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Nancy Summers
Brooks/Cole Cengage Learning
2012
Fundamentals of Case Management Practice: Skills for the
Human Services, 4th Edition
Nancy Summers
1012
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Terms used to describe the people who use social services
have changed over time
Today it is customary to call these people our consumers
In records and other documents it is respectful to refer to our
consumers or clients by their given names
Or use the term person or individual
We use Client here because the use of the words person or
individual confuses the meaning in some instances.
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A dual relationship occurs when you and a client to whom you
are giving services have more than one relationship.
Make every effort to a avoid dual relationships.
Your position gives you a position of power.
It is possible to exploit or give the impression of exploiting
this power.
When in a situation where a dual relationship cannot be
avoided, give the client a choice about continuing services
with you.
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It is best to avoid accepting gifts from clients.
Sometimes clients give gifts with the expectation of
receiving special consideration in the future.
Sometimes, however they are given out of gratitude and a
need to stop always being on the receiving end.
If you accept a gift from a client
1. Document the offer and how you responded in the
client’s chart.
2. Always attempt to accept the gift on behalf of the
entire
agency rather than as a personal gift to you.
3. It can pose a conflict of interest.
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Sexual or romantic relationships with clients are almost
always illegal and always completely unethical.
For clients the respectful and concerned relationship they
form with a case manager may be the first time they have
experienced such a relationship.
For a case manager who is facing difficulties in his or her own
life a sensitive and concerned client is appealing.
For these reasons sexual and romantic relationships can
develop
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It is the case manager’s job to make sure that sexual or
romantic relationships do not develop!
Relationships with clients are exploitive, can add to client’s
emotional burdens, and will always involve a power
differential.
(one person is the helper with all the answers and the
other is the person with all the problems).
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Values conflicts occur when religious, moral, and political
values play a pivotal role in the client’s problem.
Generally, the client’s values and your values have little to do
with why the client is seeking services.
Be prepared by knowing your own values and feelings about
certain value-laden issues.
If a major conflict occurs tell the client that this may interfere
with services.
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Be respectful of attitudes and lifestyles that differ from your
own.
Never practice prejudice toward minorities, those with
disabilities, or those with differing sexual preferences.
Always give your best eservice to your client, even when you
disagree with the person.
Never attempt to change a client’s values to coincide with
your own.
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Clients have the right to self-determination.
This includes
1. The right to research their diagnosis and treatment
and ask questions about it
2. The right to make mistakes
3. The right to decide when and for how long they will
use the services of an agency or engage in treatment
Government and other funding sources are asking case
managers to talk to clients about what clients envision for
themselves in the future beyond grappling with social and
emotional problems.
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A client always has the right to consent to or withdraw from
services.
The client has the right to be informed about:
 Side effects, adverse effects, or negative consequences that
could occur as a result of treatment, medication, or
procedures
 Any risks that might occur if the client elects not to follow
through with treatment or services
 What is being offered, including what the treatment is, what
will be included, and potential risks and benefits
 Any alternative treatments or procedures available
Informed consent consists of three parts:
 Capacity - The client has the ability or capacity to make
clear, competent decisions in his or her own behalf.
 Comprehension of Information - The client clearly
understands what is being told to him or her. To make sure
that this is so give the information carefully and check to see
if the client understands what you have told him or her.
 Voluntariness - The client gives his or her consent freely with
no coercion or pressure from the agency or the professional
offering the service.
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This is both an ethical principle and a legal right.
Ask clients for their permission before sharing their case with
colleagues unless this sharing takes place in normal
supervision and agency planning.
If asked on the phone about a client, request a release-ofinformation form and indicate that when the form is received
you will see if the client is known to your agency.
Do not discuss your cases with relatives or friends leaving out
the names. Sometimes the identity of the client can be
pieced together.
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You must have a client’s permission to release information.
Use only release-of-information forms that are specific
1. To whom will the information be released
2. How long is the form valid
Some states require special procedures for releasing
information about HIV/AIDS status of clients. What does your
state require?
It is the case manager’s responsibility to protect minors, the
elderly, the mentally ill or mentally challenged as these clients
may not fully understand the consequences of releasing too
much information.
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Use the Minimum Necessary rule. Only release the minimum
amount of information needed for the other agency to fulfill
their responsibility to the client.
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When you must warn others of possible harm by the client.
When the client needs professional services and cannot
obtain these voluntarily.
When protecting clients from harming themselves.
When you are attempting to obtain payment for services.
When obtaining a professional consultation from your regular
supervisor in the course of regular supervision.
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Passed in 1996.
Requires agencies to inform clients of the agency’s privacy
and confidentiality procedures.
Security Requires agencies to protect health information from
inappropriate access by others.
Privacy The client’s right to keep certain information private.
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Stipulates what must be stipulated on a release-ofinformation form.
PHI or Identifiable health information Clients have the right to
ask that this information be restricted.
Clients have the right to access their files, make copies of
their records, and make corrections or additions to their files
if these are accurate.
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Social networking is a way to connect with those who share
our experiences at work
Away from the work, site it helps to be able to talk frankly
and about what happened.
However, social networking sites are not secure
Comments made there can be read by others and
misconstrued
It is unethical to talk about clients in any forum where
confidentiality is not guaranteed.
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Privileged communication is a legal concept.
Protecting the right of the client to withhold information
In a court proceeding.
You can reveal information about a client in a court
proceeding when
1. You are acting in a court-appointed capacity such
guardian or payee
2. When a child under 16 is believed to be the victim of a
crime such as sexual or physical abuse
3. When you determine the client needs to be
hospitalized
4. When the client has told you of his intention to
commit a crime or harm himself or another
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All states have laws requiring professionals to report the
abuse or neglect of children.
Some states have laws requiring professionals to report the
abuse, neglect, or exploitation of older people.
What does your state require?
Even where there are no laws mandating that you report elder
abuse ethically you have an obligation to do so.
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Occurs to a facility that specializes in inpatient mental health
care.
Criteria for committing someone against his or her will are:
1. The person poses a danger to himself or others
And one of more of the following
2. Severe mental illness or severe mental illness that is
acute
3. Unable to function and thus unable to provide selfcare
4. Has refused to sign a voluntary commitment
5. There are known treatments that can be applied once
the person is committed
6. The commitment adheres to the principle of least
restrictive treatment setting
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Do not burden clients with your problems or tell clients the
same thing happened to you - only worse.
Do not ask a client to meet your needs such as asking them
to buy Avon from you or buy insurance from a friend starting
an insurance business.
Do not insist that the client do what you think the client
should do. Don’t insist that your solutions are the only
solutions.
Do not continue to treat the client as in need of your services
when the client has grown beyond needing these services.
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When you diminish another person’s self-esteem you are
stealing what feelings of confidence and self-worth they may
have.
Some workers think they can justify mistreatment of clients
because the clients are difficult, don’t follow through, call too
often and similar behaviors that the worker finds annoying.
Many clients already feel unsure, vulnerable, and awkward
over needing help.
We have a responsibility never to diminish another person’s
sense of self-esteem or self-worth
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There are 4 reasons clients are often mistreated
1. The worker is an unpleasant person with everyone.
2. The worker needs to feel superior and to have power
over the client.
3. The worker has no supervisory support and feels
isolated with unpredictable behavior or unfamiliar
problems and develops an us-versus- the clients
attitude.
4. The worker is trying to control unpredictable behavior
with verbal or physical aggression because the
worker lacks training and support in other ways
to handle the behavior
We steal a client’s self-esteem:
 By being rude, brusque or demeaning
 By ignoring the client
 By refusing to return calls or acknowledge the clients
concerns
 Denigrating, ridiculing, or demeaning the client
 Forced to perform actions the client is not capable of
performing
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A social service worker is considered impaired when he or she
is unable to function effectively due to substance abuse,
mental illness or personal problems.
If a co-worker becomes impaired:
1. Start by talking to the worker
2. If need be talk to your supervisor
3. Do not allow clients to become endangered
If you become impaired:
1. Take steps to resolve personal problems promptly
2. Do not work with clients if you are not able to
function effectively
Fundamentals of Case Management Practice: Skills for the
Human Services, 4th Edition
Nancy Summers
1012
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Case management is a process for assessing the client’s total
situation and addressing the needs and problems found.
Case management seeks to improve the quality of life for the
client.
Case management does not focus on just one problem but
the many issues, strengths and concerns the client brings.
The client’s strengths and needs are used to improve the
overall situation.
Case management seeks ways to prevent current problems
from growing worse.
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In the late 1800s there was a need to formally organize
services given to people in need.
The Charity Organization Society took over control of this
approach and developed case work as a useful means of
tracking progress of clients.
In the 1960s individuals once housed in institutions came
into the community to live and needed intense monitoring to
adjust.
In the 1980s the term caseworker became case manager and
case managers took on more responsibility to give support
and find innovative solutions.
Today case managers are a significant part of most social
service settings.
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Case Management is a method for determining an
individualized plan for each client
Then monitoring that plan to be sure it is effective for the
client.
Case management is a process used to ensure that the money
being spent for the client’s services is being spent wisely and
in the most efficient manner on behalf of the client.
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Each client receives a plan that is unique to that client
Each client’s plan should include
1. elements that take advantage of the client’s strengths
and supports.
2. A means to address the most immediate and pressing
problems for that client.
3. Elements that take advantage of the client’s social
supports, such as family, friends, teachers, or
synagogue.
4. An understanding of the client’s goals and
preferences.
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Assessment
Planning
Linking
Monitoring
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A case manager’s assessment is meant to be comprehensive
and thorough.
Assessment covers many different aspects of the client’s life
in an attempt to develop an accurate profile of the client and
the client’s problem.
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First, the case manager assesses the initial or presenting
problem.
1. Does the problem interfere with the client’s
functioning at work or socially or interfere with
self-care?
2. What is the background to this problem?
3. How long has this problem gone on?
4. Are there other social, emotional or medical problems
that exacerbate the presenting problem?
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A discussion of the problem uncovers what the client needs.
What does the client need to bring stability to his or her life?
What would be the best way to resolve the problems the client
faces?
Is the client able to think clearly and understand options?
How would you characterize the person’s general mood?
What strengths or impediments will you have to work with in
the client’s environment?
The Information from the assessment helps us to formulate a
plan for the client.
A good plan looks at a variety of resources:
 Formal agencies - agencies set up to deal with specific
problems.
 Generic Resources - entities everyone can use (such as clinics
or recreational programs, social groups like Lions Club).
 Other established community resources - such as seminars
and support groups which are often free of charge.
 Peer support -Individuals who previously had the same
problem helping those who need support.
 Informal and folk support systems - neighbors, churches,
family, and others in the client’s life or likely to be available
in the client’s life to support the client.
Planning with clients is ongoing:
 Clients improve and may need an advanced level of planning.
 Clients’ situations may interfere with progress.
 Circumstances in the client’s life or the community change.
 Crises can occur that need to be addressed before continuing
the plan.
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We link the client to the services and supports that will best
meet the client’s needs.
Once there is a plan the case manager links the client to the
service or persons who will carry out the plan.
The case manager does not carry out the plan, but monitors
the plan to be sure others are carrying it out.
This is often referred to as a referral.
You indicate on your referral the amount of time you expect
the service to take to complete and what service you are
seeking for your client.
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It is the case manager’s responsibility to monitor the services
being given.
When you monitor a client’s service or treatment plan you do so
for 2 reasons:
 To be certain the treatment or service you authorized for this
client is in fact the treatment or service that is being given.
 To keep track of the client’s progress toward the goals you
developed with the client.
 To be aware of the times when modifications and revisions
are necessary.
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Nearly all we do in relation to our clients is a form of
advocacy
We stand up for our clients when necessary
Speak to the needs of groups of clients when appropriate
Look out for what is in the best interests of each client
Speak on behalf of clients when they cannot do so for
themselves
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Service Coordination means working with other systems or
agencies in a client’s life.
Clients are often involved in more than one system (such as
schools, medical, child welfare, criminal justice, welfare).
Each may have a different plan for the client.
Sometimes the goals of one agency’s plan conflict with the
goals of another agency’s plan.
Coordination enhances the client’s ability to complete the
goals.
Wherever possible bring representatives of the different
agencies together to form a team working on behalf of the
client.
Depending on the needs and abilities of the client a level of
case management is assigned. These levels can be:
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Administrative - clients are capable of handling the services
on their own with little need for case management support.
Resource Coordination - Clients have trouble handling the
details of their treatment or plan and require support.
Intensive - Clients are at risk for crises and need considerable
support and supervision to remain in the community.
Targeted or Blended - Clients, regardless of need and
through crises and stable times, have the same case
manager.
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Provider agencies have responsibility for providing the service
or treatment.
Within provider agencies there are often positions titled “case
manager”.
These case managers have overall responsibility for the
service or treatment given to the client by the agency.
These case managers are often in contact with the referring
case manager to go over clients’ progress and needed
changes to their plans.
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Managed care is a financial system designed to contain the
soaring costs of health care.
A managed care organization (MCO) receives a pool of money
for the care of a specific number of clients.
The MCO hires case managers to oversee the care given to
clients to hold down the costs.
Because the system is designed to control costs you may find
yourself at odds with the MCO over what your client needs
and what the MCO is willing to pay for.
The best approach is to advocate for your client.
Fundamentals of Case Management Practice: Skills for the
Human Services, 4th Edition
Nancy Summers
1012
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Sometimes referred to as the person-in-situation or personin-environment.
We use the ecological model to
 Develop a broad understanding of each individual client.
 See the client in the context in which the client lives and
functions.
 See how the client has interacted and is interacting with the
environment.
 See how the environment influences the client’s choices.
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Micro Level - Where the focus is on the client’s personality,
motivation, affect, and other personal attributes.
Meso Level - Where the focus is on the context immediately
surrounding the client (family, church group, close friends,
and work group).
Macro Level - Where the focus is on the larger society’s
characteristics and the way the client experiences these or the
way these are brought to bear on the client’s situation
(institutions and organizations such as the political system,
social stratification, educational system, the economy).
Biological Characteristics
 Neurological development
 Reflexes
 Genetic makeup
 Degenerative processes
 Illness (chronic, terminal,
temporary)
 Physical health
 Nutrition
Psychological Characteristics
 Early shaping experiences
 Perception
 Personality
 Affect
 Cognition
 Nurturance
 Life transitions/position in
the life cycle
 motivation
Personal Context or Meso
Level
 Family
 work group
 Social groups
 Family culture
 Family values
 Family structure
 Religious group
 Social class
 Role status, conflict or
strain
Social Context or Macro Level
 Larger social culture
 Larger organization of the
church or workplace
 The larger community
 Government
 Economy
 Social stratification
 Prejudice and
discrimination
 Political system
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These are normal life changes.
These events move a person from one phase of life to
another.
These changes require an adjustment to new circumstances.
Many are part of the normal development from birth to death.
Some people find it harder to adjust than others.
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Starting kindergarten or
first grade
Going to high school
Going out on a first date
Leaving home for the first
time
Losing one’s job
Experiencing a disaster
Large mortgage or debt
Large financial losses
Children leaving home
Birth of a grandchild
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Starting a new job
Getting married
Buying a first home
Ill health
Losing a spouse through
death
Divorce
Losing a physical capacity
Considerable financial gains
Children marrying
Death of a child
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Use two-pronged interventions that address maladaptive
interactions between the person and the environment.
Choose interventions that strengthen the person to handle
the environment.
Find interventions that alter the environment to better
accommodate the person.
Note those parts of the environment that are positive and
useful.
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Is the ability to recognize and address issues on all three
levels.
When the case manager looks at how people and systems on
each to the three levels affects the client’s problems the case
manager has correctly made a multilevel assessment.
The generalist approach has as its goal better functioning and
increased competence of all parties.
This becomes the foundation for solid and long-lasting
change.
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In your work you will see groups of individuals who have been
harmed by one or more of the larger social systems (the
school system or the medical system, perhaps discriminatory
practices).
You have an ethical obligation to speak to the needs of the
less advantaged in our society to the larger society where the
changes need to be made.
You will also see areas of service that need to be developed
or better supported.
You are in a unique position to bring these needs to the
community that funds the services.
Fundamentals of Case Management Practice: Skills for the
Human Services, 4th Edition
Nancy Summers
1012
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Our perceptions and attitudes are influenced by our own
culture.
Ethically we have a responsibility to become acquainted with
cultures that differ from our own and with which we have
extensive contact.
The only way to work with people from different cultures is to
see them as unique individuals and make every effort to
perceive them accurately.
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Cultures - Generally refers to an entire society within a
specific political boundary wherein the citizens share a
common understanding.
Subcultures - Within a society are smaller groups who hold
the dominant culture but also hold specific ideas and beliefs
that may differ from the dominant culture in some ways.
Race and Ethnic Groups - Societies can have different races
and ethic groups within them. Race refers to a group who are
biologically similar while ethnic group refers to a group of
people who share a common cultural heritage.
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We learn who is in our in-group and who are in the out
groups through our socialization.
In-groups are seen as acceptable. They are seen as being
more like ourselves.
Out-groups are generally groups with whom we do not often
interact and with whom we feel uncomfortable
We often describe in-groups favorably while we are often
suspicious of the motives of out-groups.
We-Versus-Them attitude develops when we use our own
culture to judge the culture of others.
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When we meet people who do not think, act, or believe as we
do we often find them strange.
Often their ways of thinking and acting are unfamiliar to us.
It is always the dominant culture that defines who is a
stranger.
As the world becomes more global we are likely to encounter
people who are different from ourselves.
It is often up to the social service worker to help immigrants
make a smooth adjustment to a new culture. Immigrants who
become competent in the dominant culture are healthier.
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It is common to feel anxious when we attempt to interact with
individuals from different cultures.
We need to manage those feelings so they do not impede our
communication with others.
In order to feel less anxious we may interpret the stranger’s
behavior or beliefs through our own culture.
The more we can feel the person is like us, the less likely we
are to feel anxious.
Ways we can make our communication more thoughtful:
 Recognize our tendency to categorize - look at how we might
stereotype a person.
 Look for exceptions - seek exceptions to our stereotypes
 Check our attributions - Do we see negative behavior in
others as being part of their poor character while our negative
behavior is blamed on circumstances?
 Evaluate our scripts - People from different cultures may not
have the same scripts we do and thus we misunderstand their
actions.
 Check our perceptions - Check with the other person to see if
your perceptions are correct.
 Allow for differences - Recognize there is a lot you don’t
know and be open to finding out more.
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Basically most cultures fall into either an individualistic
culture or a collectivistic culture.
Individualistic cultures tend to place an emphasis on the
individual.
Collectivistic cultures tend to place more emphasis on the
group.
Many researchers believe communication can be better
facilitated if we know whether the person with whom we are
meeting comes from an individualistic culture or a
collectivistic culture.
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Are more vertical - people are expected to stand out from
others
Value freedom
Promote self-fulfillment
Emphasize individual initiative and achievement
Emphasize the need and goals of individuals over the group
In-group influence is specific to time and place and not
general
Support unique individual beliefs
Maximize individual outcomes
For more differences see pages 94 – 98 and page 102 in your textbook,
Fundamentals of Case Management Practice
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People are not expected to stand out
A value is placed on equality
Cooperation occurs with in-group members
In-group members look out for each other
Require that people fit into the group
Emphasize belonging
Group goals are emphasized
There are shared group beliefs
Tend to apply different value standards to members of the
in-group as compared with members of out-groups
For more differences see pages 94 – 98 and page 102 in your textbook,
Fundamentals of Case Management Practice
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Stereotypes - assumptions about people from a particular
group and we do not question these assumptions.
Ethnocentrism - we use the standards of our own culture to
judge the behavior and culture of other people.
Prejudice - based on a stereotype we avoid or deny certain
things to people from this group.
Conflict - cultural misunderstandings turn into hostility and
conflict.
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We can change our attitudes toward strangers and members
if out-groups.
Contact, especially contact around substantive issues is
helpful
Stress cooperation rather than competition.
Learn to see members of other groups as individuals rather
than as representatives of our own biases and stereotypes.
Remain open to learn more.
Confirm to others that they are valuable to you as individuals,
that their experiences and concerns are important, and that
you are willing to become involved to help them resolve their
problems.
Workers who are culturally competent are:
 Adaptable to situations.
 Flexible in choosing how to respond to situations.
 Have a commitment to give high-quality service to every
person who comes for assistance.
 Lets others know they have been heard and their concerns are
significant.
 Are respectful of others regardless of culture.
Fundamentals of Case Management Practice: Skills for the
Human Services, 4th Edition
Nancy Summers
1012
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Attitudes we hold about other people are bound to be
communicated to them one way or the other.
Positive and supportive attitudes foster rapport.
Superior or disdainful attitudes are bound to be
communicated to another no matter how we try to hide them.
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If you forgive yourself for your mistakes and troubles and see
these as part of growing, it is easier to understand and
support others through their own mistakes and struggles.
Good attitudes begin with being tolerant of yourself. If you
see yourself as basically okay you will see others in that light
as well.
There are three basic helping attitudes
 Warmth - In your presence clients feel valued, worthy of
being understood.
 Genuineness - you are open, truthful, an authentic person.
 Empathy - you are able to put yourself in another’s shoes.
You can accurately communicate to clients an understanding
of their underlying emotions.
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Because you are the worker and the clients are clients does
not make you a better person than they.
Judging people by your own standards is not helpful.
Comparing your life to theirs, your choices to their choices
clouds your objectivity.
Being wary and distrustful of clients implies that clients are
sneaky, untrustworthy, or devious.
When you sit in judgment of another person you erect a
barrier to real understanding, rapport. and the opportunity to
be of real assistance.
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All of our clients will not be cooperative and grateful.
It is unrealistic to expect that clients will be.
We are trained to deal with people who are dissatisfied,
confused, overwhelmed, have difficulty expressing
themselves or are unduly sensitive.
Just because clients present difficulties is not an excuse to
provide poor service.
There are many ways clients become discouraged by workers
 Setting up competitions where you compare the client to
others or to yourself.
 Pushing, forcing, or shaming a client into moving toward
some goal.
 Focusing exclusively on the mistakes the client has made.
 Demanding unrealistic outcomes or perfection.
 Dominating and intimidating the client.
 Failing to notice positive change, the client’s strengths.
 Failing to give positive feedback.
 Discouraging clients from trying new things.
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There are boundaries between clients and workers that
prevent ethical violations and facilitate the helping
relationship.
It is the worker who is responsible for maintaining
boundaries.
Ways we cross boundaries
 The client reminds us of ourselves.
 The client is dealing with a problem we once had.
 We are using our work with clients to resolve our own issues.
 We want the client to use solutions we used to solve a similar
problem in our own lives.
 We want the client to use a specific solution so that we
appear more effective and competent as workers.
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Expecting that people who look like me will act and think like
I do.
Expecting that people who do not look like me will not be like
me at all, but will be very different.
Points about these boundaries:
 A person of another race or culture may have similar values
and circumstances to your own.
 A person from your own race or culture may hold very
different views and have very different circumstances.
 Our beliefs about other people stem from our stereotypes,
even when we are not entirely aware of it.
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Transference is a collection of feelings and attitudes the client
holds about you.
Accept transference when it exists. Transference is neither a
good thing or a bad thing.
Sometimes we remind clients of someone they knew in the
past.
Clients may only be dimly aware of that. They just know that
you remind them of someone.
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Transference occurs when you remind the client of someone
the person liked or did not like
Positive transference occurs when the client likes you because
you remind him or her of someone they liked.
Negative transference occurs when the client dislikes you
because you remind him or her of someone they liked..
When clients act in unexpected and somewhat inappropriate
ways do not take it personally.
Reflective listening creates a safe environment.
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Countertransferece occurs when the worker projects onto the
client emotions and attitudes.
It occurs because the client reminds us of someone in the
past or because the clients issues remind us of our own.
Countertransferencec can be negative or positive.
We may give good service to someone who reminds us of a
dear aunt, while giving poor service to someone who reminds
us of a bully.
It is important to be self-aware of our feelings about another.
It is not acceptable to allow them to interfere with our service
to others.
Countertransference feelings may signal we have old issues
that need to be resolved.