Effectiveness Of The Solution Focused Treatment Model
Description of the Problem Jordan Smith (fictitious name) is a nineteen year-old boy who is currently at Broward Health Medical Center. The mother is reporting serious behavioral problems. The mother said she will keep Jordan in her home if he quits smoking cannabis and comes home before dark. Jordan has previous admission for history of schizophrenia since the age of sixteen and has history of noncompliance with treatment. Recently, in the last few months he has been hospitalized numerous times, at least two times in the last month. Reason for recent admission is that Jordan was smoking cannabis and skateboarded in front of a car. He was hit by the car and did not report it to the mother. Mother found it odd and brought him to the emergency
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room. He was then admitted to psychiatric unit because mother thought he was trying to commit suicide. Jordan denies suicide ideation. Some of the behavior problems are stealing from neighbor’s garages, opening unlocked car doors and taking valuable items, and coming home after dark. He does report that he was incarcerated for over six months for apparently eluding officers. Jordan states all misbehaviors occurred whenever he was under the influence of cannabis.
Conceptual Model/ Practice Model Broward Health Medical Center, Behavioral Health Services adopted the Solution-Focused Treatment Model for use in the inpatient units.
Therefor I will be using Solution-Focused therapy with Jordan. I will be exploring in depth how this theory works effectively with the patient. The patient is the expert in their own life and able to define their goals. One of the areas in which I will show how it works effectively is by describing the effectiveness of the theory with Jordan, providing questions that can be used to assess my client and exploring the social worker/client relationship. After focusing and explaining the areas mentioned above I will develop an intervention plan, goals and objectives to help my client work through his presenting …show more content…
problem
Social Worker/Client Relationship During the engagement stage, the social worker attempts to build an alliance by accepting, without interpreting or reformulating, the client’s perspective on the presenting problem, in the client’s own language (Walsh, 2010). Solution Focus therapy focuses on the client being the experts in their own lives, which is why it is encouraged to have them determine, in their own words and language, the goals they wish to achieve. With its emphasis on short-term intervention and a rapid focus on client goals, solution focused therapy is sometimes criticized for not adequately attending to the initial development of a positive worker/client relationship (Walsh, 2010). Social workers main role in solution focus therapy is to initiate change processes.
• Can you tell me what will be different for you that will indicate that our time working together has been a success?
• Jordan, would you be willing to tell me what you would want to be doing instead of the current issue, which you said was smoking marijuana?
• Can you describe to me, what your preferred future looks like?
Assessment of the Problem
Case Study
I. Identifying Information:
Jordan is a nineteen year-old Hispanic male who is currently at Broward Health Medical Center. The doctor is suggesting Jordan be petition to the State Hospital since Jordan has been admitted to the hospital several times this year. Last time patient was brought into hospital under a Baker Act initiated by the nurse practitioner at the Detention Center. Everyone agrees if his mother allows him to return home he will not go to the State Hospital. Jordan must then follow two rules 1. No more cannabis and 2. No staying out after dark.
II. Nature of Presenting Problem:
Jordan has a current diagnosis of schizophrenia. He was diagnosed at sixteen after using a drug called spice. That is when he began to hear voices. Jordan has history of noncompliance with treatment. He has been smoking cannabis daily and coming home late in the morning after hanging out with friends. He does not listen to his mother or mother’s partner. Jordan past psychiatric history of schizophrenia, paranoid type, chronic at least four to five hospitalizations in the past year. History of aggressive behavior and depression. Mother and doctor have determined that Jordan needs hospitalized inpatient psychiatric and be petitioned for State Hospital placement. This current admission has been his longest stay yet. Jordan has been on the unit for three weeks. Jordan says whenever he is bored he gets high and that is usually leads him into trouble. Jordan states he has been incarcerated for theft. He states he would steal things from neighbor’s garages and unlocked cars. He expresses that he was under the influence when this all happened. He was caught by a neighbor and there was an officer patrolling the community and that is how he went to jail. Jordan states he does not get along with his mother because she will not disclose any information about his father. Jordan has never met his father and whenever he asks his mother she become agitated and says “stop asking”. He feels as if he is not a real man. He has no male role model. Mother has expressed to the mental health counselor that Jordan’s father was a one night stand and that is why she does not wish to speak to Jordan about his father.
III. Client Interpersonal Issues
The social worker will be scheduling a family session with Jordan’s mother. Jordan has no other family involved in his care. Social worker will like to find out what is going on with Jordan and his mother and what can be done to help fix their relationship. Jordan does not want to go to the State hospital. There will also be a meeting with Jordan’s psychiatrist since he has been having negative side effects with the medication he is on. Jordan complains that the medication makes him sleep constantly and has no energy to get out of bed. Jordan also states that ever since he has been on the medication he has been dealing with erectile dysfunction that is another reason he does not want to take medication.
IV. Context and Social Support Networks
Effectiveness and Appropriateness to Solution Focus Therapy Solution-focused practice is a short-term approach to clinical intervention in which the social worker and client attend to solutions or exceptions to problems more than to problems themselves (DeJong & Berg, 2008).
Solution focus therapy fits nicely with crisis stabilization and the pressure from insurance companies and government agencies to provide effective treatment in a briefer time frame. Solution focus therapy treatment is patient-centered empowering and goal oriented. The focus for each patient is to establish realistic goals. Solution-focused therapy is relatively new, therefore its effectiveness has not been extensively researched. A number of experimental, quasi-experimental, single subject, and pre-experimental designs, however, provide evidence of its utility with a variety of client populations at the individual, couple, family, and group levels according to Walsh (2010). Some of the disadvantages to Solution-focused Treatment is that critics say it’s too simplistic and does not have enough empirical research to support it. It also does not attend to the fact that some problems may indeed need to be faced in order for the patient to change. As for effectiveness Solution-focus therapy provides a consistent approach to the unit’s
treatment.
Treatment Plan
Miracle Question
• Jordan, let’s say that in the middle of the night a miracle happens and the problem that prompted you to come to the hospital is solved! But because this happens while you are sleeping, you have no way of knowing that there was an overnight miracle that solved the problem. …So, when you wake up tomorrow morning, what might be a change that will make you think to yourself that something must have happened and the problem is gone?
This allows the client to see their problem from a different perspective. Social workers can ask the Miracle Question to help find indicators of change that can be incorporated into solution tasks. This also gives the social worker a better understanding on where the client wants to be.
Scaling Question:
• Select a problem stated by the patient
• Ask the patient to rate the severity of this problem on a scale of 1 to 10
Scaling Questions
• On a scale of 1-10, where 1 is unmotivated and 10 being very motivated how likely are you to invest your energy in trying to quit smoking marijuana?
• I see that you have given yourself an 8, which demonstrates effort in wanting to quit. That’s great that you have recognized that there is some motivation within yourself. Now, if you began the process in quitting with more of a gradual effort, do you think that would increase your level of motivation as opposed to the idea of going cold turkey?
Intervention Plan Will include to stabilize Jordan’s mood, thought, and behavior. According to Walsh (2010), one of the unique characteristics of solution-focused therapy is the lack of a major distinction between the assessment and intervention stages. As for Jordan an intervention that can be used is exploring exceptions to his presenting problem of cannabis smoking. Jordan would not only like to quit smoking but to find a vocational program that keeps him productive. The social worker should, as always, accept the problem from the perspective of the client, and help the client set goals… (Waslsh,, 2010). Social Workers will start where Jordan is at by listening for his perception of his situation. Help Jordan explore gals for positive changes and identify the signs to indicate change is happening.
• What were you doing or thinking differently during those you did not smoke marijuana to pass the time and overcome your boredom?
• What was going on in the past when marijuana wasn’t a problem?
• Can you think of a time within the past month that you did not resort to smoking marijuana when you began feeling anxious?
• What do you want to continue to happen?
Goals & Objectives
• Goal: To find an alternate method to overcome boredom when you have nothing to do that will discourage marijuana use.
• Objective: Jordan will spend more quality time with his mother
• Action Step 1: Jordan will stay home during the week when his mother is home from work
• Action Step 2: Jordan will join his mother on her walks around the park in the morning
• Objective: Jordan will search for other extracurricular activities that interest him
• Action Step 1: Jordan will search for activities within the community
• Action Step 2: Jordan will choose an activity and sign up to participate
• Action Steph 3: Jordan will join the vocational program that BHMC refers him to
Evaluating client Walsh (2010) mentions that the ending focuses on helping clients identify strategies to maintain changes and the momentum to continue enacting solutions.
• Jordan, what could you do to prevent yourself from coming back to the hospital again?
• What are something’s you could remember when things get difficult for you?
• What do you feel your hardest challenge to be?
• How confident do you feel about following the plan of action?
• What help will you need to persist with the plan?
room. He was then admitted to psychiatric unit because mother thought he was trying to commit suicide. Jordan denies suicide ideation. Some of the behavior problems are stealing from neighbor’s garages, opening unlocked car doors and taking valuable items, and coming home after dark. He does report that he was incarcerated for over six months for apparently eluding officers. Jordan states all misbehaviors occurred whenever he was under the influence of cannabis.
Conceptual Model/ Practice Model Broward Health Medical Center, Behavioral Health Services adopted the Solution-Focused Treatment Model for use in the inpatient units.
Therefor I will be using Solution-Focused therapy with Jordan. I will be exploring in depth how this theory works effectively with the patient. The patient is the expert in their own life and able to define their goals. One of the areas in which I will show how it works effectively is by describing the effectiveness of the theory with Jordan, providing questions that can be used to assess my client and exploring the social worker/client relationship. After focusing and explaining the areas mentioned above I will develop an intervention plan, goals and objectives to help my client work through his presenting …show more content…
problem
Social Worker/Client Relationship During the engagement stage, the social worker attempts to build an alliance by accepting, without interpreting or reformulating, the client’s perspective on the presenting problem, in the client’s own language (Walsh, 2010). Solution Focus therapy focuses on the client being the experts in their own lives, which is why it is encouraged to have them determine, in their own words and language, the goals they wish to achieve. With its emphasis on short-term intervention and a rapid focus on client goals, solution focused therapy is sometimes criticized for not adequately attending to the initial development of a positive worker/client relationship (Walsh, 2010). Social workers main role in solution focus therapy is to initiate change processes.
• Can you tell me what will be different for you that will indicate that our time working together has been a success?
• Jordan, would you be willing to tell me what you would want to be doing instead of the current issue, which you said was smoking marijuana?
• Can you describe to me, what your preferred future looks like?
Assessment of the Problem
Case Study
I. Identifying Information:
Jordan is a nineteen year-old Hispanic male who is currently at Broward Health Medical Center. The doctor is suggesting Jordan be petition to the State Hospital since Jordan has been admitted to the hospital several times this year. Last time patient was brought into hospital under a Baker Act initiated by the nurse practitioner at the Detention Center. Everyone agrees if his mother allows him to return home he will not go to the State Hospital. Jordan must then follow two rules 1. No more cannabis and 2. No staying out after dark.
II. Nature of Presenting Problem:
Jordan has a current diagnosis of schizophrenia. He was diagnosed at sixteen after using a drug called spice. That is when he began to hear voices. Jordan has history of noncompliance with treatment. He has been smoking cannabis daily and coming home late in the morning after hanging out with friends. He does not listen to his mother or mother’s partner. Jordan past psychiatric history of schizophrenia, paranoid type, chronic at least four to five hospitalizations in the past year. History of aggressive behavior and depression. Mother and doctor have determined that Jordan needs hospitalized inpatient psychiatric and be petitioned for State Hospital placement. This current admission has been his longest stay yet. Jordan has been on the unit for three weeks. Jordan says whenever he is bored he gets high and that is usually leads him into trouble. Jordan states he has been incarcerated for theft. He states he would steal things from neighbor’s garages and unlocked cars. He expresses that he was under the influence when this all happened. He was caught by a neighbor and there was an officer patrolling the community and that is how he went to jail. Jordan states he does not get along with his mother because she will not disclose any information about his father. Jordan has never met his father and whenever he asks his mother she become agitated and says “stop asking”. He feels as if he is not a real man. He has no male role model. Mother has expressed to the mental health counselor that Jordan’s father was a one night stand and that is why she does not wish to speak to Jordan about his father.
III. Client Interpersonal Issues
The social worker will be scheduling a family session with Jordan’s mother. Jordan has no other family involved in his care. Social worker will like to find out what is going on with Jordan and his mother and what can be done to help fix their relationship. Jordan does not want to go to the State hospital. There will also be a meeting with Jordan’s psychiatrist since he has been having negative side effects with the medication he is on. Jordan complains that the medication makes him sleep constantly and has no energy to get out of bed. Jordan also states that ever since he has been on the medication he has been dealing with erectile dysfunction that is another reason he does not want to take medication.
IV. Context and Social Support Networks
Effectiveness and Appropriateness to Solution Focus Therapy Solution-focused practice is a short-term approach to clinical intervention in which the social worker and client attend to solutions or exceptions to problems more than to problems themselves (DeJong & Berg, 2008).
Solution focus therapy fits nicely with crisis stabilization and the pressure from insurance companies and government agencies to provide effective treatment in a briefer time frame. Solution focus therapy treatment is patient-centered empowering and goal oriented. The focus for each patient is to establish realistic goals. Solution-focused therapy is relatively new, therefore its effectiveness has not been extensively researched. A number of experimental, quasi-experimental, single subject, and pre-experimental designs, however, provide evidence of its utility with a variety of client populations at the individual, couple, family, and group levels according to Walsh (2010). Some of the disadvantages to Solution-focused Treatment is that critics say it’s too simplistic and does not have enough empirical research to support it. It also does not attend to the fact that some problems may indeed need to be faced in order for the patient to change. As for effectiveness Solution-focus therapy provides a consistent approach to the unit’s
treatment.
Treatment Plan
Miracle Question
• Jordan, let’s say that in the middle of the night a miracle happens and the problem that prompted you to come to the hospital is solved! But because this happens while you are sleeping, you have no way of knowing that there was an overnight miracle that solved the problem. …So, when you wake up tomorrow morning, what might be a change that will make you think to yourself that something must have happened and the problem is gone?
This allows the client to see their problem from a different perspective. Social workers can ask the Miracle Question to help find indicators of change that can be incorporated into solution tasks. This also gives the social worker a better understanding on where the client wants to be.
Scaling Question:
• Select a problem stated by the patient
• Ask the patient to rate the severity of this problem on a scale of 1 to 10
Scaling Questions
• On a scale of 1-10, where 1 is unmotivated and 10 being very motivated how likely are you to invest your energy in trying to quit smoking marijuana?
• I see that you have given yourself an 8, which demonstrates effort in wanting to quit. That’s great that you have recognized that there is some motivation within yourself. Now, if you began the process in quitting with more of a gradual effort, do you think that would increase your level of motivation as opposed to the idea of going cold turkey?
Intervention Plan Will include to stabilize Jordan’s mood, thought, and behavior. According to Walsh (2010), one of the unique characteristics of solution-focused therapy is the lack of a major distinction between the assessment and intervention stages. As for Jordan an intervention that can be used is exploring exceptions to his presenting problem of cannabis smoking. Jordan would not only like to quit smoking but to find a vocational program that keeps him productive. The social worker should, as always, accept the problem from the perspective of the client, and help the client set goals… (Waslsh,, 2010). Social Workers will start where Jordan is at by listening for his perception of his situation. Help Jordan explore gals for positive changes and identify the signs to indicate change is happening.
• What were you doing or thinking differently during those you did not smoke marijuana to pass the time and overcome your boredom?
• What was going on in the past when marijuana wasn’t a problem?
• Can you think of a time within the past month that you did not resort to smoking marijuana when you began feeling anxious?
• What do you want to continue to happen?
Goals & Objectives
• Goal: To find an alternate method to overcome boredom when you have nothing to do that will discourage marijuana use.
• Objective: Jordan will spend more quality time with his mother
• Action Step 1: Jordan will stay home during the week when his mother is home from work
• Action Step 2: Jordan will join his mother on her walks around the park in the morning
• Objective: Jordan will search for other extracurricular activities that interest him
• Action Step 1: Jordan will search for activities within the community
• Action Step 2: Jordan will choose an activity and sign up to participate
• Action Steph 3: Jordan will join the vocational program that BHMC refers him to
Evaluating client Walsh (2010) mentions that the ending focuses on helping clients identify strategies to maintain changes and the momentum to continue enacting solutions.
• Jordan, what could you do to prevent yourself from coming back to the hospital again?
• What are something’s you could remember when things get difficult for you?
• What do you feel your hardest challenge to be?
• How confident do you feel about following the plan of action?
• What help will you need to persist with the plan?