Assignment 1: Termination Summary

As helping professionals, employees in the human and social services field want their client to be successful. They try to interview clients to create a social history, set goals, make recommendations, and refer clients. However, things do not always go as planned. As a human and social services professional, it might be necessary to terminate the client relationship for other reasons, such as the client becoming aggressive towards the professional or other situations such as a client no longer wanting services or moving away which makes it no longer possible for him or her to receive services. To Prepare Review your interviews and documentation related to your Final Project. Review Chapter 11 of your Summers text regarding addressing and disarming anger. Imagine that before you ended your services with the client, the client displayed some inappropriate confrontation, crisis and/or had an angry outburst in front of you. Consider how you would document this in a Termination Summary. Although your Termination Summary does not need to follow a specific format, refer to pp. 443-447 in your Summers text for ideas. For this Assignment

Create a 2-page Termination Summary of your work with your interviewee/client from your Final Project interview and document the progress related to the service plan/goals that you created in Week 10. As part of your Termination Summary, document the inappropriate confrontation, crisis and/or angry outburst incident you imagine could happen. Include what your response and the client’s response might be, that might not be the most appropriate (refer to Chapter 11 for ideas). Then, include a plan for managing this type of crisis in the future.

PG439-444 CHAPTER 26: Terminating the Case Introduction

We have seen how people enter the human service system and how their services and treatment are determined and monitored. There is usually a point at which people leave the system, moving on in their lives. Here are some of the reasons a case may be terminated. 1. The individual and the case manager agree the individual is ready to move on. This is the ideal. The service or treatment has been successful and is no longer needed. Many people do leave for this reason, feeling that their original issues and problems are less significant than they once were or that these problems have been resolved. 2. The individual dies or moves away. When people die or move to another jurisdiction, their cases are closed. If they formally request that their records be sent to the new jurisdiction, this should be done immediately to facilitate a smooth transition to the new program. 3. The funding source will no longer finance services. Managed care has introduced limitations on care that you and the client may find unrealistic. It is important that people know the limitations during the first interview so that they can prepare for termination. When termination is imposed by a funding source before you or the client feel it should, work with the person to find alternatives to your service. Support groups or specialized programs funded by other sources may not give the level of service you have provided, but they may help the person make the adjustment. It is not ethical to drop someone with no plan or referral when the insurance or funding runs out. 4. The individual no longer wants the services. People may be dissatisfied with the services being offered and request that their cases be terminated. In situations like this, sit down with the dissatisfied individuals and learn why they are not pleased with the service. This may provide you with valuable information about how you or a provider agency is perceived by people who are served there, and it may facilitate people leaving with the feeling that they can come back if they need to do so. Others decide to leave because they no longer find working with you a priority and simply wish to move on. 5. You cannot find the individual. Sometimes people indicate they are not interested in our services by disappearing. It may be a person you feel is really in need of support, medication, or treatment of some sort; but often people feel case management is either intrusive or a nuisance, and just disappear. You may make attempts to find such people, and you may even track some of them down, but they have every right to refuse services. When you encounter this situation, make sure that both your contact notes and the termination summary reflect your attempts to contact the person who has disappeared.

Not all clients will leave case management. A child with autism may need services all his life. A woman with severe developmental disabilities may require case management during her entire lifetime in order for her to live in her community successfully. A Successful Termination

Cases should not be closed without the person, or the person’s family, if they are involved, knowing that this is about to occur and why. A letter by itself cannot convey warmth and concern for the individual and often comes across as bureaucratic and unfeeling. A phone call is not much better. You might convey warmth, but there is no meaningful exchange or documentation.All clients whose cases are being closed, except those who have moved away or died, should receive two things from the case management unit: 1. An opportunity to meet with you to discuss the termination 2. Follow-up by letter outlining the main points in your final interview and inviting the person to return if the need arises Feelings about Termination

Leaving anything can be difficult, and leaving services can be particularly difficult for people who have grown fond of the workers at the agency or who feel uncertain about how they will handle life on their own. Sometimes terminations are milestones. The people have reached a new level of independence, emotional health, or sobriety. But the accomplishment still can be tinged with misgivings.In some cases, people may regress in order not to have to leave your services. Will struck a pose as a very independent person. He came with obvious reluctance to the case management unit after his supervisor demanded he get help for his drinking problem or he would lose his job. Throughout his time with his case manager, Will boasted that he could manage all this on his own and did not need to receive help. He wanted to be sure his case manager knew he had come only to please his boss and to keep his job. Will did well and at one point confided to his case manager that he was surprised at how he had managed to go to AA and “stay off the bottle.” When it was time for Will’s case management services to end, he suddenly began drinking on a Saturday afternoon. When he came in for his final interview he announced that he had been “on a bender” although his wife said he “only had a couple of beers.” The situation was perplexing and Will insisted he had strong urges to drink again and was concerned that he could lose his job if he reverted to his old behavior. His case was not terminated and Will continued to come in and report abstinence, but he wanted the case manager to know “it is a struggle.”Again when termination was about to take place, Will reported drinking again. Contrite and embarrassed, he came into the office on a Monday morning to tell his case manager that he “tied one on at the wedding Saturday.” He reported being extremely intoxicated and said he needed more time in case management to be able to “get a better handle on this.” It was at this point that the case manager and his supervisor sat down with Will and addressed what seemed to be his reluctance to leave case management, even though he had shown remarkable progress most of the time. Will agreed to terminate his case and was told he could certainly return if he had further problems. He seemed cooperative and willing to leave the services. He would continue in AA and he would work with his sponsor. His job was now secure and he appeared to be well prepared to move on. However, 3 weeks following termination while on vacation Will showed up drunk at the case management unit and his case was reopened. This episode, timed to take place on vacation when it could not interfere with his work seemed coincidental. Will reported that he had been having a “whale of a battle, I tell you,” trying to remain sober. Clearly, Will is able to control his drinking and has made progress, but leaving a case manager he has come to lean on for support has been extremely difficult for him.Try to recognize the underlying feelings your client is experiencing in the final interview and respond empathically. Some people resent being terminated. They may have grown accustomed to the support, enjoyed having a person in their lives who cared for them, or they may just be feeling that they are being “shoved out the door,” as one person put it.As the person’s case manager, you may have feelings as well about the termination. Perhaps you and your client have had a particularly good working relationship. Together a lot was accomplished. It is sometimes hard to say goodbye to clients when we are fond of them or have enjoyed our work with them.Terminations work better if clients have a chance to get used to the idea that the relationship will end and can in some ways prepare for that. This is particularly true if you and the person have had a long relationship and been through the ups and downs of the person’s life. Encourage people to talk about their feelings about leaving and respond empathically to what they have to tell you about what the change will mean to them. Acknowledge your own sense that you have worked hard together, if that applies.While this chapter is about the client leaving the services, much of what we have said here applies to times when you are leaving and the client will receive a new worker. Feelings of uncertainty, loss, even grief are not uncommon. Sometimes life intrudes inconveniently and we need to leave our positions with very little notice, but wherever possible plan your leave-taking so that clients have an opportunity to know and prepare for the change.
The Final Interview

Use the interview to summarize the work that has been accomplished and the reasons for the termination. If there are gains, review how far the person has come since first seeking help some time before. For those who have requested termination of their cases themselves, ask them to tell you more about their reasons for making the request and be open to their suggestions for change. Invite questions. People often want to know where they should turn should former problems resurface. Give them information they can use, particularly information that will help them prevent a relapse or regression.There should be a sense of reassurance during the interview that clients are not being cut off or dumped and that they are welcome to return should they need services again. These feelings are especially likely when people have run out of funding or they were funded for only a specific amount of time. They may not tell you all of that explicitly. Nevertheless, people may feel dumped or dropped and be unable to express that to you. Speak to these concerns in the final interview.It is useful to go over in the final interview the gains and accomplishments that the client has attained. Talking about these specifically is a good way to summarize for the person where you and he started, what you have accomplished together, the gains he has made, and where he is now. This is a good time to point out specifically the strengths you have come to see in this person and the specific gains made in reaching goals you set together some time before.In addition to strengths and achievements, talk about areas the person still sees as weaknesses or areas she feels still need to be addressed in her life. This too is part of summarizing for people where they have been, where they are now, and perhaps where they feel they need to go from here. This summary gives people a feeling of tying up the loose ends, relating the tasks and work, and looking positively toward an end to the relationship.Finally, talk about where people will go after the relationship ends. Will they be referred to another service? Will they join community self-help groups? Are there things they can now do on their own to continue their progress and prevent future issues?Many agencies seek an evaluation of their services when clients leave the agency. If your agency does that explain the process to people and prepare them to receive evaluation materials or a call.Digital Download Download from CengageBrain.com The Letter

The letter is a follow-up to the final interview. It should summarize the main points of the interview, recapping briefly what was discussed. There should be a brief statement about why the termination took place so the person has documentation of it. In addition, questions that seemed particularly important to the person during the interview should be answered again in the letter, especially if the individual needs addresses, names of resources, and other supportive information. Figure 26.1 provides a sample termination letter. In this letter there is a summary spelling out why Mrs. Warren is leaving the agency, the positive gains she made, and her plans for the future.

Digital Download Download from CengageBrain.com Documentation

Like all contacts with clients, this last contact and letter should be documented in the person’s chart. In the note, the focus of the interview would be the termination of the case. You would note the highlights of the discussion, any follow-up arrangements that were made for the person, and his or her response to the interview. The Discharge Summary

In most cases, your agency will ask for a termination summary or discharge summary. This is not the same thing as the final case note discussed earlier. Although you include the information from that contact note in the discharge summary, you are actually summarizing the most important information about what took place while the individual was working with you. It is wise to think of your summary as a document that may go to other professionals in other agencies who will see the person in the future. Asking for summaries is common practice when beginning work with a new person who was seen before in another agency. For that reason, your summary functions in part as an indication to other professionals of how thoroughly your agency addresses the needs of clients. This is a major way that other programs and professionals can learn about the quality of the care given in your case management unit. Sloppy summaries containing little useful information or those that indicate little organized effort on the client’s behalf can make your agency look unprofessional.What you include in your summary should be helpful to a new case manager or therapist developing a strategy to help the person. For this reason, your summary should discuss what was tried, what worked, and what was less successful and why. Figure 26.2 provides a sample discharge or termination summary.

Your agency may have a standard format for discharge summaries that you can use as a guide to writing good discharge summaries. If not, you can use the “Discharge Summary” form provided in Appendix C.Here are important items to include in the discharge summary: 1. Name, date of birth, date of admission, and date of discharge 2. Diagnosis (if there is one) 3. Any medication that was prescribed by physicians who were working with the case management unit and whether it has been discontinued. (Make sure to note the name of the medication, the dosage, the frequency, and any adverse reactions.) 4. The reason for discharge 5. The major presenting problem that brought the person to you 6. Your goals and objectives for the individual 7. The extent to which the client participated in formulating these goals and objectives 8. Progress that was made or goals that were accomplished 9. Problems that were identified but were not addressed 10. How the individual appeared to be at intake and how the individual appeared to be at termination 11. Attempts to locate the person if she has disappeared Examples

We can look at several cases and how they were terminated. First is Alex, whose insurance stopped payment for services, which stopped Alex from having further contact with the agency. Alex did not want to leave and felt he had gained support he needed to continue to work through his difficulties on his job. The reason for discharge was “insurance no longer available.” The goal for Alex to begin a course that could have led to a promotion was not met. This was noted and the need for further support to obtain this advanced training was noted under problems that had been identified but not addressed. Because Alex seemed as agitated about his work situation when his insurance ran out as he did the day he came in for assistance that too was noted and in fact, the case manager noted that the loss of insurance coverage was contributing to his difficulty. Before discharge the case manager worked with Alex and his minister to give Alex some support for attending the advanced classes. This gave Alex someone to work with before the insurance was reinstated the following year. This was not an ideal solution, but the case manager made sure there was some support system in place before the final termination.

Please! No plagiarized work. Sample paper is attached. 

Synthesis is the act of creating something new from multiple existing entities. Synthesis of research, then, is creating a new idea from existing ideas. Synthesis of research is not a single innate skill. Rather, it is a process learned through time and practice. At the doctoral level, writing is a continual process of revision as learners improve skills and build subject matter expertise.

In Topic 5, you submitted a Synthesis Paper and received both feedback from your instructor and a grade for your work. In this assignment, you will expand upon your original paper with additional research from outside sources, incorporate feedback from your instructor, and provide a reflection section addressing your revision process.

General Requirements:

· Locate the Synthesis Paper you completed in Topic 5.

· Locate and download “Enhanced Synthesis Paper Template” from the Course Materials for this topic.

· Locate and download “Enhanced Synthesis Paper Resources” from the Course Materials for this topic.

· Review the articles by Baker and Pifer (2011), Gardner (2009), and Smith and Hatmaker (2014) located in the Course Materials for this topic.

· This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

· Doctoral learners are required to use APA style for their writing assignments. 

· You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.

Directions:

Select and read two articles from the Enhanced Synthesis Paper Resources list located in the Course Materials for this topic.

Locate the Synthesis Paper you completed in Topic 5. Using the feedback provided by your instructor and information from the two additional articles you selected, write an Enhanced Synthesis Paper with Reflection (1,250-1,800 words). Include the following in your paper:

1. A Reflection (250-300 words) that discusses your revision process and how you incorporated your instructor’s feedback into the revised version. Similar to the format of an abstract, this section will receive its own page following the title page and preceding the Introduction.

2. An introduction that includes a brief description of each article and its purpose, identifies the three themes that emerged from your reading, describes how they will be discussed in the paper, and presents a clear thesis statement.

3. Support for your identified themes with evidence from each article. Provide analysis of these findings to strengthen your narrative.

4. A discussion of the conclusions that can be drawn when the articles are taken together as a single entity. What is the overall message of the group of articles?

Respond to at least two colleagues in one or more of the following ways: Provide additional resources supporting your colleague’s posting. Suggest resources your colleague might use to further his or her knowledge in a particular area. Offer alternative viewpoints and insights on your colleague’s post. Ask for clarification.

PERSON 1

For this week’s discussion on Data Analysis and Outcome Dissemination, I have chosen the topic of Ethics under qualitative data analysis and the topic of Subgroup Comparisons under quantitative data analysis as what I would like to develop further professionally. As Babbie (2016) states “researchers need both types of analysis to get a complete understanding of social science data.” I have found that research data analysis is very challenging not something of real interest to me even though it is an important part in obtaining data to be used when seeking funding. I would like to grow my knowledge in grant writing to secure funding for the programs in which I provide supports for. Creating a focus group at work will be a good way to gain insight from many different point of views which can enhance the way in which the grant proposal is submitted.

Ethics in qualitative data analysis is very important in data analysis in that as human services professionals we are going to be supporting individuals and families of several different backgrounds and cultures. As a result it will be important to maintain the privacy of those in which we are analyzing the data that has been collected from the research project that has been identified. It is crucial in that subjective judgements and biases are not introduced which can cause researchers to “see what they want to see” (Babbie 2016). The method in which I would use is to generalize the groups in which I was researching. Using an example from a prior job, rather than collecting data from our providers specifically from the different programs that are offered, they could all be placed under the same common umbrella “providers.” Upon completion, the results can then be broken into the different programs without identities being revealed. An annual satisfaction survey can be sent out to the providers seeking feedback on how to improve the program and recognize successes.

Subgroup Comparisons under quantitative data analysis can be used to get an idea as to how our supported individuals and families view a research project. Whether the study is broken down by age groups or cultural backgrounds may provide a large range of data analysis. Within the human/social services fields, there may be very different views as to certain issues that arise and research projects are designed to gather and interpret the data. For instance, older individuals and families may feel as though the services they are receiving are appropriate whereas younger individuals feel as though the services being provided fall short. Creating different surveys focusing on certain age groups using the same questions along with those geared towards each group can be a way to gather data to get an idea where younger age groups need increased supports in one area which may be plentiful in an older age group and vice versa.

References:

Babbie, E. (2016). The basics of social research (7th ed.). Belmont, CA: Cengage

Person 2

Quantitative and qualitative analysis were pretty much foreign language to me prior to this class and to be honest I have not become fluent in either all though I do understand the theory and the basics of them. To only pick 2 area’s that I need further understanding is a daunting task, but I will apply what I have learned. Two of the types of analysis that did interest me the most were case oriented analysis and multivariate analysis. I believe that both is a way to understand where people are coming from and how their background or circumstances may have affected them.

Case oriented analysis aims to understand a particular case or several cases by looking closely at the details of each (Evans, Hearn, Uhlemann, & Ivey, 2015). I like to understand what the underlying issues a client that may have may be affecting them. Looking at communities and the demographics of those communities and why there is a higher percentage of something like crime can be accomplished using this type of analysis. In my job I work with people from all demographics all their stories are different, but I have noticed that people from certain area’s often share common issues. If given the opportunity I would like to be participate in this type of research.

Multivariate analysis, which is a type of Quantitative analysis, looks at the simultaneous relationships among several variables. Examining simultaneously the effects of age, gender and social class on religiosity would be an example of multivariate analysis (Evans, Hearn, Uhlemann, & Ivey, 2015). This type of analysis would fall in line with case oriented but instead of being qualitative it would be quantitative. Again, this interest me because of how it looks at demographics as part of the cause. My job does not require any type of research, so I don’t have much opportunity to use these skills professionally. Although I would like to do research so that I can get a better understanding of how it is done. I am a hands-on visual learner and it is easier for me to understand a concept if I can do it while I am learning. References

Evans, D. R., Hearn, M. T., Uhlemann, M. R., & Ivey, A. E. (2015). Essential Interviewing. Boston: Cengage Learning.

Assignment: Client Referral Letter

At some point, your work with the client will end. Sometimes, it can be that the client no longer needs assistance. Other times, issues might still exist, but your help is no longer necessary. Using a previous example, you might have assisted the client who was homeless, had a drug addition, needed basic needs such as food and clothing, and was seeking a job. Your agency might have assisted in finding the client clothes and food and the client no longer needed assistance from your particular agency, even though the client might still be receiving assistance from a job placement center and a drug treatment center. Or, the client may have become aggressive toward you, so you had to discontinue the helping relationship.

Using your scenario developed with your interviewee, pretend that you have completed the helping relationship with your interviewee and that you are referring him/her to another agency, based on what you have learned from your interviews with the client. Think about the next steps the client would need to take to reach his or her goals, when making the referral. To Prepare Review the data that you collected during your recorded interviews on a fictitious client. Review the Referral Form in the Learning Resources. For this Assignment

Write a 1-page letter, using the template in the Learning Resources, to the referring agency that summarizes the following information: Date of Referral Demographics of Client: (whatever is appropriate to the situation) name, date of birth, gender, ethnicity/race, contact information Reason for Referral Brief summary of circumstances leading up to present reason for referral A brief description of what you would like from the agency to which you are sending the referral (i.e., evaluate and recommend, take over services, etc.) Next steps for contact (specify if client is supposed to follow up, if you will follow up, or if you will wait for referral agency to follow up with you, or follow up with client, and include the date by when you would like to hear back from the agency Your name, role (as related to client), and contact information Sign and date the request (electronically)

On a separate page, in 500–1,000 words: Analyze how your quality interviewing and case management skills as a human and social services professional can be used for creating social change. Provide examples.