Comprehensive Social Work Framework and Planning Paper
By
Helen Daly
For
Richard Ramsay
SOWK 379
Faculty of Social Work, University of Calgary
April 4, 2003
Note: The hardcopy of this paper scanned and digitalized. Hopefully, all related errors have been corrected. Minor editing was carried out.
“And now here is my secret, a very simple
secret. It is only with the heart
that one can see rightly; what is
essential is invisible to the eye.”
Antoine De Saint-Exupery
OBJECTIVE:
My objective in this paper is to take a case study of one refugee
woman, who is a client at the Calgary Immigrant Women’s Association (C1WA), and
prepare a comprehensive framework (4-component) social work assessment. To
carry out a comprehensive person-in-environment (PIE) assessment and develop a
suitable plan of action, I will utilize the following:
a) Ramsay’s (2001) comprehensive (4-component) framework;
b) assessment guidelines from Miley, O’Melia, and DuBois’ (2001a) textbook Generalist Social Work Practice: An Empowering Approach1;
c) Person-In-Environment (PIE) classification system, and
d) CIWA’s intake form.
I will address the advantages and limitations of the assessment system used in this case study from a PIE perspective. I will include further information in the Appendices to enhance the reader’s knowledge of Ramsay’s (2001) comprehensive framework (including Ramsay’s (2003) 5-chair practice model); key terms; CIWA’s Intake Form, and other documents mentioned in this paper.
INTRODUCTION:
The Calgary Immigrant Women’s Association (CIWA) was established in
1982. CIWA is a non-profit, charitable organization whose mission is to promote
and support the integration of immigrant women into the community and larger
Canadian society (Annual Report, 2002, p. 1). CIWA receives funding from
various sources including: government grants; the corporate sector; private
donors, foundations and grants. A total of 62 staff (speaking 44 different
languages) are employed by CIWA. In 2002, CIWA staff served a total of 3,912
clients from various countries and 275 volunteers provided 19,011 hours of
support to CIWA and its programs and services. At present, C1WA operates 13
programs offering clients a range of diverse services (Annual Report, 2002).
As a third year practicum student working at CIWA I am involved in the
Intake, Settlement and Referral Services (ISR) Program and The New Friends and
Neighborhood Groups Program (NFNG). The objective of the TSR program is to
“Ensure that immigrant women will become more independent by better
understanding their rights and responsibilities and being aware of the
services/resources available to them in the community.” The objective of the
NFNG Program is to “Empower isolated immigrant women to become confident,
develop a social support system and make informed decisions that will enable
them to integrate more fully into Canadian society” (Annual Report, 2002, p. 16-17).
Terms such as 4-DC framework and comprehensive framework will be used
interchangeably throughout this paper. These terms refer to Ramsay’s (2001)
comprehensive framework.
KEY TERMS: Empowering
Assessment; Indirect Work; Direct Work; Natural Systems Approach, and
Transactional View/Dimension. (Please refer to Appendix 1 for definitions of
these terms as they relate to this paper).
DEFINITION OF ASSESSMENT:
Assessment is: “A skill, a product and a phase of the interventive
process which involves the systematic collection of relevant data by ethical
means from representative sources through an appropriate data collection
methodology, and the analysis of that data by the application of selected
concepts, constructs, and theories into an organized set of perceptions about a
client’s problem-situation which can serve as a rational basis for interventive
planning” (McIntyre, 2000). Meyer (1993) noted that one of the cornerstones of
professional social work practice is to be able to understand cases through the
assessment process (p. 6). According to Meyer (1993), social workers need to
know what issues in the case are important to include, what factors belong
together, what factors have prominence over others, and what factors are
irrelevant (p. 22).
COMPREHENSIVE FRAMEWORK:
Miley, O’Melia, and DuBois (2001a) stated that “Proficiency in social
work practice requires a coherent practice framework, resourceful ways to look
at human and social system functioning, and dynamic processes for change” (p. 21).
While academics such as Pincus and Minahan (1973) and Germain and Gittermain
(1980) developed frameworks for the profession those frameworks had
shortcomings in terms of organizing frameworks for the social work profession
(Ramsay, 1985, p. 3). Karls and Wandrei (1994) reported that “the profession of
social work has suffered from the lack of a unifying framework that might bring
together the diverse areas of expertise within our profession” (p. x). Based on
the work of R. Buckminster Fuller (1981, 1982), Ramsay (2001) developed a
holistic four-dimensional tetrahedral conceptual (4-DC) framework for social
work practitioners using a natural systems approach.
Holism is derived from the Greek word “holos”
(whole) meaning everything. Whole systems represent systems with all parts
interconnected. A minimum whole system consists of four components
interconnected by six relationships. The minimum holistic system pattern is
called a tetrahedron (Ramsay and Loosmore, 1999). Ramsay (2001) noted that:
“Although the 4 components are interconnected with each other, each component
would be unique by itself, but together they would include the whole of social
work, all its specializations and the relevant bodies of knowledge from the
humanities and sciences that are needed to inform social work practice” (p. 5).
Ramsay (2001) incorporated four concepts universal to the social work
profession in his 4-DC framework. These components are: Domain of Practice;
Paradigm of the Profession; Domain of Social Work Practitioner, and Methods of
Practice. Each component can be unfolded or multiplied into its own minimum
system (or more) complexity and reconfigured to show the progressive complexity
between the components (p. 5-6). Ramsay’s (2001) comprehensive framework
appears to be one of the most inclusive, coherent, and flexible frameworks that
have been developed for social work practitioners. It is my view that Ramsay’s
(2001) 4-DC framework is an example of the unifying framework that Karls and
Wandrei (1994) referred to because it brings together the diverse areas of
expertise within the social work profession. (Please refer to Appendix II for
further information on how Ramsay’s comprehensive framework (including a
tetrahedron) can be depicted).
APPLICATION OF RAMSAY’S
(2001) COMPREHENSIVE FRAMEWORK & APPROPRIATE TEXT ASSESSMENT GUIDELINES TO
A SPECIFIC CASE STUDY:
DOMAIN OF PRACTICE (DOP)
Domain of Practice refers to social work’s central area of concern.
It is “the identifiable domain that describes the area in which social workers
do their work” (Ramsay, 2001, p. 6). Karls and Wandrei (1994) noted that the
social work profession has struggled to establish its identity and to assert
its uniqueness among human service professions (p. 4). Traditionally, social
work had a dual purpose - personal (client/micro) change, or social (environment/macro)
change (Ramsay, 2003).
The first person to clearly articulate social work’s domain of practice
as the “Person, Interaction, Environment” (PIE) system was Harriet Bartlett
(1970). She believed that interaction was a crucial dynamic in all social
systems and identified it as the central focus of all social work regardless of
specialty boundaries. This interaction focus is a distinguishing feature of
social work when compared with other human service professions that generally
identify client/patient-centered approaches as central to their respective disciplines
(Ramsay, 2001, p. 6).
In his comprehensive framework, Ramsay (2001) identified four
interrelated components of the PIE domain. These are person; personal
otherness; validator otherness and resource otherness. The person (P) element
includes the developmental, demographic and social functioning status of
individuals in families, groups, communities, or organizations (Ramsay, 2001,
p. 6). The P element can be unfolded into increasing levels of complexity. The
next level of complexity can include the social, physical, mental, and
spiritual factors of a person’s life. Environmental components include personal
otherness (P0) (personal social support systems— intimately close or
significant other to an individual or family; friends; groups; community or even
a nation); validator otherness (VO) (values, beliefs; customs, laws; policies -
culture); and resource otherness (RO) (opportunities; resources; goods and
services). (Please refer to Appendix III).
CASE STUDY: AISHA
|
I was assigned to carry out an intake assessment for a drop-in client (Aisha) at CIWA in February 2003. I had no information regarding Aisha prior to our meeting as this was her first visit to CIWA. |
My meeting with Aisha provided me with an
opportunity to put into practice Ramsay’s comprehensive framework. Having
identified PIE as the DOP, in this instance, the Person (P)/client was Aisha.
To facilitate a trusting, respectful, and collaborative relationship with Aisha
I explained to her that I was a student at C1WA. I asked for her permission to
work with her to find out what assistance CIWA could offer her (Dialogue Phase
- collaborative relationship - Miley, O’Melia, and DuBois, 2001a).
It is CIWA’s policy that a CIWA intake form be completed with each new
client. This form can be used as a means for assessing clients in relation to
their environment (PIE system). (Please refer to Appendix IV). Prior to
completing this form with Aisha I discussed the issue of confidentiality with
her. I explained to her that as a student I would need to share relevant
information with my supervisor and other work colleagues who may at some stage
be involved in her case. I obtained Aisha’s permission to discuss relevant
issues with appropriate staff members. I also explained to Aisha why we needed
the information contained in the CIWA intake form. Completing this form with
Aisha helped me to begin to get an insight into the complexities of Aisha’s
situation.
AISHA’S CASE CONTINUED
|
By gathering the data on the intake form with Aisha I learned that she was a 30 year single mother who was born in Iraq, and is of Kurdish descent. She came to Canada (Calgary) as a government sponsored refugee in December 2001 with her two sons - Abrahim -7 years old, and Moussa - 5 years old. She and her children are now classified as “landed immigrants” (because they already received their landed immigrant documents). Aisha speaks and writes three languages - Kurdish, Arabic and English. She has a college certificate in health administration from Iraq. At present she is a stay-at-home mother. She receives social assistance (Support For Independence - SFI). She has no family or relatives in Calgary. She has acquaintances - neighbors and students in her English class - but no close friends in Calgary. Her English instructor referred Aisha to CIWA. She came to seek support and information. |
As I filled-in the data on the CIWA intake form
I realized that the layout of the form influenced my approach to the assessment
process. In using the form I had become too mechanical. On the one hand, the
intake form had helped me to gather information regarding Aisha’s situation. On
the other hand, the manner in which I completed the form created a barrier
between Aisha and myself because I failed to see Aisha as a unique individual.
Yet, assessment is about individuation - acknowledging that each person’s
situation is unique. I also failed to address the interconnectedness between
Aisha (P) and her environment (PIE). I knew I could not retrace my steps and
start the intake process from scratch. I realized that if I was going to
re-establish a collaborative, trusting and positive relationship with Aisha I
had to change my approach to the assessment process. To do this I decided to
incorporate Ramsay’s (2003) 5-chair model of practice (Please refer to Appendix
V) and an empowering (strengths) approach to the assessment process. I set
aside the intake form and re-focused my attention on Aisha as a unique
individual.
AISHA’S CASE CONTINUED
|
In keeping with Ramsay’s 5-chair model of practice, I asked Aisha if she could tell me four factors that were important to her (A minimum whole system consists of 4 components interconnected by six relationships). These were: employment; her children; housing and social isolation. As Aisha talked about these issues (and before I had an opportunity to discuss the transactional dimensions of her situation), Aisha was able to explain to me how the interrelationships between herself (P) and her environment (personal otherness, resource otherness and validator otherness) inhibited her social wellbeing and the wellbeing of her children. She explained to me that as a refugee in Calgary she experienced discrimination in the workforce and was unable to find work (VO and RO issues). Therefore, she was unable to meet her children’s/her own basic needs (RO issue). As a refugee, Aisha received financial support from the Canadian government for her first year in Canada (RO). This support was discontinued in December 2002 (VO - belief that refugees are self-sufficient after 12 months in Canada/RO issue - financial support discontinued). Since then Aisha has received $828 per month from SF1, and $380 in Child Tax Benefits (RO). However, rent, utilities and her transportation loan ($1 00/month to the Canadian government for her airfare to Canada) amounted to $900 each month (RO issue). As a result, Aisha has been unable to make ends meet (RO issue). Aisha first applied for subsidized housing (Calgary Housing) in May 2002 (RO issue + strength). Her application to date has been unsuccessful (RO issue). She wondered if this might be because she was a single mother and a refugee (VO + RO issues). She visited the Calgary Housing office each week to check on her status (strength). In order to earn some extra money she was clearing snow from her neighbor’s path for a minimum fee (strength). She also told me that in her first year in Canada she studied English so that she could find a good job to support herself and children (VO, RO, + strength). Aisha then explained to me that in Kurdistan she had a strong support network and that people “cared about” each other (VO + P0 issues). Here, she finds that people don’t care about other people in the same manner (VO + RO issues). |
As I listened to Aisha describe her situation I
realized that she had taught me the significance of the PIE system (DOP) in
social work practice and how this system operates in reality.
PARADIGM OF THE PROFESSION (POP):
According to Ramsay (2001) the POP component incorporates the broad
orientation nature of practice and consists of generalist and specialist
prepared practitioners who are committed to a common PIE domain. The POP also
incorporates “Knowledge” in social work practice. Ramsay (2001) noted that
social workers need to understand the reality-defined base of knowledge they
are using. He asked social workers to think about whether their knowledge comes
from a mechanistic worldview that treats all things as independent entities
separate in space or time (modernism), or whether their knowledge comes from an
ecological and organic worldview that treats all things as deeply
interconnected in space and time (postmodernism) (p. 7). The mechanistic
worldview (modernism) fails to acknowledge the interrelationship between a
person and their environment and is therefore incongruent with postmodern
social work philosophy and the PIE domain.
“Knowledge” includes indigenous knowledge; theoretical perspectives from
different disciplines; values; ethics; practice methods and practice options
(Ramsay, 2001, p. 7). It is my belief that an appreciation of, and respect for
indigenous knowledge is critical to social work practice if social work
practitioners are to understand clients from diverse cultural backgrounds. As
social worker practitioners working in a multicultural society we have an obligation
to be culturally competent, sensitive, and responsive. Ramsay (2001) summarized
The Canadian Association of Social Workers (CASW) Code of Ethics (1983)
position on cultural competence “… social workers are expected to respect the
value of cultural and ethnic diversity and strive to alleviate discrimination,
oppression, poverty and other forms of social injustice...” (p. 7).
At the agency-level, cultural competence means choosing theories that
place clients in cultural and social contexts (Miley, O’Melia, and DuBois,
2001a, p. 72). When working with clients, CIWA staff incorporate diverse
alternative postmodern theoretical approaches such as the ecosystems
perspective; feminist perspective, and social constructionism. These
perspectives are congruent with a culturally sensitive and empowering approach
to social work practice. They reflect diversity and also recognize the
relationships between a person and their environment (PIE domain).
Gutierrez (1992 - cited by Miley, O’Melia, and DuBois, 2001a) recommended
that organizations adopt an ethno-conscious approach to enhance their level of
cultural competence. At the center of this approach is a concern with power and
confronting social inequality through work with organizations and communities
(p. 72). At the macro level, CIWA works with various immigrant agencies,
governmental, and non-governmental organizations to try to alleviate
discrimination2, oppression, and other forms of social injustice.
For example, CIWA staff work with corporations in Calgary to influence equity
policies within corporations and improve access to employment for
refugee/immigrant women.
CIWA’s core values are similar to the social work values described in
the CASW Code of Ethics (1983). These include but are not limited to: acceptance;
compassion; empathy; equality and fairness; integrity; respect and
accountability (Annual Report, 2002, p. 1). These values are congruent with an
empowering approach to social work practice with clients.
The four practice options in Ramsay’s (2001) POP component are: client
system (person who seeks services of an agency and engages the services of a
social worker as a change agent); change agent system (a person [social worker]
specifically employed for the purpose of creating a planned change); target
system (people the change agent needs to influence or change in order to
accomplish desired goals); and action system (those with whom the social worker
deals in his or her efforts to accomplish the tasks and achieve the goals of
the change effort).3 The social worker is also part of the action
system. These systems were adopted from the work of Pincus and Minahan (1973).
Practice options allow social workers to work directly with client groups,
indirectly with client groups, or both (Ramsay, 2001, p. 7).
AISHA’S CASE CONTINUED
|
At this stage in the assessment process Aisha
and I needed to move to the Discovery Phase (Miley, O’Melia, and DuBois,
2001a) in order to assess her situation and systematically explore viable
resources in her environment which she could draw upon to meet her goals and
objectives (strengths/empowering approach). It was also important that we
construct an achievable plan of action that would assist us in achieving
Aisha’s objectives. |
DOMAIN
OF PRACTITIONER (DOPr.):
Social workers, like the people they work with, function in their
own person-in- environment systems (Ramsay - cited by Karls and Wandrei, 1994,
p. 185). Authors such as Ramsay
(2001) state “. . .the disciplined use of self in relationship with others is
seen as an important conceptual component in its own right and. . . .requires
the social worker to have a comprehensive understanding of the relationships in
his/her person-in- environment network that are conceptually the same as those
that they are expected to understand and assess in their professional practice
work” (p. 8). Other authors such as Miley, O’Melia and DuBois (2001b) note that
“Workers themselves bear primary responsibility for developing competence in
multicultural social work” (p. 32). One of the key elements in developing a
personal level of competence in multicultural social work is “self-awareness”
(p. 66). Pincus and Minahan (1973) state that “A social worker brings to
his/[her] practice his/[her] own personality, values, lifestyle, and feelings
about other people along with his/[her] knowledge and skills. If he/[she]
denies his/[her] own feelings he/[she] may be perceived as a mechanistic
technician and will have difficulty in engaging other people in problem-solving
efforts” (p. 35).
My “personal” worldview is grounded in postmodernism and has been
influenced by the spiritual aspect of the “person” element and validator
otherness in the “environment” element of my personal PIE domain. However,
prior to my social work studies, I was trained as a nurse and my “professional”
worldview was grounded in the traditional mechanistic/scientific/objective
worldview (foundations of the medical model of practice). At present, one of
the greatest personal and professional challenges/inner conflicts I face as a
social work student is to make a conscious shift from the traditional
mechanistic worldview which Ramsay (2001) noted “treats all things as
independent entities in space and time” (p. 7), to an alternative postmodern
worldview which “recognizes that all things are interconnected in space and
time” (Ramsay, 2001, p. 7). Instinctively, I know that there is more congruence
in my life when I adapt a postmodern worldview in my personal and professional
life.
According to Ramsay (2001) some professions [such as nursing] “might
expect greater detached objectivity from their practitioners that in effect
requires them to leave their personal domains in the parking-lot,” whereas
“social work understands the coexistence of the personal and professional…“(p. 9).
As a practicing nurse, I did not have a framework that included the PIE domain
of the practitioner or “self-awareness.” As a social work student I have come
to understand the significant role that my PIE domain plays in my professional
(and personal) life.
AISHA’S CASE CONTINUED....
|
In Aisha’s case I had reverted to a mechanistic approach to the assessment process. On reflection, I realized that I blocked-out my feelings and ignored the interconnectedness between my personal and professional PIE systems. I blocked-out my feelings because I did not want to deal with the fact that: i) I (“P” element) felt guilty/privileged that as a Caucasian immigrant woman I did not experience the same level of discrimination as Aisha experienced/and continues to experience4 (environment - validator otherness and resource otherness issues); ii) I felt inadequate in terms of the support services (resource otherness - professional level) I was able to offer Aisha. While I advocated on her behalf, in my view this was not enough (validator otherness). I was frustrated. What has happened to Aisha has happened to/continues to happen to so many immigrant women. I knew that change needed to occur within/between the different levels of the PIE domain, especially within/between the validator otherness (policies and norms—power and privilege differentials) and resource otherness elements (job opportunities) (cause advocacy issue which CIWA is pursuing); iii) I understood from my own experience the humiliation and loss of dignity that occurs when a person is unemployed - I did not want to be reminded of these feelings (validator otherness); and iv) I was preoccupied with the fact that my father was in hospital (personal otherness issue). I had not taken time to assess how his situation was affecting my relationships with other people in my environment. On reflection, I realized that my relationship with Aisha would have been enhanced if I had taken the time (as Ramsay stated) “to be aware of and take responsibility for [my] own emotions and attitudes as they affect[ed] [my] professional functions” (2001, p. 9). |
Miley, O’Melia, and DuBois (2001a) noted that a
second key element in developing a personal level of competence in
multicultural work is knowledge of other cultures (p. 66). In order to develop
my personal level of competence and enhance my “Knowledge” base and
understanding of Aisha’s culture I researched information regarding Iraq and
Kurdistan (Please refer to Appendix VII for maps only). The information on Iraq
and the Kurdish people helped me to understand some of Aisha’s experiences
under Saddam Hussein’s regime.
It is my view that the “Domain of Practitioner” component of Ramsay’s
(2001) comprehensive framework needs to be given a greater priority in the
social work curriculum and the CASW Code of Ethics. Abramson (1996) noted that
little attention has been paid to the development of self-knowledge in the
profession (p. 195). According to Ramsay and Loosmore (1999) “Employers [and
supervisors] of social workers’ also need to include this component as part of
their holistic understanding of social work in order to recognize and maintain
practice standards at an acceptable level” (p. 4). By failing to acknowledge
the critical role that this component plays in their professional lives, social
work practitioners may cause some damage to their clients by: i) projecting
their worldviews and values onto their clients, and ii) ignoring the impact
their “personal” issues can have on their professional practice. (Please refer
to Appendix VIII).
METHODS
OF PRACTICE (MOP):
The MOP is the fourth component of Ramsay’s (2001) comprehensive
framework for social work practitioners. This component consists of the
systematic methods of problem solving and specific intervention procedures that
social workers use to contribute to the change process (Ramsay, 2001, p. 9).
One such method is the person-in-environment classification system (PIE) that
is a method for describing, classifying, and coding the common problems of
adult clients and patients served by social workers. Because of its systems
approach PIE also allows the social work practitioner and client to plan
for/evaluate interventions (Karls, 2002, p. 195). (Please refer to Appendix
IX).
The PIE classification system is a holistic system organized around the
concept of person-in-environment and consists of four factors. Factor I
describes the client’s problems in social functioning, their severity and
duration, and the client’s ability to cope with them (Karls, and Wandrei, 1994,
p. 13). Factor II describes environmental problems concerning social systems
that affect the client’s social functioning. Factor III describes the client’s
mental health problems using the Diagnostic
and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV): Axes I
and II. Factor IV describes the client’s physical health problems (based on the
International Classification of Diseases
- lCD) and is equivalent to Axis III on the DSM-IV. While Factors I and II
in the PIE Classification System are unique to social work practice and
constitute social work’s primary focus, all four factors are necessary to
provide an adequate picture of the client’s problems (Karls, and Wandrei, 1994,
p. 13-35). It is important to note that in using Factors I and II, “The
statement of a problem should be in terms of the social worker’s assessment,
not the client’s… even if the client would not necessarily agree with the
assessment” (Karls and Wandrei, 1994, p. 33).
AISHA’S CASE CONTINUED…
|
PIE ASSESSMENT FACTOR I: Social Functioning (iv) Other Interpersonal Roles: |
FACTOR I: Social Functioning:
|
The primary problem in Aisha’s social functioning is unemployment due to the lack of employment opportunities and possible discrimination. Her special life situation role as a refugee forced her to leave her immediate and extended family; her friends, neighbors, culture, and country of birth. As a result Aisha has suffered substantial losses in terms of her personal relationships and intimate friendships (personal otherness). A secondary problem for Aisha is the level of responsibility she bears as a single mother (and refugee) in terms of meeting her children’s needs. |
FACTOR II: Environmental
Problems:
|
Economic/Basic Needs
System: Lack of employment
opportunities/possible |
AISHA’S CASE/FACTOR II: Environmental Problems continued....
|
The PIE classification system was very effective in identifying, prioritizing, and describing the severity and possible duration of key problems in Aisha’s environment including the lack of: i) employment opportunities and possible discrimination; ii) access to subsidized housing and possible discrimination; iii) a social support network, and iv) an affectional support system. The PIE system also described Aisha’s coping skills that appeared to be consistently above average. |
|
FACTOR
III: Mental Health Problems: |
|
FACTOR
IV: Physical Health Problems: |
Having identified Aisha’s primary problem in
social functioning as unemployment due to the lack of job opportunities and
possible discrimination, we agreed that we would each follow-up on accessing
the necessary resources (outlined previously under Paradigm of Profession) so
that Aisha could achieve her goal and objectives (Development Phase - Miley
,O’Melia, and DuBois (2001a).
One of my tasks was to speak with the employment counselor at CIWA prior
to Aisha’s meeting with the counselor. Aisha’s task was to contact the
counselor to arrange an appointment. When Aisha and I met again at the beginning
of March, Aisha told me that she had met with the counselor and had discussed
job prospects; resume writing and interview techniques.
In terms of subsidized housing, I wrote a letter to Calgary Housing
requesting that Aisha’s case be given priority. Aisha’s task was to continue
visiting the Housing office in person. When we met in March, she informed me
that her case had been given priority.
With regard to the NFNG meetings - I contacted
the facilitators to inform them that Aisha would attend the NFNG meeting near
her home. Aisha’s task was to attend one of these meetings. It was too soon (in
March) to assess if/how effective these meetings were in terms of enabling
Aisha to build a social network. Therefore, we agreed to meet again at the
beginning of April to discuss this issue.
I contacted the family counselor at CIWA to let her know that Aisha
would be phoning her for an appointment. Aisha’s task was to arrange a meeting
with the counselor for the second week in March. Aisha and I have arranged to meet
next week to review her situation. This will probably be my second last meeting
with Aisha given the fact that my practicum at CIWA is scheduled to end on
April 17th. I plan to ask Aisha’s
permission to have my supervisor at CIWA attend our last meeting so that my supervisor
can follow-up on Aisha’s case when I leave CIWA.
ADVANTAGES AND LIMITATIONS OF MY SELECTED
ASSESSMENT SYSTEM FROM A PIE PERSPECTIVE:
My assessment system in this case study
included CIWA’s intake form; the PIE classification system and an empowering
(strengths) approach to the assessment process.
ADVANTAGES & LIMITATIONS OF
THE C1WA INTAKE FORM:
CI WA’s intake form provided me with a means of collecting relevant
information regarding Aisha in a short period of time. However, as I previously
stated, the manner in which I collected the information on this form inhibited
my relationship with Aisha. The layout of the form is linear
(scientific/mechanistic worldview) and did not provide Aisha and myself with a
transactional view of Aisha’s situation (everything interconnected in time and
space - postmodern worldview). The form also had shortcomings in terms of the
type of information I collected. For example, I did not gather information
regarding Aisha’s spiritual; mental and physical well-being (holistic
perspective). As a result, I failed to acknowledge the significance of these
areas in Aisha’s life in the dialogue phase. In fact, I failed to acknowledge
Aisha’s spiritual well-being altogether5.
The CIWA form focused on micro issues in Aisha’s environment. The form
did not assist Aisha and myself in identifying macro issues in Aisha’s
environment. For example, the information that I gathered using this form did
not assist Aisha and myself in exploring or acknowledging discriminatory or
oppressive policies in her environment that may have affected her ability to
obtain subsidized housing and employment. (The PIE system and Ramsay’s (2001)
comprehensive framework assisted us in making this connection). The information
I gathered also focused more on Aisha’s needs (focus on deficiency - modernistic
worldview) versus strengths and resources in her environment (resources - postmodern
worldview). Therefore, it is my belief that the utilization of CIWA’ s intake
form in the assessment process failed to address key issues in Aisha’ s
life/failed to provide a transactional view of Aisha’s situation.
ADVANTAGES OF THE PIE CLASSIFICATION SYSTEM:
The PIE system emphasizes “a person in an interactive context rather
than in a person-in-a-vacuum scenario” (Karls and Wandrei, 1994, p. x). PIE enables the
practitioner and client to assess the client’s situation from a transactional
viewpoint. PIE also assists the practitioner and client to identify micro
issues in the individual’s environment that need to be addressed.
Because of its systems approach, PIE also allows the social work
practitioner and client to plan for/evaluate interventions (Karls, 2002, p. 195)
and outcomes. By evaluating interventions, client’s success and achievements
are recognized/acknowledged and future actions are informed. Evaluating
outcomes ensures the social worker’s accountability to the client and helps
bring closure to professional relationships (Miley, O’Melia, and DuBois, 2001a,
p. 103). In Aisha’s case, I have not yet brought closure to our professional
relationship. Aisha understands that I am a student at C1WA and that our
relationship will end in mid-April, which is when my practicum is scheduled to
finish.
Karls and Wandrei (1994), and Karls and Lowery (1997) have identified
other general advantages (strengths) associated with the PIE classification
system. Advantages include: i) recognition of the diversity in the lives of
clients; ii) identification/descriptions of social functioning problems in
terms that most clients, other social work practitioners, and other human
services professionals can easily understand (Karls and Wandrel, 1994, p. 25,
and p. 70, and iii) identification of problems in the social environment;
mental health problems; and physical health problems, so that the practitioner
and the client develop a holistic and comprehensive picture of a client’s
situation (Karls, and Lowery, 1997, p. 50). The PIE system also “helps to
unravel the problem complex brought to the social worker and leads to better intervention
planning” (Karls, and Wandrei, 1994, p. 18). In Aisha’s case, the PIE
classification system helped us to identify mental health problems (stress) as
one of the factors that needed to be addressed if Aisha was to continue to cope
effectively with her situation. PIE also helped us to select appropriate
interventions so that Aisha could achieve her objectives.
LIMITATIONS OF THE PIE CLASSIFICATION SYSTEM:
It is interesting to note that the PIE system (which includes the
PIE classification system) has been developed by western academics (please
refer to Karls and Wandrei, 1994, p. xix). It is also worth noting that while
the PIE classification system has been tested in developed countries such as
Italy and the Netherlands; Australia; Japan and Canada, less developed war torn
countries such as Iraq; Iran; Cambodia; Rwanda; and the former Yugoslavia have
been excluded in the testing process. As a result, it is my view that because
“PIE classification system attempts to avoid defining social roles in a culture-specific
context” (Karls and Wandrei, 1994. p. 24) significant roles such as child
soldier/war victim (forced role as child prostitute to army staff) are not
given the priority/recognition they deserve in the PIE classification system.
Karls, and Wandrei (1994) stated that “As a developing system PIE will need
continued testing, and refinement” (p. 19). In my opinion, the testing process
needs to be expanded to include war torn countries, and other less developed
countries throughout the world so that social roles in culture-specific
contexts are given priority. If academics and indigenous peoples in these
countries are excluded in the testing process (of the PIE classification
system) then the system may be limited in terms of its “global” application.
Lowery and Mattaini (cited by Karls and Lowery, 1997) stated that
inter-rater reliability continues to be a problem in the PIE classification
system especially with regard to the type of social problem a person is
experiencing (i.e. power type/victimization type/ambiguity type etc.). They
noted that further testing of inter-rater reliability is needed, and that the
PIE system is not yet reliable and valid enough for clinicians to adopt (p. 50).
Although the PIE classification system describes the problems of adult
clients, Karls and Wandrei (1994) noted that this system “ ...can be used with
families and children by describing the individual adult’s problems in the case
situation” (p. 16). While this system may be used with families and children by
describing the individual adult’s problems in the case situation, it is my view
that this system may not be very effective when working with very young
orphaned street children (especially those who live in war torn countries) who
have no parents or “other” adult relationships. It is important to note that
authors such as Karls and Wandrei (1994), and Karls and Lowery (1997) stated
that the PIE classification system is for use with “adults only.”
The PIE classification system includes assessment of mental health and
physical health problems using the Diagnostic and Statistical Manual-I V-TR
(DSM) and the International Classification of Diseases (lCD) which are based on
the “disease model systems” [modern mechanistic worldview] (Karls, 2002, p. 194).
Advantages associated with the DSM are that: i)
it provides a common language and aids communication among mental health
workers; ii) its ability to categorize makes assessment more efficient; iii) it
summarizes the basic awareness of the characteristics of mental illness and
assists workers in screening clients (and other family members) for mental illness
(McQuaide, 1999, p. 413).
Limitations of the DSM are that it: i) fails to provide convincing
evidence for the reliability and validity of diagnostic criteria and standards
that other medical specialties require; ii) fails to provide sufficient and
hard-to-operationalize conceptualization of mental disorders; iii) has an
extensive white male bias and a history of developing diagnostic categories
that are inimical to some racial groups and to women; iv) objectifies
individuals with mental disorders through its numeric system of taxonomy; v)
ignores the assets; talents; capacities; knowledge; survival skills; personal
virtues; or environmental and cultural resources that might assist a person
recover, adapt to stressful situations, confront environmental challenges, and
improve the quality of life (Saleebey, 2001, p. 183-184). Both Saleebey (2001)
and McQuaide (1999) noted that the DSM labels/pathologizes clients’ behaviors
and does not seek to understand them in their social contexts. As stated
previously, the DSM is based on the “disease model” (modern mechanistic
worldview). As a result, the DSM fails to acknowledge the interrelationship
between a person and their environment and is therefore incongruent with postmodern
social work philosophy.
Karls and Wandrei (1992—cited by McQuaide, 1999) pointed out that the
“DSM stresses treatment of the disease first and the alleviation of the
client’s problems in living, the major focus of social work practice, second”
(p. 410)6. McQuaide (1999) stated that “The relationship between
social workers and the DSM has never been an easy one… because it seems
inimical to social work’s emphasis on strengths… and to the person-in-environment
perspective” (p. 1). However, McQuaide (1999) also noted that “Depending on how
the individual uses it, the DSM can be used to empower or disempower” (p .3).
What is important as a postmodern practitioner is to use tools such as the DSM
and lCD in an empowering manner versus a disempowering manner. It is this
author’s view that if social work practitioners are to implement the PiE
classification system in their practice they need to be aware of the tensions
and dilemmas they may encounter when using this classification system (DOP and
POP issues).
ADVANTAGES & LIMITATIONS OF
AN EMPOWERING (STRENGTHS) APPROACH TO ASSESSMENT FROM A PIE PERSPECTIVE:
An empowering approach to assessment involves looking for client and
environmental resources. (Miley, O’Melia and DuBois, 2001a, p. 231). Resources
include clients’ strengths. Karls and Wandrei (2001) stated that the PIE system
incorporates a clear recognition of clients’ strengths to cope with their
problems (Factor II of the PIE classification system). Coping ability is
generally interpreted as “the client’s use of knowledge, experience, and
psychological and physical strength to master stressful situations” (p. 14).
The advantages of an empowering (strengths based) approach to the
assessment process are that it enables social workers to: i) to build a
collaborative and respectful relationship with their client(s); ii) to define
their relationship with client(s) in an egalitarian way so that that
practitioners and clients can maximize their respective contributions; iii) to
actively listen to their client(s) and respond with warmth, genuineness, and in
a non-judgmental manner; iv) validate client(s) experiences and add
transactional dimensions; v) explore resources on which to build solutions; vi)
identifying client(s) strengths in general functioning (empowering clients),
and constructing an achievable plan of action using client(s) resources to
achieve goals (Miley, O’Melia, and DuBois, 2001a). An empowering approach to
the assessment process is an integral part of the PIE perspective.
I believed that one of the limitations of the strengths based
(empowering) approach to assessment was that it tended to downplay real
problems in people’s lives. However, after incorporating this approach with
Aisha I realized that my belief was invalid. Saleebey (1997) addressed the
issue that some people believe the strengths approach downplays peoples
problems. He stated that: “There is nothing… in the strengths approach that
mandates the discounting of the problems of life that people bring to us” (p. 238).
He also noted that “If practitioners using a strengths [approach] do disregard
the real problems that afflict their clients and those around them and, thus,
end up contributing to the damage done to people’s lives, that is capricious,
perhaps even reckless” (p. 238). According to Saleebey (1997), research
complied by Rapp (1997)7 implied that the strengths approach, when
evaluated on its own or compared to other approaches, is effective (p. 238).
CONCLUSION:
In this paper I have prepared a comprehensive framework
(4-component) social work assessment of an individual case study of one refugee
woman (Aisha) using Ramsay’ s (2001) comprehensive (4-component) framework;
appropriate assessment guidelines from Miley, O’Melia, and DuBois’ (2001a)
textbook; CIWA’s intake form, and the PIE classification system. I have also
discussed the advantages and limitations of the assessment system I used in
this case study from a PIE perspective.
As an assessment tool, the P1E classification system was effective in
identifying, prioritizing, and categorizing problems in the following areas of
Aisha’s life: i) social functioning; ii) environment; iii) mental health, and
iv) physical health. Problems identified were: i) access to employment; ii)
access to subsidized housing; iii) no social support network, and iv) stress.
The PIE classification system was also effective in identifying Aisha’s ability
to cope (strengths); the duration of her problems, and interventions required
so that she could achieve her primary goal and her objectives.
By utilizing an empowering approach to the assessment and planning
process, Aisha and I worked together in a collaborative manner to identify
resources that would assist Aisha in achieving her objectives. Resources
included Aisha’s above average coping skills; her resilience, and her capacity
to access resources in her environment.
As part of the action system (AS) CIWA’s employment counselor provided
information and support for Aisha with regard to employment opportunities;
resume writing, and interview techniques. As an organization, CIWA (AS) has
worked with, and continues to work with corporations (target system - TS) to
reduce the barriers to employment opportunities for refugee/immigrant women. As
a change agent system (CAS) and as part of the action system (AS) I contacted
Calgary Housing (TS) and advocated for subsidized housing on Aisha’s (client’s)
behalf Aisha’s support network was initiated through CIWA’ s NFNG facilitators
(AS). CIWA’s family counselor (AS) provided support for Aisha in dealing with
stress.
In preparing an assessment of Aisha’ s situation (PIE) and a plan of
action with Aisha I learned the following: i) CIWA’s intake form lacks relevant
questions and is not holistic in terms of assessing clients’ mental health
issues; physical health issues, and spiritual issues (PIE); ii) CIWA’s intake
form also fails to show how aspects of a client’s life are interrelated
(transactional view), and iii) tools such as the PIE classification system have
strengths and limitations. As a student using these (and other) tools I need to
be aware of these strengths and limitations so that I can use the tools in an
empowering versus a disempowering manner; iv) I need to remain vigilant to the
challenge I face in making a paradigm shift from the disease model of practice
(modernistic worldview) to a postmodern worldview (which includes a strengths
based approach to practice); v) ignoring my own PIE domain can have adverse
effects on my relationship with clients, and vi) what an empowering approach to
assessment involves and the significance of this approach in social work
practice.
The process of writing this paper and the practical application of
Ramsay’s (2001) comprehensive framework in my practicum has provided me with a
deep understanding of the significant role that this framework has played, and
will continue to play in my career as a social worker.
NOTES
1. Appropriate assessment guidelines include what Miley, O’Melia, and
DuBois (2001a) term: “Dialogue, Discovery, and Development” phases, and the strengths
approach to practice.
2. “Discrimination includes those policies,
procedures, decisions, habits, and acts that overlook, ignore, or subjugate
members of certain groups or that enable one group of people to maintain
control over another group. Such discrimination creates obstacles and barriers
for its targets and provides unfair privileges for its beneficiaries” (Appleby,
Colon, and Hamilton, 2001, p. 38). In an article titled: Educated and underemployed: Refugee integration into the Canadian
Labour Market, researchers Krahn, Mulder, and Wilkinson (2000) found that
refugees: i) were more likely to be unemployed versus other Canadians, ii)
experienced downward occupational mobility, and iii) experienced overt
discrimination by employers.
3. Definitions relating to the four practice options were taken from
Pincus and Minahan (1973, p. 53-61).
4. When I first arrived in Calgary eight years
ago I had difficulty gaining any employment. My previous education, training,
and work experience were not recognized. I concluded that I needed a university
education and enrolled as an undergraduate student at the University of
Calgary. Unlike Aisha, I am in a privileged position to be able to pursue a
Bachelor’s Degree in Social Work.
5. I believe that asking a person about their spiritual well-being is an
invasion of a person’s privacy. While there were different categories in Factor
I of the PIE classification system that might have assisted me in addressing this issue, my personal
views (my own PIE domain) prevented me from asking Aisha about her spiritual
well-being. Working with Aisha has taught me about my own PIE domain and how this affects my relationship with clients, and
the assessment process.
6. McQuaide (1999) provided a summary of various authors’ criticisms of the DSM. Some of these criticisms are similar to/different from the criticisms put forward by Saleebey (2001). It was not possible in this paper to discuss all the limitations of the DSM. Authors such as Pardeck and Murphy (1993) - please see the “References” section of this paper - provide a critical analysis of the disease model.
7. Further information regarding the strengths perspective can be found in articles by Brun and Rapp (2001); Saleebey (1995), and Cowger (1994). Please refer to the “References” section of this paper for details.
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