Chapter 16 Summary: Integrating Gains

Chapter 16 Summary: Integrating Gains

Social worker—client relationships will come to an end. Social work literature refers to this as termination. However, this can also been seen as a new beginning. Clients move on without the help of the professional person and are empowered to incorporate what they have learned into how they continue to cope. This process is called “integrating gains” and is the last step in empowering social work ventures that are crucial for the success of the process as a whole. Thus, clients are “integrating” what they have “gained” in their work with the social worker.

Many issues are considered by the social worker when planning effective closure processes:

The degree of success that the clients has achieved thus far
The possible advantages of continuing the work
The time and intensity of the client system/worker relationship
The available resources to extend the work in this particular setting
The client’s reason for being there—whether it is voluntary or mandated
The plans of the client
The social worker’s role to be played in the client’s life after the closure

Social Work Endings

There are three types of closure for client systems and each involves a unique wrap-up process:

Completing Contracts—Clients have made significant progress or achieved success and no longer need social work services. Social workers prepare the clients for resolution, discuss readiness, review progress made thus far, share feelings and generalize outcomes.
Closing with Referral—Clients require continued services beyond the contracted work with the social worker. These clients need a more specialized provider or agency programming. Social workers acknowledge limited resources, smooth the transition, and track clients’ progress.
Responding to Client Withdrawal—Clients, on their own initiative, end the helping relationship. Social workers prepare for early withdrawal, recognize exit cues, and pursue mutual resolution.

Completing Contracts

Resolving a social work relationship by successfully completing the contract is the culmination of a collaborative effort. Both social workers and clients deserve credit. Social workers and clients examine where they are, review where they have been, and predict where they are going after they work together ends.

There are steps to endings in social work:

Clarify the time-limited nature of the relationship from the first meeting.
Remind clients of closure throughout the process and increase these reminders near the end.
Determine a specific ending point at which time the client is no longer a client.
Review the work done that was done collaboratively throughout the process by the social workers and clients.
Discuss the client’s future plans, new goals, potential challenges that could arise, follow-up contacts, and process for reconnecting with the social worker if necessary.

Preparing for Resolution

Social workers anticipate an end of the professional relationship from the beginning of the work and maintain a purposeful and professional relationship throughout the intervention process. Social workers continually remind their clients that there will be an ending to the professional relationship. As the ending time draws nearer, they remind them more frequently so that the discussion of the ending becomes central in conversations between clients and workers. An example of an ending reminder might be: You always come up with such sound ideas on your own. It gives me confidence that you’ll be able to handle things after we’re done.

Stopping Short of Goals

Clients may have reached a plateau where continued joint efforts are producing no appreciable benefit—or goals were overly ambitious—or the immediate crisis has passed, leaving clients comfortable with where they are now. In any case, social workers may suggest renegotiating the original goals and ask “is this good enough?” Then social workers proceed with closure activities that celebrate what clients have already achieved.

Discussing Readiness

Social workers must be aware of when their time with a client has come to an end. They can do this by either taking clues from their client, or by recognizing when their client might be prolonging the client-worker relationship as a crutch. When the worker recognizes that the client has reached established goals, or is progressing independently towards the established goals, the conversations should be geared toward preparing the client for continuing on independently. The worker should share their observations with the client and get feedback about how the client feels about their progress. Comments to the client such as, “You are handling things much better.” Or affirming the client when they make such comments is empowering to them.

Evaluating, Reviewing Progress, and Sharing Feelings

After these conversations, it might be a good idea to begin evaluating. Workers can do this by simple conversation or written evaluations. Some questions to ask would be: What did you like most about our work together, and then What did you like least. These will give you valuable feedback that will be useful in other relationships that the worker will engage in. It might be also helpful to find out from the client what they feel they will miss from your work with them. By knowing what the client’s thoughts are will also allow the worker to evaluate where the client is. What they feel about their accomplishments and this is a strength that the worker can capitalize on. When a client is grateful for the help the worker provided, she/he should be accepting of this graciously and recognize their contribution to the progress the client has made, but also highlight the accomplishments of the client. Keep the focus on them! The worker should also be prepared for criticisms and should respond to those in a nondefensive manner.

Evaluation and review reinforces the client’s sense of achievement and the worker can feel comfortable at this point in reminiscing about the changes that they have seen beginning with the time the client first presented to the present. The worker can feel comfortable about sharing their feelings about the working relationship with the client as well.

Workers should keep in mind that endings should not be viewed as a grim process. When the client is allowed to move on in life with newfound knowledge about the situation that brought them to the worker and also new findings about themselves, this arms the client for future crises. This should be instead viewed as a victorious time for the client and the worker.

Outcomes Regarding Closure

It is important for worker to teach their clients the process of change. They need to work with their clients on defining problems, assessing the situation, create action plans, and implement change. This is important so clients are equipped when an issue arises in the future.
Worker can need to build clients up by focusing on their strengths and their ability to conquer future issues.
It is important for the worker to give an honest view of the client and his or her strengths and as to how this will help them solve future issues.
The more cohesive the worker and client are the more anxiety the client will feel at the closure of the relationship
Clients that maintain support from outside sources are more likely to function more effectively after the relationship with the worker has ended.

Celebratory Endings

Rituals can help clients have a structured environment to deal with emotions, communicate, and celebrate accomplishments.
This can resemble a graduation.
This is a good time for the worker to help the client look in the future. It is important for workers to focus on client strengths and yet prepare them for what may lay a head in their future.

Following Up

Workers need to clarify where their relationship is and will be.
Will there by a follow up meeting, what can clients do if they feel they need to see you again, is it okay for clients to get back in touch, what happens when they see each other in public. These are some things a worker can discuss with a client in the closing stage.
A “contract for closure” can occur at this stage.

Closing With Referral

Acknowledging Limited Resources

Practitioners contract with clients for social work services, and the workers must agree to keep their end of the bargain. The clients’ needs must fit with what the agency provides.

Workers monitor three systems in accordance with their agreements:

The agency
The client
The worker

If there is a change in any of these systems a gap could be created between what the client seeks and what the agency or worker can provide.

When Client Needs Exceed Worker Limits

Workers need to recognize that sometimes their abilities or setting can offer nothing further to the client. The ethical worker will recognize this and accept their limits and refer the client to an agency or provider that can provide to their needs.

Service Restrictions

There are times when organizational constraints prescribe endings rather than leaving the actual choice to social workers or clients. These may be due to:

Time limits based on guidelines from fund sources or policies about the distribution of services.

Agency policies that target a specific population: Age, sex, feature-time limited interventions, crisis resolution versus long-term work

Other organizational stipulations affect the nature and duration of services as well: Hospitals, schools, private institutions

Internal changes in an agency’s structure or mission may shift a worker’s responsibilities and create other personnel and programmatic changes which affect the continuity of services.

Fiscal constraints can determine parameters for services.

When agency practices, guidelines or changes force clients out before they are ready, ethical social workers build bridges to other assistance to sustain client motivation, safety and progress.

Implementing Legal Mandates

All social workers are mandated to report situations that threaten client safety or the safety of others. These include:

Child-abuse
Domestic abuse
Threat to self
Threat to others

This may require the Social worker to report concerns to state protective services, local police, potential victims, etc. It is the social worker’s ethical responsibility to report concerns to the proper authorities, but to also not abandon the client who is in need.

A worker’s goal at this time is similar to other situations in which the client transfers to a new provider or withdraws prematurely from service.

Recognizing interim success

Resolving a professional relationship by referring clients elsewhere is not a defeat, but a step on the way to success. By identifying a more appropriate service clearly moves the client toward the solutions that they seek. When making the transition to a new service, workers reflect this perspective by reviewing the client’s successes so far in a positive way:

Guide clients to discuss their readiness to discontinue
Highlight achievements
Encourage the exchange of feelings
Anticipate future development

Making Referrals

When workers reach the limit of what they can offer, they have an obligation to discuss this with clients openly and offer clients other resource possibilities. Failure to offer honest information about the worker or agency limitations may leave clients with feelings that they are being dumped.

Smoothing the Transition

The worker must recognize the potential hazards that could occur in closing a case by referral. The practitioner needs to work carefully on transitions that keep the client system moving forward, not backward.

Facilitating Client Control

By recognizing that clients don’t want to start over, the provider can help the client to accept referrals to subsequent services in the following ways:

Refer the client to another human being with a name, description and set of qualifications rather than an agency, program or department.
Find out who the new worker will be and inform the client.
Give the client alternatives from which to choose
Let the client decide if they want you to call to facilitate their entry or whether they should make the first contact and mention your name,
Learn the agency’s entry procedures so you can prepare clients to expedite those sometimes confusing and uncomfortable beginning processes.
Remember that the client has already entered the social service network. They are on the inside and you should not throw them back out to leave them to enter all over again.
Collaborate with the client on how to transfer information
Find out what the client wants said and what not to share.
Consider a collective meeting between self, the client and the new worker and the client system.

Tracking Progress

Follow up on referrals to ensure that the client has made the new connections and to receive feedback on whether clients felt prepared for the changes.
Do not intrude on the new relationship of the client and worker.
With client permission practitioner may be able to contact the new worker, acting to cement the referral link between the programs

Responding to Clients’ Discontinuation of Services

Preparing for Early Withdrawal--Practitioners work actively to resolve relationships successfully even with clients who drop out of services:

Workers structure each meeting with clients so that if they do not return, they may still feel like they have gained something from the first meeting.
Workers are aware of signs indicating that clients may be drifting away and then proceed to encourage them to discuss the direction of the work to keep them interested.
Workers follow up with clients who drop out to find out why they did so and let them know they can return any time they desire.

Preparing for the inevitable ending of the working relationship, workers “integrate gains” throughout the entire intervention process.

Workers are always guiding their clients in the direction of their strengths, their goals, and their power. Therefore, if they exit early, they may leave with more confidence in themselves.

This is a marvelous quote to remember: “Every session is the first and every session is the last”. If workers end each session with a summary of progress made and plan the next step to take, clients can experience a sense of accomplishment and some sort of direction to take if they do not come back for a next session.

Recognizing Exit Clues

Clients begin to show up late for meetings.
Clients cancel sessions frequently.
Clients miss sessions entirely.
They do not carry out agreed-upon planned activities from the prior session.
Clients are inattentive during sessions.
Clients stop bringing up important details.

When workers begin to notice such “withdrawing” behaviors, they should convey acceptance and acknowledge that the client has the right to exit early. If the client’s intent was to depart from the relationship, then the worker can wrap up the work more productively. If the client’s intent was not to depart, then the worker’s comments may refocus the client to the tasks at hand or open communication for feedback from him regarding his satisfaction with the worker. This reminds the client that he has the privilege to take charge of the direction the relationship goes next.

The Meaning of Service Discontinuation—can mean good news, not failure

Early exits by clients can mean that they feel their stories have not been heard, expectations were not met, or processes used were worker-focused rather than client-focused. Their dropping out sends messages of hopelessness or rejection. However, sometimes, after a single session, clients were “able to determine and meet their own needs”. In this case the discontinuation of services ends on an optimistic note.

Pursuing Mutual Resolutions

Workers should follow up with clients who leave prematurely. There are several reasons for doing so:

Understanding a client’s reasons for withdrawing
Validating a client’s right to withdraw
Inviting the client back for future work if desired
Reinforcing any client progress thus far
Evaluating and improving the worker’s own skills in “reading” client messages, and resolving relationships effectively
Clarifying the “open” or “closed” status of clients for agency accountability purposes

It is important that workers accept and support a client’s decision to withdraw prematurely for the purpose that the work done thus far remain empowering beyond the resolution of the relationship.