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Process Recording 6

Process Recording Outline

Student’s Name: Karen Latorre

Date/time of Encounter: Encounter #: 10/1/2021

Client’s identifying information: Y, 16-year-old female

Purpose of the encounter: Address concerns with hygiene and doing laundry

Location of the encounter (office, home, school, hospital room, etc.): Office

Was the encounter in person or virtual? Virtual

Participants in the encounter: Clinician (CL), Behavior Support Specialist (BSS), Case Planner (CP), Foster Parent (FP), Youth (Y)

Pre-engagement: How have you prepared for this contact (i.e. read the client’s file? reflected on the last session, examined the case in its totality?)

· I was not prepared for this contact. I was a bystander as I was completing training a couple steps away from the CL facilitating the call. I did not read Y’s file before the session. I observed a virtual check-in meeting. The CL, BSS, CP, CL, FP and Y were present on the call. It appeared as if the team was waiting for Y to get on the call. After three minutes of waiting, the clinician proceeded to call Y on the phone and inquired about her whereabouts. Y reported that she had just gotten out from school and was on her way home. She reported she was about to catch the train and will connect anyway. Y got on the call shortly after and had her camera and volume off throughout the meeting. The clinician began to explain the purpose of the meeting. It appeared as if the foster parent had complaints about Y not showering and doing her own laundry. As the foster parent was expressing her concerns, the clinician attempted to engage Y in the conversation. Y expressed her thoughts via the chat. The clinician was not able to see Y’s facial expressions or listen to Y’s tone during the check-in.

·

Verbatim Dialogue

Verbatim Dialogue: Duration of Virtual Check-in: 15 minutes

CL: Thank you so much for joining us today. We are still waiting for Y to get on the call.

CL: One sec, let me call her. CL proceeds to call Y.

CL: Hey Y. How are you? *After a long pause* Did you forget about our meeting?

CL: Oh, I see. Where are you now? Will you still be able to join? *After Pause* Speak to you soon.

CL: Okay everyone. Y is on the call. Thank you so much for joining. Today’s meeting, FP has brought some things to our attention.

CL: Y is currently on the train but she is responsive via the chat and is listening. Please feel free to unmute yourselves. *Seems as if FP proceeds to speak*

CL: Y, what can you tell me about that?What can we do to have everyone on the same page?

CL: Yes! I love that idea. *Seems as BSS suggested for CP, and CL to go to the foster home and assist in laundry*

CL: *Reads Y’s response from the chat: Yes, that can work.

CL: That is a great idea, thank you for bringing it up. We are not going to do your laundry for you, but we will be there in every way for moral support. We will even accompany you to the laundry mat and will stay with you if it makes you feel comfortable. Is that something we can discuss further? *Reads Y’s response from the chat: Yes

CL: We mitigated ½ concerns. What is the other? *Seems as if FP proceeds to talk*

CL: Are you still going to your mother’s house over the weekend? *After long Pause* I can call her and ensure you’re showering. *Reads Y’s response from the chat: Y says she showers a lot more often and wipes down.

CL: That is great news! I will still be calling your mom and will check-up over the weekend when you are with her. Is that okay with you? *Reads Y’s response on the chat: Y said yes.

CL: Does anyone else have anything they’ll like to bring up? Every one okay?

CL: Okay, great! If no one has anything else, thank you so much for joining. This was a successful meeting. Thanks for all the good suggestions. Y, I will touch base so we can schedule session.

Non-Verbal

Communication What did you

observe?

Y’s camera and volume was off during the session

CL shows feelings of concern. Trust

CL has high energy

CL showed working together as a team by identifying the client’s support system

CL assured and validated Y’s feelings.

Student’s Feeling What were you feeling then?

Curious

Uncomfortable due to sensitive topic

Guilty that I was listening in a confidential session

A little distracted due to the training

Assured that Y had outside supports. Building positive therapeutic relationship due to not having the minor have feelings of non-support/abandonment

Student’s Thoughts

What were you

Thinking then?

Psychoeducation on personal hygiene/cleanliness and agency

How old is Y?

How long has she been in the same foster home?

Does Y have siblings?

How can everyone come together to support Y in this transition?

Identify Skills,

Techniques and

Theory Used

Healthy attachment styles – Ainsworth

CL always asks if it’s okay for the client. Does not want to agree with anything on her behalf/without consent

CL provided support

CL allowed others to voice their opinions

Secure attachment between Y and CL

Instructor’s Comments

Yes! As we discussed, the camera and volume off could signal that she was uncomfortable with the situation. Good observation!

Being a therapist/clinical social worker often means confronting the uncomfortable! But this feeling can also be useful information. What might your discomfort tell you?

This is a good observation of the CL. Allowing autonomy/voice and choice is really important!

The high energy serves a purpose! Validation, especially in the context of a difficult conversation, helps buffer the discomfort!

Observations are always a little awkward. I’m glad you had the chance to see a rich conversation on what can be an uncomfortable subject.

These are great questions! Age, time in care, siblings are all good things to think about. We often see hygiene concerns that are dystonic with the clients’ age. This could be due to trauma, mental health, developmental delay, or cultural difference. Time in care can let us know how stable a client is and how robust their support systems are.

It looks like you were able to observe a lot of skills and techniques that the CL was using, even in this short observation!


Reflect on and briefly give response to these items below:

Impressions: Self-critique your interventions and responses in the encounter, highlighting your strengths and areas that you think need improvement.

Assessment/Analysis of the Session:

· Identify the stage of work with the client (pre-engagement, engagement, assessment, intervention, evaluation) – What did you learn from the session that adds to your understanding of the client? The stage of work with the client was assessment, intervention, and evaluation. This stage promoted participation from the team, addressed the concerns, and provided possible solutions. The team was able to express concerns that almost worked as an intervention for Y to get into the routine of being more responsible and independent, promoting self-agency. 

 

· What were the challenges presented? The challenges presented were: Unable to hear all the participants on the call due to virtual communication. I was also unable to see or hear Y. I was not familiar with Y’s case and did not know the context.    

What was accomplished?

· The CL had a prior session with Y regarding hygiene. I did not observe this session; however, it appeared the topic seemed casual. The CL reminded Y of the previous session and did not disclose personal information to the other team members. The CL did not break Y’s trust and kept everything confidential. The CL suggested calling her biological mother over the weekend to ensure she showers. This relationship shows positive rapport between Y and her clinician. The clinician has a healthy therapeutic relationship with Y as she was able to identify her close supports. Y proceeded to say that she showers “a lot more often and wipes down.” Y felt comfortable to express at that moment. The CL then gave praise, assurance, and validation. The session was also successful because the team decided that Y needed additional support to complete her laundry. The BSS recommended that the CL and CP visit Y on designated laundry days, assist with sorting clothes, and accompany her to the laundry mat. Y’s CL assured that she would not do her laundry for her but support her in every way. Y agreed to the plan. The CL also assured Y that she would still have her personal space even when she was in her room touching her clothes. This gesture from the CL allows transitions to routines promoting self-autonomy.

How did intersecting identities and positionality (i.e. power and privilege) influence the encounter?

· The FP’s positionality allowed her to voice her concerns with the intention of them getting addressed. The CL used her positionality to facilitate the check-in to address the pressing problems. The BSS and CP used their positionality to give suggestions and assured Y made her own decision. Y’s positionality as a foster child at Cayuga Centers allows her to get the needed resources available. 

Power: Foster parent used her ability to address concerns with CL, CP, and BSS. Y had agency in the sense that she determined how she wanted to show up in the meeting.

Privilege: Y has a phone. Y has her room. Y has a foster parent that is concerned. Y has a CL, CP, and BSS that are supportive. Y goes to school. 

Next steps: Identify unfinished business and your thoughts about interventions you may wish to consider for future encounters. What have you and the client decided to work toward? Short-term goals? Longer term goals?

· I would explore Y’s reasoning for not wanting to shower. Did Y suffer a traumatic experience? Does she appear to have low self-esteem?

· I would also provide psychoeducation on the importance of obtaining good hygiene.

· Suggest Y complete short-term goals such as: Showering at least one extra day per week and sorting clothes to organize the laundry.

· Encouraging setting daily routines for Y to encourage good hygiene habits.

· Encouraging weekly laundry visits would validate her accomplishments—praise Y when she has completed a goal.

· In addition, I would have liked to know more background of Y before the check-in to understand the context. The CL also had headphones on throughout the meeting, and I could not hear what the others had to say. I would have liked to ask/know: How long has she been with her current foster parent? How would they describe their relationship? Has this issue been brought up before? How long has the CL been working with Y? How often does Y have sessions? Does Y have siblings?

· Throughout the session, I would have wanted Y to be present. The team lacked to see her non-verbal communication, which is essential in effective communication. Y could have felt defensive or embarrassed due to the topic’s sensitivity being discussed and decided she was uncomfortable showing her face. Y could have had multiple feelings regarding her emotions at that moment. The knowledge of that could have created a deeper insight into Y’s thought processes and feelings.

· I would have also encouraged Y to be in a safe/quiet place for the meeting to avoid distractions. This session addressed concerns with showering and doing laundry. It appeared as if Y had the option to choose which suggestion she wanted to follow. The team also assured Y that she was going to have support every step of the way. Although I observed the team not thoroughly grasping Y’s emotions, all supports came to a mutual consensus of possible solutions for Y’s overall safety and well-being, creating an environment where issues are being addressed and assessed.

· Questions for field instructor:

· What can the clinician do if the youth seem discouraged to accomplish their goals?

This is a good question! We might start by first setting small manageable goals – ensuring that we’re setting our youth up for success from the start! If the goal is to clean their room, setting a goal of putting all the clothes in the hamper would be a manageable start. It’s also important to recognize every small step that is progress, even if we don’t reach our goal, knowing that our progress is recognized can be motivating. Exploring any barriers to their goals is important to – and then validating and normalizing difficulty in response to barriers. Using your motivational interviewing tools can be useful too if they are feeling ambivalent about their goals/making a change. Finally, a youth’s discouragement about their goals may be a signal that the goal is not a good fit to their needs – maybe they set a goal to please another, instead of matching it to their own purposes. Goals should feel relevant to the client!

This was an excellent first PR, Karen! It seems like you were able to get a lot out of this observation! –RB

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