Family Involvement in the Treatment Process: A Need for Macro Change
...nd possibly clients. The target system would be Miracles House itself. Finally, the macro client system would be the current and future clients of Miracles House and their families. As the change agent, I would take on several social work practice roles. First, my role would be as an initiator. I would call attention to the need of family involvement at Miracles House by speaking with the CEO and director of the agency. Next, I would want to involve other staff members and clients in order to obtain more input on this need for change. Hopefully, this would gain support for my effort and recruit the members of the action system. Bringing these people together for a common goal would require me to take on the role of coordinator. The third practice role that I would need to fulfill is that of a facilitator. I would utilize my micro and mezzo skills to lead the action system meetings and aid the group in moving forward in the macro change process. The role of negotiator would be required to settle disputes or come to an agreement. These disputes may occur within the action system or when dealing with opponents of the change. For example, I might need to help settle a disagreement on the action steps necessary to implement change, the types of family interventions required, or whether the macro change is even relevant. I feel this task is that of a negotiator and not a mediator because I would have a vested interest in the issue. Finally, I would take on the role of an evaluator. First, I would need to evaluate the possibility of moving forward with this change. If the change is implemented, I would then need to evaluate it’s effectiveness (Kirst-Ashman & Hull, 2001). The next area to consider when addressing this need is the type of micro and mezzo skills necessary for macro change. I feel that communication is the most important micro skill for me to possess. As a good communicator I would need to be an attentive listener, use facial expressions, clarification, and reflective responding appropriately. I would also need to be warm, genuine, and empathetic. These skills would be used throughout the macro change process. They will help me fulfill the practice roles, aid in gaining support for this issue, and insure the preservation of existing relationships. Another micro skill necessary is multicultural sensitivity. I would use this skill in dealing with both staff and clients. The idea of family differs in various cultures. An awareness of these differences would help me understand what the clients feel is necessary to fulfill this need (or whether they feel there is a need at all). Lastly, I would need to have the micro skill of assertiveness. Being assertive would help me get my point across, avoid conflict, and reduce my stress during the planned change process. It would be important to do this without being aggressive. This could counteract my efforts by possibly losing support or damaging relationships with colleagues (Kirst-Ashman & Hull, 2001). There are two mezzo skills that would be important to have: being able to resolve conflict and plan a meeting. Conflict might occur during any part of the change process. It might arise from a difference in opinion or simply from the stress of working to fulfill this need. Conflict might come about when dealing with funding issues, when to hold an action system meeting, or from a personality clash. In any of these situations, I would need to remember that conflict is a natural part of macro change, and that if managed properly, can be an asset to the process (Kirst-Ashman & Hull, 2001). As the change agent I would need to know how to adequately plan and conduct the action system meetings. At Miracles House, my biggest challenge would be setting a time and day that would allow everyone to attend. While most of the staff work during the day, some do work as late as 10 pm. In order to properly understand this need for macro change, I would have to be knowledgeable on the issues surrounding family, addiction, recovery, and how these areas are interrelated. When looking at the concept of family, I would want to know about how family functions as a system. I would also want to have a definition of family that takes into consideration cultural differences and allows friends and significant others to be included. According to the Center for Substance Abuse Treatment, . . . “family can be defined according to the individual client’s closest emotional connections” (2004, p. 3). Knowledge on how drug and alcohol addiction affects family dynamics would be necessary. This would include information on the problems faced by spouses when a mate is recovering, and problems faced by parents when an adult child is in recovery. I would want to know whether Miracles House has used family involvement in the past. If so, what were the outcomes, and why was it terminated? Finally, I would want to know about the types of family interventions that are used at other drug and alcohol treatment facilities in the community. As a social worker considering macro change, it is important for me to think about how this issue relates to my personal values system. I believe one of the main reasons why I feel so strongly about fulfilling this need has to do with my personal feelings about family. To me, having a close and healthy relationship with my family is what I value most in life. I cannot imagine going through something as difficult as recovering from a chemical dependence without the love and support of at least one person who was close to me. For this reason I feel that this unmet need is an injustice to the clients of Miracles House. While considering personal values, it is also necessary to address any ethical issues that may arise from this macro change. The first dilemma I have identified deals with self-determination. I feel the client should be given the choice whether or not to involve family in her recovery process. The NASW’s Code of Ethics says that “social workers [should] respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals” (1996, Ethical Standards section). Debbie Schuessler believes there are situations in which involving family would not be beneficial. Sometimes a client will have a no contact order, or the family is currently abusing drugs and alcohol. There are also circumstances where family members are very controlling over the client. Unless the family would be willing to work on this issue, the client must distance herself in order to focus on her recovery (D.S. Schuessler, personal communication, November 5, 2004). Another ethical issue surrounding family involvement in the treatment process deals with confidentiality. Ethically, social workers who lead groups or conduct counseling sessions are obligated to seek an agreement between those involved about each person’s right to confidentiality (NASW, 1996). There might be situations where several families are in a group. It is important that information shared is not taken outside of the group context. Also, in therapy sessions with a client and member of her family, what is sh...