Assignment: Introduction to Research Proposals

1. Social Work Research: Couples Counseling

Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years. Assignment: Introduction to Research Proposals

 

Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.

 

Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.

 

I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.

 

I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.

 

The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on treatment and delivery style.

 

I informed Kathleen and Lisa that both measurement tools were obtained from the National Registry of Evidence-Based Programs and Practices. We use these tools in the agency to assess the experience of the client and whether the goals of treatment are being achieved. Lisa questioned how the information would be used, and I told them that this information would be shared with them weekly and would only be in their chart.

 

Lisa and Kathleen came every week for 15 weeks. In that time, we charted each week using both tools. The chart demonstrated significant progress and then began to level off. During that time, Kathleen and Lisa worked on effective communication strategies to discuss the presenting issues. The arguments had become less frequent and shorter in duration as both Kathleen and Lisa learned to appreciate the other’s perspective. They expressed that some members of their families of origin were not supportive of their sexual orientation, and this was the main challenge for them as a couple. They were able to identify their strengths and not let family or societal opinions inform how they wanted to live. They were able to see that this was their decision.

 

During treatment there were times when the measurement tool indicated that they felt we were not connecting on certain issues. As I could pinpoint when that was and the topic we discussed, we were able to address it in the next session to clarify and get back on track.

 

 

 

 

2. Social Work Research: Using Multiple Assessments

Lucille is a 68-year-old, Caucasian female. Her husband of 43 years passed away 4 years ago after a long and debilitating illness during which Lucille was his primary caregiver. During their marriage, he worked at the sanitation department, and she was a homemaker. She continues to live in the house where she and her husband raised their three children. Lucille receives a limited income of approximately $2,100/month from her husband’s retirement pension and Social Security; she owns her home and has no major outstanding debts. She receives Medicare to cover her major medical expenses and a small supplemental health plan to cover any outstanding medical costs. Her physical health is good, and she has not had any major illnesses or surgeries, although she has not had a complete physical in over two years. Her favorite hobbies are gardening and cooking. Lucille has two sons and one daughter, each living away from home with their own families. Lucille’s daughter and one son reside in the local area; her other son lives in another state.

 

Lucille’s major concern is about her daughter, Alice (33), who has battled substance abuse and alcoholism since adolescence. At present, Alice is not employed and has had several encounters with law enforcement for drug possession and intent to sell illegal substances. Alice has admitted that she has used cocaine as well as other substances in the past. She has made several attempts to go into drug rehabilitation, but she has never completed a program. Her siblings have essentially disowned her. Alice has three children, Michael (6), Rachael (4), and Randy (18 months), who was recently diagnosed with fetal alcohol effects (FAE). Lucille is not certain who is the father of her grandchildren; it is a subject Alice refuses to discuss. Alice has repeatedly left her children alone for several hours in their tiny apartment, and once she was gone for several days. Child Welfare has interceded, but Alice continues to have custody of her children. Whenever Lucille visits her daughter and grandchildren, the living conditions are filthy, there is little food in the house, and there is talk of constant “visitors” to the house well into the night. Because of Alice’s instability, Lucille has taken physical custody of her grandchildren without any redress from Alice. Lucille’s family members are not aware of the stress Lucille is feeling about possibly having to spend the rest of her life raising her grandchildren, including one with a disability. This causes Lucille to often feel “down in the dumps,” resulting in overeating because, as she stated, “comfort food makes me feel better.” Within 2 months, she gained 15 pounds.

 

Lucille heard about a counseling program at the local community center for grandparents raising grandchildren. The program provides support, group meetings, parenting classes, individual counseling sessions with a social worker, and referrals for other supporting services. At first, Lucille was skeptical about attending the program. She was embarrassed to tell others about her family circumstances; she was particularly fearful that others would blame her for her daughter’s lifestyle and wonder how she could now care for her grandchildren if she could not raise her daughter properly. She already blamed herself for her daughter’s actions, which made her bouts of depression more frequent and difficult to overcome.

 

Eventually, Lucille came to the community center after some encouragement from her neighbor. Lucille is quite concerned about the fate of her daughter. Fearing the worst, she is constantly worried she will get a late night phone call that her daughter was found dead somewhere from a drug overdose or something related to her drug life. She once believed caring for her grandchildren was a temporary arrangement but more recently believes this will become permanent. Although Lucille loves her grandchildren, she is afraid that she will have to raise them alone and is angry with her daughter for putting her in this position. She does not know if she can do it at her age. Her youngest grandchild will need many resources over the years, and she does not even know where to begin to access them. She admits feeling overwhelmed and depressed frequently, but she does not have a wide circle of family or friends to talk to about her concerns. She spoke to her church minister once about her family circumstances but did not feel she got much out of it. “He just did not seem to understand what I was talking about,” she stated, “so I never went back.” She stated she was feeling unable to manage her family needs and that “I just want to get control of the ship again.” Assignment: Introduction to Research Proposals

 

After a thorough psychological assessment, the agency psychiatrist determined that medication was not necessary for her bouts of depression. After our initial talk, I administered a series of baseline measures on her emotional and physical functioning, specifically the Center for Epidemiologic Studies—Depressed Mood Scale (CES-D), Family Resource Scale, Family Support Scale, and the Medical Outcome Survey, SF-12v2. Our plan is to administer these measures at 3-month intervals for 1 year to assess her emotional functioning and social progress. Using a strengths-based approach to problem solving, I collaborated with Lucille on a biweekly basis to define personal goals that focused on helping her address feelings of depression and broaden her support network for managing family challenges. She attended monthly support group meetings with other grandparents who discussed their challenges and celebrated their triumphs. Lucille never missed a meeting. I made two home visits per month to observe Lucille in her home environment. Our individual sessions included assessing strengths, defining/redefining needs, targeting problems and goals, identifying resources to address needs, and monitoring goal progress. A nutritionist also conducted two home visits to help her with food options for herself and her grandchildren. Lucille is an excellent cook, and the nutritionist showed her how to reduce calories without sacrificing taste. Within four weeks, Lucille was able to make small changes in her everyday life. She began walking her grandchildren to the local park for playtime, preparing her front yard for spring flowers, and preparing Sunday dinners to reengage her family. She also visited her family physician and learned that she has high blood pressure, which can be controlled with proper diet and exercise, and she has asked her son and daughter-in-law for respite once per month so she can have some “down time.”

 

After 6 months, I facilitated a family group conference with Lucille and her sons and their wives. The focus of the meeting was to plan how the family would support Lucille as the primary caregiver for her grandchildren and to define the role other family members would play in assisting in raising Alice’s children. There was family agreement that it was in the children’s best interest for Lucille to seek legal counsel so she could establish temporary custody for her grandchildren, as well as learn the options for a more permanent relationship, such as adoption. She also applied for disability benefits for her youngest grandchild. Later, the family would meet to conduct permanency planning for the grandchildren. After 9 months, Lucille’s emotional health improved, and we decided to suspend individual counseling, but she continues to participate in the weekly support group meetings where she can have her blood pressure checked by the program nurse. After 12 months in the program, Lucille has a positive perception of her support network, including her family; familiarity with community resources and how to access them; a positive emotional state; and she has lost 10 pounds and her blood pressure is normal. Lucille has even initiated a grandparent mentoring service for new custodial grandparents who want to partner with a “seasoned” grandparent caregiver. Last week, Lucille found out her daughter Alice, who she has not seen in nearly a year, is 6 months pregnant. Assignment: Introduction to Research Proposals