MGT 3302 Case study Last updated July 26, 2019 Page 1

MGT 3302 Case study
Last updated: July 26, 2019 Page 1 of 2
CASE STUDY
Instructions: This assignment requires that you demonstrate a
sound understanding of the
concepts and principles included in this class. Read the case
presented below and complete the
assignment presented at the end. Proofread your work before
submitting. You can submit
multiple times. I will grade your last submission considering the
quality and sufficiency of
answers given, your demonstration of understanding of the
concepts included, and the extent to
which you satisfy the questions asked. In addition to the written
report, you will need to submit a
video explaining your solution. This video must be less than 4
minutes long. The written report is
worth 50 points. The video is worth 50 points. Total value: 100
points.

MOTORS AND MORE INC.
You are hired as the HR director for the fictitious Motors and
More, Inc. This business-to-
business sales company manufactures small motors and
accessories for industrial and home
products. The industry is highly competitive and the company
follows a prospector strategy.
A prospector strategy takes advantage of new markets and
products. Organizational emphasis is
on growth, innovation, and new product development. A
prospector wants to be first to the
market. To respond to competitive and rapidly changing
markets, prospectors have flexible, flat,
and decentralized organizational structures.
Motors and More is headquartered in a small southern town of
28,000 people, with a low
unemployment rate of 3.1%. This means that demand for
workers exceeds labor supply. There is
a technical school and a community college within 50 miles of
Motors and More. Motors and
More’s president is a former military and is highly patriotic. He

is committed to staying in the
community. Recently, other local companies have experienced
labor organizing activities.
Motors and More employs 116 people. Until you were hired,
there was no HR department.
Recently, the organization’s employee turnover rate has been
higher than normal. The marketing
and sales department continues to sell products to an expanding
market. Because of this
increased product demand, output must be increased by 96
percent.
In Motors and More, 88% of the employees are Caucasian.
Except for one female supervisor in
the customer service department, the president and all other
managers are Caucasian men.
Promotions have been based on seniority. Local labor market is
approximately 48% minority,
with a growing Hispanic and Kurdish population not fully
accepted into the community.
All the employees in manufacturing (including quality control),
customer service and operations
(responsible for shipping and receiving; distribution of raw

materials, components parts and
finished goods inventory; and maintenance and cleaning) have
at least a high school degree or
GED. The organization provides some skills training courses.
Please refer to the organizational
chart in Figure 1 for more details.
MGT 3302 Case study
Last updated: July 26, 2019 Page 2 of 2
Figure 1. Motors and more organization chart.
ASSIGNMENT
1. Describe a typical HR department, not one for Motors and
More. Include:
a. A chart for the HR department, with each position properly
labeled (job title).
b. For each position, show:
i. Objective.
ii. Expected outcomes.
iii. Activities to perform to produce the expected outcomes.
iv. Competencies necessary to perform the activities.

2. Given the size of Motors and More, indicate:
a. Which positions identified in your typical HR department (#1
above) should be
combined or eliminated to reduce the number of HR employees.
b. Create a new chart, specific for the HR department of Motors
and More.
c. Identify and label each position in Motors and More’s HR
Department chart.
d. For each position, show:
i. Objective.
ii. Expected outcomes.
iii. Activities to perform to produce the expected outcomes.
iv. Competencies necessary to perform the activities.
3. Discuss the differences in the organizational charts you
showed in numbers 1 and 2 above.
This case was adapted from McCain, D. (2007). Society for
Human Resource Management.

Figure 31.1
Logic Model
Logic Models
Karen A. Randolph
A
logic model is a diagram of the relationship between a need that
a
p rogram is designed to addret>s and the actions to be taken to
address the
need and achieve program outcomes. It provides a concise, one-
page pic-
ture of p rogram operations from beginning to end. The diagram
is made
up of a series of boxes that represent each of the program's com
ponents,
inpu ts or resources, activities, outputs, and outcomes. The
diagram shows how these
components are connected or linked to one another for the
purpose of achieving
program goals. Figure 31.1 provides an example of the frame
work for a basic logic model.
Th e program connections illustrate the logic of how program
operations will result in
client change (McLaughlin & Jordan, 1999). The connections
show the "causal" relati on-
ships between each of the program components and thus are
referred to as a series of"if-
then" sequence of changes leading to th e intended outco mes
for the target client group

(Chinman, hum, & Wandersman, 2004). The if-then statements
represent a program's
theory of change underlying an intervention. As such, logic
models provide a framework
that g uides the evaluation process by laying out important
relationships that need to b e
tested to demonstrate program results (Watso n, 2000).
Logic models come from the field of program evaluation. The
idea emerged in
response to the recognition among program evaluators regardin
g the need to systema tize
the p r ogram evaluation process (McLaughlin & Jordan, 20 04).
Since then , logic models
have become increasingly popular among program managers for
program planning and
to monitor program performance. With a growing emphasis on
accountability and out-
come measurement, logic models make explicit the entire
change process, Lhe assu mp-
tions t hat underlie this process, and the pathways to reach ing
outcomes. Researchers have
begun to use logic models for intervention research planning
(e.g., Brown, Hawkins,
Arthur, Brin ey, & Abbott, 2007).
The followin g sections provide a description of the components
of a basic logic model
and how these compon ents are linked together, its relationship
to a p rogram's theory of
[ : Inputs 1--_.,•1 Ac~vities ,II----.~•{ .Outputs ·11---~·1
Outcomes I
AUTHOR'S NOTE: The author wishes to acknowledge Dr. Tony
Tripodi for his though lful comments
on a drafl of this chapter.

547
548 PART V • CONCEPTUAL RESEARCH
change, and its uses and benefits. The steps for creating a logic
model as well as the chal-
lenges of the logic modeling process will be presented. The
chapter concludes with an
example of how a logic model was u~cd to enhance program
outcomes for a family liter-
acy program.
Components of a Logic Model
Typically, a logic model has four components: inputs or
resources, activities, outputs, and
outcomes. Outcomes can be further classified into short-term
outcomes, intermediate
outcomes, and long-term outcomes based on the length of time
it takes to reach these
outcomes (McLa ughlin & Jordan , 2004) . The components
make up the connection
between the planned work and the intended results (W. K.
Kellogg Foundation, 2004).
The planned work includes the resources (the inp uts) needed to
im plement the program
as well as how the resources will be used (the activities) . The
intended results include the
outputs and outcomes that occur as a consequence of the
planned work. Figure 31.2
expands on the model illuslrated in Figure 3 1.1 by adding
examples of each component.
This particular logic model, adopted from frec htling (2007),

provides an illustration of
the components of an intervention designed to prevent substance
abuse and other prob-
lem behaviors among a population of youth. The intervention is
targeted toward improv-
ing parenting skills, based on the assumption that positive
parenting leads to prosocial
behaviors among yo uth {Bahr, Hoffman, & Yang, 2005). The
following section provides
definitions and examples of each logic model component, using
this illustration.
Resources
Resources, sometimes referred to as inputs, in clude the human,
fin ancial, organizational,
and community asse ts that are available to a program to
achieve its objectives (W. K.
Kellogg Foundation, 2004). Resources are used to support and
facilitate the program
activities. They are usually categorized in terms of funding
resou rces or in -kind contribu-
tion s (Frechtling, 2007) .
Some resources, such as laws, regulations, and funding
requirements, are external to
the agency (United Way of America, 1996). Other resources,
such as staff and money, are
easier lo quantify than others (e.g., community awareness of the
program; Mertinko,
Novotney, Baker, & Lange, 2000). As Fn.:c:htli ng (2007)
notes, it is important to clearly and
tho roughly id ent ify the available resources during the logic
modeling process because this
information defines the scope and parameters of the program.
Also, this inCormation is
critical for others who may be interes ted in replicating the

program. The logic model in
Figure 31.2 includes fu nding as one of its resources.
Activities
Activities represent a program's service methodology, showing
how a program intends on
using the resources described previously to carry out its work.
Activities are also referred
to as ac tion step!; (McLaughlin & Jordan, 2004). They are the
highly specifi c tasks that
p rogram staffs engage in on a daily basis to provide services to
clients (Mertinko
et al., 2000) . They include all aspects of pro gram
implementation, the processes, tools,
events, technology, and program actions. The ac tivities form
the foundation toward facil-
itating intended client changes or reaching oulcornes (W. K.
Kellogg Fo undation, 2004).
Some examples are establishing community councils, providing
professional develop -
ment training, or initiating a media campaign (Frechtling,
2007). Other examples are
CHAPTER 31 • l OCIC MO DELS 549
Inputs Activities Outputs Outcomes
Short Term Intermediate Long Term
Feedback Loop j
_J
I
Decreased

K~
Increased
I
Develop and Numbe r of Increased
youth Funds .~ initiate ~edi a st~tions a~opti ng r-- awareness
f- positive 1-----+ of positive substance
-~m~tg~-- -.:::c -campatgn J pa renting parenti ng - abv?~d'
~-'.:-
/
I
Develop and Number of Increased
distribute - 1> fact sheets 1- enrollment
fact sheets distributed in parenting
programs
Fig ure 31.2 Example of l ogic Model With Com ponents, Two
Types of Connections, and a Feedbaclc loop
providing shelter for homeless families, educating the public
about signs of child abuse,
or providing adult mentors for youlh {United Way of Ame rica,
1996) . Two activities,
" Deve lop and initiate media campaign" and "Develop and
distribute fact sheets;' are
included in the logic model in Figure 31.2. Activities lead to or
produce the program o ut-
puts, described in the following section.
Outputs

The planned works (resources and activities) bring about a
program's des ired res ul ts,
including outputs and outcom es (W. K. Kell ogg Foundatio n,
2004) . Outputs, also referred
to as units of service, are the immediate results of program
activities in the form of types,
levels, and targets of services to be delivered by the program
(McLaughl in & Jordan ,
1999). They are tangible products, events, o r serv ices. They
provide the documentation
that activities have been implemented and, as such, indicate if a
program was delivered to
the intended audience at the intended dose (W. K. Kellogg
FounJation, 2004). Outputs
arc typical ly desc ribed in terms of th e size and/or scope of the
services an d products pro-
duced by the program and thus are expressed numerically
(Frechtling, 2007). Examples of
program ou tpu ts include the number of classes ta ught,
meetings held, o r materials p ro-
duced and distributed; program par ticipation rates and
demography; or hours of each
type of serv ice provided (W. K. Kellogg Foundation, 2004) .
Other examples are the
number of meals provided, classes taught, brochures distributed
, or participants ser ved
(Frecht1ing, 2007) . W hile outputs have little inherent value in
themselves, they provide
the link between a program's activ ities and a program's
outcomes (United Way of
America, 1996). The logic model in Figure 31.2 includes Lhc
number of stations adopting
the media campaign and the number of fact sheets distributed as
two outputs for the pre-
vention program.

550 PART V • CONCEPTUAL RESEARCH
Outcomes
Outcomes arc Lhe specific changes experienced by the
program's clients or target group as
a consequence of participating in the program. Outcomes occur
as a result of the program
activities and outputs. These changes may be in behaviors,
attitudes, skill level, status, or
level of functioning (W. K. Kellogg Foundation, 2004).
Examples include increased knowl-
edge of nut r itional needs, improved reading skills, more
effective responses to conflict,
and finding employment (United Way of America, 1996) .
Outcomes are indicalors of a
program's level of success.
McLa ughlin and Jordan (2004) make the point that some
programs have multiple,
sequential outcome structures in the form of short-term
outcomes, intermediate out-
comes, and long-term outcomes. In these cases, each type of
outcome is linked tempo-
rally. Short-term outcomes arc client changes or benefits th at
are mos t immediately
associated with the program's outputs. They are usually realized
by clients wi thin 1 to
3 years of program completion. Short-term outcomes are linked
to accomplishing inter-
mediate outcomes. Intermediate ou tcomes are generally attain
able in 4 to 6 years. Long-
term outcomes are also referred to as program impacts or
program goals. They occur as a
result of the intermediate outcomes, usually within 7 to 10

years. In this format, long-
term outcomes or goals are directed at macro-level change and
target organizations, co m-
munities, or systems (W. K. Kellogg Foundation, 2004).
As an example, a sequen tial outcome structure with short-
term, intermediate, and
long-term outcomes for the prevention program is displayed in
Figure 31.2. As a result of
hearing the public service announ cemen ts about positive
parenting (th e activity), parents
enroll in parenting programs to learn new parenting skills (the
short-term outcome).
Then they apply these newly learned skills with their children
(the intermediate out-
come), which leads to a reducti on in substance abuse among
youth (the long-term impact
or goal the parenting program was designed to achieve).
Outcomes ar e often confused with outputs in logic models
because their correct clas-
sification depends on the context within which they are being
included. A good exa mple
of this potential confusion, provided in the United Way of
America manual ( 1996, p. 19),
is as follows. The number of clients served is an output when it
is meant to describe the
volume of work accomplished. In this case, it does not relate
directly to cl ient changes or
benefits. H owever, the number of clients served is considered
to be an outcome when the
program's intention is to encourage clients to seek services,
such as alcohol treatment.
What is important to remember is that outcomes describe
intended client changes or
benefits as a result of participatin g in the program whil e

outputs document products or
services produced as a result of activities.
Links or Connections Between Components
A critical part of a logic model is the connections or links
between the components. The
connections illustrate the relationships between the components
and the process by
which change is hypothesized to occur among program
participants. This is referred to as
the program theory (Frechtling, 2007). It is the con nections
illustrating the program's
theory of change that make the logic model complicated.
Specifying the connections is
one of the more difficult aspects of developing a logic model
because the process requires
predicting the process by which client change is expected to
occur as a result of program
participation (Frech tling, 2007).
CHIII'TER 31 • lOGIC M ODtLS 551
Frechtling (2007) describes nvo types of connections in a logic
model: connections
that link items within each compo nent and connections that
illustrate the program's
theory of change. The first type, items within a component, is
connected by a straight line.
This line shows that the items make up a
particularcomponent.As an example, in Figure 31.2,
nvo activities, "Develop and initiate media campaign" and "
Develop and distribute fact
sheets," are linked together with a straight line beca use they

represent the items within the
activities component. Similarly, two outputs, "Number of
stations adop ting the cam-
paign" and "Number of fact sheets distributed;' arc connected as
two items within the
outputs component.
The second type of connection sh<.>ws how the components
interact with or relate to
each other to reach expected outcomes (Frechtling, 2007) . In
essence, this is the program's
theory of change. Thus, instead of straight lines, arrows are
used to show the direction of
influence. Frechtling (2007) clarifies that "these directional
connections are not just a
kind of glue ancho ring the otherwise floating boxes. Rather
they portray the changes thaL
arc expected to occur after a previous ac Livity has taken place,
and as a result of it" (p. 33).
She points out that the primary purpose of the evaluation is to
determine the nature of
the relationships between components (i.e., whether the
predictions are correct). A logic
mod el that illustrates a fully developed theory of change
includes links between every
item in each co mponent. In other words, every item in every
component must be co n-
nected to at least one item in a subsequent component. This is
illustrated in Figure 3 1.2,
which shows that each of the two items within th e activities co
mpon en t is linked to an
item within the output co mponent.
Figure 31.2 provides an example of the predicted relationships
between the compo-
nents. This is the program theory about how the target group is

expected to change. The
input or resource, funding, is co nnected to the tv,ro activities,
"Develop and initiate media
campaign" and "Develop and distribute fac t sheets." Simply
put, this part of Figure 31 .2
shows that funding will be used to support the development and
initiati on of PSA cam-
paigns and the distribution of fact sheets.
The sequencing of the connections between components also
shows th at these steps
occur over a period of time. While this may seem obvious and
relatively inconsequential,
specifying an accurate sequence has time-based implications, pa
rticularly when short-
term, intermediate, and long-term outco mes are proposed as a
part of the theory of
change (Frechtling, 2007). Rcca11 that the short-term outcomes
lead to achieving the
intermediate outcomes, and the intermediate outcomes lead to
ach ieving long-term out-
comes. Thus, the belief or underl}ing ass umption is that short-
term outco mes mediate
(or come between) relationships benv-een activities and
intermediate o utcomes, and
intermediate outcomes mediate relations between sho rt-te rm
and long-term outcomes.
Related, sometimes logic models display feedback loops.
Feedback loops show how the
information gained from implementing one item can be used to
refine and improve other
items (Frechlling, 2007). f or instance, in Figure 31.2, the
feedback loop from the short-
term outcome, " Increased awareness of positive parenting;'
back to the activity, "Develop

and initiate media campaign;' indicates that the findings for "
Increased awareness of pos-
itive parenting" arc used to im prove the PSA campaigns in the
next program cycle.
Contextual Factors
Logic models describe programs that exist and are affected by
contextual factors in the
larger environment. Contextual factors are those important
features of the environment
552 PART V • CONCEPTUAL R ESEARCH
in which the project or inter vention takes place. They include
the social, cultural, and
political aspects of the environment (Frechtling, 2007). They
are typically not under the
program's control yet are likely to influe nce the program either
positively or negatively
(McLa ughlin & Jordan, 2004 ). T hu s, it is critical to identify
relevant contextual factors
and to consider their potential impact on the program.
McLaughlin and Jordan (1999)
point out that understanding and articulating contex tual factors
co ntr ibu tes to an under-
standing of the fo undat io n u pon whi ch performance
expectatio ns a re established.
Mo reover, this knowledge h elps to establish the parameters for
explaining program
results and developing program improvement strategies that are
li kely to be more m ean-
ingful and thus more successful because the information is more
complete. finally, con-

textual factors clarify situations under which the program
results might be expected to
generalize and the issues that might affect replication
(Frechtling, 2007) .
Harrell, Burt, Hatry, Rossm an, a nd Roth ( 1996) identify two
types of contextual fac-
tors, antecedent and media6ng, as o utside facto rs that could
influence th e program's
design, implementa tio n, and results. Anteceden t factors are
thos e that exist prior to
program implemen tatio n, such as cha racteristics of the client
target population o r com-
munity characteristics such as geographical and economic
conditions. Mediating factors
are the environmental influences that emerge as the program
unfolds, such as new laws
and policies, a change in economic con ditions, or the startup of
other new programs pro-
viding similar services (McLaughlin & jordan, 2004).
Logic Models and a Program's Theory of Change
Definition
Log ic models p rovide an illustration of the compo nents of a
program's theo t-y and how
those components are linked togeth er. Program theory is
defined as "a plausible and sen-
sible model of how a program is supposed to wo rk" (Bickman,
1987, p. 5). Program
theory in corporates "program resources, program activities, and
intended program out-
comes, and specifies a chain of causal assumptions linking
resources, activities, interme-
di ate outcomes, and ulti mate goals" (Wholey, 1987, p. 78).
Program theory e.>..-plicates the

assumptions abou t how the program components link together
from program star t to
goal attainmen t to realize the program's intended outcomes
(Frechtling, 2007). Thus, it is
often referred to as a p rogram's theory of change. Frechtling
(2007) suggests that both
previous research and knowledge gained from practice
experience arc useful in develop-
ing a theory of change.
Relationship to logic Models
A logic model provides an illustration of a program's theory of
change. It is a useful tool
for describing program theory because it shows the connections
or if-then relationships
between program components. In other words, moving from left
to right from one com-
po nent to the next, logic models provide a diagram of the
rationale or reasoning underly-
ing the theory of change. If-th en statements connect the
program's co m po nents to form
the theory of change (W. K. Kellogg Founda tion, 2004). For
example, certain resources or
inputs are needed to carr y out a program's activities. The first
if-then statement links
reso urces to acti vities and is stated, " If you have access to
these resources, then yo u can use
them to accomplish yo ur planned activities" (W. K. Kellogg Fo
undation, 2004, p. 3). Each
CHAPTER 31 • LOCIC MODELS SS3
component in a logic model is linked to the other components
using if-then statemen ts to

show a program's chain of reasoning about how client change is
predicted to occur. The
idea is that "if the right resources are transformed into the right
activities for the right
people, then these will lead to the results the program was
designed to achieve"
(McLaughlin & Jordan, 2004, p. 11). It is important to define
the components of an inter-
vention and make the connections between them explicit
(Frechtling, 2007).
Program Theory and Evaluation Planning
Chen and Rossi (1983) were among th e first to suggest a
program theory-driven
approach to evaluation. A program's theory of change has
significant utility in develop-
ing and implementing a program evaluation because the theory
provides a framework
for determining the evalu ation questions (Rossi, Lipsey, &
Freeman, 2004) . As such, a
logic model that ill ustrates a program's theory of change
provides a map to inform the
developmen t of relevant eval uation questions at each phase of
t he evaluation. Rossi
et al. (2004) explain how a program theory-based logic mode l
enha nces the devel op-
ment of evaluation questions. First, the process of articulating
the logic of the
program's change process through the development of the logic
model prompts discus-
sion of relevant and meaningful evaluation questions. Second,
these questions then lead
to articulating expect ations fo r p rogram performance and
inform the identification o f
criteria to measure that performance. Third, obtaining input
from key stakeholders

about the theory of change as it is displayed in the logic model
increases the likelihood
of a more comprehensive set of questions and that critical issues
have not been over-
looked. To clarify, most agree that this is a team effort that
should include the program
development and program evaluation staff at a minimum, as
well as other stakeholders
both internal and external to the program as they are available
(Dwyer & Makin, 1997;
Frech tling, 2007; Mclaughlin & Jordan, 2004). The diversity of
perspective and skill sets
among the team members (e.g., program developers vs. program
evaluators) enhances
the depth of understanding of how the program will work, as
diagramed by the logic
model (Frechtling, 2007). As D"vyer and Makin (1997) state,
the team approach to
develop ing a theory-based logic model promotes "greater
stakeholde r invo lvement, the
opportunity for open negotiation of program objectives, greater
commitment to the
final co nceptualization of the program, a shared vis ion, and
increased likeliho od to
accept and utilize th e evaluation results" (p. 423) .
Uses of Logic Models
Logic models have many uses. They help Lo integrate the entire
program's planning and
implementation process from beginning to end, including the
evaluation process (D wyer
& Makin, 1997). They can be used at all of a program's stages
to enhance its success
(Frechlling, 2007; W. K. Kellogg Foundation, 2004). For
instance, at the program design

and planning stage, going through the process of developing
logic models helps to clarify
the purpose of the program, the development of program
strategies, resources that are
necessary to attaining outcomes, and th e identification of
possible barriers to
the program's success. Also, identifying program components
such as activities and
outcomes prior to program implementation provides an
opportunity to ensure that
program outcomes inform program activities, rather than the
other way aroun d (Dwyer
& Makin, 1997) .
554 PART V • CoNcEPTUAl R ESEA RC H
During the p rogmm implementation phase, a logic model p
rovides the basis fo r th e
development of a management plan to guide program
monitoring ac tiv ities and to
improve program processes as issues arise. In other words, it
helps in identifying and
highlighting the key program processes to be tracked to ensure a
program's effectiveness
(United Way of America, 1996).
Most important, a logic model facilitates evaluatio n planning
by providing the evalua-
tion framework fo r shapin g the evalua tion across all stages of
a project. Intended out-
comes and the process for measuring these outcomes are
displayed in a logic model
(Watson, 2000), as well as key points at which evaluation
activities should take place

across the life of the program (McLaughlin & Jordan) 2004).
Logic models suppo rt both
formative and summative evaluations (Frechtli ng, 2007). They
can be used in conducting
summativc evaluations to determine what has been
accomplished and, importantly, the
process by which these accomplishments have been achieved
(Frechtling, 2007) . Logic
models can also support formative evaluations by organizing
evaluatio n activities, incl ud-
ing the meas urement of key variables or performance indicators
(McLaughlin & Jordan,
2004) . From this info rmation, evaluation questions, relevant
indicators, and data collec-
tion strategies can be developed. The following section expands
on using the logic model
to develop evaluation questions.
The logic m odel provides a framework for developing eval uat
ion q uestions about
prog r am co n text, program efforts, and p rogram effec
tiveness ( Frech t ling, 2007;
Mer ti nko et al., 2000). Together, these three sets of quest ions
help to explicate the
progr am's theory of change by describing the assumptions
about the r elationship s
between a program's operations and its predicted outcomes
(Ross i et al. , 2004) .
Context questio ns explore program capacity and relationships
external to the program
and help to identify and understand the impac t of confo unding
factors or externa l
infl uences. Pr ogram effort and effectiveness quest ions
correspond to particular co m -
ponents in the logic model and thus exp lore program processes
t oward ach ieving

program outcomes. Questions a bout effor t address the planned
work of the program
and come from the input and activities sections of the eva luatio
n mo d el. They address
program implementation issues such as the services that were
provided and to who m.
These questio ns focus on what happene d and why.
Effectiveness or outco m e questions
address program results as described in the output and outcomes
section of the logic
m odel. From the questions, indicators and da ta collection
strategies can the n be d evel-
oped. Guidelines for using logic mo d els to develop evaluation
questi ons, ind icators,
and data collection strategies are provided in the Logic Model
Development Guide
( W. K. Kellogg Foundation, 200 4 ).
In addition to supporting program effo rts, a logic model is a
useful comm unication
tool (McLaughlin & Jordan, 2004 ). For instance, devel oping a
logic model provides the
opportunity fo r key stakeholders to discuss and reach a
common understanding, includ-
ing underlying assumptions, about how the program opera tes an
d the resources needed
to achieve program p rocesses and outcomes. ln fact, some
suggest t hat the logic model
development process is actually a form of strategic planning
because it requ ires partici-
pants to articulate a program's vision, the rationale for the
program, and the program
processes and procedures ('Watson, 2000) . T his also promotes
stakeholder involvem ent in
program planning and consensus building on the program's
design and operations.

Moreover, a logic model can be used to explain program
procedures and sha re a compre-
hensive yet concise picture of th e p rogram to comm unity
partners, funders, and others
outside of the agency (McLaughlin & Jordan, 2004) .
CHAPTER 3 1 • LOGIC M ODF I S 555
Steps for Creating Logic Models
McLaughlin and Jordan (2004) descri be a five-stage process for
developing logic models.
The first stage is to gather extensive baseline information from
multiple sources abo ut the
nature of the problem or need and about alternative solutions.
The W. K. Kellogg
Foundation (2004) also suggests collecting information about
community needs and
assets. This information can then be used to both define the
problem (the second stage of
developing a logic model ) and identify the program clements in
the form of logic model
componen ts (the third stage of logic model development).
Possible information sources
include existing program documentation, interviews with key
stakeholders internal and
exte rn al to the program, strategic plans, annual performance
plans, previous program
evaluations, an d relevant legislation and regulations. It is also
important to review the lit-
erature about factors related to the problem and to determ ine
the strategies others have
used in attemp ting to address it. This type of information
provides supportive evidence

that informs the approach to addressing the problem.
The information collected in the first stage is th en used to
define the problem, the
con textual factors that relate to the problem, and Lhus the need
for the program. The
program sho uld be conceptualized based on what is uncovered
abo ut the nature and
extent of the problem, as well as the factors that are correlated
with or cause the prob-
lem. It is also impor tan t at this stage to develop a clear idea of
the impact of the prob-
lem across micro, mezzo, and macro domains. The focus of the
program is then to
address the "causal" factors to solve t he problem. In addition,
McLaughlin and Jordan
(2004, p. 17) recommend identifyi n g the environmental factors
that are likely to affect
the program, as well as ho·w these conditions might affect progr
am outcomes.
Understanding the relationship between the program and relevan
t environmental fac-
tors contributes to framing its parameters.
During the third stage, the elemen ts or components of the logic
model are identified,
based on the findings that emerged in the second stage.
McLaughlin and Jorda n (2004)
recommend starting out by categorizing each piece of
information as a resource or input,
activity, o utput, short-term outcome, intermediate outcome,
long-term outcome, or con-
textual factor. While some suggest that the order in which the
components arc identified
is in consequen tial to developing an effective logic mod el,
most recommend beginning

this process by identifying long-term outcomes and working
backward (United Way of
America, 1996; W. K. Kellogg Foundation, 2004) .
The lo gic model is drawn in the fourth stage. Figure 31 .2
provi.des an example of a typ -
ical logic model. This diagram includes columns of boxes
representing the items for each
component (i.e., inputs, activities, outputs, and shor t-term,
intermediate, and long- ter m
outcomes). Text is provided in each box to describe the item.
The connections between
the items within a component are shown with straight lines. The
links or connections
between components are shown with one-way directional
arrows. Prog ram components
may or may not have one-on-one rela tionships with o ne
another. In fact, it is likely that
components in one group (e.g., inputs) will have multiple
connections to components in
another group (e.g., activities). For example, in Figure 31.2, we
show that the funding
resource leads to two activities, "Develop and initiate media
campaign" and "Develop and
distribute fact sheets." Finally, because activities can be
described at many levels of detail,
McLaughlin and Jordan (2004) suggest simplifying the model
by group ing activities that
lead to the same outcome. They also recommend including no
more than five to seven
activity groupings in one logic model.
556 PART V • CO NCEPTUAl RESEARCii

Stage 5 focuses on verifying the logic model by getting input
from all key stakeholders.
McLaughlin and Jordan (2004) recommend applying the if-then
statements presented by
United Way of America ( 1996) in developing hypotheses to
check the logic model in the
following manner:
given observations of key contextual factors, if resources, then
program activities; if
program activities, then out puts for targeted customer groups;
if outputs change
behavior, first short term, then intermediate outcomes occur. If
intermediate out-
comes occur, then longer-term outcomes lead to the problem
being solved. (p. 24)
They also recommend answering the following questions as a
part of the verification
process (pp. 24-25):
1. Is the level of detail sufficient to create understanding of the
elements and their
interrela ti onsh ips?
2. Is the program logic complete? That is, arc all the key
elements accounted for?
3. Is the program logic theoretically sound? Do all the elements
fit together logically?
Are there other plausible pathways to achieving the program
outcomes?
4. Have all the relevant external contextual factors been
identified and their potential
influences described?

Challenges in Developing Logic Models
Frechtling (2007 ) describes three sets of challenges in
developing and using logic models,
including (a) accurately portraying the basic features of the
logic model, (b) determining
the appropriate level of detail in the model, and (c) having
realistic expectations about
what logic models ca n and canno t contribute to program
processes. These challenges are
reviewed in more detail in the following section.
Portraying the Logic Model's Basic Features Accurately
The basic features of a logic model must be clearly understood
in order for the logic
model to be useful. In particular, logic model developers often
enco unter difficulty in four
areas: confusing terms, substituting specific measures for more
gene ral outcomes, assum-
ing unidirectionality, and failing to specify a timefrarne for
program processes (Frechtling,
2007; McLaughlin & Jordan, 2004).
One issue in developing the logic model is accurately
differentiating between an activity
or outp ut and an outcome. Frequently, activities and outputs
are confused witl1 outcomes
(Frechtling, 2007). They can be distinguished by remembering
that activities are steps or
actions taken in pursuit of producing the output and thus
achieving the outcome. Outputs
are products that come as a result of completing activities. They
are typically expressed
numerically (e.g., the number of training sessions held).
Outputs provide the documenta-

tion that activities have occurred. They also link activities to ou
tcomes. Outcomes are
statements about participant cha nge as a result of experiencing
the intervention.
Outcomes describe how participants will be different after they
finish the program.
Another issue in portraying the basic features of logic models
accurately is not confus-
ing outcomes with the instruments used to measure whether the
outcomes were achieved.
C HAP t ER 31 • l OGIC M ODHS 557
For example, the outcome may be decreased depression, as
measured by an instrument
assessing a participant's level of depression (Center for
Epidemiological Studies-
Depression Scale; Radloff, 1977). Some may confuse the
outcome (i.e., decreased depres-
sion) with the instrument (i.e., Center for Ep idem iological
Studies- Depression Scale) that
was used to determine whether the outcome was met. To
minimize the potential for this
confusion, Frechtling (2007) recommends developing the
outcome lirsl and then identify-
ing the appropriate instrument for determ ini ng that the
outcome has been reached.
A thiru issue in logic model development is avoiding the
assumption that the logic
model and, by implication, the theo ry of change that the logic
model portrays move in a
unidirectional progression from left to right {Frechtling, 2007;

McLaughlin & Jordan,
2004) . While the visual display may compel users to thi nk
about logjc mod els in this way,
logic models and the programs they represent are much more
dynamic, with feedback
loops and interactions among components. The feedback loop is
illustrated in Figure 31.2,
showing that the experi ences and information generated from
reachin g short-term out-
comes are used to refine and, it is hoped, improve the activities
in the next program cycle
that are expected to lead to these outcomes. Also, assuming
uniform directionality can
enforce the belief that the inp uts dTi ve the project, rather than
attaining the outcomes.
This underscores the importance of starting with the
development of outcomes when
putting together a logic modeL
The final issue is including a timeframe for carrying out the
processes depicted in the
logic model. The lack of a tirneframe results in an incomplete
theory of chan ge as well as
problematic expectations about when outcomes will be reached
(Frechtling, 2007).
Whether outcomes are expected too soon or not soon enough,
key stakeholders may
assume that the theory of change was not accurate. Developing
accurate predictions of
when outcomes will be reached is often d ifficu lt, especially
with n ew projects in which
very li ttle is known abou t program processes and so forth. In
this case, as more clarity
emerges abo ut the amount of time it will take to complete
activities, tirneframes should
be revisited and modified to reflect the new information.

Determining the Appropriate Level of Detail
A second set of challenges is to determine how much detail to
include in the logic model.
T he underlying dilemma is the level of complexity. Models that
are too complex, with too
much detail, are lime-consuming to develop and difficult to
interpret. Thus, they are
likely to be cumbersome to use. Models that lack enough
information may depict an
incomplete theory of change by leaving out impor tant
information. For instance, if activ-
ities are combined into par ticular groups, it is possible that
important links between spe-
cific activiti es, outp uts, and outcomes wiJJ not be represented.
This increases Lhe
possibility of making faulty assumptions about program opera
lions and how these oper-
ations lead to positive participant outcomes.
Realistic Expectations
The fmal set of challenges in using logic models is no t
expecting more from logic models
than what th ey are intended to provide. Frechtling (2007, p. 92)
notes that some may
inaccurately view the logic model as a "cure-ali" a nd that, just
by its mere existence, the
logic model wi ll ensure the success of the program and the
evaluation. Of course, the effi-
cacy of a logic model depends on the quality of its design and
components. A log ic model
cannot overcome these types of problems. Frcchtling identifies
four commo n issues
here. First, sometimes new programs are such that applying the
theory of change and a

558 P11RT V • CoN ctPI'UAl R ESEARCH
representative logic model is premature. This is the case for
programs in which a priori
expectations about relationships between activities and
outcomes do not exist.
A second risk in this area is fai ling to consider alternative
theories of change.
Alternative explanations and competing hypotheses sho ul d be
explored. Focusing on only
one theory of change may result in not recognizing and
including important factors that
fall o utside of the theorys domain. Ignoring these competing
fac to rs may result in the
fail ure of the logic model and the program.
Third and related, it is critical to acknowledge the influenc e of
contextual factors that
arc likely to affect the program. Interventions always exist and
function wiLhi n a larger
environment. Contextual factors influence the success or failure
of these interventions.
For instance, one contextual factor that might affect outcomes
of the program diagrammed
in Figure 31 .2 is the diversity of the target group. As
Frechtling (2007) observes, this d iver-
sity may include language differences among subgroups, which
need to be accounted for
in developing program m aterials.
fin ally, logic models cannot fully co mp ensate for the rigor of
expe rimental design
when testing the impact of interventions o n outco m es (Frech

tling, 2007) . T he logic
model explicates the critical components of a program and the
processes that lead to
desired outcomes (the program theory of cha nge). The
implementation of the model
provides a test of th e accuracy of the theory. However,
validatio n of the logic model is not
as rigorous a proof as what is established through study designs
employing experimental
or quasi-experimental methodologies. Causality cannot be
determined through logic
models. Alhen possible, an evaluation can be strengthened by
combining the advantages
of logic modeling with experimental design.
Logic Modeling in Practice: Building
Blocks Family Literacy Program
The following provides an example of logic modeling in
practice. The example describes the
use of a program logic model in developing, implementing, and
evaluating the Building
Blocks family literacy program and how client exit data were
then used to revise the model in
a way that more explicitly illustrated the program's path•.vays
to achieving intended outcomes
(i.e., feedback loop; Unrau, 2001, p. 355). The original program
outcomes were to increase
(a ) children's literacy skills and (b) parents' abilities to assist
their children in developing lit-
eracy skills. The sam ple included 89 families who participated
in the 4-week program du ring
its initial year of operation. The following describes the process
by which the logic model was
developed and how the client outcome data were used to fme-
tune the logic model.

The family literacy program's logic model was created at a one-
day workshop facili-
tated by the evalua tor. Twenty key stakeholders representing
various constituenc ies,
including program staff (i.e., steering committee members,
administration, and literacy
workers), representatives from other programs (i.e., public
school teachers, child welfare,
and workers and clients from other literacy programs), and oth
er interested citizens, par-
ticipated in the workshop (Unrau, 2001, p. 354). A consensus
decision- making process
was used to reach an agreement on all aspects of the process,
including the program pur-
pose, the prog ram objectives, and the pro gram activities.
During the workshop, stakeholders created five products that
defined the program
parameters and info rmed the focus of the evaluation. These
products included an organi-
zational chart, the beliefs and assumptions of stakeholders about
client service delivery,
the questions for the eval uation, the program's goals and
objectives, and the program
CHAPTER 31 • l OGIC MoDElS 559
activities. The program goals, objectives, and activities were
then used to develop the orig-
inallogic model.
One of the evaluation methods used to assess client ou tcomes
was to conduct semi-

st ructured phone interviews with the parents after families
completed the program.
Random select ion procedu res were used to identify a su bset (n
= 35 or 40o/o) from the
list of all parents to participate in the interviews. Random
selection procedures were used
to ensure that the ex-periences of the interviewees represented
those of all clients served
during the evaluation time period. Relative to the two program
outcomes, respondents
were asked to provide examples of any observed changes in
both their children's literacy
skills (Outcome 1) and their ability to assist their children in
developing literacy skills
(Outcome 2; Unrau, 2001, p. 357). The co nstant comparison
method was used to analyze
the data (Pa tton, 2002 ). In this method, meani ngful units of
texi: are assigned to similar
categories to identify common themes.
What emerged from the parent interviews was more detailed
information about how
the two inten ded outcomes were achieved. Parent experiences
in the program suggested
four additional processes that li nk to reaching the two final
outcomes. Thi s infor mation
was added to the original logic model to more fully develop the
pathways to improving
children's literacy skills through the family literacy program.
These additional outcomes
were actually steps toward meeting the two originally intended
outcomes and thus iden-
tified as intermediate outcomes and ne-cessary steps toward ach
ieving the or iginally stated
long-term outcomes. Figure 31.3 provides a diagram of the
revised logic model. The

shaded boxes represent the components of the original logic
model. The other compo-
nents were added as a result of the parent exit interview data.
Input j I Activities I Short-Term Outcomes I [ Intermediate
Outcomes J I Long-Term :Outcomes j
Improve child's
behavior
Increase parent's
own literacy skills
Figure 31.3 Example of a Revised Program Logic Model for a
Family Literacy Program
SOURCE: Unrau (200 1}. Copyright November 21 , 2007 by
Elsevier limited. Reprinted with permission.
NOTE: The shaded boxes represent the logic model's original
components. The other boxes were added as a result of feedbac k
from clients
after program compl etion.
560 PART V • CONCEPTUAL R ESEARCH
While the parent in terview data were useful in revising the
program logic about client
change, it is important to interpret this process withi n the app
ropriate context. This part
of the evaluation does not provide evidence that the program
caused client change (Rossi
et al., 2004). This can only be determined through the use of
experimental methods with

random ass ignmen t. Nonetheless, these paren t data contr ibute
to developing a mo re fully
developed model fo r unde rstanding how fam ily literacy
programs wo rk to improve out-
comes for children. Experimental methods can then be used to
test the revised model for
the purpose of es tablishing the causal pathways to the intended
outcomes.
Conclusion
The purpose of this chapter was to introduce the rea der to logic
models and to the logic
modeling process. Logic models present an illustration of th e
components of a program
(inputs, activities, outputs, and outcomes) and how these
components connect with one
another to facilitate participant change (pro gram theory). They
are tools to assist key
stakeholders in program plann ing, program implementation and
monitoring, and espe-
cially program eva lu ation. They can also be used as
communication tools in expla ining
program processes to key stakeholders external to the program.
Creating a logic model is
a time-consuming process with a number of potential
challenges. Nonetheless, a well-
developed and thoughtful logic mo del is likely to ensure a
program's success in reaching
its intended outcomes.
References
Bahr, S., Hoffman, J., & Yang, X. (2005) . Parental and peer
influence on the risks of adolescent drug
use. journal ofPrirnary Prevention, 26, 529- 551.

Bickman, L. (1987) . The function of program theory. In L.
Bickman (Ed .), New directions in evalu-
ation: Vol. 33. Using program theory in evaluation (pp. 1- 16).
San Francisco: Jossey- Bass.
Brown, E. C., Hawkins, J. D., Arthur, M. W., Briney, J. S., &
Abbot t, R. D. (2007) . Effects of
Comm un ities that Care on prevention services systems:
Findings from the Community Youth
Devcloprnenl sLudy at 1.5 years. Prevention Science, 8, 180-
191.
Chen, H.-I., & Ross i, P. H. (1983) . Evaluating with sense: The
theory-driven approach. Evaluation
Review, 7, 283- 302.
Chinrnan, M., Imrn, P., & Wandersman, A. (2004). Geuing to
outcomes 2004. Santa Monica, CA:
RAND Corporation.
Dvvyer, J. J. M., & Makin, S. (1997) . Usi ng a program logic
model that focuses on perfo rmance mea-
surement to develop a program. Canadian journal of Public
Health, 88, 421-425.
Frechtling, J. A. (2007). Logic modeling methods in program
evaluat.ion. San Francisco: Jossey-Bass.
Harrell, A., Burt, M ., Hatry, H ., Rossman, S., & I"l.oth, J. (
1996). Evaluation strategies for human
services programs: A guide for policy make1·s and providers.
Wash ington , DC: The Urban
Institute.
McLaughlin, J. A. , & Jordan, G. B. (1999) . Logic models: A

tool fo r tell ing you r program's pe rfor-
mance stor y. Evaluation and Program Plar~ning, 22, 65- 72.
McLaughlin, J. A., & Jordan, G. B. (2004). Using logic models.
In J. S. Wholey, H. P. Hatry, & K. E.
Newcomer (Eds.), Handbook of program evaluatiOn (pp. 7- 32).
San Francisco: )ossey- Bass.
Mertinko, E., Novotney, L. C., Baker, T. K., & Lange, J.
(2000). Evalual'ing your program: A beginner's
self-evaluation workbook for mentoring programs. Potomac,
MD: Information Technology
International.
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Patton, M. (2002). Qualitative research and evaluation methods
(3rd ed.). Thousand Oaks, CA: Sage.
Radloff, L. S. (1977). The CES-D scale: A self-report
depression scale for research in the general
popuJation. Applied Psychological Measurement, 3, 385-401.
Rossi, P. H., Lipsey, M. W., & Freeman, I I. E. (2004) .
Evaluation: A systematic approach. Thousand
Oaks, CA: Sage.
United Way of America. (1996). Measuring program outcomes:
A practical approach. Retr ieved
N ovem ber I I, 2007, from ww·w.unitedway.o rg/Outcom
es/Resources/MPO/iudcx.cfm
Unrau, Y. A. (2001). Using client exit interviews to ill uminate
outcomes in program logic models: A

case example. Evaluation and Program Planning, 24, 353-361.
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children and families: A guide for public-private
child care partnerships. Retrieved ~ovember 11, 2007, from
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resource.htm
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W. K. Kellogg Foundation . (2001) . Logic model development
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fr om h ttp://www. wkkf.org/d efau lt.aspx?tabid= l 01 &Cm
=28l&Catl0=28 l &ltemTD- 28 13669&
N ID= 20&La nguageiD=O
http:/ /www.wkkf.org
Web site from theW. K. Kellogg Foundation conta ining useful
templates and exercises in developing
a logic model for a resea rch proj ect.
http:/
/www.unitedway.org/Outcomes/Resources/MPO/index.cfm
Web site from the United Way's Outcome Mea su rement
Resource Network, demonstra ting th e use of
logic models in cla rifying and com municating outcomes.
http:/ /www.cdc.gov/eval/resources.htm#logic%20modcl
Web site from the Centers for Disease Control and Prevention's
Evaluatio1 Working Group, containing
logic model resources.

1. Define the term logic model.
2. Describe th e difference between program activities, program
outputs, and program outcomes.
3. Discuss the purpose of including lines with arrows in logic
models.
4. Discuss the relationship between a program's theory of
change and its logic model.
5. Describe the uses of logic models.
SESSIONS
Case Histories
Editors
Sara-Beth Plummer
Sara Makris
Sally Margaret Brocksen
Published by
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Editorial Services: Christina Myers
Copyright © 2014 by Laureate Education, Inc.
All rights reserved. No part of this publication may be
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ISBN-13: 978-1-62458-012-3 (VitalSource edition)
First Edition 14 15 16 17 18 / 10 9 8 7 6 5 4 3 2 1
Editors
Sara-Beth Plummer, PhD, MSW
Walden University
Sara Makris, PhD
Laureate Education, Inc.
Sally Margaret Brocksen, PhD, MSW
Walden University

Contributors
Marlene Coach, EdD, MSW, ACSW, LSW
Walden University
Eileen V. Frishman, MSW, ACSW, LCSW-R, CH
Mary E. Larscheid, PhD, MSW, LICSW
Walden University
Vanessa Norris, MSW, LCSW
West Chester University
Sara-Beth Plummer, PhD, MSW
Walden University
Stephanie C. Sanger, MA, MSS, LSW
Assistant Director, RHD, Tri-County Supportive Housing
Eric Youn, PhD, LMSW
Walden University
iii
Contents
Introduction 1
Part 1: Foundation Year 2
The Hernandez Family 3
The Parker Family 6

The Logan Family 9
The Johnson Family 11
Part 2: Concentration Year 14
The Levy Family 15
The Bradley Family 17
The Petrakis Family 20
The Cortez Family 23
Appendix 26
Reflection Questions 27
The Hernandez Family 27
The Parker Family 28
The Logan Family 30
The Johnson Family 31
The Levy Family 32
The Bradley Family 33
The Petrakis Family 35
The Cortez Family 36
Trademarks and Disclaimers 38

iv
Introduction
The following eight cases are based on the true experiences of
social workers in the field, although names and other
identifying circumstances have been changed. The narratives in
this book, combined with filmed repre-
sentations of scenes inspired by the cases, provide you an
opportunity to use true-to-life cases as an experiential
learning tool. Whereas some academic programs, professors, or
instructors may offer an occasional glimpse into
past social work experiences, this book and these cases weave
through multiple courses in your foundation and
concentration year. Like in true-to-life practice, you will follow
these cases through a variety of circumstances, prac-
tice behaviors, and learning opportunities. This unique format
for a social work program enables you to integrate
and connect the expected learning outcomes for each course.
Each case either explicitly or implicitly offers content
on practice skills, research, human behavior theory, and policy.
Further, you will see that each family’s concerns can
be addressed across all levels of practice, from micro to mezzo
to macro.
Approach this book as a series of cases to which you have been
assigned during your first professional experi-
ence in social work. We encourage you to use a critical eye to
analyze the approaches provided. Remember that
each practitioner has his or her own lens or perspective that
guides his or her practice and these cases, written in
the voices of each individual social worker, offer you authentic,
varied perspectives. As you review and dissect these

cases, consider your own lens and perspective as a future social
worker.
The families described in these cases have been connected to
social work services in myriad ways. Look closely at
how each family member is introduced to the social worker and
at the services and interventions that follow. Through
reading these cases and then watching them come to life on
video, you will see the skills used by social work practi-
tioners. Carefully identify for yourself how the social worker
engages, assesses, and intervenes with his or her client.
The social workers who provided these cases offer some of their
own personal thoughts about these cases as
a series of reflection questions. Use the answers to the
questions, posed to the social workers as they wrote these
stories, to gain additional insight into the decisions they made
to address their clients’ concerns. Reflect on the ques
tions and answers as a way to consider whether you would have
addressed the client or clients in the same manner.
Imagine your first day of practice, preparing for your first client
meeting. On your desk is a folder with the last
name of the client on the tab. You open the folder to find a case
history for your client—perhaps it details family
background, medical history, or an accounting of interactions
with other agencies. This book is like that folder,
preparing you for the client you will soon meet.
1
PART 1: FOUNDATION YEAR

2
The Hernandez Family
Juan Hernandez (27) and Elena Hernandez (25) are a married
Latino couple who were referred to the New York City
Administration for Children Services (ACS) for abuse
allegations. They have an 8-year-old son, Juan Jr.,
and a 6-year-old son, Alberto. They were married 7 years ago,
soon after Juan Jr. was born. Juan and Elena were
both born in Puerto Rico and raised in Queens, New York. They
rent a two-bedroom apartment in an apartment
complex where they have lived for 7 years. Elena works as
babysitter for a family that lives nearby, and Juan works
at the airport in the baggage department. Overall, their physical
health is good, although Elena was diagnosed with
diabetes this past year and Juan has some lower back issues
from loading and unloading bags. Both drink socially
with friends and family. Juan goes out with friends on the
weekends sometimes to “blow off steam,” having six to
eight beers, and Elena drinks sparingly, only one or two drinks
a month. Both deny any drug use at all. While they
do not attend church regularly, both identify as being Catholic
and observe all religious holidays. Juan was arrested
once as a juvenile for petty theft, but that has been expunged
from his file. Elena has no criminal history. They
have a large support network of friends and family who live
nearby, and both Elena’s and Juan’s parents live within
blocks of their apartment and visit frequently. Juan and Elena
both enjoy playing cards with family and friends on
the weekends and taking the boys out to the park and beach near
their home.

ACS was contacted by the school social worker from Juan Jr.’s
school after he described a punishment his parents
used when he talked back to them. He told her that his parents
made him kneel for hours while holding two encyclo-
pedias (one in each hand) and that this was a punishment used
on multiple occasions. The ACS worker deemed this
a credible concern and made a visit to the home. During the
visit, the parents admitted to using this particular form
of punishment with their children when they misbehaved. In
turn, the social worker from ACS mandated the family
to attend weekly family sessions and complete a parenting
group at their local community mental health agency.
In her report sent to the mental health agency, the ACS social
worker indicated that the form of punishment used by
the parents was deemed abusive and that the parents needed to
learn new and appropriate parenting skills. She also
suggested they receive education about child development
because she believed they had unrealistic expectations of
how children at their developmental stage should behave. This
was a particular concern with Juan Sr., who repeat-
edly stated that if the boys listened, stayed quiet, and followed
all of their rules they would not be punished. There
was a sense from the ACS worker that Juan Sr. treated his sons,
especially Juan Jr., as adults and not as children.
This was exhibited, she believed, by a clear lack of patience and
understanding on his part when the boys did not
follow all of his directions perfectly or when they played in the
home. She mandated family sessions along with the
parenting classes to address these issues.
During the intake session, when I met the family for the first
time, both Juan and Elena were clearly angry that
they had been referred to parenting classes and family sess ions.
They both felt they had done nothing wrong, and
they stated that they were only punishing their children as they
were punished as children in Puerto Rico. They said

that their parents made them hold heavy books or other objects
as they kneeled and they both stressed that at times
the consequences for not behaving had been much worse. Both
Juan and Elena were “beaten” (their term) by their
parents. Elena’s parents used a switch, and Juan’s parents used
a belt. As a result, they feel they are actually quite
lenient with their children, and they said they never hit them
and they never would. Both stated that they love their
children very much and struggle to give them a good life. They
both stated that the boys are very active and don’t
always follow the rules and the kneeling punishment is the only
thing that works when they “don’t want to listen.”
They both admitted that they made the boys hold two large
encyclopedias for up to two hours while kneeling
when they did something wrong. They stated the boys are
“hyperactive” and “need a lot of attention.” They said
they punish Juan Jr. more often because he is particularly
defiant and does not listen and also because he is older
and should know better. They see him as a role model for his
younger brother and feel he should take that respon-
sibility to heart. His misbehavior indicates to them that he is not
taking that duty seriously and therefore he should
be punished, both to learn his lesson and to show his younger
brother what could happen if he does not behave.
During the intake meeting, Juan Sr. stated several times that he
puts in overtime any time he can because money
is “tight.” He expressed great concern about having to attend
the parenting classes and family sessions, as it would
interfere with that overtime. Elena appeared anxious during the
initial meeting and repeatedly asked if they were
going to lose the boys. I told her I could not assure her that they
would not, but I could assist her and her husband
through this process by making sure we had a plan that satisfied
the ACS worker’s requirements. I told them it

3
SESSIONS: CASE HISTORIES • THE HERNANDEZ FAMILY
would be up to them to complete those plans successfully. I
offered
my support through this process and conveyed empathy around
their
response to the situation.
Juan Hernandez: father, 27
Elena Hernandez: mother, 25
Juan Hernandez Jr.: son, 8
Alberto Hernandez: son, 6
or immediately after the PPP so that they did not have to come
to
the agency more than once a week. They agreed that this would
be helpful because they did not have money for
multiple trips to the agency, although Juan Sr. stated that this
would still affect his ability to work overtime on that
day. I asked if they had any goals they wanted to work toward
during our sessions. Initially they were reluctant to
share anything, and then Elena suggested that a discussion on
money management would be helpful. I told them
I w ould be their primary contact at the agency—meeting with
them for the family sessions and co-facilitating the
PPP group with an intern. I explained my limitations around

confidentiality, and they signed a form acknowledging
that I was required to share information about our sessions with
the ACS worker. I informed them that the PPP is an
evidenced-based program and explained its meaning. I informed
them that there is a pre- and post-test administered
along with the program and specific guidelines about missed
classes. They were informed that if they missed more
than three classes, their participation would be deemed
incomplete and they would not get their PPP certification.
Initially, when the couple attended parenting sessions and
family sessions, Juan Sr. expressed feelings of anger
and resentment for being mandated to attend services at the
agency. Several times he either refused to participate
by remaining quiet or spoke to the social worker and intern in a
demeaning manner. He did this by questioning our
ability to teach the PPP and the effectiveness of the program
itself, wanting to know how this was going to make
him a better parent. He also reiterated his belief that his form of
discipline worked and that it was exactly what his
family members used for years on him and his relatives. He
asked, “If it worked for them, why can’t that form of
punishment work for me and my children?” He emphasized that
these were his children. He maintained throughout
the sessions that he never hit his children and never would.
Both he and Elena often talked about their love for their
children and the devastation they would feel if they were ever
taken away from them.
Treatment consisted of weekly parenting classes with the goal
of teaching them effective and safe discipline skills
(such as setting limits through the use of time-out and taking
away privileges). Further, the classes emphasized the
importance of recognizing age-appropriate behavior. We spent
sessions reviewing child development techniques to
help boost their children’s self-esteem and sense of confidence.

We also talked about managing one’s frustration
(such as when to take a break when angry) and helping their
children to do the same.
Family sessions were built around helping the family members
express themselves in a safe environment. The
parents and the children were asked to talk about how they felt
about each other and the reason they were mandated
to treatment. They were asked to share how they felt while at
home interacting with one another. I thought it was of
particular importance to have them talk about their feelings
related to the call to ACS, as I was unsure how Juan Sr.
felt about Juan Jr.’s report to the social worker. It was
necessary to assist them with processing this situation so that
there were no residual negative feelings between father and son.
I asked them to role-play—having each member act
like another member of the household. This was very effective
in helping Juan Sr. see how his boys view him and
his behavior toward them when he comes home from work. As a
result of this exercise, he verbalized his newfound
clarity around how the boys have been seeing him as a very
angry and negative father.
I also used sessions to explore the parents’ backgrounds. Using
a genogram, we identified patterns among their
family members that have continued through generations. These
patterns included the use of discipline to maintain
order in the home and the potentially unrealistic expectations
the elders had for their children and grandchildren.
Elena stated that she was treated like an adult and had the
responsibilities of a person much older than herself while
she was still very young. Juan Sr. said he felt responsible for
bringing money into the home at an early age. He was
forced by his parents to get working papers as soon as he turned
14. His paychecks were then taken by his parents
each week and used to pay for groceries and other bills. He

expressed anger at his parents for encouraging him to
drop out of high school so that he could get more than one job
to help out with the finances.
Other sessions focused on the burden they felt related to their
finances and how that burden might be felt by
the boys, just as Juan Sr. might have felt growing up. In one
session, Juan Jr. expressed his fears of being evicted
and the lights being turned off, because his father often talked
of not having money for bills. Both boys expressed
sadness over the amount of time their father spent at work and
stressed their desire to do more things with him
at night and on the weekends. Both parents stated they did not
realize the boys understood their anxieties around
4
Together we discussed the plan for treatment, following the
requirements of ACS; they would attend a 12-week Positive
Parenting
Program (PPP) along with weekly family sessions. In an effort
to
reduce some of the financial burden of attending multiple
meetings
at the agency, I offered to meet with the family either just
before
SESSIONS: CASE HISTORIES • THE HERNANDEZ FAMILY
paying bills and felt sad that they worried about these issues.
We also
took a couple of sessions to address money management. We
worked
together to create a budget and identify unnecessary expenses

that
might be eliminated.
It was clear that this was a family that loved each other very
much.
Juan Sr. and Elena were often affectionate with each other and
their
sons. Once the initial anger subsided, both Juan Sr. and Elena
fully
Key to Acronyms
ACS: Administration for
Children Services
PPP: Positive Parenting Program
engaged in both the family sessions and the PPP. We assessed
their progress monthly and highlighted that progress.
I also was aware that it was important to learn about the
Hernandez family history and culture in order to under-
stand their perspective and emotions around the ACS referral. I
asked them many questions about their beliefs,
customs, and culture to learn about how they view parenthood,
marriage roles, and children’s behaviors. They were
always open to these questions and seemed pleased that I asked
about these things rather than assumed I knew the
answers.
During the course of treatment they missed a total of four PPP
classes. I received a call from Elena each time
letting me know that Juan Sr. had to work overtime and they
would miss the class. She was always apologetic and
would tell me she would like to know what they missed in the
class so that she could review it on her own. During
a call after the fourth missed parenting class, I reminded Elena

that in order to obtain the certificate of completion,
they were expected to attend a minimum of nine classes. By
missing this last class, I explained, they were not going
to get the certificate. Elena expressed fear about this and asked
if there was any way they could still receive it. She
explained that they only had one car and that she had to miss
the classes when Juan Sr. could not go because she
had no way of getting to the agency on her own. I told her that I
did not have the authority to change the rules
around the number of classes missed and that I understood how
disappointed she was to hear they would not get
the certificate. When I told her I had to call the ACS worker and
let her know, Elena got very quiet and started to
cry. I spoke with her for a while, and we talked about the
possible repercussions.
I met with my supervisor and informed her of what had
occurred. I knew I had to tell the ACS worker that they
would not receive the certificate of completion this round, and I
felt bad for the situation Juan Sr. and Elena and
their boys were now in. I had been meeting with them for family
sessions and parenting classes for almost three
months by this point and had built a strong rapport. I feared that
once I called the ACS worker, that rapport would
be broken and they would no longer want to work with me. I
saw them as loving and caring parents who were trying
the best they could to provide for their family. They had been
making progress, particularly Juan Sr., and I did not
want their work to be in vain.
I also questioned whether the parenting and family sessions
were really necessary for their situation. I felt there
was a lack of cultural competence on the part of the ACS
worker—she had made some rather judgmental and
insensitive comments on the phone to me during the referral. I
wondered if there was a rush to judgment on her

part because their form of discipline was not commonly used in
the United States. In my own professional opinion,
some time-limited education on parenting and child
development would have sufficed, as opposed to the 3-month
parenting program and family sessions.
My supervisor and I also discussed the cultural competence at
the agency and the fact that the class schedule may
not fit a working family’s life. We discussed bringing this
situation to a staff meeting to strategize and see if we had
the resources to offer the PPP multiple times during the week,
perhaps allowing clients to make up a class on a day
other than their original class day.
I met with Elena and Juan Sr. and let them know I had to
contact the ACS worker about the missed classes.
I explained that this was something I had to do by law. They
told me they understood, although another round of
parenting classes would be a financial burden and they had
already struggled to attend the current round of classes
each week. I validated their concerns and told them we were
going to look at offering the program more than once
a week. I also told them that when I spoke to the ACS worker, I
would also highlight their progress in family and
parenting sessions.
I called the ACS worker and told her all the positive progress
the parents had made over the previous 3 months
before letting her know that they had missed too many classes
to obtain the PPP certificate. The ACS worker was
pleased with the progress I described but said she would
recommend to her supervisor that the parents take the
PPP over again until a certificate was obtained. She would wait
to hear what her supervisor’s decision was on this
matter. She said that family sessions could end at this point. In
the end, the supervisor decided the parents needed

to come back to the agency and just make up the four classes
they missed. Elena and Juan Sr. were able to complete
this requirement and received their certificate, and the ACS
case was closed. They later returned on their own for a
financial literacy class newly offered at the agency free of
charge.
5
The Parker Family
Sara is a 72-year-old widowed Caucasian female who lives in a
two-bedroom apartment with her 48-year-old daughter,
Stephanie, and six cats. Sara and her daughter have lived
together for the past 10 years, since
Stephanie returned home after a failed relationship and was
unable to live independently. Stephanie has a diagnosis
of bipolar disorder, and her overall physical health is good.
Stephanie has no history of treatment for alcohol or
substance abuse; during her teens she drank and smoked
marijuana but no longer uses these substances. When
she was 16 years old, Stephanie was hospitalized after her first
bipolar episode. She had attempted suicide by swal-
lowing a handful of Tylenol® and drinking half a bottle of
vodka after her first boyfriend broke up with her. She has
been hospitalized three times in the past 4 years when she
stopped taking her medications and experienced suicidal
ideation. Stephanie’s current medications are Lithium, Paxil®,
Abilify®, and Klonopin®.
Stephanie recently had a brief hospitalization as a result of
depressive symptoms. She attends a mental health
drop-in center twice a week to socialize with friends and

receives outpatient psychiatric treatment at a local mental
health clinic for medication management and weekly therapy.
She is maintaining a part-time job at a local super-
market where she bags groceries and is currently being trained
to become a cashier. Stephanie currently has active
Medicare and receives Social Security Disability (SSD).
Sara has recently been hospitalized for depression and has some
physical issues. She has documented high
blood pressure and hyperthyroidism, she is slightly
underweight, and she is displaying signs of dementia. Sara has
no history of alcohol or substance abuse. Her current
medications are Lexapro® and Zyprexa®. Sara has Medicare
and receives Social Security benefits and a small pension. She
attends a day treatment program for seniors that
is affiliated with a local hospital in her neighborhood. Sara
attends the program 3 days a week from 9:00 a.m. to
2:00 p.m., and van service is provided free of charge.
A telephone call was made to Adult Protective Services (APS)
by the senior day treatment social worker when
Sara presented with increased confusion, poor attention to daily
living skills, and statements made about Stephanie’s
behavior. Sara told the social worker at the senior day treatment
program that, “My daughter is very argumentative
and is throwing all of my things out.” She reported, “We are
fighting like cats and dogs; I’m afraid of her and of
losing all my stuff.”
During the home visit, the APS worker observed that the living
room was very cluttered, but that the kitchen was
fairly clean, with food in the refrigerator and cabinets. Despite
the clutter, all of the doorways, including the front
door, had clear egress. The family lives on the first floor of the
apartment building and could exit the building without
difficulty in case of emergency. The litter boxes were also fairly

clean, and there was no sign of vermin in the home.
Upon questioning by the APS worker, Sara denied that she was
afraid of her daughter or that her daughter had
been physically abusive. In fact, the worker observed that
Stephanie had a noticeable bruise on her forearm, which
appeared defensive in nature. When asked about the bruise,
Stephanie reported that she had gotten it when her
mother tried to grab some items out of her arms that she was
about to throw out. Stephanie admitted to throwing
things out to clean up the apartment, telling the APS worker,
“I’m tired of my mother’s hoarding.” Sara agreed with
the description of the incident. Both Sara and Stephanie
admitted to an increase in arguing, but denied physical
violence. Sara stated, “I didn’t mean to hurt Stephanie. I was
just trying to get my things back.”
The APS worker observed that Sara’s appearance was unkempt
and disheveled, but her overall hygiene was
adequate (i.e., clean hair and clothes). Stephanie was neatly
groomed with good hygiene. The APS worker deter-
mined that no one was in immediate danger to warrant removal
from the home but that the family was in need of
a referral for Intensive Case Management (ICM) services. It was
clear there was some conflict in the home that had
led to physical confrontations. Further, the house had hygiene
issues, including trash and items stacked in the living
room and Sara’s room, which needed to be addressed. The APS
worker indicated in her report that if not adequately
addressed, the hoarding might continue to escalate and create an
unsafe and unhygienic environment, thus leading
to a possible eviction or recomme ndation for separation and
relocation for both women.
As the ICM worker, I visited the family to assess the situation
and the needs of the clients. Stephanie said she

was very angry with her mother and sick of her compulsive
shopping and hoarding. Stephanie complained that
they did not have any visitors and she was ashamed to invite
friends to the home due to the condition of the apart-
ment. When I asked Sara if she saw a problem with so many
items littering the apartment, Sara replied, “I need
all of these things.” Stephanie complained that when she tried to
clean up and throw things out, her mother went
6
SESSIONS: CASE HISTORIES • THE PARKER FAMILY
7
outside and brought it all back in again. We discussed the need
to
clean up the apartment and make it habitable for them to remain
in their home, based on the recommendations of the APS
worker. I
also discussed possible housing alternatives, such as senior
housing
for Sara and a supportive apartment complex for Stephanie. Sara
and Stephanie both stated they wanted to remain in their
apartment
together, although Stephanie questioned whether her mother
would
cooperate with cleaning up the apartment. Sara was adamant
that she did not want to be removed from their apart-
ment and would try to accept what needed to be done so they
would not be forced to move.

Stephanie reported her mother is estranged from her younger
sister, Jane, because of the hoarding. Stephanie
also mentioned she was dissatisfied with her mother’s
psychiatric treatment and felt she was not getting the help
she needed. She reported that her mother was very anxious and
was having difficulty sleeping, staying up until all
hours of the night, and buying items from a televised shopping
network. Sara’s psychiatrist had recently increased
her Zyprexa prescription dosage to help reduce her agitation and
possible bipolar disorder (as evidenced by the
compulsive shopping), but Stephanie did not feel this had been
helpful and actually wondered if it was contributing
to her mother’s confusion. I asked for permission to contact
Jane and both of their outpatient treatment teams, and
both requests were granted.
I immediately contacted Jane, who initially was uncooperative
and stated she was unwilling to assist. Jane is
married, with three children, and lives 3 hours away. At the
beginning of our phone call, Jane said, “I’ve been
through this before and I’m not helping this time.” When I
asked if I could at least keep in touch with her to keep her
informed of the situation and any decisions that might need to
be made, Jane agreed. After a few more minutes of
discussion around my role and responsibilities, I was able to
establish a bit of rapport with Jane. She then started to
ask me questions and share some insight into what was going on
in her mother and sister’s home.
Jane informed me that she was very angry with her mother and
had not brought her children to the apartment
in years because of its condition. She said that her mother
started compulsively shopping and hoarding when she
and Stephanie were in high school, and while her father had
tried to contain it as best he could, the apartment was
always cluttered. She said this had been a source of conflict and

embarrassment for her and Stephanie all of their
lives. She said that after her father died of a heart attack, the
hoarding got worse, and neither she nor Stephanie
could control it. Jane also told me she felt her mother was
responsible for Stephanie’s relapses. Jane reported that
Stephanie had been compliant with her medication and
treatment in the past, and that up until a few years ago, had
not been hospitalized for several years. Jane had told Stephanie
in the past to move out.
Jane also told me that she “is angry with the mental health
system.” Sara had been recently hospitalized for
depression, and Jane took pictures of the apartment to show the
inpatient treatment team what her mother was
going home to. Jane felt they did not treat the situation
seriously because they discharged her mother back to the
apartment. Stephanie had been hospitalized at the same time as
her mother, but in a different hospital, and Jane had
shown the pictures to her sister’s treatment team as well.
Initially the social worker recommended that Stephanie not
return to the apartment because of the state of the home, but
when that social worker was replaced with someone
new, Stephanie was also sent back home.
When I inquired if there were any friends or family members
who might be available and willing to assist in
clearing out the apartment, Jane said her mother had few friends
and was not affiliated with a church group or
congregation. However, she acknowledged that there were two
cousins who might help, and she offered to contact
them and possibly help herself. She said that she would ask her
husband to help as well, but she wanted assurance
that her mother would cooperate. I explained that while I could
not promise that her mother would cooperate
completely, her mother had stated that she was willing to do
whatever it took to keep living in her home. Jane

seemed satisfied with this response and pleased with the plan.
I then arranged to meet with Sara and her psychiatrist to discuss
her increased anxiety and confusion and the
compulsive shopping. I requested a referral for neuropsyc hiatric
testing to assess possible cognitive changes or
decline in functioning. A test was scheduled, and it indicated
some cognitive deficits, but at the end of testing, Sara
told the psychologist who administered the tests she had
stopped taking her medications for depression. It was
determined Sara’s depression and discontinuation of medication
could have affected her test performance and it
was recommended she be retested in 6 months. I suggested a
referral to a geriatric psychiatrist for Sara, as she
appeared to need more specialized treatment. Sara’s
psychologist was in agreement.
Because they had both stated that they did not want to be
removed from their home, I worked with Sara and
Stephanie as a team to address cleaning the apartment. All
agreed that they would begin working together to clean
the house for 1 hour a day until arrangements were made for
additional help from family members. In an attempt
The Parker Family
Sara Parker: mother, 72
Stephanie Parker: daughter, 48
Jane Rodgers: daughter, 45
SESSIONS: CASE HISTORIES • THE PARKER FAMILY

8
to alleviate Sara’s anxiety around throwing out the items, I
suggested
using three bags for the initial cleanup: one bag was for items
she
could throw out, the second bag was for “maybes,” and the third
was for “not ready yet.” I scheduled home visits at the
designated
cleanup time to provide support and encouragement and to
inter-
vene in disputes. I also contacted Sara’s treatment team to
inform
them of the cleanup plans and suggested that Sara might need
addi-
tional support and observation as it progressed. Jane notified me
that her two cousins were willing to assist with the cleanup,
make
minor repairs, and paint the apartment. Jane offered to schedule
a date that would be convenient for her and her
cousins to come and help out.
We then discussed placement for at least some of the cats,
because six seemed too many for a small apartment.
Sara and Stephanie were at first adamant that they could not
give up their cats, but with further discussion admitted
it had become extremely difficult to manage caring for them all.
They both eventually agreed to each keep their
favorite cat and find homes for the other four. Sara and
Stephanie made fliers and brought them to their respective
treatment programs to hand out. Stephanie also brought fliers
about the cats to her place of employment. Three of
the four cats were adopted within a week.
During one home visit, Stephanie pulled me aside and said she
had changed her mind—she did not want to

continue to live with her mother. She requested that I complete
a housing application for supportive housing stating,
“I want to get on with my life.” Stephanie had successfully
completed cashier training, and the manager of the super-
market was pleased with her performance and was prepared to
hire her as a part-time cashier soon. She expressed
concern about how her mother would react to this decision and
asked me for assistance telling her.
We all met together to discuss Stephanie’s decision to apply for
an apartment. Sara was initially upset and had
some difficulty accepting this decision. Sara said she had fears
about living alone, but when we discussed senior
living alternatives, Sara was adamant she wanted to remain in
her apartment. Sara said she had lived alone for a
number of years after her husband died and felt she could adjust
again. I offered to help her stay in her apartment
and explore home care services and programs available that will
meet her current needs to remain at home.
Key to Acronyms
APS: Adult Protective Services
ICM: Intensive Case Management
services
SSD: Social Security Disability
The Logan Family
Eboni Logan is a 16-year-old biracial African
American/Caucasian female in 11th grade. She is an honors

student, has been taking Advanced Placement courses, and runs
track. Eboni plans to go to college and major
in nursing. She is also active in choir and is a member of the
National Honor Society and the student council. For the
last 6 months, Eboni has been working 10 hours a week at a fast
food restaurant. She recently passed her driver’s
test and has received her license.
Eboni states that she believes in God, but she and her mother do
not belong to any organized religion. Her father
attends a Catholic church regularly and takes Eboni with him on
the weekends that she visits him.
Eboni does not smoke and denies any regular alcohol or drug
usage. She does admit to occasionally drinking
when she is at parties with her friends, but denies ever being
drunk. There is no criminal history. She has had no
major health problems.
Eboni has been dating Darian for the past 4 months. He is a 17-
year-old African American male. According to
Eboni, Darian is also on the track team and does well in school.
He is a B student and would like to go to college,
possibly for something computer related. Darian works at a
grocery store 10–15 hours a week. He is healthy and
has no criminal issues. Darian also denies smoking or regular
alcohol or drug usage. He has been drunk a few times,
but Eboni reports that he does not think it is a problem. Eboni
and Darian became sexually active soon after they
started dating, and they were using withdrawal for birth control.
Eboni’s mother, Darlene, is 34 years old and also biracial
African American/Caucasian. She works as an adminis-
trative assistant for a local manufacturing company. Eboni has
lived with her mother and her maternal grandmother,
May, from the time she was born. May is a 55-year-old African

American woman who works as a paraprofessional
in an elementary school. They still live in the same apartment
where May raised Darlene.
Darlene met Eboni’s father, Anthony, when she was 17, the
summer before their senior year in high school.
Anthony is 34 years old and Caucasian. They casually dated for
about a month, and after they broke up, Darlene
discovered she was pregnant and opted to keep the baby.
Although they never married each other, Anthony has
been married twice and divorced once. He has four other
children in addition to Eboni. She visits her father and
stepmother every other weekend. Anthony works as a mechanic
and pays child support to Darlene.
Recently, Eboni took a pregnancy test and learned that she is 2
months pregnant. She actually did not know
she was pregnant because her periods were not always
consistent and she thought she had just skipped a couple
of months. Eboni immediately told her best friend, Brandy, and
then Darian about her pregnancy. He was shocked
at first and suggested that it might be best to terminate. Darian
has not told her explicitly to get an abortion, but
he feels he cannot provide for her and the baby as he would like
and thinks they should wait to have children. He
eventually told her he would support her in any way he could,
whatever she decides. Brandy encouraged Eboni to
meet with the school social worker.
During our first meeting, Eboni told me that she had taken a
pregnancy test the previous week and it was positive.
At that moment, the only people who knew she was pregnant
were her best friend and boyfriend. She had not told
her parents and was not sure how to tell them. She was very
scared about what they would say to her. We talked
about how she could tell them and discussed various responses

she might receive. Eboni agreed she would tell her
parents over the weekend and see me the following Monday.
During our meeting I asked her if she used contracep-
tion, and she told me that she used the withdrawal method.
Eboni met with me that following Monday, as planned, and she
was very tearful. She had told her parents and
grandmother over the weekend. Eboni shared that her mother
and grandmother had become visibly upset when
they learned of the pregnancy, and Darlene had yelled and
called her a slut. Darlene told Eboni she wanted her to
have a different life than she had had and told her she should
have an abortion. May cried and held Eboni in her
arms for a long time. When Eboni told her father, he was
shocked and just kept shaking his head back and forth, not
saying a word. Then he told her that she had to have this child
because abortion was a sin. He offered to help her
and suggested that she move in with him and her stepmother.
Darlene did not speak to Eboni for the rest of the weekend. Her
grandmother said she was scheduling an appoint-
ment with the doctor to make sure she really was pregnant.
Eboni was apprehensive about going to the doctor, so
we discussed what the first appointment usually entails. I
approached the topic of choices and decisions if it was
confirmed that she was pregnant, and she said she had no idea
what she would do.
9
10
SESSIONS: CASE HISTORIES • THE LOGAN FAMILY

Two days later, Eboni came to see me with the results of her
doctor’s appointment. The doctor confirmed the pregnancy, said
her hormone levels were good, and placed her on prenatal
vitamins.
Eboni had had little morning sickness and no overt issues due to
the
pregnancy. Her grandmother went with her to the appointment,
but
her mother was still not speaking to her. Eboni was very upset
about
the situation with her mother. At one point she commented that
parents are supposed to support their kids when they are in
trouble
and that she would never treat her daughter the way her mother
was
treating her. I offered to meet with Eboni and her mother to
discuss
the situation. Although apprehensive, Eboni gave me permission
to call her mother and set up an appointment.
I left a message for Darlene to contact me about scheduling a
meeting. She called back and agreed to meet with
Eboni and me. When I informed Eboni of the scheduled
meeting, she thanked me. She told me that she was going
to spend the upcoming weekend with her father, and that she
was apprehensive about how it would go. When I
approached the topic of a decision about the pregnancy, she
stated that she was not certain but was leaning in
one direction, which she did not share with me. I suggested we
get together before the meeting with her mother to
discuss the weekend with her father.
At our next session, Eboni said she thought she knew what to do
but after spending the weekend with her father
was still confused. Eboni said her father went on at length about
how God gives life, and that if she had an abortion,

she would go to hell. Eboni was very scared. Anthony had taken
her to church and told the priest that Eboni was
pregnant and asked him to pray for her. Eboni said this made
her feel uncomfortable.
When I met with Eboni and her mother, Darlene shared her
thoughts about Eboni’s pregnancy and her belief
that she should have an abortion. She said she knows how hard
it is to be a single mother and does not want this
for Eboni. She believes that because Eboni is so young, she
should do as she says. Eboni was very quiet during the
session, and when asked what she thought, said she did not
know. At the end of the session, nothing was resolved
between Eboni and her mother.
When I met with Eboni the next day to process the session, she
said that when they got home, she and her
mother talked without any yelling. Her mother told Eboni she
loved her and wanted what was best for her. May said
she would support Eboni no matter what she decided and would
help her if she kept the baby.
Eboni was concerned because she thought she was beginning to
look pregnant and her morning sickness had
gotten worse. I addressed her overall health, and she said that
she wanted to sleep all the time, and that when she
was not nauseated, all she did was eat. Eboni is taking her
prenatal vitamins in case she decides to have the baby.
Only a couple of her friends know about the pregnancy, and
they had different thoughts on what they thought
she should do. One friend even bought her a onesie. In addition,
Eboni was concerned that her grades were being
affected by the situation, possibly affecting her ability to attend
college. She was also worried about how a pregnancy
or baby would affect her chances of getting a track scholarship.
In response to her many concerns, I educated her

on stress-reduction methods.
Eboni asked me what I thought she should do, and I told her it
was her decision to make for herself and that she
should not let others tell her what to do. However, I also stated
that it was important for her to know all the options.
We discussed at length what it would mean for her to keep the
baby versus terminating the pregnancy. I mentioned
adoption and the possibility of an open adoption, but Eboni said
she was not sure she could have a baby and then
give it away. We discussed the pros and cons of adoption, and
she stated she was even more confused. I reminded
her that she did not have much time to make her decision if she
was going to terminate. She said she wanted a few
days to really consider all her options.
Eboni scheduled a time to meet with me. When she entered my
office, she told me she had had a long talk with
her mother and grandmother the night before about what she
was going to do. She had also called her father and
Darian and told them what she had decided. Eboni told me she
knows she has made the right decision.
The Logan Family
May Logan: mother of Darlene, 55
Darlene Logan: mother, 34
Anthony Jennings: father, 34
Eboni Logan: daughter, 16
Darian: Eboni’s boyfriend, 17

The Johnson Family
Talia is a 19-year-old heterosexual Caucasian female, who is a
junior majoring in psychology and minoring in English. She has
a GPA of 3.89 and has been on the dean’s list several times over
the last 3 years. She has
written a couple of short articles for the university’s newspaper
on current events around campus and is active in
her sorority, Kappa Delta. She works part time (10–15 hours a
week) at an accessory store. Talia recently moved off
campus to an apartment with two close friends from her
sorority. She is physically active and runs approximately
three miles a day. She also goes to the university’s gym a
couple of days a week for strength training. Talia does not
use drugs, although she has smoked marijuana a few times in
her life. She drinks a few times a week, often going out
with friends one day during the week and then again on Friday
and Saturday nights. When she is out with friends,
Talia usually has about four to six drinks. She prefers to drink
beer over hard liquor or wine, but will occasionally
have a mixed drink.
Talia has no criminal history. She reports a history of anxiety in
her family (on her mother’s side), and on a few
occasions has experienced heart palpitations, which her mother
told her was due to nervousness. This happened
only a handful of times in the past and usually when Talia was
“very stressed out,” so Talia had never felt the need
to go to the doctor or talk to someone about it until now. Talia
is currently not dating anyone. She was in a relation-
ship for 1

1
2 years, but it ended a few months ago. She had since been
“hooking up” with a guy in one of her English
classes, but does not feel it will turn into anything serious and
has not seen him in several weeks.
Talia’s parents, Erin (40) and Dave (43), and her siblings, Lila
(16) and Nathan (14), live 2 hours away from
the university. Erin works at a salon as a hairdresser, and Dave
is retired military and works for a home security
company. Erin is on a low-dose antidepressant for anxiety,
something she has been treated for all of her life.
Talia came to see me at the Rape Counseling Center (RCC) on
campus for services after she was sexually
assaulted at a fraternity party 3 weeks prior. She told me she
had thought she could handle her feelings after the
assault, but she had since experienced a number of emotions and
behaviors she could no longer ignore. She was not
sleeping, she felt sad most days, she had stopped going out with
friends, and she had been unable to concentrate on
schoolwork. Talia stated that the most significant issues she had
faced since the assault had been recurrent anxiety
attacks.
Talia learned about the RCC when she went to the hospital after
the sexual assault. She went to the hospital to
request that a rape kit be completed and also requested the
morning-after pill and the HIV prevention protocol (Post-
Exposure Prophylaxis, or PEP). At that time, a nurse contacted
me through the Sexual Assault Response Team
(SART) to provide Talia with support and resources. I spent
several hours with Talia at the hospital while she went
through the examination process. Talia shared bits and pieces of
the evening with me, although she said most of

the night was a blur. She said a good-looking guy named Eric
was flirting with her all night and bringing her drinks.
She did not want to seem ungrateful and enjoyed his company,
so she drank. She also mentioned that the drinks
were made with hard liquor, something that tends to make her
drunk faster than beer. She said that at one point she
blacked out and has no idea what happened. She woke up naked
in a room alone the next morning, and she went
straight to the hospital. Once Talia was done at the hospital, I
gave her the contact information for RCC. I encour-
aged her to call if she had any questions or needed to talk with
someone.
During our first meeting at the RCC, I provided basic
information about our services. I let her know that every-
thing was confidential and that I wanted to help create a safe
space for her to talk. I told her that we would move
along at a pace that was comfortable for her and that this was
her time and we could use it as she felt best. We talked
briefly about her experience at the hospital, which she described
as cold and demeaning. She told me several times
how thankful she was that I had been there. She said one of the
reasons she called the RCC was because she felt I
supported and believed her. I used the opportunity to validate
her feelings and remind her that I did, in fact, believe
her and that the assault was not her fault.
We talked briefly about how Talia had been feeling over the last
3 weeks. She was very concerned about her
classes because she had missed a couple of assignment
deadlines and was fearful of failing. She told me several
times this was not like her and she was normally a very good
student. I told her I could contact the professors
and advocate for extensions without disclosing the specific
reason Talia was receiving counseling services and
would need additional time to complete her assignments. Talia

thanked me and agreed that would be best. I intro-
duced the topic of safety and explained that she might possibly
see Eric on campus, something that might cause
11
SESSIONS: CASE HISTORIES • THE JOHNSON FAMILY
her emotional distress. We talked about strategies she could use
to protect herself, and she agreed to walk with a friend while on
campus for the time being. She also agreed she would avoid the
gym where she had seen Eric before.
During our second meeting, Talia seemed very anxious.
We talked about how she had been feeling over the last week,
and
she indicated she was still not sleeping well at night and that
she
was taking long naps during the day. She had missed days at
work,
something she had never done before, and was in jeopardy of
losing
her job. Talia reported experiencing several anxiety attacks as
well.
The Johnson Family
Erin Johnson: mother, 40
Dave Johnson: father, 43

Talia Johnson: daughter, 19
Lila Johnson: daughter, 16
Nathan Johnson: son, 14
She described the attack symptoms as feeling unable to breathe,
accompanied by a swelling in her chest, and an
overwhelming feeling that she was going to die. She said that
this was happening several times a day, although
mostly at night. I provided some education about trauma
responses to sexual assault and the signs and symptoms
of post-traumatic stress disorder (PTSD). We went over a
workbook on trauma reactions to sexual assault and
reviewed the signs and symptoms checklist, identifying several
that she was experiencing. We practiced breathing
exercises to use when she felt anxious, and she reported feeling
better. I told her it was important to identify the
triggers to her anxiety so that we could find out what exactly
was causing her to be anxious in a given moment.
I explained that while the assault itself had brought the attacks
on, it would be helpful to see what specific things
(such as memories, certain times of the day, particular smells,
etc.) caused her to have anxiety attacks. I gave Talia
an empty journal and asked her to record the times of the
episodes over the next week as well as what happened
right before them. She agreed.
We met over several sessions and continued to address Talia’s
anxiety symptoms and feelings of sadness. She
told me she was unable to talk about what happened on the night
of the rape because she felt ashamed. She said
that it was too difficult for her to verbalize what happened and
that the words coming out of her mouth would hurt
too much. I reassured her that we would go at her pace and that

she could talk about what happened when she felt
comfortable. We practiced breathing and reviewed her journal
log each week.
It had become clear that the evenings seemed to be the peak
time for her anxiety, which I told her made sense as
her assault had occurred at night. I described how sleep is often
difficult for survivors of sexual assault because they
fear having nightmares about what happened. She looked
surprised and said she had not mentioned it, but she kept
having dreams about Eric in which he was talking to her at the
party. The dreams ended with him holding her hand
and walking her away. She said she also thought about this
during the day and could actually see it happening in her
mind. We talked about the intrusive thoughts that often occur
after trauma, and I tried to normalize her experience.
I told her that often people try to avoid these intrusions, and I
wondered if she felt she was doing anything to avoid
them. She told me she had started taking a sleep aid at night.
When I asked about her exercise habits, she said that
right after the assault she had stopped running and going to the
gym. We set a goal that she would run one to two
times a week to help her with anxiety and sleeping. I also
suggested that now would be a good time to start writing
her feelings down because journaling is a very useful way to
express feelings when it is difficult to verbalize them.
Talia mentioned that she had decided not to go to the police
about the sexual assault because she did not want to go
through the process. I informed her that if she wanted to, she
could address the assault in another way, by bringing
it to the campus judicial system. She said she would think about
this option.
During another session weeks later, Talia came in distraught.
She said she had been feeling better overall since
working on her breathing and doing the journaling, but that a

few things had happened that were making her more
and more anxious and that her attacks were increasing again.
Talia said her parents were pushing her to drop out
of school and to come home. She said they had been calling and
texting her often, something she found annoying
but understandable. They were very upset about what had
happened, although they were more upset with her that
she had waited for weeks to tell them about “it.” Her father
threatened to come and beat the guy up, and her mother
cried. She avoided talking with them, but they had become
relentless with the calls. Her mother had shown up with
her sister unannounced the previous weekend and had treated
Talia like she had a cold—making chicken soup and
rubbing Talia’s feet. The pressure from her parents was
weighing on her and upsetting her. Talia was also distressed
by a friend who kept pushing her to talk about what happened.
When Talia finally relented, her friend asked her
why she had gone upstairs with him. Talia said this made her
feel terrible, and she started to cry. This friend also
told her that Eric had heard she had gone to the hospital and
was telling people that she had wanted to have sex.
Eric had been telling people she was “all over him” and that she
had taken her own pants off. This made Talia very
angry and upset.
12
SESSIONS: CASE HISTORIES • THE JOHNSON FAMILY
We talked about how there are certain myths in society around
sexual assault and that the victim is often blamed. We also
talked
about how the perpetrator often blames his or her victim to
make

himself or herself feel better. Talia said she has felt some sense
of
blame for what happened and that she should not have drunk so
much. She started to cry. I gently reminded her that she was not
at
fault for Eric’s actions, and her drinking was not an invitation
to have
sex. I reminded her that he should have seen how incapacitated
she
was and that she could not have consented to sex. Talia
continued
to cry. She clearly had a number of emotions she wanted to
express
but was having difficulty sharing them, so I offered her some
clay and
asked her to use it to mold representations of different areas in
her
life and how she felt about them. We spent the rest of the
session
talking about the shapes she made and how she felt. Toward the
end of the session she told me she had decided to
put in a complaint with the campus judicial system about the
assault. She worried that Eric would assault another
woman and she would feel responsible if she did not alert the
university. I offered my support and told her I would
be there for her through the process.
13
Key to Acronyms
HIV: Human Immunodeficiency
Virus Infection
PEP: Post-Exposure Prophylaxis

PTSD: Post-Traumatic
Stress Disorder
RCC: Rape Counseling Center
SART: Sexual Assault
Response Team
PART 2: CONCENTRATION YEAR
14
The Levy Family
Jake Levy (31) and Sheri (28) are a married Caucasian couple
who live with their sons, Myles (10) and Levi (8), in a two-
bedroom condominium in a middle-class neighborhood. Jake is
an Iraq War veteran and employed as
a human resources assistant for the military, and Sheri is a
special education teacher in a local elementary school.
Overall, Jake is physically fit, but an injury he sustained in
combat sometimes limits his ability to use his left hand.
Sheri is in good physical condition and has recently found out
that she is pregnant with their third child.
As teenagers, Jake and Sheri used marijuana and drank. Neither
uses marijuana now but they still drink. Sheri
drinks socially and has one or two drinks over the weekend.
Jake reports he has four to five drinks in the evenings

during the week and eight to ten drinks on Saturdays and
Sundays. Neither report having criminal histories.
Jake and Sheri identify as being Jewish and attend a local
synagogue on major holidays. Jake’s parents are
deceased, and he has a sister who lives outside London. He and
his sister are not very close but do talk twice a year.
Sheri is an only child, and her mother lives in the area but
offers little support. Her mother never approved of Sheri
marrying Jake and thinks Sheri needs to deal with their
problems on her own. The couple has some friends, but due
to Jake’s recent behaviors, they have slowly isolated
themselves.
My first encounter with Jake was at an intake session at the
Veterans Affairs Health Care Center (VA). During this
meeting, Jake stated that he came to the VA for services
because his wife had threatened to leave him if he did not
get help. She was particularly concerned about his drinking and
lack of involvement in his sons’ lives. She told him
his drinking had gotten out of control and was making him mean
and distant. Jake had seen Dr. Zoe, a psychiatrist
at the VA, who diagnosed him with post-traumatic stress
disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce
his symptoms of anxiety and depression and suggested that he
also begin counseling.
During the assessment, Jake said that since his return to civilian
life 10 months ago he had experienced difficulty
sleeping, heart palpitations, and moodiness. He told me that he
and his wife had been fighting a lot and that he
drank to take the edge off and to help him sleep. Jake admitted
to drinking heavily nearly every day. He reported
that he was not engaged with his sons at all and he kept to
himself when he was at home. He spent his evenings on
the couch drinking beer and watching TV or playing video

games. When we discussed Jake’s options for treatment
he expressed fear of losing his job and his family if he did not
get help. Jake worked in an office with civilians and
military personnel and mostly got along with people in the
office. Jake tended to keep to himself and said he some-
times felt pressured to be more communicative and social. He
was also very worried that Sheri would leave him. He
said he had never seen her so angry before and saw she was at
her limit with him and his behaviors.
Based on the information Jake provided about his diagnosis and
family concerns, we agreed that the best course
of action would be for him to participate in weekly individual
sessions with me and a weekly support group that
was offered at the VA for Iraq veterans. I then offered a referral
for couples counseling at the local mental health
agency. I also printed out a list of local Alcoholics Anonymous
(AA) meetings in his area if he decided he wanted to
attend in order to address his drinking. He would continue to
follow up with Dr. Zoe on a monthly basis to monitor
the effectiveness of his medications.
The following session, I spent time explaining his diagnosis and
the symptoms related to PTSD. Jake said that he
did not really understand what PTSD was but thought it meant
that a person who had it was “going crazy,” which
at times he thought was happening to him. He expressed
concern that he would never feel “normal” again and said
that when he drank alcohol, his symptoms and the intensity of
his emotions eased. I explained to Jake that PTSD is
a severe anxiety disorder that develops after a person has
experienced an event that results in psychological trauma.
The event may involve the threat or perceived threat of death to
oneself or to someone else. I also explained that
the disorder is characterized by re-experiencing the traumatic
event, including the symptoms of increased arousal,

and by the desire to avoid stimuli associated with the trauma.
We talked about how his behaviors fit into this cycle
of hyperarousal and avoidance, including his lack of sleep and
irritability and the isolation and heavy drinking.
He talked about always feeling “ready to go.” He said he was
exhausted from being always alert and looking for
potential problems around him. He told me he always felt on
edge and every sound seemed to startle him.
He shared that he often thinks about what happened “over there”
but tries to push it out of his mind. It is the
night that is the worst as he has terrible recurring nightmares of
one particular event. He said he wakes up shaking
and sweating most nights. He then said drinking was the one
thing that seemed to give him a little relief. I gave him
a handout on PTSD and reviewed the signs and symptoms. Jake
seemed relieved to receive the information. I told
15
SESSIONS: CASE HISTORIES • THE LEVY FAMILY
him that naming the issue or concern was often helpful in the
healing
process. During the first few sessions my goal was to help Jake
feel
safe and validate his feelings. We consistently assessed his
feelings of
safety, including any potential suicidal ideation. He was
reluctant to
attend AA at that time, so we began monitoring his drinking and
his
behaviors after several drinks.

The Levy Family
Jake Levy: father, 31
Sheri Levy: mother, 28
Myles Levy: son, 10
Levi Levy: son, 8 Jake began his individual sessions practicing
techniques I had
shown him to help reduce his anxiety symptoms. We used deep
breathing and guided meditation to help him remain calm and in
the
moment. We started to chart when he had intrusive thoughts
about the war, potential triggers to his hyperarousal,
and when he tried to dissociate or numb in reaction to these
episodes.
Jake slowly began to share his experiences while in combat. I
helped to gently guide him through the events that
seemed to haunt him the most. I explained that telling one’s
story in effect helped him “own it,” and in turn it would
be integrated into his life on his terms. I told him that the act of
telling his story can actually change the processing
of the traumatic event in his brain. I was careful through this
process not to push him into talking about events that
seemed too traumatic for fear of re-traumatizing him. There
were many sessions in which he started to share a
specific event and then stopped mid-story and had to begin his
relaxation exercises.
During this time he had also started participating in the
veterans’ support group. Jake reported that he was
uneasy during the first couple of meetings because he did not
know anyone, but that the other vets were supportive.

He said it was helpful to hear from others who experienced the
same feelings he had since he returned home.
He said he no longer felt alone nor did he feel “crazy.” Jake
also shared that he had started attending AA meetings.
While I did not participate in the couples’ sessions, Jake felt it
was important that I hear about how these sessions
were going. He told me the social worker at the local mental
health clinic helped Sheri understand what he was
going through by teaching her about PTSD.
The social worker explained how PTSD affected not only the
individual, but the whole family and, in turn, the
home environment. Jake said Sheri admitted that she did not
understand what he was going through but that he
was not the same person when he returned home from Iraq, and
this scared her. Jake said Sheri seemed to be
empathetic toward him and appeared to be relieved when the
social worker explained his diagnosis.
Jake said he and Sheri worked together to address her main
concerns. She felt he drank too much, was not
communicating with her, was isolating himself from the family,
and appeared to be depressed. She was particularly
concerned about his lack of interaction with his sons and lack of
interest in the current pregnancy. She worried that
he would be uninvolved in caring for this new baby just as he
was uninvolved with his boys.
Jake shared that in another couples’ session, Sheri talked about
wanting to be able to communicate with Jake
without feeling that she was “nagging him” or fearful that she
was making him withdraw. She said she avoided
asking him things or talking to him for fear it would “set him
off” and make him retreat to the basement on his own.
As it stood, she did not think she could talk with Jake about her

concerns. She told him she missed socializing with
friends and having family outings and felt isolated. Jake said
just keeping his intrusive thoughts at bay took all the
energy he could muster, so making small talk with friends was
not something he felt he could do right now. Sheri
admitted that she did not know that socializing affected him that
way. He said the social worker explained that for
veterans with PTSD, oftentimes crowds, loud noises, and open
spaces triggered intrusive memories and caused
anxiety attacks. He said that he and Sheri had developed a plan
that would improve their communication. He said
they were going to slowly begin planning outings that he felt he
could handle, and that they also agreed that if at any
time he felt uncomfortable while out that they would leave.
Through individual, group, and couples sessions, Jake was able
to address his trauma and his PTSD symptoms abated. He real -
ized that drinking was being used as a way to avoid his feelings
and attended AA meetings regularly. He has been able to
maintain
his sobriety and found a sponsor who is also a veteran. Sheri
gave
birth to a healthy baby boy, and Jake shared pictures of his son.
He
continues to attend group sessions and has become involved in
some
mentoring with young vets here at the VA. He feels strongly in
giving
back and has suggested that the VA begin a program that has
been
piloted in another state.
16
Key to Acronyms

AA: Alcoholics Anonymous
PTSD: Post-Traumatic Stress
Disorder
VA: Veterans Affairs
Health Care Center
The Bradley Family
T iffani Bradley is a 16-year-old heterosexual Caucasian female
referred to me after being arrested for prostitu-tion. I worked
with Tiffani at Teens First, a brand new court-mandated teen
counseling program for adolescent
victims of sexual exploitation and human trafficking. At Teens
First we provide a holistic range of services for our
clients. Tiffani has been provided room and board in our
residential treatment facility and will meet with a number
of social workers to address her multiple needs and concerns.
Tiffani has been arrested three times for prostitution in the last
2 years. Right before her most recent charge,
a new state policy was enacted to protect youth 16 years and
younger from prosecution and jail time for prostitu-
tion. The Safe Harbor for Exploited Children Act allows the
state to define Tiffani as a sexually exploited youth and
therefore the state will not imprison her for prostitution. She
was mandated to services at our agency, unlike her
prior arrests when she had been sent to detention.
Tiffani had been living with a man she has identified as Donald
since she was 14 years old. She had had limited

contact with her family members and had not been attending
school. She described Donald as her “husband”
(although they were not married) and her only friend. She had
contacted her sister, Diana, a few times over the
previous 2 years and stated that she missed her very much.
Donald had recently sold Tiffani to another pimp, “John
T.” Tiffani reported that she was very upset that Donald did this
and that she wanted to be reunited with him. She
had tried to make contact with him by sending messages through
other people, as John T. did not allow her access
to a phone.
During intake it was noted that Tiffani had multiple bruises and
burn marks on her legs and arms. She reported
that Donald had slapped her when he felt she did not behave and
that John T. burned her with cigarettes. Tiffani
has been treated for several sexually transmitted infections
(STIs) at local clinics and is currently on an antibiotic
for a kidney infection. Although she was given condoms by
Donald and John T. for her “dates,” there were several
“Johns” who refused to use them. It appears that over the last 2
years, Tiffani has had neither outside support nor
interactions with anyone beyond Donald, John T., and some
other young women also being prostituted.
Other members of the Bradley family include Tiffani’s 33-year-
old mother, Shondra; Tiffani’s 38-year-old father,
Robert; and Tiffani’s 13-year-old sister, Diana. Shondra and
Robert have been separated for a little over a year and
have started dating other people. Diana currently resides with
her mother and Anthony, her mother’s new boyfriend.
Shondra and Anthony abuse a variety of drugs, including
marijuana and methamphetamine.
Robert also abuses a number of drugs and has recently been
arrested for possession of crack cocaine. Robert has

been arrested several times over the last 5 years: twice for
domestic violence calls and twice for drug possession.
He is currently in jail awaiting sentencing.
The goals Tiffani and I set in our initial sessions centered on
helping her feel safe and secure in her new home and
utilizing as many of the available resources as possible.
Through individual and group counseling, Tiffani will have
the opportunity to discuss her experiences prior to coming to
Teens First, including what led to her relationship with
Donald. A long-term goal I presented was to help her
understand that Donald, the person who she maintained “is
the love of my life,” had actually had a negative impact on her
life. Tiffani listed some of her own long-term goals,
including obtaining a General Education Development (GED)
credential, getting her own apartment, getting a job,
and reunifying with her sister.
During our sessions over the year, Tiffani gave a rather in-depth
description of her childhood. At first Tiffani
provided a family history that was filled with only happy
memories. She remembered her life up to age 8 as filled
with moments of joy. She remembered going to school, playing
with her sister, and her mother and father getting
along.
As we continued to meet, Tiffani shared what she remembered
as a gradual but definitive change in the family
dynamics around the time when she turned 8 years old. She
remembered being awakened by music and laughter in
the early hours of the morning. When she went downstairs to
investigate, she saw her parents along with her uncle
Nate passing a pipe back and forth between them. She
remembered asking them what they were doing and her
mother saying, “adult things” and putting her back in bed.

Tiffani remembered being woken up by noise several times after
that and seeing her father and her uncle passing
the pipe between them. Sometimes her mother was there and
sometimes she was not. Often when her mother was
not there, Nate would see her and ask her to come over. Her
father would sometimes ask her to show them the
17
SESSIONS: CASE HISTORIES • THE BRADLEY FAMILY
dance that she had learned at school. When she danced, her
father
and Nate would laugh and offer her pocket change. Sometimes
they
were joined by their friend Jimmy.
For years the music and noise downstairs continued, later accom
panied by screams and shouting and sounds of people fighting.
One
morning, Shondra yelled at Robert to “get up and go to work.”
Tiffani
and Diana saw Robert come out of the bedroom and slap
Shondra
so hard she was knocked down. Robert then went back into the
bedroom.
The Bradley Family
Robert Bradley: father, 38
Shondra Bradley: mother, 33

Nate Bradley: uncle, 36
Tiffani Bradley: daughter, 16
Diana Bradley: daughter, 13
Donald: Tiffani’s self-described
husband and her former pimp
Shondra currently lives with
her boyfriend, Anthony
Tiffani also noticed significant changes in her home’s
appearance.
The home, which was never fancy, was almost always neat and
tidy.
Tiffani noticed that dust would gather around the house, dishes
would
pile up in the sink, dirt would remain on the floor, and clothes
would
go for long periods of time without being washed. Tiffani
remem-
bered cleaning her own clothes and making meals for herself
and her sister during this period. Sometimes Tiffani
and her sister would come downstairs in the morning to find
empty beer cans and liquor bottles on the kitchen table
along with the pipe. Her parents would be in the bedroom, and
Tiffani and her sister would leave the house and go
to school by themselves. Tiffani was unclear if her parents were
working or how the bills were paid. Often there was
not enough food to feed everyone and she would go to bed
hungry.
During one session, Tiffani described an incident of sexual
abuse. One night she was awoken by her uncle Nate

and his friend Jimmy in her room. Her parents were apparently
out, and they were the only adults in the home.
They asked her if she wanted to come downstairs and show
them the new dances she learned at school. Once
downstairs, Nate and Jimmy put some music on and started to
dance. They asked Tiffani to start dancing with them,
which she did. While they were dancing, Jimmy spilled some
beer on her. Nate said she had to go to the bathroom
to clean up. Nate, Jimmy, and Tiffani all went to the bathroom.
Nate asked Tiffani to take her clothes off so she
could get in the bath. Tiffani hesitated to do this, but Nate
insisted it was okay since he and Jimmy were family.
Tiffani eventually r elented and began to wash up. Nate would
tell her that she missed a spot and would scrub the
area with his hands.
After this incident, others occurred, with increasing levels of
molestation each time. Tiffani felt very bad about
this, but had difficulty explaining why, even to herself. She was
very afraid of everyone in her family except her sister
Diana. She was also afraid that Diana might be subjected to the
same thing.
The last time it happened, when Tiffani was 14, she pretended
to be willing to dance for them, but when she got
downstairs she ran out the front door of the house. Tiffani ran
down the block to her school because, as she said,
it was one of the few places where she felt safe. She said she
was barefoot and in her pajamas and it was very cold.
About halfway to her school, a car stopped, and a man inside
asked her where she was going. When Tiffani replied
that she was going to school, the man asked why she was going
to school in the middle of the night. Tiffani did not
want to tell him the whole story, so she told him that there was
trouble at home and she just wanted to go to school
early.

The man introduced himself as Donald and asked her why she
did not go to her boyfriend’s house. When Tiffani
said she did not have a boyfriend, Donald replied that if she had
a boyfriend, she would have somebody to take
care of her and keep her safe when these things happened. He
then offered to be her boyfriend. Tiffani did not say
anything, but when Donald then offered to give her a ride, she
agreed and got in the car.
Donald took Tiffani to his apartment, explaining that the school
would be closed for hours. When they got to his
apartment, Donald fed Tiffani and gave her beer, expl aining that
it would help keep her warm. Tiffani did not like
the taste of the beer, but at Donald’s insistence, she drank it.
When Tiffani was drunk, Donald began kissing her, and they
had sex. Tiffani knew about sex from school and
some of her girlfriends but she had never had it with anyone
before. She was grateful to Donald because he had
helped her get away from Nate and Jimmy. Donald had also told
her that he loved her and they would be together
forever. Tiffani was also afraid that if she did not have sex,
Donald would not let her stay and she had nowhere else
to go.
For the next 3 days, Donald brought her food and beer and had
sex with her several more times. Donald told
Tiffani that she was not allowed to do anything without his
permission. This included watching TV, going to the
bathroom, taking a shower, and eating and drinking.
Donald bought Tiffani a dress, explaining to her that she was
going to “find a date” and get men to pay her to
have sex with her. When Tiffani said she did not want to do
that, Donald hit her several times. Donald explained

18
SESSIONS: CASE HISTORIES • THE BRADLEY FAMILY
that if she didn’t do it, he would get her sister, Diana, and make
her
do it instead. Out of fear for her sister, Tiffani relented and did
what
Donald told her to do.
Key to Acronyms
GED: General Education
Development
STI: Sexually Transmitted
Infection
Tiffani and I met over the course of a year for individual
sessions.
We talked often about her continued desire to be reunited with
Donald. We discussed what Donald represented for her and why
he
was such an important part of her life. She often described him
as
the person who “saved” her and felt she owed much to him. She
vividly remembered the fear she felt the nights Nate and Jimmy
touched her, and she was convinced they would have
raped her that last night. My efforts were to help her recognize
that Donald was not a savior, but someone who did,
in fact, rape her and then force her into prostitution. A lot of

time and discussion went into changing this cognition
around Donald and their relationship.
After about six months at Teens First, Tiffani said that she had
a strong desire to see her sister and her mother,
and I helped to arrange a family session at the agency. Tiffani
and I talked about what her hopes were for the
meeting and her intent for scheduling this session. Tiffani first
and foremost just wanted to see them and hug them.
She had not seen either of them in over two years and missed
them very much. Tiffani also felt some anger toward
her mother that she wanted to able to share in a safe
environment. She said she felt that both her parents did not
do enough to protect her and that they should have known better
than to have let Nate and Jimmy into the house
when they were not home. She also said she felt her mother
should have tried harder to find her when she was with
Donald. I wanted her to be realistic about the potential outcome
of the meeting, so I did my best to explain that the
session might not provide all of the answers she hoped for. We
were aware, through a conversation with her sister,
that her mother was still using drugs, and we talked about how
this might cloud her mother’s ability to engage in a
substantial conversation.
In the family session, Shondra was very critical of Tiffani and
her current situation. She ultimately blamed Tiffani
for her current state. When Tiffani confronted her mother about
the drug use and the lack of parental guidance and
protection, Shondra denied ever having used drugs. She told
Tiffani she was exaggerating and a liar and that neither
she nor Tiffani’s father ever put her in harm’s way.
Throughout our time working together, Tiffani utilized all of
the services at the agency and stopped trying to
contact Donald. She had learned that he had actually gotten

married to one of the other women that worked for
him, and this made her very angry. She has passed her GED test
and started working at a local fast food restaurant.
She plans on applying to a community college and a fashion
institute.
19
The Petrakis Family
Helen Petrakis is a 52-year-old heterosexual married female of
Greek descent who says that she feels overwhelmed and “blue.”
She came to our agency at the suggestion of a close friend who
thought Helen would
benefit from having a person who could listen. Although she is
uncomfortable talking about her life with a stranger,
Helen said that she decided to come for therapy because she
worries about burdening friends with her troubles.
Helen and I have met four times, twice per month, for
individual therapy in 50-minute sessions.
Helen consistently appears well-groomed. She speaks clearly
and in moderate tones and seems to have linear
thought progression; her memory seems intact. She claims no
history of drug or alcohol abuse, and she does not
identify a history of trauma. Helen says that other than chronic
back pain from an old injury, which she manages
with acetaminophen as needed, she is in good health.
Helen has worked full time at a hospital in the billing
department since graduating from high school. Her

husband, John (60), works full time managing a grocery store
and earns the larger portion of the family income.
She and John live with their three adult children in a 4-bedroom
house. Helen voices a great deal of pride in the
children. Alec, 27, is currently unemployed, which Helen
attributes to the poor economy. Dmitra, 23, whom Helen
describes as smart, beautiful, and hardworking, works as a sales
consultant for a local department store. Athina, 18,
is an honors student at a local college and earns spending
money as a hostess in a family friend’s restaurant; Helen
describes her as adorable and reliable.
In our first session, I explained to Helen that I was an advanced
year intern completing my second field placement
at the agency. I told her I worked closely with my field
supervisor to provide the best care possible. She said that
was fine, congratulated me on advancing my career, and then
began talking. I listened for the reasons Helen came
to speak with me.
I asked Helen about her community, which, she explained,
centered on the activities of the Greek Orthodox
Church. She and John were married in that church and attend
services weekly. She expects that her children will
also eventually wed there. Her children, she explained, are
religious but do not regularly go to church because they
are very busy. She believes that the children are too busy to be
expected to help around the house. Helen shops,
cooks, and cleans for the family, and John sees to yard care and
maintains the family’s cars. When I asked whether
the children contributed to the finances of the home, Helen
looked shocked and said that John would find it deeply
insulting to take money from his children. As Helen described
her life, I surmised that the Petrakis family holds
strong family bonds within a large and supportive community.

Helen is responsible for the care of John’s 81-year-old widowed
mother, Magda, who lives in an apartment
30 minutes away. Until recently, Magda was self-sufficient,
coming for weekly family dinners and driving herself
shopping and to church. But 6 months ago, she fell and broke
her hip and was also recently diagnosed with early
signs of dementia. Through their church, Helen and John hired a
reliable and trusted woman to check in on Magda
a couple of days each week. Helen goes to see Magda on the
other days, sometimes twice in one day, depending on
Magda’s needs. She buys her food, cleans her home, pays her
bills, and keeps track of her medications. Helen says
she would like to have the helper come in more often, but she
cannot afford it. The money to pay for help is coming
out of the couple’s vacations savings. Caring for Magda makes
Helen feel as if she is failing as a wife and mother
because she no longer has time to spend with her husband and
children.
Helen sounded angry as she described the amount of time she
gave toward Magda’s care. She has stopped going
shopping and out to eat with friends because she can no longer
find the time. Lately, John has expressed displeasure
with meals at home, as Helen has been cooking less often and
brings home takeout. She sounded defeated when
she described an incident in which her son, Alec, expressed
disappointment in her because she could not provide
him with clean laundry. When she cried in response, he offered
to help care for his grandmother. Alec proposed
moving in with Magda.
Helen wondered if asking Alec to stay with his grandmother
might be good for all of them. John and Alec had
been arguing lately, and Alec and his grandmother had always
been very fond of each other. Helen thought she
could offer Alec the money she gave Magda’s helper.

I responded that I thought Helen and Alec were using creative
problem solving and utilizing their resources well
in crafting a plan. I said that Helen seemed to find good
solutions within her family and culture. Helen appeared
concerned as I said this, and I surmised that she was reluctant to
impose on her son because she and her husband
20
SESSIONS: CASE HISTORIES • THE PETRAKIS FAMILY
seemed to value providing for their children’s needs rather than
expecting them to contribute resources. Helen ended the session
agreeing to consider the solution we discussed to ease the stress
of
caring for Magda.
The Petrakis Family
Magda Petrakis: mother
of John Petrakis, 81
John Petrakis: father, 60
Helen Petrakis: mother, 52
Alec Petrakis: son, 27
Dmitra Petrakis: daughter, 23

Athina Petrakis: daughter, 18
In our second session, Helen said that her son again mentioned
that he saw how overwhelmed she was and wanted to help care
for
Magda. While Helen was not sure this was the best idea, she
saw how
it might be helpful for a short time. Nonetheless, her instincts
were
still telling her that this could be a bad plan. Helen worried
about
changing the arrangements as they were and seemed reluctant to
step away from her integral role in Magda’s care, despite the
pain it
was causing her. In this session, I helped Helen begin to explore
her
feelings and assumptions about her role as a caretaker in the
family. Helen did not seem able to identify her expecta-
tions of herself as a caretaker. She did, however, resolve her
ambivalence about Alec’s offer to care for Magda. By
the end of the session, Helen agreed to have Alec live with his
grandmother.
In our third session, Helen briskly walked into the room and
announced that Alec had moved in with Magda and
it was a disaster. Since the move, Helen had had to be at the
apartment at least once daily to intervene with emer-
gencies. Magda called Helen at work the day after Alec moved
in to ask Helen to pick up a refill of her medications
at the pharmacy. Helen asked to speak to Alec, and Magda said
he had gone out with two friends the night before
and had not come home yet. Helen left work immediately and
drove to Magda’s home. Helen angrily told me that
she assumed that Magda misplaced the medications, but then
she began to cry and said that the medications were
not misplaced, they were really gone. When she searched the

apartment, Helen noticed that the cash box was
empty and that Magda’s checkbook was missing two checks.
Helen determined that Magda was robbed, but because
she did not want to frighten her, she decided not to report the
crime. Instead, Helen phoned the pharmacy and
explained that her mother-in-law, suffering from dementia, had
accidently destroyed her medication and would need
refills. She called Magda’s bank and learned that the checks had
been cashed. Helen cooked lunch for her mother-
in-law and ate it with her. When a tired and disheveled Alec
arrived back in the apartment, Helen quietly told her son
about the robbery and reinforced the importance of remaining in
the building with Magda at night.
Helen said that the events in Magda’s apartment were repeated 2
days later. By this time in the session
Helen was furious. With her face red with rage and her hands
shaking, she told me that all this was my fault for
suggesting that Alec’s presence in the apartment would benefit
the family. Jewelry from Greece, which had been
in the family for generations, was now gone. Alec would never
be in this trouble if I had not told Helen he should
be permitted to live with his grandmother. Helen said she
should know better than to talk to a stranger about
private matters.
Helen cried, and as I sat and listened to her sobs, I was not sure
whether to let her cry, give her a tissue, or
interrupt her. As the session was nearing the end, Helen quickly
told me that Alec has struggled with maintaining
sobriety since he was a teen. He is currently on 2 years’
probation for possession and had recently completed a
rehabilitation program. Helen said she now realized Alec was
stealing from his grandmother to support his drug
habit. She could not possibly tell her husband because he would
hurt and humiliate Alec, and she would not consider

telling the police. Helen’s solution was to remove the valuables
and medications from the apartment and to visit
twice a day to bring supplies and medicine and check on Alec
and Magda.
After this session, it was unclear how to proceed with Helen. I
asked my field instructor for help. I explained
that I had offered support for a possible solution to Helen’s
difficulties and stress. In rereading the progress notes in
Helen’s chart, I realized I had misinterpreted Helen’s reluctance
to ask Alec to move in with his grandmother. I felt
terrible about pushing Helen into acting outside of her own
instincts.
My field instructor reminded me that I had not forced Helen to
act as she had and that no one was responsible for
the actions of another person. She told me that beginning social
workers do make mistakes and that my errors were
part of a learning process and were not irreparable. I was
reminded that advising Helen, or any client, is ill-advised.
My field instructor expressed concern about my ethical and
legal obligations to protect Magda. She suggested that
I call the county office on aging and adult services to research
my duty to report, and to speak to the agency director
about my ethical and legal obligations in this case.
In our fourth session, Helen apologized for missing a previous
appointment with me. She said she awoke the
morning of the appointment with tightness in her chest and a
feeling that her heart was racing. John drove Helen
to the emergency room at the hospital in which she works. By
the time Helen got to the hospital, she could not
21

SESSIONS: CASE HISTORIES • THE PETRAKIS FAMILY
catch her breath and thought she might pass out. The hospital
ran tests but found no conclusive organic reason to
explain Helen’s symptoms.
I asked Helen how she felt now. She said that since her visit to
the hospital, she continues to experience short-
ness of breath, usually in the morning when she is getting ready
to begin her day. She said she has trouble staying
asleep, waking two to four times each night, and she feels tired
during the day. Working is hard because she is more
forgetful than she has ever been. Her back is giving her trouble,
too. Helen said that she feels like her body is one
big tired knot.
I suggested that her symptoms could indicate anxiety and she
might want to consider seeing a psychiatrist for an
evaluation. I told Helen it would make sense, given the
pressures in her life, that she felt anxiety. I said that she and
I could develop a treatment plan to help her address the anxiety.
Helen’s therapy goals include removing Alec from
Magda’s apartment and speaking to John about a safe and
supported living arrangement for Magda.
22
The Cortez Family
Paula is a 43-year-old HIV-positive Latina woman originally
from Colombia. She is bilingual, fluent in both Spanish and
English. Paula lives alone in an apartment in Queens, NY. She

is divorced and has one son, Miguel,
who is 20 years old. Paula maintains a relationship with her son
and her ex-husband, David (46). Paula raised Miguel
until he was 8 years old, at which time she was forced to
relinquish custody due to her medical condition. Paula is
severely socially isolated as she has limited contact with her
family in Colombia and lacks a peer network of any
kind in her neighborhood. Paula identifies as Catholic, but she
does not consider religion to be a big part of her li fe.
Paula came from a moderately well-to-do family. She reports
suffering physical and emotional abuse at the hands
of both her parents, who are alive and reside in Colombia with
Paula’s two siblings. Paula completed high school in
Colombia, but ran away when she was 17 years old because she
could no longer tolerate the abuse at home. Paula
became an intravenous drug user (IVDU), particularly of
cocaine and heroin. David, who was originally from New
York City, was one of Paula’s “drug buddies.” The tw o eloped,
and Paula followed David to the United States. Paula
continued to use drugs in the United States for several years;
however, she stopped when she got pregnant with
Miguel. David continued to use drugs, which led to the failure
of their marriage.
Once she stopped using drugs, Paula attended the Fashion
Institute of Technology (FIT) in New York City. Upon
completing her BA, Paula worked for a clothing designer, but
realized her true passion was painting. She has a
collection of more than 100 drawings and paintings, many of
which track the course of her personal and emotional
journey. Paula held a full-time job for a number of years before
her health prevented her from working. She is now
unemployed and receives Supplemental Security Insurance (SSI)
and Medicaid.

Paula was diagnosed with bipolar disorder. She experiences
rapid cycles of mania and depression when not prop-
erly medicated, and she also has a tendency toward paranoia.
Paula has a history of not complying with her psychi-
atric medication treatment because she does not like the way it
makes her feel. She often discontinues it without
telling her psychiatrist. Paula has had multiple psychiatric
hospitalizations but has remained out of the hospital for at
least five years. Paula accepts her bipolar diagnosis, but
demonstrates limited insight into the relationship between
her symptoms and her medication.
Paula was diagnosed HIV positive in 1987. Paula acquired
AIDS several years later when she was diagnosed with
a severe brain infection and a T-cell count less than 200.
Paula’s brain infection left her completely paralyzed on the
right side. She lost function of her right arm and hand, as well
as the ability to walk. After a long stay in an acute
care hospital in New York City, Paula was transferred to a
skilled nursing facility (SNF) where she thought she would
die. It is at this time that Paula gave up custody of her son.
However, Paula’s condition improved gradually. After
being in the SNF for more than a year, Paula regained the
ability to walk, although she does so with a severe limp.
She also regained some function in her right arm. Her right
hand (her dominant hand) remains semiparalyzed and
limp. Over the course of several years, Paula taught herself to
paint with her left hand and was able to return to her
beloved art. In 1996, when highly active antiretroviral therapy
(HAART) became available, Paula began treatment.
She responded well to HAART and her HIV/AIDS was well
controlled.
In addition to her HIV/AIDS disease, Paula is diagnosed with
hepatitis C (Hep C). While this condition was
controlled, it has reached a point where Paula’s doctor is

recommending she begin treatment. Paula also has signifi-
cant circulatory problems, which cause her severe pain in her
lower extremities. She uses prescribed narcotic pain
medication to control her symptoms. Paula’s circulatory
problems have also led to chronic ulcers on her feet that
will not heal. Treatment for her foot ulcers demands frequent
visits to a wound care clinic. Paula’s pain paired with
the foot ulcers make it difficult for her to ambulate and leave
her home. As with her psychiatric medication, Paula
has a tendency not to comply with her medical treatment. She
often disregards instructions from her doctors and
resorts to holistic treatments like treating her ulcers with
chamomile tea. Working with Paula can be very frustrating
because she is often doing very well medically and
psychiatrically. Then, out of the blue, she stops her treatment
and deteriorates quickly.
I met Paula as a social worker employed at an outpatient
comprehensive care clinic located in an acute care
hospital in New York City. The clinic functions as an
interdisciplinary operation and follows a continuity of care
model. As a result, clinic patients are followed by their
physician and social worker on an outpatient basis and on
an inpatient basis when admitted to the hospital. Thus, social
workers interact not only with doctors from the clinic,
but also with doctors from all services throughout the hospital.
23
SESSIONS: CASE HISTORIES • THE CORTEZ FAMILY
After working with Paula for almost six months, she called to
inform me that she was pregnant. Her news was shocking
because she

did not have a boyfriend and never spoke of dating. Paula
explained
that she met a man at a flower shop, they spoke several times,
he
visited her at her apartment, and they had sex. Paula thought he
was a “stand up guy,” but recently everything had changed.
Paula
began to suspect that he was using drugs because he had started
to
become controlling and demanding. He showed up at her
apartment at all times of the night demanding to be let in.
He c alled her relentlessly, and when she did not pick up the
phone, he left her mean and threatening messages.
Paula was fearful for her safety.
Given Paula’s complex medical profile and her psychiatric
diagnosis, her doctor, psychiatrist, and I were concerned
about Paula maintaining the pregnancy. We not only feared for
Paula’s and the baby’s health, but also for how Paula
would manage caring for a baby. Paula also struggled with what
she should do about her pregnancy. She seriously
considered having an abortion. However, her Catholic roots
paired with seeing an ultrasound of the baby reinforced
her desire to go through with the pregnancy.
The primary focus of treatment quickly became dealing with
Paula’s relationship with the baby’s father. During
sessions with her psychiatrist and me, Paula reported feeling
fearful for her safety. The father’s relentless phone
calls and voicemails rattled Paula. She became scared, slept
poorly, and her paranoia increased significantly. During

a particular session, Paula reported that she had started smoking
to cope with the stress she was feeling. She also
stated that she had stopped her psychiatric medication and was
not always taking her HAART. When we explored
the dangers of Paula’s actions, both to herself and the baby, she
indicated that she knew what she was doing was
harmful but she did not care. After completing a suicide
assessment, I was convinced that Paula was decompen-
sating quickly and at risk of harming herself and/or her baby. I
consulted with her psychiatrist, and Paula was invol-
untarily admitted to the psychiatric unit of the hospital. Paula
was extremely angry at me for the admission. She
blamed me for “locking her up” and not helping her. Paula
remained on the unit for 2 weeks. During this stay she
restarted her medications and was stabilized. I tried to visit
Paula on the unit, but the first two times I showed up
she refused to see me. Eventually, Paula did agree to see me.
She was still angry, but she was able to see that I had
acted with her best interest in mind, and we were able to repair
our relationship. As Paula prepared for discharge,
she spoke more about the father and the stress that had driven
her to the admission in the first place. Paula agreed
that despite her fears she had to do something about the
situation. I helped Paula develop a safety plan, educated
her about filing for a restraining order, and referred her to the
AIDS Law Project, a not-for-profit organization that
helps individuals with HIV handle legal issues. With my support
and that of her lawyer, Paula filed a police report
and successfully got the restraining order. Once the order was
served, the phone calls and visits stopped, and Paula
regained a sense of control over her life.
From a medical perspective, Paula’s pregnancy was considered
“high risk” due to her complicated medical situ
ation. Throughout her pregnancy, Paula remained on HAART,
pain, and psychiatric medication, and treatment for

her Hep C was postponed. During the pregnancy the ulcers on
Paula’s feet worsened and she developed a severe
bone infection, ostemeylitis, in two of her toes. Without
treatment the infection was extremely dangerous to both
Paula and her baby. Paula was admitted to a medical unit in the
hospital where she started a 2-week course of intra-
venous (IV) antibiotics. Unfortunately, the antibiotics did not
work, and Paula had to have portions of two of her toes
amputated with limited anesthesia due to the pregnancy,
extending her hospital stay to nearly a month.
The condition of Paula’s feet heightened my concern and the
treatment team’s concerns about Paula’s ability to
care for her baby. There were multiple factors to consider. In
the immediate term, Paula was barely able to walk and
was therefore unable to do anything to prepare for the baby’s
arrival (e.g., gather supplies, take parenting class, etc.).
In the medium term, we needed to address how Paula was going
to care for the baby day-to-day, and we needed to
think about how she would care for the baby at home given her
physical limitations (i.e., limited ability to ambulate
and limited use of her right hand) and her current medical
status. In addition, we had to consider what she would
do with the baby if she required another hospitalization. In the
long term, we needed to think about permanency
planning for the baby or for what would happen to the baby if
Paula died. While Paula recognized the importance
of all of these issues, her anxiety level was much lower than
mine and that of her treatment team. Perhaps she did
not see the whole picture as we did, or perhaps she was in
denial. She repeatedly told me, “I know, I know. I’m just
going to do it. I raised my son and I am going to take care of
this baby too.” We really did not have an answer for her
limited emotional response, we just needed to meet her where
she was and move on. One of the things that amazed
me most about Paula was that she had a great ability to rally

people around her. Nurses, doctors, social workers: we
all wanted to help her even when she tried to push us away.
The Cortez Family
David Cortez: father, 46
Paula Cortez: mother, 43
Miguel Cortez: son, 20
24
SESSIONS: CASE HISTORIES • THE CORTEZ FAMILY
While Paula was in the hospital unit, we were able to talk about
the baby’s care and permanency planning. Through these
discus-
sions, Paula’s social isolation became more and more evident.
Paula
had not told her parents in Colombia that she was having a
baby.
She feared their disapproval and she stated, “I can’t stand to
hear
my mother’s negativity.” Miguel and David were aware of the
preg-
nancy, but they each had their own lives. David was remarried
with
children, and Miguel was working and in school full-time. The

idea
of burdening him with her needs was something Paula would not
consider. There was no one else in Paula’s life. Therefore, we
were
forced to look at options outside of Paula’s limited social
network.
After a month in the hospital, Paula went home with a surgical
boot, instructions to limit bearing weight on her foot, and a list
of
referrals from me. Paula and I agreed to check in every other
day
by telephone. My intention was to monitor how she was feeling,
as
well as her progress with the referrals I had given her. I also
wanted
to provide her with support and encouragement that she was not
getting from anywhere else. On many occasions, I hung up the
phone frustrated with Paula because of her procrastination and
lack
of follow-through. But ultimately she completed what she
needed to
for the baby’s arrival. Paula successfully applied for WIC, the
federal Supplemental Nutrition Program for Women,
Infants, and Children, and was also able to secure a crib and
other baby essentials.
Paula delivered a healthy baby girl. The baby was born HIV
negative and received the appropriate HAART treat-
ment after birth. The baby spent a week in the neonatal
intensive care unit, as she had to detox from the effects of
the pain medication Paula took throughout her pregnancy. Given
Paula’s low income, health, and Medicaid status,

Paula was able to apply for and receive 24/7 in-home child care
assistance through New York’s public assistance
program. Depending on Paula’s health and her need for help,
this arrangement can be modified as deemed appro-
priate. Miguel did take a part in caring for his half sister, but
his assistance was limited. Ultimately, Paula completed
the appropriate permanency planning paperwork with the
assistance of the organization The Family Center. She
named Miguel the baby’s guardian should something happen to
her.
Key to Acronyms
AIDS: Acquired
Immunodeficiency
Syndrome
HAART: Highly Active
Antiretroviral Therapy
HIV: Human
Immunodeficiency Virus
IVDU: Intravenous Drug User
SNF: Skilled Nursing Facility
SSI: Supplemental
Security Insurance

WIC: Supplemental Nutrition
Program for Women,
Infants, and Children
25
APPENDIX
26
Reflection Questions
The social worker in each of the cases answered these
additional questions as follows.
1. What specific intervention strategies (skills, knowledge, etc.)
did you use to address this client situation?
I used role-playing to help the family members view how each
of them perceived their behaviors. For
example, Juan Jr. acted like Juan Sr. when he came home from
work each day. Juan Jr. portrayed his father

as grumpy and irritated at the sight of the boys. His tone was
angry and he yelled instead of using a calm tone.
Juan Sr. was shocked at how Juan Jr. depicted him and his
interactions with his family members. Drawing on
family systems theory and the strengths perspective, I
highlighted the family’s assets and made sure to recog
nize that they were the experts of their own life and
experiences. I also wanted to treat the family as a unit
rather than concentrate on one “identified client.” Therefore,
rather than focusing on Juan Jr. and why he
called, I had the family express their thoughts and feelings
about interactions in the home on a daily basis. We
did review how each felt about the call to the ACS worker, but
the intent was to release any underlying resent-
ment or anger felt by any of the family members. Using a
genogram helped to identify patterns in the family
history. This clearly unlocked some firmly held beliefs around
expectations of how children should behave and
shared financial burdens that no longer worked for this family.
2. Which theory or theories did you use to guide your practice?
I used the strengths perspective and family systems theory. I
focused on what the family had and how they
could access the available resources that had yet been untapped.
I looked at how the family interacted as a unit
rather than four separate individuals. We worked together to
identify how each member of the family affected
the others in various ways—sometimes in a positive manner and
sometimes in ways that were challenging and
provoking.
3. What were the identified strengths of the client(s)?
It was clear from the beginning that Elena and Juan Sr. loved
each other and their sons. There was clearly

a bond among the family members that appeared to get stronger
over the course of the sessions. Elena and
Juan Sr. were able to see that while they had not elected to seek
counseling, family and parenting sessions
could be helpful to them and their children. They allowed me to
learn about their family and took great pride
in describing their heritage and culture.
4. What were the identified challenges faced by the client(s)?
The biggest challenge to this family was the financial concern
they faced each day. It was clear that their
economic situation weighed heavily on all members of the
family. The need for Juan Sr. to put in many hours
of overtime negatively affected his behavior toward his
children. The children were perhaps acting out due
to the fear and anxiety they felt about money issues, which were
constantly being discussed in the home.
Through our discussion about money management, it was clear
that neither Elena nor Juan Sr. had sat down
and completed a budget. Many expenses were unaccounted for
in their bank register and neither balanced the
checkbook regularly.
5. What were the agreed-upon goals to be met to address the
concern?
Because the clients were mandated to services, the goals were
essentially set by the ACS worker. That being
said, I tried to work with the family to identify potential topics
that they wanted to discuss during our family
sessions. Elena and Juan Sr. said they wanted to learn more
about managing their money.
27

SESSIONS: CASE HISTORIES • REFLECTION QUESTIONS
6. Did you have to address any issues around cultural
competence? Did you have to learn about this
population/group prior to beginning your work with this client
system? If so, what type of research did
you do to prepare?
Because I felt that the ACS worker had neglected to take into
consideration the Hernandez’s culture when
she made the referral, I was very aware that I needed to learn
about them and their beliefs around parenting.
As a Caucasian woman, I was not familiar with the form of
discipline they had used nor did I understand their
perspective as Latino (Puerto Rican) individuals. I asked them
many questions about their culture and how
children are treated and viewed. They shared many stories of
their own childhood with me and helped me to
understand their perspective based on their cultural lens.
7. What local, state, or federal policies could (or did) affect this
case?
It would positively affect cases like this if ACS, a state agency,
decided that each potential abuse case needed

to be reviewed for cultural competence in order to eliminate or
reduce bias.
8. How would you advocate for social change to positively
affect this case?
I would encourage such a policy as described above to be
implemented across all child protective service
agencies. Further, I would encourage that a strengths
perspective be adopted by child protective workers when
addressing these cases.
9. Were there any legal or ethical issues present in the case? If
so, what were they and how were they
addressed?
The legal issues surrounded the fact that I was mandated to
contact the ACS worker about the clients’
progress or lack thereof. Ethically, I felt torn about calling the
ACS worker but knew that in the end it was what
I had to do.
10. How can evidence-based practice be integrated into this
situation?
It was integrated through the use of an evidenced-based
program to teach parenting skills.
11. Is there any additional information that is important to the
case?
No, there is no additional information.
12. Describe any additional personal reflections about this case.
I believe that including a positive report when I notified the
ACS that the clients had missed too many classes

was helpful in advocating for them. As their social worker, I
believed that they had tried to attend the classes.
I felt it was my responsibility to advocate for them and share all
of the positive strides they made while working
with me. I highlighted their strengths when talking with the
ACS worker rather than focusing on the negatives.
The clients recognized this and did not get angry with me when
I told them I had to contact the ACS worker.
They continued to contact me to share their sons’ milestones
and elected to participate in some holiday events
at the agency and eventually the financial literacy program we
offered. I wish I had reported the inappropriate
comments made by the ACS worker to her supervisor. I feel
now that I should have said something and regret
not reporting these statements.
The Parker Family
I encouraged Sara and Stephanie to work together in clearing
out the apartment with the common goal of
being able to remain in their apartment. Sara and Stephanie thus
both had some control in the cleaning and
the choice of items to be discarded. I developed a rapport with
Jane and was able to enlist her help in cleaning.
I explored alternative housing options for both Sara and
Stephanie. I also improved Sara’s outpatient psychiatric
care by arranging treatment with a geriatric psychiatrist.
28

Family therapy and engagement was essential in encouraging
Sara and Stephanie to work together in
cleaning the apartment and in obtaining the assistance of Jane in
the process.
Stephanie was organized and kept her living area clean. She was
working part-time and was training to
become a cashier. Sara was attending a senior day program
regularly. Sara and Stephanie were willing to work
together and were open to suggestions and making changes.
Sara and Stephanie were at risk of removal from their
apartment. Sara had poor insight into her hoarding,
which made cleaning up the apartment very challenging. Sara
was estranged from Jane, which was the only
close family member who could be of assistance in participating
in an intervention to clean the apartment.

concern?
Sara and Stephanie made the decision to work together to clean
up the apartment with the goal of being
able to remain living in their apartment. Sara gave me
permission to contact Jane with the intention of enlisting
her help in cleaning up the apartment. Sara also agreed to
neuropsychological testing and changed her outpa-
tient psychiatric treatment. Both Stephanie and Sara agreed to
each keep one favorite cat, and Stephanie
would look for homes for the remaining cats.
you do to prepare?
There were no cultural issues that needed to be addressed.
case?
Adult Protective Services was monitoring this family and had
the authority to remove them from their apart-
ment if the situation was deemed dangerous or if the family was
unable to clean the apartment and improve
living conditions. Intensive Case Management services were put
in place by Adult Protective Services to assess
the needs of the family and to develop a plan and resources to
meet these needs. An Intensive Case Manager
met with the family weekly to address a variety of issues and
actively begin implementing planned interventions.
affect this case?

There is tremendous pressure placed on hospitals by insurance
companies to discharge patients within
a short prescribed time. This poses a serious challenge for
social workers, who often are responsible for
discharge planning. There are ethical questions such as whether
a patient is truly prepared for discharge and
whether their discharge plan is optimum or hastily planned.
addressed?
Adult Protective Services was monitoring this family and had
the authority to remove them from their apart-
ment if the situation was deemed dangerous. Intensive Case
Management services were put into place by Adult
Protective Services to assess the needs of the family. As the
Intensive Case Manager, I met with the family
weekly to address a variety of issues and develop a plan and
appropriate interventions.
situation?
Utilizing family therapy and engaging an estranged family
member was essential to working with this family.
Utilizing cognitive and behavioral therapy helped Sara finally
acknowledge the condition of the apartment and
prepared her to begin throwing out or giving away items to
create a clean, habitable apartment.
29

case?
As their social worker, I reached out to an estranged family
member and was eventually able to enlist her
support. I was able to improve the quality of Sara’s psychiatric
treatment by arranging neuropsychological
testing and treatment with a geriatric psychiatrist. I explored
housing and community, local, and state resources.
I have concerns regarding Sara living alone, even with home
care services in place. Sara will also need a
follow-up appointment with the neurologist to determine if she
is experiencing symptoms of early dementia.
The Logan Family

I used individual and family counseling, education, assessment,
problem solving, and skills training in this
situation.
I used systems, social learning, and conflict theories, as well as
theories of moral reasoning, theories of
cognition, and stage theories.
Eboni is a good student who is goal oriented and athletic. She
has the support of family and friends, good
health, and is not chemically dependent. Additionally, she is
employed and has housing.
Eboni was dealing with teenage pregnancy and family discord.
concern?
Eboni and I agreed that she would inform her family and
process all of her options.
you do to prepare?
No, there were no issues of cultural competence.

case?
Roe v. Wade, state adoption laws, and medical policies all
affected this case.
affect this case?
Because there is a divide in society about abortion, it is difficult
to look at social change from this perspec-
tive. However, there could be increased programming for single
teenage mothers who would like to go to
college and parent their child.
addressed?
Termination of pregnancy, parental rights if the child is a
minor, role the biological father plays in the
decision-making process, and open versus closed adoption were
all present in this case.
situation?
There are evidence-based teenage pregnancy prevention
programs that could be implemented in the school
system.
30

case?
The final decision was left unanswered to provide the
opportunity for discussion.
I have none.
The Johnson Family
I used anxiety-reducing strategies such as breathing exercises to
help Talia regulate her physical responses to
the memories of the sexual assault. I used education tools to
help validate and normalize her reactions, sharing
information on sexual assault trauma and PTSD. I used
journaling, worksheets, and art to help her express her
feelings in a safe manner when she felt she could not verbalize
them. I worked to build a collaborative working
relationship with her, spending a lot of time on building a
rapport.
I used empowerment theory to guide my practice. I let Talia
guide the sessions, and together we decided on
goals and objectives. I never pressed her to share her story and I
worked to make the time together feel safe
and supportive. I always let her know she was in charge of the
session and the content. Cognitive theory was
used to help her challenge her thoughts of self-blame. Survivors
often blame themselves for what has happened
and question what they did in the scenario to encourage the
sexual assault.

Talia was an intelligent, strong woman who worked hard at
addressing what happened to her. She was
physically active, had many strong friendships, and utilized her
resources to the fullest extent. She had a loving
mother and father who supported her through the process.
She was experiencing strong feelings of anxiety and was
predisposed to anxiety on her mother’s side of the
family. She met with much skepticism about the sexual assault
and was treated at times unfairly by friends and
the hospital staff.
concern?
Talia wanted to feel better overall, but in particular she wanted
to address her anxiety attacks. Together we
created mini goals to help her manage her anxiety and find ways
to express her feelings about what happened.
Weekly, we would set up goals around her use of the journal,
her breathing exercises, and running.
you do to prepare?
For this case, I needed to be aware of her age and development.
I was also aware of the high rates of sexual
assault on college campuses. I took into consideration her
connection to her family of origin and her sorority

sisters.
case?
The university’s policy for addressing sexual assault cases
could and did affect the situation. A dean is
assigned the case and makes his or her determination after
hearing from both sides. Had the dean not found
Eric guilty, Talia would have had to be on campus for a year
with a man who sexually assaulted her. Further, it
was required that Talia be face-to-face with Eric in the dean’s
office. She then had to state the charges against
him. This could potentially re-victimize and traumatize her.
Lastly, Talia’s assault had to be reported to the
university’s campus safety administrator in accordance with the
Cleary Act (a federal regulation).
31
32
affect this case?
Too often people believe the rape myths that are perpetuated in
our society. I would strive to educate people
about sexual assault and work to eliminate these myths. I would
also advocate for education in hospitals and
the law and court system around sexual assault. Research
indicates that many survivors do not press charges or
drop charges because they feel like they are being treated

unfairly, judged, and re-victimized by the very people
who are supposed to be there to help them.
addressed?
The only legal aspects pertained to Talia’s decision not to press
charges against Eric. My role was to support
her decision and not try to persuade her to do something she did
not feel comfortable doing. While I may
believe that perpetrators of sexual assault should be hel d
accountable, I also recognize that the process of a
court hearing can be quite difficult for survivors of sexual
assault. While a survivor’s past sexual experiences
cannot be brought in as evidence because of the rape shield
laws, often the questions are accusatory, humili-
ating, and intimidating.
situation?
When working with victims of trauma, there are several scales
that can be used to measure a client’s change
in emotional state. A scale for PTSD, depression, or quality of
life could be incorporated each month.
case?
The majority of Talia’s friends were supportive and rallied
around her, but there were a few people who
blamed her for the assault and Eric’s suspension. Some of her
sorority sisters attempted to get her thrown out
of Kappa Delta. The couple of times that Talia tried to resume
going out with friends on the weekends at the

local bars she was verbally accosted by Eric’s fraternity
brothers. She decided to leave the sorority and ceased
going to the bars near the school. Eric’s family got a lawyer to
fight the suspension, but withdrew the case after
another student came forward to the administration and said he
had raped her also.
12. Describe any additional personal reflections about this
case.
I truly enjoyed working with Talia. She came to sessions
motivated to address her feelings. While she at times
was unable to verbalize her emotions, she was willing to try
alternative forms of therapy to explore her feelings.
I am particularly proud of her desire to be part of the SART
team. I think she will be a great addition to our
team. We talked about her readiness to meet with someone who
experienced a sexual assault, and it seemed
that she had fully integrated what happened and wanted to help
others through the process as well. She knows
that if in the future she has any difficulties processing a hotline
call that I am available to support her.
The Levy Family
1. What specific intervention strategies (skills, knowledge,
etc.) did you use to address this client situation?
The intervention strategies I used with this client situation
included problem-solving techniques. I gathered
information, assessed the situation, and developed a plan of
action. I used the strengths perspective to show
Jake that he had the ability and motivation to change his
situation. Couples counseling was suggested so that
Sheri would learn about Jake’s diagnosis. The systems
perspective was used in assessing what resources and

services Jake needed. I used a variety of techniques to address
his trauma symptoms, including PET, journaling,
deep breathing, and guided meditation.
I used the theory of cognitive behavioral therapy and PET to
address his trauma.
The client was clearly motivated to address his situation, he was
employed, and he had a supportive and
loving wife.
The client had symptoms of PTSD, he was self-medicating, and
he was depressed and isolating himself from
his family.
concern?

Jake and I agreed the goals for him were to follow -up with the
psychiatrist to monitor his medication, attend
weekly individual therapy sessions with me to address his PTSD
issues, start attending an Iraq veterans support
group at the Vet Center to develop a network of veterans he
could connect with, participate in couples coun-
seling to improve his relationship with his wife, and consider
attending a local AA meeting to aid in his sobriety.
population/group prior to beginning your work with this client?
If so, what research did you do to
prepare?
I was aware of the culture connected to being in the military.
Often those in the military do not speak up and
share their feelings for fear of looking weak and ineffective. I
recognized that stepping forward was difficult for
Jake and reminded him of the use of confidentiality in our
sessions.
case?
Policies that could be addressed are those that outline services
for the military.
affect this case?
I would advocate for a policy change that would establish a
program for all military personnel returning from
combat. Both the veterans and their family members should be
educated about the symptoms of PTSD, how
it can be treated, and the services available for those returning

from combat. Families should be prepared for
what to expect when their loved one returns home.
9. Were there any legal or ethical issues present in this case? If
addressed?
There were no legal issues in this case.
situation?
Evidence-based practice can be integrated into this situation by
looking at previous research studies that
relate to this client situation. Previous studies quantify and
support PET for PTSD.
case?
There is no other information at this time.
As I reflected on this case, I was reminded that this war was one
of the longest our country has engaged in.
Unlike the Vietnam War, military personnel were often sent
back to Iraq more than once, meaning they spent
more time in the line of fire. Jake’s case is typical of what
happens when a person returns from a hostile envi-
ronment. He had been running on adrenaline nonstop for
months. The length of time in that environment and
the things witnessed while there are factors that affect an
individual’s ability to function in an environment that
is not hostile. Jake has had a hard time adjusting to being home
because home was no longer the norm for him.

The Bradley Family
Various counseling skills including reflection, summarization,
empathy, and rapport were used when Tiffani
was sharing her life story. Cognitive behavioral therapy
techniques helped Tiffani adjust her thoughts around
her self-worth. Further, we addressed her feelings related to
Donald and her potentially dangerous view of him
as her savior.
33
We focused on Tiffani’s goals and cognitive behavioral theory
to help with her history of sexual abuse.
Tiffani’s strengths lie in her dedication to her sister and her
desire to be reunited with her. Another strength

is that she no longer seems to be emotionally attached to her
former pimp, Donald, and does not seem to be
attached emotionally to her last pimp, John T.
Tiffani has had to become self-sufficient enough to care for
herself.
concern?
The goals were to help her utilize all of the services provided
and address her traumatic experiences in her
early childhood and with Donald and John T. Her goals included
attaining a level of self-sufficiency by obtaining
her GED, getting a job, and renting an apartment. She also
wanted to reunite with her sister and begin a mean-
ingful relationship with her.
you do to prepare?
I had to understand her background and how she became
involved with Donald and then John T. I learned
about domestic human trafficking and the tactics used by pimps
to maintain power and control over others.
case?
New laws and policies concerning human trafficking and their
tie-in with laws that address youth who are

prostituted affected this case.
affect this case?
I would advocate for a national policy that addresses young men
and women as survivors of human traf-
ficking rather than prostitutes in our legal system.
addressed?
The legal issue in this case concerned the new policy on how
youth are penalized by the court system when
found guilty of prostitution. There was an ethical issue that was
not identified in the narrative. The director of
Teens First requested that I ask Tiffani if we could use her
image and story to promote the agency’s services.
I felt it was unethical to present this request to her because it
was still early in her healing process and there
were potential unintended negative consequences that could
occur that she might not consider due to her age.
situation?
Evidence-based practice techniques are key methods used in the
work with this client.
case?
While Tiffani was a client, the director of Teens First asked that
I see if she would be willing to allow us to use
her image and story to promote our services. I explained to the
director that I felt Tiffani was in no position to

make this decision. I explained that she had not been i n
treatment long enough to able to truly separate herself
from what had happened. I worried that seeing her image on
posters throughout the city might negatively
affect her over time. I also felt that due to her age, she could
not clearly make this decision and comprehend
the potential negative consequences that might occur by
agreeing to this. For example, I worried that people
on the street might recognize her from the advertisements and
point her out and say demeaning things to her.
I also wondered what effect this might have on her relationships
with her family if they saw the advertisements.
Finally, I was concerned that there might be retribution on the
part of Donald or John T. if they saw the posters.
34
I had strong feelings over the ethics of using a client’s image
and story to market the agency. While in the
end it is the client’s decision, I did not feel she was in a
position to make this decision clearly. Due to her age
and the limited time in treatment, I felt she could easily be
manipulated to do something she might regret
later. I had mixed feelings about making this decision for her or
presenting the situation for her to make on
her own.
The Petrakis Family

35
I used solution-focused and then psychodynamic interventions.
2. Which theory or theories did you use to guide your
practice?
I used family systems and environmental theories to guide my
practice.
The identified strengths of the client were strong family bonds
and good community support.
Helen found it challenging to manage good self-care while
acting as the primary caretaker of a family
member. She also was challenged by the substance abuse and
risky behaviors of her adult son.
concern?
There were three identified goals in Helen’s therapy sessions.
One was to develop behavioral interventions to
help Helen manage her feelings of anxiety. The second was to
help Helen arrange to have a psychiatric evalu
ation to determine if medication management would help her
manage her anxiety. The third was to help Helen
develop and secure a safe and supported housing plan for
Magda.

you do to prepare?
It was important to recognize that Helen lives within a specific
ethnic community.
7. What local, state, or federal policies could (or did) affect
this case?
Adult protection services are of primary concern to this case.
affect this case?
I would advocate for supportive services for primary caretakers,
including respite arrangements, shopping
services, and assistance with medication management for
Magda.
addressed?
The legal issues of Alec’s substance abuse and theft were not
addressed in this case. The legal and ethical
issues of theft were also not addressed.
situation?
Evidence-based treatment may be integrated into the treatment
of both anxiety and supportive interventions
for codependency among substance-abusing family members. I
would help Helen to identify measurable and
quantifiable behavioral goals for treatment, specify my

interventions, and evaluate every 12 sessions to see if
my interventions were successfully addressing Helen’s goals.
case?
I think providing Helen with information about harm reduction
approaches to understanding substance
abuse would be helpful, should Helen be interested. I would
also provide information about Al-Anon. I would
be curious about whether Helen’s church or community offered
support for substance abusers, caregivers, or
families of substance abusers. I would also inquire about case
management services for the elderly and provide
that information to Helen, if she expressed an interest.
case.
Helen is very involved in the care of her family and is losing
her energy to care for herself. I would work to help
Helen recognize her own strength and resilience and begin to
identify ways she can nurture and recharge herself.
The Cortez Family
-
-
-

Skills I used included engagement and repairing relationship,
assessment, asking open-ended questions, gath
ering information, identifying presenting problems and
treatment planning, coordination of and collaboration
with an interdisciplinary team, and coordination of and
collaboration with community resources. Interventions
I used included providing support, partializing problems, setting
small achievable goals, suicide assessment, and
case management. I had knowledge of the hospital system,
Medicaid and public assistance, and HIV/AIDS.
2. Which theory or theories did you use to guide your
practice?
My practice was guided by strengths perspective, motivational
interviewing, psychodynamic theory, and
goal-oriented practice.
Paula had many strengths. She was intelligent, completing both
high school and college. She was able
to create relationships with helping professionals. She was able
to rally people around her. Paula was also a
survivor and drew on her life experience. She taught herself
how to use her nondominant hand to paint. Even
though it took a lot of effort and convincing, Paula was able to
get things done.
Paula’s challenges included social isolation, physical illness,
mental illness, and limited financial resources.

concern?
We agreed that we would address Paula’s domestic violence
relationship by creating a safety plan and
obtaining a restraining order. I would assist Paula in making a
decision about keeping or ending her preg
nancy. We would monitor Paula’s mental and physical health. I
would help Paula prepare for her baby’s arrival
by helping her get baby supplies; arrange for appropriate
services such as in-home child care assistance, WIC
benefits, baby’s Medicaid; emotionally prepare for how life will
change with a baby; and arrange for perma
nency planning.
you do to prepare?
Some cultural competence issues were addressed. It was
important for me to understand Paula’s Catholic
background. While Paula claimed that religion was not a big
part of her life, her Catholic views did affect her
decision to keep her pregnancy. They were also intertwined in
her thoughts and feelings about death and dying.
There were also aspects of Paula’s Latino culture that played
out in her case. For example, her tendency to
give up on mainstream medical interventions and resort to more
holistic and home remedies is consistent with
Latino culture. In addition, Paula was always resistant to
involving outsiders (i.e., community resources, friends,
aides, etc.) in her care/life. She held onto the cultural belief that

family issues should be dealt with from within.
What made this difficult for Paula was the fact that her family
was not involved in her life. She did not want to
rely on outsiders, but she was alone and really had no choice.
36
7. What local, state, or federal policies could (or did) affect
this case?
The local and state policies that affected this case include
Medicaid, WIC, New York State public assistance,
New York City court system, and hospital policies such as
length of stay, the Health Insurance Portability and
Accountability Act of 1996 (HIPPA), coordination of care
across disciplines, etc.
affect this case?
This does not apply to this case.
addressed?
The big ethical issue that was present in this case was Paula’s
decision to keep her baby. Several of Paula’s
doctors held strong feelings that Paula should abort her
pregnancy. They felt she was too ill to care for an infant
and a child at all. As her social worker, I was not sure what the
right answer was. It really did not matter because
the decision was hers. My role was to support whatever decision

she made and help her reach the best outcome
given either scenario.
With regard to legal issues, Paula did obtain a restraining order
for the baby’s father. Throughout the course
of treatment, the father violated the order once. I helped Paula
file a report with the police regarding the viola
tion. We also made sure that Paula’s advance directives were in
order and helped Paula file permanency plan
ning paperwork with the courts. When working in a hospital
setting, one must always deal with HIPPA and
protected health information.
situation?
Evidence-based practice can be integrated into the situation by
using appropriate scales to measure depres
sion, such as the Beck Depression Inventory-II, and by using
formal suicide assessment, such as the Beck Scale
for Suicide Ideation.
case?
There is no additional information.
case.
Paula’s case is one of the most difficult cases I have
encountered in my career. I worked with Paula for a little
bit over a year. We terminated because I left my position at the
hospital. Paula not only challenged my social
work skills, but she also drew me into her case emotionally.
Yes, I was Paula’s social worker, but at times I felt
like I was her only friend and her caregiver. At the beginning, I

felt an enormous sense of responsibility for the
outcome of her situation. Paula consumed a lot of my time. She
called me often and required a great deal of
hand-holding. The irony is that when I did not hear from her, I
worried. When I did hear from her, I felt like
she was demanding and she drew me right into the chaos of her
life and her situation. Eventually, when I real
ized the extent of my emotional involvement in this case, I had
to set boundaries for Paula and myself. This
became crucial to our work together. I ultimately realized that
the boundaries were actually good for Paula as
they demonstrated structure and the limitations of others’
involvement in her life. They forced Paula to take
personal responsibility for her situation and take an active role
in dealing with it. For me, the boundaries kept
me sane. They allowed me to realize my own limitations. Many
times, I reminded myself, “You can lead a horse
to water, but you can’t make them drink.”
I feel very fortunate that I was able to work with Paula as part
of an interdisciplinary team. Working on a
team allowed me to consult with colleagues about the direction
we should take with Paula. It also helped me
cope with the stress and challenges of Paula’s case. My
colleagues and I often found ourselves venting our frus
trations, concerns, and fears with each other. I truly do not
think I would have been as successful as I was in
helping Paula if I had been on my own.
37
Trademarks and Disclaimers

“Abilify” is a registered trademark of Otsuka Pharmaceutical.
Otsuka Pharmaceutical is not affiliated with Laureate
Education Inc., nor do they sponsor or endorse Laureate
products or services.
“Klonopin” is a registered trademark of Hoffmann-La Roche
Inc. Hoffmann-La Roche Inc. is not affiliated with
Laureate Education Inc., nor do they sponsor or endorse
Laureate products or services.
“Lexapro” is a registered trademark of Forest Laboratories, Inc.
Forest Laboratories, Inc. is not affiliated with
Laureate Education Inc., nor do they sponsor or endorse
Laureate products or services.
“Paxil” is a registered trademark of GlaxoSmithKline LLC.
GlaxoSmithKline LLC is not affiliated with Laureate
“Tylenol” is a registered trademark of The Tylenol Company.
The Tylenol Company is not affiliated with Laureate
“Zyprexa” is a registered trademark of Eli Lilly and Company.
Eli Lilly and Company is not affiliated with Laureate
38
Session Case Histories
Copyright Editors and Contributors
ContentsIntroductionPart 1: Foundation Year The Hernandez
Family The Parker Family The Logan Family The Johnson
Family Part 2: Concentration Year The Levy Family The

Bradley Family The Petrakis Family The Cortez Family
Appendix Reflection Questions The Hernandez Family The
Parker Family The Logan Family The Johnson Family The Levy
Family The Bradley Family The Petrakis Family The Cortez
Family Trademarks and Disclaimers
Week7: Developing a Logic Model Outline Handout
Complete the tables below to develop both a practice-level logic
model and a program-level logic model to address the needs of
Helen in the Petrakis case history.
Practice-Level Logic Model Outline
Problem
Needs
Underlying Causes
Intervention Activities
Outcomes
Program-Level Logic Model Outline
Problem
Needs
Underlying Causes
Outcomes
© 2014 Laureate Education, Inc.
Page 1 of 1
Week7: Developing a Logic Model Outline Handout

Complete the tables below to develop both a practice-level logic
model and a program-level logic model to address the needs of
Helen in the Petrakis case history.
Problem
Needs
Underlying Causes
Outcomes
Problem
Needs
Underlying Causes
Outcomes
© 2014 Laureate Education, Inc.
Page 1 of 1
Excerpts from Measuring Program Outcomes: A Practical
Approach
© 1996 United Way of America

Introduction to Outcome Measurement
If yours is like most human service agencies or youth- and
family-serving organizations, you regularly
monitor and report on how much money you receive, how many
staff and volunteers you have, and what
they do in your programs. You know how many individuals
participate in your programs, how many hours
you spend serving them, and how many brochures or classes or
counseling sessions you produce. In
other words, you document program inputs, activities, and
outputs.
Inputs include resources dedicated to or consumed by the
program. Examples are money, staff and staff
time, volunteers and volunteer time, facilities, equipment, and
supplies. For instance, inputs for a parent
education class include the hours of staff time spent designing
and delivering the program. Inputs also
include constraints on the program, such as laws, regulations,
and requirements for receipt of funding.
Activities are what the program does with the inputs to fulfill
its mission. Activities include the strategies,
techniques, and types of treatment that comprise the program's
service methodology. For instance,
sheltering and feeding homeless families are program activities,
as are training and counseling homeless
adults to help them prepare for and find jobs.
Outputs are the direct products of program activities and usually
are measured in terms of the volume of
work accomplished--for example, the numbers of classes taught,
counseling sessions conducted,
educational materials distributed, and participants served.
Outputs have little inherent value in

themselves. They are important because they are intended to
lead to a desired benefit for participants or
target populations.
If given enough resources, managers can control output levels.
In a parent education class, for example,
the number of classes held and the number of parents served are
outputs. With enough staff and
supplies, the program could double its output of classes and
participants.
If yours is like most human service organizations, you do not
consistently track what happens to
participants after they receive your services. You cannot report,
for example, that 55 percent of your
participants used more appropriate approaches to conflict
management after your youth development
program conducted sessions on that skill, or that your public
awareness program was followed by a 20
percent increase in the number of low-income parents getting
their children immunized. In other words,
you do not have much information on your program's outcomes.
Outcomes are benefits or changes for individuals or populations
during or after participating in program
activities. They are influenced by a program's outputs.
Outcomes may relate to behavior, skills,
knowledge, attitudes, values, condition, or other attributes.
They are what participants know, think, or can
do; or how they behave; or what their condition is, that is
different following the program.
For example, in a program to counsel families on financial
management, outputs--what the service
produces--include the number of financial planning sessions and
the number of families seen. The

desired outcomes--the changes sought in participants' behavior
or status--can include their developing
and living within a budget, making monthly additions to a
savings account, and having increased financial
stability.
In another example, outputs of a neighborhood clean-up
campaign can be the number of organizing
meetings held and the number of weekends dedicated to the
clean-up effort. Outcomes--benefits to the
target population--might include reduced exposure to safety
hazards and increased feelings of
neighborhood pride. The program outcome model depicts the
relationship between inputs, activities,
outputs, and outcomes.
Note: Outcomes sometimes are confused with outcome
indicators, specific items of data that are tracked to measure
how well a
program is achieving an outcome, and with outcome targets,
which are objectives for a program's level of achievement.
For example, in a youth development program that creates
internship opportunities for high school youth, an outcome
might be that
participants develop expanded views of their career options. An
indicator of how well the program is succeeding on this
outcome
could be the number and percent of participants who list more
careers of interest to them at the end of the program than they
did at
the beginning of the program. A target might be that 40 percent
of participants list at least two more careers after completing
the
program than they did when they started it.

Program Outcome Model
Resources dedicated
to or consumed by
the program
money
staff and staff time
volunteers and
volunteer time
facilities
equipment and
supplies
Constraints on the
program
laws
regulations
funders' requirements
What the program
does with the inputs
to fulfill its mission
feed and shelter
homeless families
provide job training

educate the public
about signs of child
abuse
counsel pregnant
women
create mentoring
relationships for youth
The direct products of
program activities
number of classes
taught
number of counseling
sessions conducted
number of educational
materials distributed
number of hours of
service delivered
number of participants
served
Benefits for
participants during
and after program
activities
new knowledge
increased skills
changed attitudes or
values
modified behavior
improved condition
altered status

Why Measure Outcomes?
In growing numbers, service providers, governments, other
funders, and the public are calling for clearer
evidence that the resources they expend actually produce
benefits for people. Consumers of services and
volunteers who provide services want to know that programs to
which they devote their time really make a
difference. That is, they want better accountability for the use
of resources. One clear and compelling
answer to the question of "why measure outcomes?" is to see if
programs really make a difference in the
lives of people.
Although improved accountability has been a major force
behind the move to outcome measurement,
there is an even more important reason: to help programs
improve services. Outcome measurement
provides a learning loop that feeds information back into
programs on how well they are doing. It offers
findings they can use to adapt, improve, and become more
effective.
This dividend doesn't take years to occur. It often starts
appearing early in the process of setting up an
outcome measurement system. Just the process of focusing on
outcomes--on why the program is doing
what it's doing and how participants will be better off--gives
program managers and staff a clearer picture
of the purpose of their efforts. That clarification alone
frequently leads to more focused and productive
service delivery.
Down the road, being able to demonstrate that their efforts are

making a difference for people pays
important dividends for programs. It can, for example, help
programs:
• Recruit and retain talented staff
• Enlist and motivate able volunteers
• Attract new participants
• Engage collaborators
• Garner support for innovative efforts
• Win designation as a model or demonstration site
• Retain or increase funding
• Gain favorable public recognition
Results of outcome measurement show not only where services
are being effective for participants, but
also where outcomes are not as expected. Program managers can
use outcome data to:
• Strengthen existing services
• Target effective services for expansion
• Identify staff and volunteer training needs
• Develop and justify budgets
• Prepare long-range plans
• Focus board members' attention on programmatic issues
To increase its internal efficiency, a program needs to track its
inputs and outputs. To assess compliance
with service delivery standards, a program needs to monitor
activities and outputs. But to improve its
effectiveness in helping participants, to assure potential
participants and funders that its programs

produce results, and to show the general public that it produces
benefits that merit support, an agency
needs to measure its outcomes.
These and other benefits of outcome measurement are not just
theoretical. Scores of human service
providers across the country attest to the difference it has made
for their staff, their volunteers, their
decision makers, their financial situation, their reputation, and,
most important, for the public they serve.
Eight Steps to Success
Measuring Program Outcomes provides a step-by-step approach
to developing a system for measuring
program outcomes and using the results. The approach, based on
methods implemented successfully by
agencies across the country, is presented in eight steps, shown
below. Although the illustration suggests
that the steps are sequential, this is actually a dynamic process
with a good deal of interplay among
stages.
Example Outcomes and Outcome Indicators for Various
Programs
These are illustrative examples only. Programs need to identify
their own outcomes and indicators,
matched to and based on their own experiences and missions
and the input of their staff, volunteers,
participants, and others.

Type of Program Outcome Indicator(s)
Smoking cessation
class
Participants stop smoking. • Number and percent of participants
who report that they have quit smoking by
the end of the course
• Number and percent of participants who have not relapsed six
months after
program completion
Information and
referral program
Callers access services to which
they are referred or about which
they are given information.
• Number and percent of community agencies that report an
increase in new
participants who came to their agency as a result of a call to the
information
and referral hotline
• Number and percent of community agencies that indicate these
referrals are
appropriate
Tutorial program
for 6th grade
students
Students' academic performance
improves.

• Number and percent of participants who earn better grades in
the grading
period following completion of the program than in the gradi ng
period
immediately preceding enrollment in the program
English-as-a-
second-language
instruction
Participants become proficient in
English.
• Number and percent of participants who demonstrate increase
in ability to
read, write, and speak English by the end of the course
Counseling for
parents identified
as at risk for child
abuse or neglect
Risk factors decrease. No
confirmed incidents of child
abuse or neglect.
• Number and percent of participating families for whom Child
Protective
Service records report no confirmed child abuse or neglect
during 12 months
following program completion
Employee
assistance
program

Employees with drug and/or
alcohol problems are
rehabilitated and do not lose
their jobs.
• Number and percent of program participants who are gainfully
employed at
same company 6 months after intake
Homemaking
services
The home environment is
healthy, clean, and safe.
Participants stay in their own
home and are not referred to a
nursing home.
• Number and percent of participants whose home environment
is rated clean
and safe by a trained observer
• Number of local nursing homes who report that applications
from younger
and healthier citizens are declining (indicating that persons who
in the past
would have been referred to a nursing home now stay at home
longer)
Prenatal care
program
Pregnant women follow the
advice of the nutritionist.

• Number and percent of women who take recommended vitamin
supplements
and consume recommended amounts of calcium
Shelter and
counseling for
runaway youth
Family is reunified whenever
possible; otherwise, youths are
in stable alternative housing.
• Number and percent of youth who return home
• Number and percent of youth placed in alternative living
arrangements who
are in that arrangement 6 months later unless they have been
reunified or
emancipated
Camping Children expand skills in areas
of interest to them.
• Number and percent of campers that identify two or more
skills they have
learned at camp
Family planning for
teen mothers
Teen mothers have no second
pregnancies until they have
completed high school and have
the personal, family, and
financial resources to support a
second child.

• Number and percent of teen mothers who comply with family
planning visits
• Number and percent of teen mothers using a recommended
form of birth
control
• Number and percent of teen mothers who do not have repeat
pregnancies
prior to graduation
• Number and percent of teen mothers who, at the time of next
pregnancy, are
high school graduates, are married, and do not need public
assistance to
provide for their children
Glossary of Selected Outcome Measurement Terms
Inputs are resources a program uses to achieve program
objectives. Examples are staff, volunteers,
facilities, equipment, curricula, and money. A program uses
inputs to support activities.
Activities are what a program does with its inputs-the services
it provides-to fulfill its mission. Examples
are sheltering homeless families, educating the public about
signs of child abuse, and providing adult
mentors for youth. Program activities result in outputs.
Outputs are products of a program's activities, such as the
number of meals provided, classes taught,

brochures distributed, or participants served. A program's
outputs should produce desired outcomes for
the program's participants.
Outcomes are benefits for participants during or after their
involvement with a program. Outcomes may
relate to knowledge, skills, attitudes, values, behavior,
condition, or status. Examples of outcomes include
greater knowledge of nutritional needs, improved reading skills,
more effective responses to conflict,
getting a job, and having greater financial stability.
For a particular program, there can be various "levels" of
outcomes, with initial outcomes leading to
longer-term ones. For example, a youth in a mentoring program
who receives one-to-one encouragement
to improve academic performance may attend school more
regularly, which can lead to getting better
grades, which can lead to graduating.
Outcome indicators are the specific items of information that
track a program's success on outcomes.
They describe observable, measurable characteristics or changes
that represent achievement of an
outcome. For example, a program whose desired outcome is that
participants pursue a healthy lifestyle
could define "healthy lifestyle" as not smoking; maintaining a
recommended weight, blood pressure, and
cholesterol level; getting at least two hours of exercise each
week; and wearing seat belts consistently.
The number and percent of program participants who
demonstrate these behaviors then is an indicator of
how well the program is doing with respect to the outcome.
Outcome targets are numerical objectives for a program's level
of achievement on its outcomes. After a

program has had experience with measuring outcomes, it can
use its findings to set targets for the
number and percent of participants expected to achieve desired
outcomes in the next reporting period. It
also can set targets for the amount of change it expects
participants to experience.
Benchmarks are performance data that are used for comparative
purposes. A program can use its own
data as a baseline benchmark against which to compare future
performance. It also can use data from
another program as a benchmark. In the latter case, the other
program often is chosen because it is
exemplary and its data are used as a target to strive for , rather
than as a baseline.
2
Assignment: Outlining a Logic Model
Name
Institutional Affiliations
Course Title
Instructor’s Name
Due Date

Problem
Needs
Underlying Causes
Outcomes
Helen has elevated levels of stress, disquiet, and back pain. She
is also faced with medication management issues,
Hellen does not know the best way of addressing her sons
substance addiction and how she can secure a reliable support
system for her mother-in-law
Hellen needs to know how she can manage her anxiety, address
her son addiction issues Family support system
Magda care
Lack of work-life balance. Hellen works full time and she is
tasked with performing most of the house chores as well as
taking care of Magda who lives in a different apartment. Lack
of work-life balance is the cause of Helen's increased stress,
anxiety, and back pain.
Lack of family support and her son's addiction problems also
contribute to Hellen’s health problems and the quality of care
she offers to Magda.
The cognitive restructuring will be used to identify and stop
negative thoughts and feelings experienced by Hellen and
replace them with desirable thoughts (Ciharova et al., 2021)
Physical therapy will be used to ease Hellen’s back pain

psychotherapy and counseling services to aid in reducing stress
(Ciharova et al., 2021)
The cognitive restructuring will help Reduce symptoms of
stress and anxiety disorders (Ciharova et al., 2021)
Physical therapy will lead to
Pain management with
reduced need for opioids (Ciharova et al., 2021)
Fall prevention
Enhance mobility and movement
Psychotherapy will improve Helen's relationship with her family
and also enhance her mental health.
Problem
Needs
Underlying Causes
Outcomes
Helen's anxiety elevates her stress levels
Helen lacks emotional and financial support from the family
Her son's Substance issues
Magda care management
Work-life balance issues.
Helene needs to address stress and anxiety.

She also needs family support to aid her in the care
management of Magda
Helen's back pain issues also need to be addressed
Her son's addiction issues are also top of her priorities
The Petrakis family lacks a reliable caregiver for Magda.
Lack of support systems
Family financial position, considering that two of her children
are not employed.
Her son's addiction issues lead him to steal and become
negligent.
The Petrakis should hire a reliable caregiver for Magda
Social services such as income support, mental health services
to address Helen's sons addiction, and nutrition for Magda
Provide emotional support through Cognitive behavior therapy.
A reliable caregiver will ease Helen's burden
Social support such as income support will increase the family
income while mental health services will help Helen’s son over
addiction
CBT will help help relax and manage stress positively
Practice Level Logic
Helen’s response to her challenges is not good. She is
concerned about maintaining order in her family. As such, she
cannot even disclose her son’s addiction to the family. She also
lacks a work-life balance considering that she works full-time
and has to take care of Magda. Helen needs to cope with her
normal stressor, and ensure that her well-being is at the top of
her priority. Cognitive restructuring is an ideal intervention to
aid Helen to cope with her negative thoughts (Ciharova et al.,
2021). This type of therapy yields desirable thoughts and helps
Helen cope with her stress triggers.
Program Level Logic
The Petrakis family culture and religious beliefs do not permit
them to share their issues with strangers. As such, implementing
family psychodynamic therapy will be ideal for addressing the

highlighted problems. The problems that Helen faces are a
result of a lack of family support and her son’s additional
issues. In family psychodynamic therapy, the social worker
guides group therapy with the family (Becker-Haimes et al.,
2019). This therapy session creates and maintains a healthy
family dynamic which aids in addressing challenges
collaboratively with the input of family members. Getting a
reliable caregiver and income support, as well as medication
and nutrition, can also help address Helen’s underlying
problems. The outcomes of interventions will help Helen to
manage stress and anxiety and receive the needed support in the
care of her mother-in-law.
References
Becker-Haimes, E. M., Williams, N. J., Okamura, K. H., &
Beidas, R. S. (2019). Interactions between clinician and
organizational characteristics to predict cognitive-behavioral
and psychodynamic therapy use. Administration and Policy in
Mental Health and Mental Health Services Research, 46(6),
701-712.
Ciharova, M., Furukawa, T. A., Efthimiou, O., Karyotaki, E.,
Miguel, C., Noma, H., ... & Cuijpers, P. (2021). Cognitive
restructuring, behavioral activation and cognitive-behavioral

therapy in the treatment of adult depression: A network meta-
analysis. Journal of Consulting and Clinical Psychology, 89(6),
563.

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