Applying a Crisis Intervention Model to a Case Study

Case Study

David Goings is a seventy-year-old heterosexual divorced white male of European and Italian descent. He is a retired veteran who fought in the Korean War. Mr. Goings wife died about 30 years ago from breast cancer and they did not have any children. He has no family members and lived alone with his dog “Charlie.” Mr. Goings has been a loner for years and communicated with just a few neighbors that stopped by to chat periodically. The Department of Social Services Adult Protective Services (APS) referred him to our agency because he lost his house in a house fire, which left him homeless. A neighbor saw the house burning down and immediately called 911 for help. The local police and fire department were dispatched to the location and had to pull Mr. Goings from his home, but they could not save “Charlie.” Mr. Goings was devastated by the loss of his home and his dog. He has been severely depressed, angry and displayed signs of hopelessness and suicidal ideation. He is currently living in a shelter. He was referred for crisis counseling by an (APS) social worker from his local (DSS) office because our agency provides geriatric care management services and counseling. We also help individuals and families cope with the challenges of ill health, aging, and crises by explaining choices and options for getting the care they need.

Agency Description and the Role of the Social Worker within the Agency

Adult Protective Services (APS) exists to assist adult members of the community who suffer from a variety of disadvantages, including disability, old age, or victimization through elder abuse and neglect (Wold, 2010). It is the responsibility of APS to provide assistance to adults in need who have experienced these problems. An agency specializing in geriatric care management and counseling services would necessarily maintain an ongoing working relationship with APS concerning such issues. It is appropriate that David Goings would be referred to our agency because of the severe difficulties he now faces regarding his own life management issues. The role of a social worker employed by a geriatric care management and counseling agency would be to assist individuals such as David Goings with adjusting to the life transitions he is now facing (Greenstone, 2008). A social worker assigned to counsel Mr. Goings is responsible for providing him with the most optimal assistance possible in order to insure that his transition process is one that maximizes his own well-being.

Application

The social worker assigned to review David Goings’ case would be responsible for the application of Roberts’ seven stages to the development of a comprehensive analysis of Mr. Goings’ issues (Roberts, 2006). The social worker would then seek to formulate the best possible prescriptive program for the management of David Goings’ situation. The first step in the application of Roberts’ stages would be to assess matters of safety and lethality. The information outlined in the case study indicates that Mr. Goings has no social support system, as his wife is long deceased and he has no children. Additionally, his contacts within his wider community appear to be very limited in number, and his circle of friends and acquaintances is inordinately small (Landau, Mittal, & Wieling, 2008). In short, Mr. Goings has no family, friends, or neighbors to care for him, and he is highly dependent on the care he receives from public or other agencies.

Not only does Mr. Goings suffer from severe social isolation, but he has also undergone significant losses in his life, both recently and in the past. Mr. Goings appears to have lived a hermit-like lifestyle since his wife’s death decades ago, and the recent loss of his home and his dog have been emotionally devastating to him. His observable mental state is one that demonstrates multiple warning signs including anger, depression, grief, and despair. Therefore, Mr. Goings would appear to currently be a high risk for a possible suicide attempt or other self-destructive behavior (Jackson-Cherry, Erford, 2010). Social workers dealing with Mr. Goings case would need to attempt to identify any other problematic issues that may be present, such as excessive use of alcohol and prescription or illegal drugs, and physical health factors that may aggravate Mr. Goings mental state.

When dealing with Mr. Goings, rapport building will be an essential part of the social worker’s efforts. A client such as Mr. Goings will not likely be one who is immediately inclined to trust those with whom he comes into contact within the context of the social service agencies (Roberts, 2006). His longstanding loner lifestyle and very small social network indicates that he is not a so-called “people person.” He likely does not make friends easily. He will likely view even a caseworker who is attempting to help him as an intrusive, alien figure. Additionally, the trauma Mr. Goings has recently experienced in his life has likely left him not only angry and depressed, but also disoriented, confused, and with a loss of his sense of bearing. Living in a shelter and having to deal on a daily basis with unknown persons no doubt increases these feelings on the part of Mr. Goings by an order of magnitude. It is vital that Mr. Goings is able to develop a feeling of trust when dealing with the social worker. The social worker must be aware of what Mr. Goings is experiencing and proceed with the utmost sensitivity to his needs and concerns as they arise. A friendly, pleasant, and helpful attitude on the part of the social worker is essential. The social worker should present herself in a personable and congenial manner when dealing with Mr. Goings, and strive to increase his comfort level as he adjusts to the difficulties he faces.

Problem identification is the next step in the application of Roberts’ methodology with which the social worker must be concerned (Roberts, 2006). It is helpful that the social worker is going into the situation involving Mr. Goings while in possession of detailed background knowledge of the series of events that brought him to his current situation. If the social worker is not already aware of these events, it is vital that the social worker assigned to Mr. Goings’ case become familiar with the back story to his circumstances as quickly as possible. The primary concern of the caseworker at this particular point is to identify the problems which Mr. Goings wishes to deal with as a priority. Does he wish to first seek to improve his mental state? Is seeking help for his emotional issues his first concern? Is he most concerned with altering his present living situation and finding a place to live other than the shelter? Does he qualify for additional benefits resulting from his veteran’s status or his position as a senior citizen? Is claiming these benefits his chief concern?

In such a scenario, the social worker is clearly in a position to offer substantive advice. A conscientious and compassionate caseworker will respect Mr. Goings’ wishes regarding how he wants to proceed concerning the management of his own life, and the formulation of his future plans. However, the responsible social worker will also identify those areas of Mr. Goings’ life that appear to be the most problematical, and encourage him to address those issues in an appropriate way as a matter of priority. It is fairly clear that the mental health and emotional issues currently faced by Mr. Goings are paramount in terms of their relationship to his overall health, safety, and well-being. The social worker should seek to insure that Mr. Goings maintains access to the best possible counseling services concerning these issues (Roberts, 2006). It has been ascertained that Mr. Goings exhibits several high-risk factors concerning the possibility of suicide or self-harm, and it is the responsibility of the caseworker to seek to minimize these risks by referring Mr. Goings to the proper forms of assistance.

It is at this point that the interpersonal and listening skills of the social worker become indispensable. Given the feelings of extreme despair being experienced by Mr. Goings, the provision of encouragement and a sense of validation is one of the most important tasks a caseworker can perform in such a scenario. An important function of the caseworker at this stage is to simply allow the client to openly express their own feelings concerning their situations, and other matters that may be troublesome to them. Clearly, Mr. Goings has very intense feelings about his circumstances. His inability to adequately express these feelings outwardly, or to find sympathetic listeners, may well intensify his feelings of despair and the probability of self-destructive actions (Roberts, 2006). Simply being a good listener or a good “friend” to Mr. Goings at this stage in his traumatic experience may well be the most significant form of assistance the social worker can be offering at this point. The social worker can become a source of support for the client under such circumstances, and this is a particularly vital role when dealing with clients such as Mr. Goings who have no external support system.

At the same time, the social worker who is dealing with a client such as Mr. Goings can also help the client to readjust his own thinking processes in such a way as to clarify his assessment of his own needs (Roberts, 2006). For instance, the social worker may help the client overcome his sense of social isolation by encouraging him to find support among others facing situations of similar difficulty. The social worker may assist the client in cultivating a social circle for himself. In the case of Mr. Goings, who lost a valued house pet, the social worker might help him to overcome this sense of loss by encouraging him to volunteer at an animal shelter where he will potentially have the opportunity to bond with other animals. Mr. Goings might then be able to compensate for his sense of loss that originates from the death of “Charlie.” Someone in Mr. Goings’ condition or state mind may be neglecting issues pertaining to his own physical health, and his sense of depression may undermine his motivation to effectively pursue important life management issues, such as finding a permanent place to live. The social worker can assist the client with identifying and overcoming such problematic areas within his own life.

The next stage for the social worker and client relationship is to create alternatives to the client’s present condition. In fact, stage four described immediately above is a necessary prelude to this stage (Roberts, 2006). In the case of Mr. Goings, the first concern is obviously to address his mental health issues. Finding the appropriate counseling services, and encouraging Mr. Goings to utilize them, is the most important task the social worker can perform at this stage. Mr. Goings obviously needs to be in a mental state that is conducive to further addressing the multiple life management issues which he now faces. Once effective counseling services are procured, the social worker should also assist Mr. Goings with the development of a specific plan of action for addressing his present material circumstances. Besides his mental health issues, the next step is for Mr. Goings to find adequate and permanent shelter. Because his home has been destroyed by a fire, Mr. Goings must now rent an apartment, purchase a new house, or find others with whom he may reside under conditions that he finds satisfactory. If he has no children, are there other relatives with whom he may stay? If not, what is his financial condition and what limitations does he face when seeking a new home? Can he afford monthly rent from whatever income sources he has? Does he have savings that might allow him to place a down payment on a new house? These are all issues which the social worker must help the client address.

The sixth stage in the application of Roberts’ system is to develop an actual plan of action for the client (Roberts, 2006). This should involve the creation of an actual list of items on the agenda for the client to accomplish. The social worker should assist the client in the formulation of such an agenda. Once Mr. Goings has established a plan for addressing his mental health issues and subsequently seeking permanent shelter, the social worker can help him formulate a daily routine that incorporates these and other issues into an ordinary time schedule that will help him regain a sense of purpose and accomplishment. The social worker should assist a client such as Mr. Goings by helping him to develop a specific set of goals to be achieved within a particular time frame. This can be done through the creation of an actual physical list of objectives and their “due date” by which the client wishes to see them achieved. But it can also include the offering of routine encouragement to the client towards the identification of such goals. The social worker might serve as a “sounding board” for Mr. Goings, and help him to reflect on his current situation and put it into some kind of wider life context.

The seventh state is one that is equally important to the previous six and that is the matter of follow up (Roberts, 2006). It is not enough for the caseworker to simply assist the client with the procuring of basic services and the development of a minimal plan of action. Rather, the social worker should be there to offer support to the client at every phase of the client’s efforts to recover from the trauma they have experienced. The case worker should inquire as to whether Mr. Goings finds his counseling services to be adequate and beneficial. If Mr. Goings expresses discontent with the services he is receiving, the social worker should seek to refer him to more satisfactory services. Likewise, while Mr. Goings is attempting to find permanent housing the social worker should monitory his progress, and seek to assist him with whatever obstacles he may encounter along the way (Aguilera, 1998). The intervention process should never be considered finished until the client has sufficiently addressed each of the life issues which have arisen from the crisis situation.

References

Aguilera, D.C. (1998). Crisis intervention: Theory and methodology. St Louis: Mosby.

Greenstone, J.L. (2008). The elements of disaster psychology: Managing psychosocial trauma– An integrated approach to force protection and acute care. Springfield,Illinois: Charles C. Thomas, Publishers.

Jackson-Cherry, L.R., & Erford, B.T. (2010). Crisis intervention and prevention. NJ:Pearson Education, Inc.

Landau, J., Mittal, M., & Wieling, E. (2008). Linking human systems: Strengthening individuals, families, and communities in the wake of mass trauma. Journal ofMarital and Family Therapy, 34(2), 193-209.

Roberts, A. (2006). Assessment, crisis intervention, and trauma treatment: the integrative actintervention model. Brief Treatment and Crisis Intervention, 2(1), 1-22.

Wold, K. (2010). Adult Protective Services specialists in Texas: Perceptions of three factorsaffecting turnover. Applied Research Projects. Texas State University.Paper 328. Retrieved from http://ecommons.txstate.edu/arp/328