (e.g. personality, behavioral, social system, etc.)

Length of treatment varies with approach
Extended periods of time for treatment are needed for those approaches that focus on personality change. Shorter-term treatment is called for in those approaches that focus on behavioral change, cognitive change, or problem solving. Examples are crisis intervention, task-centered treatment, cognitive, and behavioral treatment.

Views of treatment relationship
One view of the treatment relationship sees the therapeutic relationship as the main channel for promoting change and providing support.
Another view sees the worker's role as ally, teacher, or coach. In this view, a here-and-now approach is taken. This can be seen in behavioral, cognitive, or crisis intervention models for practice.
Similarities among social work practice approaches
The following are some similarities seen among all approaches to social work practice:
The use of relationship in some way.
Some form of assessment, treatment plan, and goal-setting.
A means of evaluating treatment.

Psychosocial approach
Basic tenets
The basic tenets of the Psychosocial approach are:
Psychosocial
Problem-solving
Crisis intervention
Task-centered casework
Planned short-term treatment

Assumptions about human behavior
The following are the assumptions about human behavior that the Psychosocial approach to practice makes:
The individual always seen in the context of environment, interacting with social systems (such as family), and influenced by earlier personal experiences.
Conscious, unconscious, rational, and irrational motivations govern individual behavior.
Individuals can change and grow under fitting conditions throughout the life cycle.

Change
In the Psychosocial approach to Social Work practice, the following are the means through which change occurs:
Development of insight and resolution of emotional conflicts.
Corrective emotional experience in relationship with the worker.
Changes in affective, cognitive, or behavioral patterns that induce changes in interpersonal relationships.
Changes in the environment.

In the Psychosocial approach to practice, the motivations for change are as follows:
Disequilibrium induces anxiety and releases energy to change.
Conscious and unconscious needs and wishes.
Relationship with the worker (or group in group treatment).

Role of therapeutic relationship
The role of the therapeutic relationship in the Psychosocial approach is described as follows:
Mindful use of the relationship can motivate and create energy to change.
Corrective emotional experience.
Client and client's needs are central. Self-disclosure by worker is used purposefully and only for client's benefit.
Some transference dynamics may hamper treatment, but generally they should be seen and used as potential vehicles for promoting client self-understanding and changing problematic interpersonal patterns.
To deal with possible countertransference, worker should be self aware, seek supervision and consultation to decrease countertransference reactions, and use her/his own therapy for dealing with countertransference.
Worker should be aware that s/he may be perceived as more competent than the client and as the expert who is there to 'fix' the client's problems. This can be disempowering to the client and works against a strengths perspective.

Treatment planning
In the Psychosocial approach to Social Work practice, the components of treatment planning are:<ol><li>Development of a unique treatment plan based on the client's situation.
Client goals and their practicality, given the client's abilities, strengths, and weaknesses, as well as availability of relevant services.
Treatment plan is directed at changing the individual, the environment, or the interaction between the two.</li></ol>

Phases of treatment
The following are the phases of treatment in the Psychosocial approach:<ol><li>Engagement/assessment (applicant becomes client; increasing motivation; initial resistance; establishing work relationship, assessment; informed consent re: confidentiality; client/worker's roles, rights, responsibilities)
Contracting/goal setting (client/worker's mutual understanding re: goals, treatment process, nature of relationship/roles, intended time of treatment)
Ongoing treatment/interventions (working toward improving previously agreed upon problems; major focus: current functioning/conscious experience; dealing with ongoing resistance, transference, countertransference)
Termination (potential for growth, reiterate major themes of treatment, experience feelings about relationship ending)</li></ol>

Problem-Solving approach
Change
In the Problem-Solving approach to Social Work practice, the motivations for change are as follows:
Disequilibrium between reality and what the client wants.
Conscious desire to achieve change.
Positive expectations based on new life possibilities.
The strength of a supportive relationship and positive expectations of the worker.

In the Problem-Solving approach to Social Work practice, the means through which change occurs are as follows:
Improved problem-solving skills. These may produce changed in personality or improved functioning, but these are secondary to problem resolution.
Gratification, encouragement, and support which result from improvement in the problem situation. This and the worker's emotional support increase the possibility of change.
Repetition and practice (drilling) of the problem-solving method increases possibility for replication of effective strategies in new situations.
Insight, resolution of conflicts, and changes in feelings.
Problem resolution concerning changes in the individual, the environment, and/or the interaction between the two.

Role of therapeutic relationship
The role of the therapeutic relationship in the Problem-Solving approach to Social Work practice is as follows:
Mindful and continual use of the supportive social work relationship to motivate clients to engage in problem resolution.
The worker is an expert in problem-solving methodology and guides clients through steps of problem resolution. The relationship grows as worker and client work on problems jointly.
Work is focused on practical problem solving, therefore transference/countertransference are less likely. These are only addressed if interfering with the work.

Treatment planning
In the Problem-Solving approach to Social Work practice, the components of treatment planning are as follows:<ol><li>Psychosocial: derived from an evaluation of the problem and the client's motivation, capacity, and opportunities (MCO).
Functional: the function of the agency serves a boundary of service (i.e., adoption agency, mental health service)
Interagency: using resources from other agencies in a network of services designed to help the client.

Phases of treatment
The four Ps are the basic elements involved in treatment: A person has a problem, comes to a place for help given through a process.

Clearly identify the problem and the client's subjective response to it.
Select a part of the problem that has possibility for resolution, identify possible solutions, assess their achievability in light of MCO.
Engage client's ego capacities.
Determine steps/actions to be taken by worker and client to resolve or alleviate the problem.
Help client carry out problem-solving activities and determine their effectiveness.
Termination.

Crisis Intervention approach
Change
The motivations for change in the Crisis Intervention approach are:
Disequilibrium caused by a stressful event or situation.
Energy, which is made available by anxiety about the situation.
A supportive relationship.

Change occurs through:
Challenging old coping patterns and a reorganization of coping skills.
Growth, which occurs as the ego develops a larger repertoire of coping skills and organizes them into a more complex pattern.

Phases of treatment
The phases of treatment in the Crisis Intervention approach to practice are as follows:<ol><li>Identify events that brought on the crisis.
Promote awareness of impact of crisis, both cognitive and emotional.
Manage affect leading to tension discharge and mastery.
Seek resources in networks (individual, family, social) and in community.
Identify specific tasks associated with healthy resolution of crisis.

Treatment skills and techniques
The following treatment skills or techniques are used in the Crisis Intervention approach:- Brief treatment. Like the crisis itself, treatment is time limited.- Present- and future-oriented. Treatment can deal with the past, however, to resolve old conflicts if they prevent work on the present crisis.- Uses all psychosocial and problem-solving techniques, but reorders them; clinician is active, directive, and at times authoritative.

Behavioral Modification approach
Change
The Behavioral Modification approach sees the following as the motivations for change:
Disequilibrium
Anxiety
Conscious desire to eliminate a symptom
Agreement to follow a behavior modification program

In the Behavioral Modification approach to Social Work practice, the means through which change occurs are as follows:
Operant/voluntary behavior which is 1) increased by positive or negative reinforcement and 2) decreased by withholding reinforcement or punishing.
Involuntary behavior which is increased or decreased by conditioning.
Change depends upon environmental conditions or events that precede, are connected with, or follow the behavior.
As a result of observing and imitating in a social context, modeling occurs; this is not learned by reward and punishment.

Treatment planning
Treatment planning in the Behavioral Modification practice approach is described as follows:<ol><li>Prioritize problems. Identify maintaining conditions for selected problems.
Engage client in establishing goals for change.
Establish baseline data re: frequency of behavior.
Develop written or oral contract.

Cognitive Therapy approach
Change
The motivations for change in the Cognitive Therapy practice approach are:
Disequilibrium
Anxiety
Desire to live without a symptom
Agreement to work toward changing thought patterns.

In the Cognitive Therapy approach to social work practice, the following are the means through which change occurs:
Structured sessions
Exploring and testing cognitive distortions and basic beliefs
Homework between sessions which allows client to practice changes in thinking in the natural environment.
Changes in feelings and behaviors in the future come about through changes in the way the client interprets events.

Treatment planning
The treatment planning process in the Cognitive Therapy approach to practice is as follows:<ol><li>Establish baseline data measuring client's negative automatic thoughts, distortions, and dysfunctional beliefs. How often do these thoughts occur and under what circumstances?
Create target goals for change and alternative ways of thinking.
Agree to contract for goals, homework, and time frame of treatment.
Treatment skills and techniques
Some treatment skills/techniques used in the Cognitive Therapy approach are listed below:

Short term treatment
A focus on symptom reduction
Using a rational approach, focus on concrete tasks in sessions and for homework.
Per Albert Ellis—Be forcefully confrontational in order to reveal client's thought system, get client to see how that system defeats her/him, and work to change the thoughts that make up that system.
Per Aaron Beck—A gentler, more collaborative approach. Help client restructure interpretations of events. 'What is the evidence for this idea?' or 'Is there another way to look at this situation?' Social skill building, group therapy, milieu treatment.

Task-Centered approach
Change
The motivations for change according to the Task-Centered approach to practice are:
Temporary breakdown in coping influences client to seek help.
A conscious wish for change.
Strengthening of self-esteem through task completion.

In the Task-Centered approach to social work practice, the following are the means through which change occurs:
Clarification of problem/problems
Steps taken to resolve or alleviate problems.
Changes in environment.

Treatment planning
The treatment planning process in the Task-Centered approach to practice is explained as follows:<ol><li>A contract must state agreement on what will be worked on, the worker's and client's willingness to engage in the work, and the limits of the treatment (time, etc.). The contract can be formal, oral, or written; it is dynamic and can be renegotiated.
Both worker and client agree on a specific definition of the problem/s to be worked on and the changes sought in the process. Expressed in both behavioral and measurable terms.</li></ol>
Clients for which Task-Centered approach is not appropriate
The Task-Centered approach to practice is not appropriate for the following clients:
Clients who are interested in existential issues, life goals, and/or discussion on stressful events.
Clients who are unwilling or unable to use the structured approach to tasks.
Clients who have problems that are not subject to resolution or improvement by problem-solving.
Clients who are involuntary, where treatment is mandated.

Systems Theory approach
Change
The motivations for change according to the Systems Theory approach to practice are changes in the individual, environment, or in the interaction between the individual and the environment.

Treatment planning
Treatment planning in the Systems Theory approach is as follows:<ol><li>Establishing specific goals, their practicability, and their priority.
Target systems for intervention are identified in collaboration with the client.
Specific contract is developed with the client and/or other systems that may be involved in change.

Change in the Ecological/Life Model approach
Motivation for change in this approach stems from changes that the individual wants in relation to her/himself, the environment, or the interplay between the two.

Family Systems theory
Disequilibrium of the normal family homeostasis is the primary motivation for change according to this perspective. The family system is made up of three subsystems: the marital relationship, the parent-child relationship, and the sibling relationship. Dysfunction that occurs in any of these subsystems will likely cause dysfunction in the others. The means for change in the Family Systems theory approach is the family as an interactional system.

Child-treatment approach
The motivations for change in the child-treatment (age related treatment) approach to practice are as follows:
If child is in alternative placement (foster care, etc.), child's behavior may be seen as problematic by the agency or worker and treatment interventions may be sought.
Child is unhappy with peer relations, may be socially immature.
Unsatisfactory school adjustment (grades, problems with authority)
Conflict with parents (struggle to cope with dysfunctional family or problems in parents' marriage)
Feelings of anger, unhappiness
Self-destructive behaviors such as cutting or eating disorders.

Geriatric Social Work
Motivations for change include:
The need for individuals to adapt to longer periods of old age and retirement as life expectancy increases. With longer period of old age comes increased risk for chronic illness and physical/cognitive limitations.
Greater need for multiple types of social services, supported housing, and care options.
Adult children are also affected by their parents' aging and may need help dealing with the emotional impact or with care planning.

Change occurs through:
Individual, couples, family treatment
Support groups or group therapy
Recreational programs
Education

Trauma-Related practice
Change
The following are the motivations for change in Trauma-Related practice:
Reality-based fear and the need for protection.
Symptoms including depression, anxiety, dissociation, low self-esteem.

Treatment planning
For PTSD: treatments available include

Psychodynamic therapy
Dialectical Behavioral Therapy (DBT)—teaches skills to cope with intense feelings, reduce symptoms of PTSD, and enhance respect for self and quality of life
EMDR (Eye Movement Desensitization and Reprocessing)
Group Therapy (support or DBT)

For domestic violence
Develop a safety plan for safe shelter, etc. to protect victim from perpetrator.
Do not assess or treat domestic violence in marital or family therapy sessions as this may increase risk to the victim, inhibit revealing the violence history, and enrage the perpetrator.

Clinical Practice
Clinical Practice in social work is described as follows:
Seeks to improve the internalized negative effects of environmental factors including stress from health, vocational, family, and interpersonal problems.
The worker assists individuals, couples, and families to change feelings, attitudes, and coping behaviors that hinder optimal social functioning.
Practice is conducted in both agencies and private practice.
Is differentiated from other practice by its goal of helping individuals change, facilitating personal adjustment, treating emotional disorders and mental illness, or enhancing intrapsychic or interpersonal functioning.
Like all social work practice, assessment is psychosocial, focused on the person-in-environment, and has the goal of enhancing social functioning.

Assumptions and knowledge base
The assumptions made by and the knowledge base necessary for Clinical Practice are as follows:
Individual behavior, growth, and development are brought about by a complex interaction of psychological and environmental factors.
Theories of personality development
Systems Theory
Clinical Diagnosis (DSM)
Significant influences are socio-cultural factors including ethnicity, immigration status, occupation, race, gender, sexual orientation, and socioeconomic class.

Contracting and goal setting
The contract is compatible with various models of social work practice and is not limited to an initial working agreement, but is part of the total treatment process. The contract is helpful in facilitating the client's action in problem solving, maintaining focus, and continuing in therapy.
The contract is an explicit agreement between the client and the worker concerning target problems, goals, and strategies of social work intervention and distinguishing the roles and tasks of the client and the worker. The contract includes mutual agreement, differentiated participation, reciprocal accountability, explicitness, realistic agreement, and flexibility.
It is difficult to contract with involuntary clients who do not acknowledge/recognize problems, who see the worker as unhelpful, or who are severely disturbed or intellectually disabled. The worker should acknowledge openly the difficulty for both client/worker in mandated treatment and negotiate a contract within those realities.

Terms used in Clinical social work practice

-  Supporting/Sustaining: Worker conveys confidence in, interest in, and acceptance of client in order to decrease client's feelings of anxiety poor self-esteem and low self confidence. Worker uses interest, sympathetic listening, acceptance of client, reassurance, and encouragement.
-  Direct influence: Worker offers advice, suggestions in order to influence client
-  Exploration: Worker continually seeks to understand the client's view of self and situation
-  Confrontation: Worker challenges client to deal with inconsistencies between her/his words and actions, maladaptive behaviors, or resistance to treatment or change
-  Clarification: Worker questions, repeats, or rephrases material client discusses. Worker must use sensitivity to client's defensiveness.
-  Partialization: Helping client to break down problems/goals into smaller, more manageable elements in order to decrease client's sense of overwhelm and increase client's empowerment. Discrete elements of problem/goal can then be prioritized as more manageable or more important.
-  Universalization: Normalization of problems; problems are presented as a part of the human condition in order to help the client see them as less pathological.
-  Ventilation: Client's airing of feelings associated with the information presented about self and the situation. May alleviate intensity of client's feelings or feeling that s/he is alone with them. Worker may need to help client distinguish times when ventilation is useful and when it may increase intensity of feelings.
-  Catharsis: The release of tension or anxiety through reliving and intentionally examining early life, repressed, or traumatic experiences.

Interpretation
Worker offers the psychodynamic meaning of the client's thoughts, feelings, and fantasies, particularly about the origins of problem behaviors. Interpretation seeks to improve the client's insight and working through difficult material by deepening and expanding the client's awareness. Interpretation may entail the following:
Exposing repressed (unconscious) or suppressed (conscious) information.
Making connections between the present and the past to help the client see present distortions more clearly.
Integrating information from different sources, so that the client can gain a more realistic perspective.
Interpretation should be used with clients who are not emotionally fragile.

Resistance
In the psychodynamic understanding, resistance is an unconscious defense against painful or repressed material. Resistance can be conveyed through silence, evasiveness, balking at worker's suggestions, or by wanting to end treatment prematurely.
The worker ought to recognize and understand resistance as a chance to learn more about the client and work more deeply with the client to help him/her face resistance and use it effectively.
Transference and countertransference
Transference is the client's unconscious redirection of feelings for another person toward the worker in an attempt to resolve conflicts attached with that relationship or relationships. The worker should help the client understand transference, how it relates to relationships in her/his past, and how it may be contributing to present difficulties in relationships.
Countertransference is the worker's unconscious redirection of feelings for another person or relationship toward the client. The worker should understand her/his own countertransference reactions, be aware of their presence and consequences, and use supervision or therapy to gain greater understanding of them and not impose them on the client.

Termination
Termination offers an opportunity to rework previously unfinished issues. Frequently, earlier symptoms of the presenting problem resurface at this time. The worker should not necessarily use this reemergence as a reason to continue treatment, but the worker/client should work during the termination period to strengthen earlier gains.
Termination offers an opportunity for growth in dealing with loss and endings. The worker should acknowledge, verbalize, and manage feelings about endings (such as anger, abandonment, sadness, etc.). Termination can be an opportunity to reassess the meaning of previous losses in the client's life.
Termination provides a chance to evaluate treatment and the treatment relationship. What goals were met or unmet? What was effective or ineffective? Which client resources outside of treatment may continue after termination?
The following factors will affect how the client approaches termination in Clinical Practice:
The degree of the client's participation in the treatment process.
The degree of the client's success and satisfaction.
Earlier losses the client may have experienced.
Mastery of the separation-individuation stage of development in early life.
The reason treatment is ending. If worker is leaving or if ending is seen as against client's wishes or as a rejection, termination may be more intense.
The timing of termination—is it occurring at a difficult or favorable moment in the client's life?
Is termination part of a plan to transfer client's work to a new worker? If so, worker and client should use this time to put together ideas about focus and goals for next treatment relationship.

The worker's role in the termination process in Clinical Practice is described below:

-  Plan sufficient time for termination. In long- term treatment this would be four to eight sessions.
-  Inform the client if the work is ending prematurely.
-  Be aware of worker's own countertransference attitudes and behaviors about termination.
-  Continue to be sensitive, observant, empathic, and responsive to the client's response to termination.
-  Encourage client's dealing with the experience of termination. Confront client's inappropriate, dysfunctional coping with the experience.
-  Promote the client's belief in her/his ability to care for self and direct her/his own life.
-  Present the possibility for future contact at times of difficulty. Go over the client's resources (internal and environmental) that client can draw on before making decision to reenter treatment.

 

Group work
Contracting working agreements
The process and importance of contracting working agreements in group work is explained as follows:
Only if group members are involved in clarifying and setting their own personal and common group goals can they be expected to be active participants in their own behalf.
Working agreements consider not only worker-member relationships, but also others with a direct or indirect stake in the group's process. Examples would be agency sponsorship, collaborating staff, referral and funding sources, families, caretakers, and other interested parties in the public at large.

Influencing group process
Influencing group processes in group work methodology is described below:
The worker's ability to recognize, analyze, understand, and influence group process is necessary and vital. The group is a system of relationships rather than a collection of individuals. This system is formed through associations with a unique and changing quality and character (this is known as group structures and processes).
Processes that the worker will be dealing with include understanding group structures, value systems, group emotions, decision-making, communication/interaction, and group development (formation, movement, termination).

Individualizing
The process of individualizing in group work methodology is explained as follows:
The worker must be prepared to help individual members profit from their experiences in and through the group.
Ultimately, what happens to group members and how they are influenced by the group's processes determines the success of any group experience, not how the group itself functions as an entity.

Externalizing
The worker should give attention to helping members relate beyond the group, to encouraging active participation and involvement with others in increasingly wider spheres of social living. This should occur even when the group is relatively autonomous.

Programming
The following explains the importance of programming in group work methodology:
The worker uses activities, discussion topics, task-centered activities, exercises, and games as a part of a planned, conscious process to address individual and group needs while achieving group purposes and goals.
Programming should build on the needs, interests, and abilities of group members and should not necessitate a search for the unusual, esoteric, or melodramatic.
Social work skills used in implementing programs include the following: initiating and modifying program plans to respond to group interests, self-direction and responsibility, drawing creatively upon program resources in the agency and environment, and developing sequences of activities with specific long-range goals.
Using program activities is an important feature of group practice.

Worker's role in contracting
The worker's role in 'contracting' during group formation is as follows:
Setting goals (contracting)
Determining membership
Establishing initial group structures and formats.
All three of these elements require skillful management by the worker.

Group member selection
The worker's process of selecting members for a group is as follows:
Worker explains reasons for meeting with group applicants.
Worker elicits applicants' reactions to group participation. Worker assesses applicants' situations by engaging them in expressing their views of the situation and goals in joining the group.
Worker determines appropriateness of applicants for group, accepts their rights to refuse membership, and provides orientation upon acceptance into the group.

Facilitating group work
The worker's tasks in facilitating the group's work are as follows:
Promote member participation and interaction.
Bring up real concerns in order to begin the work.
Help the group keep its focus.
Reinforce observance of rules of the group.
Facilitate cohesiveness and focus the work by identifying emerging themes.
Establish worker identity in relation to group's readiness.
Listen empathically, support initial structure and rules of the group, and evaluate initial group achievements.
Suggest ongoing tasks or themes for the subsequent meeting.

Termination
Group members may have feelings of loss and may desire to minimize the painful feelings they are experiencing. Members may experience ambivalence about ending. The worker will:
Examine her/his own feelings about termination.
Focus the group on discussing ending.
Help individuals express their feelings of loss, relief, ambivalence, etc.
Review achievements of the group and members.
Help members prepare to cope with next steps.
Assess members' and group's needs for continued services.
Help members with transition to other services.

Substance use disorder treatment
Hospitalization for substance use
Hospitalization is appropriate for the following types of clients with substance use disorders:
Those with a drug overdose who can't be adequately treated in outpatient or emergency room settings.
Those at risk for severe or medically complicated withdrawal.
Those with medical conditions that make ambulatory detoxification unsafe.
Those with a documented record of not engaging in or benefitting from treatment in a less restrictive setting.
Those with mental health problems that would markedly impair their ability to participate in, comply with, or benefit from treatment. Also, those whose associated disorder would on its own require hospital level care.
Those who have not responded to less intensive treatments and whose substance use disorder poses an ongoing threat to their physical and mental health. Also those who exhibit behaviors that constitute an acute danger to self or others.

Residential treatment for substance use disorder
Residential treatment is appropriate for those who do not meet the clinical criteria for hospitalization, but whose lives and social interactions focus primarily on substance use, and who do not have adequate social and vocational skills and drug-free social supports to maintain abstinence in an outpatient setting.

Outpatient treatment
Outpatient treatment is appropriate for those whose clinical condition or environmental circumstances don't require a more intensive level of care.

Relapse prevention
This is an approach to treatment that uses cognitive behavioral techniques to help clients develop greater self-control to avoid relapse. Strategies used:

Discussing ambivalence
Identifying emotional and environmental triggers
Developing and reviewing specific coping strategies
Exploring the decision chain that leads to resuming substance use
Learning from brief relapses (slips) about triggers that lead to relapse and developing effectual techniques for early intervention.

Motivational enhancement therapy
This therapy is based on cognitive behavioral, client-centered, systems, and social-psychological persuasion techniques. It is a brief treatment modality and includes an empathic approach in which the worker helps to motivate the client through asking about the pros and cons of specific behaviors, through exploring the client's goals and related indecision about reaching those goals, and through listening reflectively.

Operant behavioral therapy
This therapy involves operant rewarding or punishing of clients for desirable or undesirable behaviors, such as treatment compliance or relapse. Rewards may include vouchers or other prizes awarded for drug-free testing or community reinforcement in which family members or peers reinforce abstinence.

Contingency management therapy
This is a behavioral treatment which is based on the use of predetermined consequences (both positive and negative) to reward abstinence or punish drug-related behaviors. Examples of negative consequences are notification of courts, employers, or family members. The effectiveness of this treatment requires the use of frequent, random, supervised urine monitoring for substance use. If negative contingencies are based upon the expected response of others, the worker must obtain the written informed consent of the client at the initiation of the contract.

Aversion therapy
This involves combining substance use with an unpleasant experience, such as a mild electric shock or pharmacologically induced vomiting. It is used in specialized facilities and controlled trials have had mixed results.

Cue exposure treatment
This treatment is based on Pavlov's extinction paradigm and involves exposure of the individual to cues that stimulate drug craving, at the same time preventing actual drug use and the experience of drug-related enforcement. It can also be combined with relaxation techniques and drug refusal training to ease the disappearance of classically conditioned craving.

Group therapy
The advantages of group therapy in substance use disorder treatment are as follows:
Can be a supportive, therapeutic, and educational experience that helps motivate and sustain participants.
Gives clients opportunities to identify with others.
Helps participants understand the impact of substance use on their lives.
Helps participants to learn more about their own and others' feelings and reactions.
Commonly regarded as the preferred mode of psychotherapeutic treatment for substance-dependent clients.

Family interventions
Family interventions are used in substance use disorder treatment when abstinence disrupts a previously well-established maladaptive style of family interaction and family members need help adjusting to a new set of individual and familial goals, attitudes, and behaviors. Family/couple therapy can be useful to promote psychological differentiation of individual family members, to provide a forum for the exchange of information and ideas about the treatment plan, to develop behavioral management contracts for continued family support, and to reinforce behaviors that prevent relapse and enhance recovery prospects.

Clinical risks
The following are clinical risks in substance use disorder treatment:- Suicide attempts and completions are substantially higher with substance use disorders than in the general population, with completed suicides 3-4 times than in the general population.- Increased risks for homicide and other violence.- Impaired reality testing, anxiety, irritability, increased aggressiveness, and impaired impulse control.
 

Research
Research can be defined as follows:

- Systematic study adding to or verifying existing knowledge that relies on systematic and orderly procedures in the search for new knowledge or the corroboration of existing knowledge.

- There are standardized procedures for collecting data that are described in detail and published so that the research may be replicated by other researchers.

- Peer review through the publication process is an important feature of research.

Research steps
The following are the steps involved in research:
Problem formulation
Methodology
Collection of data
Analysis of results
Dissemination of results

Problem formulation: Problem formulation is the first step in the research process. It is the method that researchers use to develop a statement that can be operationalized. Problem formulation should be worded in a way that will allow measurement.
Methodology: Methodology consists of choosing measurement techniques, the setting in which the research will be conducted, and the group/population that will be studied.
Study design selection
The following are relevant factors that go into selecting a study design:
How much interviewers must be trained.
How data will be managed and controlled.
Available research resources, such as subjects, availability of existing data, and quality of professional researchers.
Adequacy of funding.
Level of certainty required by consumers of research.
Involvement of human subjects and ethical issues related to their involvement.
Time required/available for research.

Concepts

As used in research, concepts are words used to organize experience. Concepts are perceptions created by generalizing from specifics.
Operationalizing a concept: Condensing a concept to a set of directions and actions so that a study can progress in a systematic and replicable manner. An example of this would be operationalizing the concept of 'succeeding on an exam' to 'earning a score of 75 or above.'
Hypothesis: An assertion about a relationship between two or more variables that can be tested with an outcome that can be confirmed, failed to confirm, or refuted.

Components of a hypothesis:
States there is a relationship between two variables.
Identifies the quality of that relationship in a testable way.
Should be precise about what is referred to and should allow some type of measurement.
Avoids value judgments.
Is related to a body of theory.

Null hypothesis
The Null hypothesis states that there is no significant relationship between two variables. Standard research practice is to test a hypothesis against the Null hypothesis.

Variable
A variable is a trait which everyone in the population has in varying amounts or types. It is the opposite of a constant, which is a trait that does not vary with different people. Independent variables are believed to cause some variation in another variable. Dependent variables have variation that must be explained. Intervening and extraneous variables come between the independent and dependent variables. This type of variable changes or confuses the variation of the dependent variable, which was believed to result from the effects of the independent variable. Researchers may not be aware of these variables, or may be unable to control their effects. Presence of these variables can lead to uncertainty regarding the meaning of the results obtained.

Theory
In the context of research, a theory is a set of related hypotheses linked in a way to explain some phenomena or predict some phenomena. Hypotheses that test theories are typically the basis of research studies.

Exploratory study
This type of study is used to explore an area of knowledge about which little is known and in order to gain familiarity with real life settings, problems, or phenomena. It is used to clarify concepts and develop hypotheses for further research. It is built on assessment of pre-existing knowledge, but is used to explore new areas. Examples include systematic review of related literature, survey of experts, analysis of case material, and participant observation.

Descriptive studies
These types of studies are used in areas where there is more knowledge than in exploratory studies.
Concerned with verifying facts; are carefully designed studies of phenomena with systematic and well-defined procedures.
Frequently are studies of a small representative sample in order to draw inferences about the broader population. Carefully constructed samples of subjects to be studied in order to avoid bias. Hypothesis may or may not be stated in advance.
These studies can be used to depict the traits of a population or the relationship among given variables.
Data collection may be accomplished through observation, questionnaires, interview, study of case materials, or testing of subjects.

Experimental studies
These studies are the most rigorous and their purpose is to test for causality. They always involve testing a prediction by manipulating an independent variable and measuring the effect on a dependent variable.
A rigorous study of this type determines if a behavior or change in a dependent variable is caused by an independent variable. The study must be conducted under controlled conditions in order to eliminate the effect of other extraneous variables and alternative explanations for the observed relationship.
In an experimental study, one must show the following to determine causality:- Concomitant variation, or that the treatment of the independent variable is associated with changes in the dependent variable.- That the change in the independent variable occurs before the change in the dependent variable.- Controlling other variables that may be present
Threats are alternate operating variables which may influence the results of a study in unknown ways. Examples include:
Effects resulting from the passage of time, some may be more powerful than the intervention.
Measurement decay—exhaustion or burnout of judges or observers

Selection process bias
Mortality—loss of some of the subjects from a sample
Hawthorne effect (Test-Taking effect)—subjects may alter their behavior simply as a result of being studied.
Placeb- 

Field experiment
This is a type of experimental study that is conducted in a concrete, natural environment.
In this type of study the researcher tests a hypothesis, but doesn't have strict control over participants' exposure to the experimental variable.

Laboratory experiments
A type of experimental study in which tests are conducted under tightly controlled laboratory conditions. The conditions are artificial (not conducted in the real world and the researcher's conclusions may be suspect, even though these experiments offer the most control over the independent variable.
Classical Before-After Experimental and Control Group Design studies with randomization
In this type of experimental study, all subjects are randomly assigned to experimental and control groups. In this way, the researcher can assume that the two groups are analogous at the beginning of the study. The researcher then administers the independent variable/intervention to the experimental group, after which both groups are measured.
Placebos are often used in this design type to control for the influence of testing.

Ex-post facto analysis or correlational analysis
This type of experimental study uses statistical analysis of the data to control for a given variable's effect.
The researcher examines the relationship between the independent variable and the dependent variable under a variety of conditions of a third variable.
Is conducted after data collection is completed and the researcher seeks to rule out alternative explanations for changes.

Validity
How well a study actually measures what it intends.

Concurrent validity
The measure used in a study is compared with another instrument presumed to measure the same variable. Concurrent validity is indicated by a higher correlation between the results.

Predictive validity
A measure used in a study is compared with a predicted future outcome.

Content validity
Analysis by those considered expert in the field studied of an instrument. The test has content validity if the experts judge it to be a good measure of what is being studied. Also described as face validity.

Construct validity
The degree to which a measure relates to other variables expected within a system of theoretical relationships.

Reliability
Consistency in the measurement of a variable.
Without reliability, there is no validity, though reliability does not guarantee validity.

Tests of reliability:

- Test-Retest: A test is repeated to the same participants under the same conditions. Reliability is higher with higher correlation between the initial and retest scores.

- Split-Half: random place assignments are given to each item in a test, which is then split into two halves. Each half is scored separately. Reliability is measured through the degree of correlation between the two scores.

- Alternate Forms: the researcher administers comparable measures of the same variable to the same subjects at approximately the same time. Reliability is measured by the degree of correlation between the two scores.

- Inter-judge Agreement: Multiple judges are trained to observe and score the same phenomenon in the same way. Their independent measures of the same observed phenomenon are correlated. Reliability is measured by the degree of correlation between the scores.

The following are some methods for increasing reliability:
Standardizing administration of the measurement instrument.
Adding additional items to cancel out random error.
Statistically identifying and eliminating items which do not agree with other items.

Scales of measurement
Nominal scale of measurement:
This category of measurement has two or more name categories, such as pass/fail, male/female, or various colors. Difference, but not degree of difference is shown by the categories. Few available statistical procedures as the measurement involve placing subjects in categories and counting them. This category is not highly sensitive in determining differences.
Ordinal scale of measurement:
This category of measurement shows the position of each subject with respect to a particular characteristic. An example is the order in which subjects complete a task. A number of non-parametric statistics can be used with ordinal measurements.
Interval scale of measurement:
This category of measurement shows ordinal positions with equal intervals between scores. (Examples: scores on an exam, height, or weight) This category ranks data and also uses categories of equal size. The most powerful statistics (those that more accurately measure differences with a small size sample) can be used with this category.
Ratio scale of measurement:
This category of measurement is comprised of an interval scale with an absolute zero.
Sample
A part of a larger population that represents the total group from which it is drawn.
Subject
One element within the sample and population.
Representativeness
The extent to which a sample accurately reflects the characteristics of the greater population from which it is drawn.
Probability sampling
This is a sample that permits the researcher to indicate that each element of the population has a known probability of inclusion in the sample. This type of sample is more useful than a non-probability sample as it is more precise, allows statistical inferences about the larger population, and assures representativeness. With this type of sampling, the researcher can estimate the degree to which the sample is expected to differ from the total population, and therefore estimate how much the findings may be in error.
Simple random sample: subjects are drawn randomly from a known population and each has an equal probability of inclusion in the sample.
Stratified random sample: After subjects are grouped into strata of interest (age, sex, ethnicity), they are then drawn randomly from each group.
Cluster random sample: multiple-stage sampling; successive random samples are drawn from natural groups/clusters.

Non-probability sampling
In this type of sampling, it is not possible to specify the probability that each element of the population has an equal chance of being included. Representativeness is uncertain. Does not allow for statistical inference and is less precise than a probability sample.
Accidental sample: uses the first case encountered
Quota sample: includes some cases from each segment of a population
Purposive sample: intentionally draws a sample from a part of the population assumed to have particular knowledge of what is being studied.

Statistics
Descriptive statistics: Calculations that depict some characteristic of a group of sample. They allow users of research to summarize information about the group and make useful comparisons among two or more groups.
Inferential statistics:
These calculations allow researchers to generalize from a sample to a larger population (from which the sample is taken). They are based on probability theory and permit findings to be interpreted.
Cultural competence
A social worker can acquire more knowledge in order to become more culturally competent by doing the following:
Read applicable practice or scientific professional literature.
Become familiar with the literature of the relevant group(s).
Identify and consult with cultural brokers.

Working with gay, lesbian, bisexual, or transgender clients
The following are some practice issues when working with clients who may be gay, lesbian, bisexual, or transgender:
Stigmatization and violence
Internalized homophobia
Coming out
AIDS
Limited civil rights
Orientation vs. preference (biology vs. choice)

Working with older adults
Some strategic practice issues to be considered when working with older adults are:
Role reversal (worker often younger than client)

Physiological changes
Variation in physical and mental decline
Clients often have experienced multiple losses
Clients are often involuntary
Respect/formality can be important to client
Differences in generational perceptions: socialization  around problems, values, mores; and attitudes toward receiving help, charity, counseling
Two categories of older adults: young-old (60-80), old-old or frail-old (80+)

The following are some clinical considerations the worker should make in practice with older adults:
Shorter interviews, possibly more frequent
Varied questioning styles
Worker is more active, directive, and demonstrative
Home visits may be preferred to office visits
Consider roles and attitudes of relatives and caretakers
Awareness of possibility for abuse or exploitation
Access to social services or other publicly funded programs
Possible hearing impairment and need to make responses shorter, louder, and slower
Reminiscence is an important style of communication

Administration
Administration is defined as follows:
Means of managing organizations and all of their parts in order to maximize goals and have the organization succeed and grow

Directing all the activities of an agency
Organizing and bringing together all human and technical resources in order to meet the agency's goals
Motivating and supervising work performed by individuals and groups in order to meet agency goals

Max Weber's characteristics of bureaucracy
Max Weber's characteristics of a bureaucracy are as follows:
Formal hierarchical structure.
Written rules that delineate functions of the organization.
Spheres of competence/organization by specialty

Impersonal relationships
Employment based on basis of competence
Thorough and expert training.

Classical Management/Scientific Management theory
The Classical Management/Scientific Management theory of administration is described as follows:<ol><li>Employee is an appendage of the company. Well-disciplined, closely supervised workers achieve high productivity.
Workers most productive when they have little individual discretion.
Primary motivation for all work is economic.
Productivity linked to compensation.
Authority is distributed through the formal, hierarchical organizational structure.
Formal organizational structure emphasizes production, compliance, and efficiency.
For highest efficiency, workers should have specialized, repetitive tasks that do not call for individual judgment.</li></ol>

Mayo's Human Relations theory
The Mayo's Human Relations theory of administration is described below:<ol><li>A person must be viewed differently than an industrial machine.
More than physical capacities, workplace social norms influence production.
Motivation is not solely economic but is also emotional.
Employee participation can enhance motivation.
Informal organization and peer groups are important in influencing workers. Work groups and worker involvement in task design can increase production as they increase worker morale.
Management should consider the work group, social relationships, and other human factors when planning.</li></ol>

Challenges of social welfare organizations
Challenges unique to social welfare organizations in terms of administration are as follows:
Clinical services can be difficult to assess objectively.
Difficult to evaluate prevention programs as few techniques are able to measure events that have not occurred.
Staff turnover due to low salary and burnout.
Often dependent on political environment for funding.
Can be difficult to implement systematization or routine work due to flexibility often required when dealing with human problems.

Structuralists' perspectives
The Structuralists' (Etzioni and Drucker) perspectives on Administration are as follows:
A synthesis of the classical and human relations schools of thought.
Strains between organizational needs and personal needs are prevalent. The two will always be in conflict.
There is stress among various levels within organizations.
Motivations are both economic and non-economic (social).
Organizational structures are both formal and informal.

Systems perspective
The Systems perspective on administration (Katz, Kahn) is as follows:
Organizations are systems that contain interacting, interdependent parts.
Organizations are related to other surrounding systems.
Major organizational processes include input (energy, resources to be acquired, such as clients or funds), throughput (the work that is done, such as counseling), and output (the results, such as clients with improved psychosocial functioning).
Systems can be open or closed (i.e. more or less open to changes in the environment)

Decision-Making School
The perspective on administration of the Decision-Making School (March, Simon) is concerned with the process of decision making within an organization and the forces that influence decisions.
It uses the idea of satisfying rather than maximizing objectives in decision making, such as seeking acceptable rather than maximum achievement.

Program evaluation
The following are the steps in program evaluation:<ol><li>Determine what will be evaluated.
Identify who will be the consumer of the research.
Request the staff's cooperation.

Indicate what specific program objectives are.
Outline objectives of evaluation.
Choose variables.
Develop design of evaluation.
Apply evaluation design (conduct the evaluation).
Analyze and interpret findings.
Report results and put them into practice.

COP
Community organization practice (COP) differs substantially from other forms of practice:
COP highlights knowledge about social power, social structure, social change, and social environments.
COP acknowledges the reciprocal process between the individual and the social environment. It seeks to influence and change the social environment as it is seen as the source and likely solution for many problems.
In the view of COP, social problems result from structural arrangements rather than from personal inadequacies. Consequently, resource and social power reallocation leads to changes in the community and eventually in individuals.

Social policy
A collection of laws, regulations, customs, traditions, mores, folkways, values, beliefs, ideologies, roles, role expectations, occupations, organizations, and history—all focusing on the fulfillment of critical social functions.
Social welfare policy making

Rational approach
This is an idealized and structured approach. It includes identifying and understanding a social problem, identifying alternative solutions and their consequences for consumers and society, and rationally choosing the best alternatives. The rational approach minimizes ideological issues.

Political approach
This approach recognizes the importance of compromise, power, competing interests, and partial solutions. Those who are most affected by social policies often have the least amount of political power to promote change. Those who have political power are often influenced by interests that are seeking to protect their own position. Policy makers are often concerned with retaining privilege and power. Without aggressive advocacy, the needs of the disadvantaged can become marginalized.