Engagement, Assessment, Goal Setting and Contracting for Client Relationship Development

Introduction  

Developing a relationship with a client system is an on-going process with many aspects. Client engagement, assessment, goal setting, and contracting are all important mechanisms to client/social worker dynamics. This paper will focus on these four systems and how they have come into play while working with my client at Hebrew Educational Society. 

Client Engagement

At Hebrew Educational Society (HES) I had the opportunity to engage with numerous clients in both individual and group settings. EF is a four-year-old student in one of our universal pre-kindergarten (UPK) classrooms and a client I have engaged with the longest. Initially I was surprised at how much bigger EF was than the rest of his cohort. After a short period of time I also realized that he was behind cognitively as well. EF is a very friendly, lovable child who has an Individualized Education Plan (IEP). He struggles with body placement, awareness of others, obtaining and using verbal language, and exhibits numerous negative behaviors such as crying instead of using verbal language when he wants something and destructive behaviors when he is frustrated. The main challenges he faces, as identified by his teacher, are transitions and speaking properly without the use of jargon. It was a challenge in the beginning understanding how to address his tantrums at the time of transitions to avoid harm to himself or others because of his size. 

In my opinion there were not inherently any value conflicts between myself and the agency. There seems to be an accepted approach to handling children in a physical manner by grabbing them when they are acting out that I was very uncomfortable with when I first started. I do not believe that this is a value that the agency upholds, but an approach that is allowed. I myself do not lay a hand on the children I work with unless they are physically hurting themselves or others, but I do understand how physically restraining a child works for other teachers to calm children down and reorient their bodies. I also did not have any value conflicts with the client as he is a four-year-old boy without very much to say. There are times where your values may conflict with the child’s parents. I have not spent much time speaking with the parents to notice any conflicts in our values.

Valutis and Rubin (2016) conducted a quantitative study to learn more about the value conflicts social workers experience in the field. They begin by discussing the underlying professional values of social workers, as can be found outlined in the National Association of Social Workers (NASW) Code of Ethics. They ascertain the core values of social work to be service, social justice, dignity, worth of the person, importance of relationships, integrity, and competence. Although these shared core values are assumed to be shared by social workers, there are unavoidable differences in the personal values and beliefs of social workers. Osteen (2011) pointed out that it was common for students of social work to come across differences in values at some point during their educational programs. 

I originally believed I may have been lucky that none of my values conflicted with the agency nor client but I realized that this is actually more common than not. In the study done by Valutis and Rubin (2016) they found that there was a general rarity in experiences of value conflicts. Even among the individuals who did have such experiences, they used the NASW Code of Ethics to navigate their decision-making, thereby helping them through any conflict. Mattison (2000) recognized that some workers may prefer the use of their own judgement when a conflict arises while others specifically prefer a policies and rules to navigate their issues.

Assessment of Client System

Hebrew Educational Society is an agency where the primary role is not part of the main reason the client comes to the agency. EF came to HES specifically because of location. There is no referral source, instead the organization promotes their UPK programming and has a waiting list of applicants. If the family gets their documents submitted in a timely manner, then any open spots are given to their child. This was EF’s first formal classroom experience and quickly the teachers noticed he was demonstrating difficulties in the classroom which was brought to the attention of the director of the Early Childhood Center (ECC). The director discussed it with the parents, who were then referred to services to obtain observations of the child’s behavior. A multidisciplinary team meeting was held with the teachers, director of the program, and the executive and associate directors of HES. They discussed a plan of what to do in the classroom, how to work with the parents, and what the social work team could do coming from outside the classroom with additional support. In the meantime, EF’s parents took him for evaluations and that is how he got his IEP. The Mental Health Counselor and director of the ECC program met with the parents to discuss the behaviors and what they believed the approach should look like. They discussed having extra help come into the classroom and signed a consent form so individuals like myself could work with him one on one. This happened a few weeks before I came into the classroom, and then I was introduced to EF.

The presenting problem that first had the teachers identify him as someone who needed extra services was his behavioral issues, along with challenges in both speech and body control that a typical four-year-old should exhibit. EF’s parents did not previously have him in any type of structured setting and as this was their first child they were unable to identify his weaknesses themselves.

Using a biopsychosocial-spiritual (BPSS) approach, we were able to get a better understanding of the presenting problem and were subsequently able to assess EF and break the problem down into parts. Sotomayor and Gallagher (2018) define the biopsychosocial model as “a systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery.” This model clashes with the medical model which focuses on breaking the individual down into molecules and lacks a holistic view of the individual. By looking at his social environment made up of his home life, we were able to identify some of the underlying causes to his behaviors. This included a new born at home taking away the one on one attention he was used to as well as a very unstructured sleep schedule that left him unable to control his emotions the closer it got to midday. BPSS is a valuable model of caring for patients because of its ability to address all aspects of a client’s care and helps to humanize the practice (Sotomayor & Gallagher, 2018). If the BPSS model was not all-inclusive, we may have missed important aspects to EF’s environment that play a role in his presenting problems.

The way we partialize these presenting problems are by breaking them into different goals. This will be discussed in depth later, but essentially, we were able to break his presenting problems down into two main goals to start the process of working together which was pertinent to the overlying goal of his proper integration into his class. We worked through these problems through setting objectives of how the goals will be met, and attempted to match an intervention to each goal.

Black and Hoeft (2015) write about the utilization of the biopsychosocial model and strengths-based approaches within the field of child health and found that research increasingly now focuses on BPSS models because of the ability of these domains to interact with one another during early years of life and actually can affect one’s life course. The developmental outcomes by which risk and protective factors actually act remain largely unknown and need further research, but the discoveries in the field of child health show that the BPSS lens helps to measure developmental outcomes and designing interventions.

There are other systems interacting with the client that I must connect with including the client’s teachers, the para in the room, and his parents. EF also gets physical therapy and speech therapy outside of HES, but we have no contact information for them so any information would come directly from the client’s parents. I have met EF’s mother once and introduced myself, my role in the classroom with EF, and how we plan to move forward. EF’s mother was able to give me insight into what reinforcers would be beneficial and this also opened the floor for further conversations between us down the line.

Conscious Use of Self

Heydt and Sherman (2005) define social workers as “instruments” used purposefully to promote change with client systems. This concept is termed the conscious use of self and affects the development of an effective helping relationship, it is considered to be the medium through which change occurs in social work practice. Sheafor and Horeksi (2003) described this as a social workers motivation and capacity to communicate and interact with others in ways that facilitate change.

The way I understand conscious use of self is that it is using my strengths to bring out the strengths in the individuals I am working with. It is also using self-awareness of my own competencies and weaknesses. I use this on a daily basis when working with EF by using my own knowledge of how I may act in a given situation and applying it to his behaviors. It is often very helpful when I see a behavior I don’t understand because I utilize my knowledge of what could trigger such a reaction. For example, knowing that when I am hungry, I cannot control my own emotions nor focus on the task at hand, really helps me to understand his negative behaviors close to lunch time. Conscious use of self is also the acknowledgement of where I am mentally and emotionally on any given day and perceiving how this could be harmful or helpful to my work with a client. Increasing one’s understanding of self can boost the possibilities of effectively engaging in the conscious use of self as a social worker (Heydt & Sherman, 2005). In my process recording for EF on October 29^th, I wrote

“Before going down to the Red Room I had heard EF was having a bit of a day so I attempted to mentally prepare myself. I didn’t get much sleep the previous night so I knew I would have to really work on my patience and keep my cool. Monday’s seem to be difficult, there is a pattern. The first and last day of the week are just rough transition days.”

I was able to acknowledge that I was tired and could likely be lacking patience so I mentally prepared myself. I also consciously used this knowledge of myself to identify why Mondays may be such a difficult day for EF, he is also lacking sleep from the weekend.

Heydt and Sherman (2005) claim that making use of teaching strategies that reintroduce the emphasis of cultural and self-awareness as it relates to the conscious use of self results in social workers becoming more in tune with themselves as individuals and more prepared for conducting effective helping relationships with clients.

Goal Setting

EF and I did not identify goals together as he is only four-years-old. I had a meeting with the head teacher of his classroom and asked her to identify her main goals for him as I was working on EF’s first service plan. Although there are a handful of areas we’d like to see progress in, we honed in on two main goals. The first goal is that EF will be able to move on to the next activity without a tantrum or getting distracted and the second is that EF will use his words to ask for what he wants and stop using jargon. Based off of these goals, I then set up objectives (What will the client say or do? Under what circumstances? How often will he/she do this?) to meet these goals. Lastly, interventions (What will the staff do to assist the client? Under what circumstances?) were created. The aim is that these two goals are met in a three month period of time.

Goals are important to know where we’re going, and to be able to see how far we’ve come. They also keep us accountable, working towards something. These goals for EF were created with the idea of SMARTER goals in mind. In class, we discussed SMARTER goals to be Specific, Measurable, Achievable, Relatable, Time Bound, Evaluate, and Re-Evaluate. MacLeod (2012) writes that there is a lot of confusion with the term “goals” and that goals themselves are much broader and SMARTER goals would be better labeled as SMARTER objectives.

Motivational studies have verified that an essential factor in bringing about desired outcomes is rewards. MacLeod (2012) suggests that the ‘-ER” should stand for engaging and rewarding. By adding engagement to the SMARTER objectives, the client will feel more as though their time is being valued and more inclined to work towards these goals. The proverb, “Tell me and I’ll forget; show me and I may remember; involve me and I’ll understand,” has shown to be extremely well-suited with current change theory findings. SMARTER goals are set up for EF, but are implemented by myself and his teachers so MacLeod (2012) would argue that the one implementing these goals also needs to feel engaged to succeed in attaining the client’s goals. Our current goals are engaging for us because we see the changes in EF over time, and EF is motivated by the chart system we have in place. Rewarding as the final R was chosen because motivational studies have shown that reward is essential in bringing about any changes we wish to see. We see this to be true with EF because knowing that there is a reward at the end of every sticker chart motivates him to keep earning stickers.

These goals are consistent with the client’s needs to integrate properly into a classroom and the goals are able to be met by the services we offer at HES. Although EF isn’t an active participant in the terms of voicing his opinions, he is active in showing us where he needs extra support and what he can do. Setting achievable goals that are adapted to him is the objective. The outcome of the work in many settings can definitely be impacted by client participation or lack thereof, but in this case with EF, it is not reasonable for us to believe he could determine where he is needing more support.

Goal setting was not ethically problematic for EF and me because he was not an active participant in making the goals. An ethical dilemma that could have arisen was keeping in mind cultural differences that could affect the goals that were set. Cultural competency is important to always think of because a social worker may believe what they are doing is best for the client when in actuality it is detrimental to the clients cultural beliefs.

Lastly, there were linkages we are still working to obtain information on. We are aware he is receiving speech and physical therapy services outside of HES but unaware of their goals and progress working with him. We did not make these referrals, the IEP had recommended it. We want to connect with them to make sure they are all in accordance.

Contracting

Seabury (1976) states that the contract in social work practice normally is defined as an agreement between the client and social worker that sets forth the reason for the interaction and the processes through which this will be attained. Maluccio and Marlow (1975) highlighted the aspect of goal agreeance and procedures to take place and that they need to be unambiguously stated.

Originally with EF, we hadn’t formally contracted. The social work team and I decided upon a reinforcement system of giving EF a pompom every time he displayed a positive behavior appropriate for the classroom and we would offer him one to do certain behaviors to start shaping them. I attempted to explain this to EF but his comprehension is low and it didn’t really seem to register. He wanted to hold on to the pompoms and subsequently we were not able to gather enough in the jar to offer a reinforcer. We ended up recontracting after the realization that this system wasn’t offering quick enough reinforcement to register its purpose in EF’s mind. I moved on to a reinforcement plan with shorter intervals to make it clear to EF that he was working towards something. I sat EF down and explained in the easiest to understand manner that we would be giving him a letter sticker every time he listened and when he got the whole alphabet, he would get a prize. Right away, we began giving him as many as we could for small, typical behaviors such as looking at the person speaking to him, sitting when asked, throwing away his plate after lunch, etc. After two days, he had made it through the whole alphabet for his sticker chart and got a small toy car. We immediately started over to show him how this system is going to work. From the quick turnover, it seemed that EF understood the point and was excited to continue to work again for another prize. After I saw we had a system in place that was proving successful, I made a formal written contract – a service plan.

Some researchers in the field write that a contract should be a tangible item with explicitly written goals while others believe it is just a naturally evolving part of the client/worker development (Fischer, 1978; Thomas, 1970). I started off my work with EF with our goals naturally evolving as we went, but realized that using specific goals written in a contract helps me focus on the most important goals. The literature points to the importance of contracting and more precisely about the need for open contracts that allow for change and renegotiation as the assessment process continues while working together (Rothery, 1980). Rothery (1980) writes it is widely accepted for social workers to develop secondary contracts with new interventions to fulfill the general goals of the client. This is exactly what I did for EF, when one intervention failed, I looked for a new one to reach the goals contracted on in his service plan. Rapoport (1970) believes an advantage to contracting is the opportunity to avoid unrealistic beliefs – contracts set out specific goals and steps to reaching that goal to allow for the client to anticipate the work. Contracting also is meant to involve clients more but in the case with EF, this doesn’t really apply. The contract did give me the opportunity to meet with the teachers and parents to formalize any type of treatment. Our goal is to re- the service plan in three months and re-contract based on any progress we have made (or not made). Finally Rapoport writes “Less widely discussed, but hardly less important, is the suggestion that contracting renders the helping process more efficient and increases the possibility of positive outcomes” (Rapoport, 1970).

Conclusion

Through client engagement, assessment, goal setting and contracting social workers work to identify and resolve any problems a client may have. In social work, working with a client is an ever changing process. Individuals are not meant to be static, so we see our clients progressing and regressing, and need to always take in to account where they stand. Not only are our clients not static individuals – we as the social workers are also ever changing. Social workers are able to learn about their own values through engagement with clients, reassess areas they need to work on, and set their own goals to make sure they are taking care of themselves and always staying updated with latest topics in the field. Working with clients brings mutual benefit to both the client and social worker, something not to be taken for granted.  

References

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