Crises at Every Level of Service
HUMN 8110 Advance d Social Work Theory and Practice Week 3 – Crisis Theory – Part 1 (CT1) TYNEESE BOYD: My name is Tyneese Boyd. I go to Building for the Future. I’m 19. And I’m here to get my high school diploma. I found out about the school by another school I attended, and it wasn’t the right fit for me. I had a baby. And her father went to that school. So it was like, his problems on top of my problems, and me not wanting to come. So they split us up. He went to one school and I came here. TW ILAH ANTHONY: Tyneese is a very, very energetic young lady. She wants the world. She’s gotten caught up in her own world; because now she has a two year old that she doesn’t know how to raise because she doesn’t know how to read. And because she doesn’t k now how to read, it’s impacting her. Because she realizes that her daughter’s going to grow up and go to kindergarten and first grade. And when the child brings work home, she’s not sure if she’s going to be able to help her child read or do the work that she can’t do. She knows that she’s low, and she kind of camouflages it with always wanting to be out of class because she doesn’t want anybody to know she doesn’t know the work. With that, she struggles with the fact of building a life for her kid, meanin g just being able to find a home for her, because she’s been bounced from home to home to home. Right now, she has her own place. She had no idea that you had to pay her bills at a certain time, the due date, or they would turn it off. And then they would require you to pay all the money up front before you can even get it turned on. And so she was devastated about that. Or for some reason her social security check got cut off, as she didn’t have a way to buy Pampers or milk. And she’s brought the baby to school and was like, “We haven’t eaten.” How do you fix that? TYNEESE BOYD: Before I got here, from my other school I heard that I am going to have a social worker. And I was happy ’cause throughout all the years I’ve been going to school, I always had a social worker. And once you build a relationship with them, you’re really going to just go talk to a friend about all your problems. So I was happy. When they told me I have a social worker, I’m like, “That’s good,” because there was a lot of things I n eeded to talk about and talk to someone that I trust. They know that they can’t tell nobody. It’s good to know that they can’t tell nobody. AJIA MEUX: So this is a classic example of how theory informs practice, but sometimes practice has to stand alone. All those tools in your toolbox, you use what works. Tyneese can be manipulative. She can be manipulative in this sense that she absorbs a lot of what she hears. And she absorbs a lot of things around her. But what she absorbs doesn’t necessarily become h er. It just becomes what she hears, and then what she knows. So in a 10 -minute span, Tyneese can string together five one -liners, and then when you ask her her opinion about all of these things that she just said, it will be completely the opposite. It wil l be completely the opposite. So a lot of work that I do with Tyneese is around challenging her true perspective on circumstances. And that can take a long time. It can take a really, really long time. TYNEESE BOYD: The challenges that I am facing is getting on my own and keeping it, knowing that it’s not about me. It’s about the baby now. Her name is Tynea. She’s two years old. And every day I go to Miss Ajia and let her know how I’m feeling. My daught er’s father, we were discussing two weeks ago that he was thinking about moving with me, and that it was a good idea. He can support and help. But it’s not good right now for my age. I have a lot on my mind so I can’t really deal with your problems, my pro blems, come to school, getting up. Miss Ajia explained to me just let him know how you feel. And however way he take it, he just take it. You have to be comfortable with yourself and let people know how you feel. And when she let me know that, I’m like, y ou’re right. I gotta really let people know how I feel in a way that’s going to make me comfortable because then it’s about making me comfortable to make Tynea comfortable. Being a mom, for me, every day has been challenging. Dealing with problems has bee n frustrating, and trying not to take it out on her. But she’s still a little baby. And she don’t understand sometimes that I’m not in a good mood, and just go ahead and do something else. So I’m with my mom. So in the morning, I have to wake up at 7:30 a nd get her dressed, and make sure I feed her in the morning and get myself together. I have to get on one bus and walk up a hill to take her to daycare. And I got to make sure I’m at her daycare at least by 8:30, 8:45. I walk back down the hill, tired an d sweaty and ready to get to school so I can first sit down. And I know I got a lot on my mind, but I have to sit down and take a good breath. I’m really doing it because I love her. I get on another bus. And it bring me all the way to the school. After I think about and I get here, I say, that’s not too bad. Two buses? That’s not really bad for right now ’cause it might can get worse. And so you got to appreciate what you’re doing right now, and just take it and go with the flow. That’s my everyday life f or me and Tynea. It’s getting up, making sure I get to school on time, getting her to daycare, praying every day to make sure we get there safe. One problem that I had to deal with in life was dealing with my mother all over again. My mother had been on d rugs ever since I was young. And I had to understand that people go through things in life. And it took me a long time to understand that. So that’s why I had to deal with social workers. And this problem came up where my mom had stabbed me. And a casewor ker from the Child and Family Service had to get involved. And I had to learn that she my mom, and she had problems. So I can’t take things to the heart all the time with my mother. It wasn’t really her at the time. So my caseworker, his name was Mr. Jone s, he let me know you got a baby now, Tyneese. So everything that a mom do, they human. We make mistakes. So he taught me that can’t always get mad at her. And everything’s going to be fine. You can’t always bring up what she did wrong. Let it go or you’re not going to live right if you don’t let it go. And ever since I had my little one, ways that she act now, it’s like, sometimes you don’t appreciate what your mother do. He let me know she trying. You’ve got to give her props for that. So if it wasn’t fo r him, I don’t know — it was a long time I could have just been like, I really don’t care. And I always wanted to say, “I just need to give up,” but I have a purpose for being here. If it wasn’t for him, I could have just been like, “It just don’t matter. Everything just don’t matter.” But he really let me understand. He talked to me like I was human and let me know that it’s going to be fine. TWILAH ANTHONY: I take my hats off to the kids, because if I had to walk in the their shoes, I don’t know that I would. And even though they had their difficult days, the baggage that they carry, I feel like I wouldn’t handle it as well as they do. And so with that being said, they carry a lot of weight, a whole lot of weight. TYNEESE BOYD: Where I see myself in the future is being someone that can help children that’s dealing with problems that don’t have no one to talk to and don’t see that someone every day, don’t matter who they are, can help you. My social worker, Miss Ajia — all the social workers that I had in my life — show me that to us, it looks like it’s just their job to be a social worker and talk to people. But then they have a life. And you don’t know what they’ve been through. So all the ones that I meet and talk to and I let them know what I’ve been through, they say, “Tyneese, it’s going to be fine. You’re going to get through it.” She made me want to help people that is in my situation. © Laureate Education, Inc.
Crises at Every Level of Service
HUMN 8110 Advance d Social Work Theory and Practice Week 3 — Crisis Theory (ACT) AJIA MEUX: Good morning. Today is July 6th — Wednesday. I am getting ready to go in to work this morning. I’m tired. I’m starting to get adjusted to the time difference. I have one client today, doing an intake for her at the shelter. And the rest of my day is going to be spent doing a lot of paperwork, reorganization, creating processes for the programs. It seems like that’s what my role has evolved into. I’ve been able to help Miss Silva focus on what she needs to focus on, which is like organizational stuff. And being out there in the community. And talking to the right folks and things like that, by seeing clients. Right now I have about six clients. One of the clients, we’re trying to help her leave the country. She was in a very abusive — she has a protective order but her husband has been violating the protective order. He’s been driving by her home, and he’s threatened to kill her on many occasions. So we are trying to get her out of the country. AJIA MEUX: OK. So we have the application. And the application actually seems really, it’s not complicated, it’s very simple. So it just says t hat you need to provide the details of your employment, even if you were self -employed for the last 10 years. And have you ever served in the military? Did you ever participate in any, I think that says, combat? Let me pull this up. OK. Oh, have you ever p articipated in any form of combat. Just like if you were in the military, did you fight? Have you ever witnessed or participated in any ill treatment of prisoners, civilians, looting or desecration of religious buildings? Were you ever a member of a politi cal party or other group or organization? I don’t really know what that means, but — FEMALE SPEAKER: Were you ever a member of a political party or politician. AJIA MEUX: Are you a member of a political party? FEMALE SPEAKER: Not really. AJIA MEUX: We found a shelter in, or they found a shelter for before I got here, in Canada. But the visa paperwork for her and all of her children, it would cost too much money. So we’re trying to find other alternatives. Right now I’ve been looking for a shelter in Mex ico. Trying to find her — because you don’t need a visa to cross the Mexican border from Belize — so we’ve been try to find a shelter in Mexico. And then we’re going to start the process of applying for her US visa, just for her, to see whether or not she can get it. ANNA SILVA: What I’m saying is that I cannot disclose the information. We’re looking for safety for a client of ours. I don’t know who is working at your bank. I cannot disclose the person’s information. Well, we can — I will be purchasing the draft. My name is Anna Silva from Mary Open Doors. I’ll be purchasing the draft for the client to travel to Guatemala City to get the visa. So I will bring in my passport. Is that correct, my passport and information from the Guatemalan Embassy, and not t he client’s? That’s what I’m saying. Is it my passport, or the person traveling? And so, can I speak to your manager? Because what I’m trying to explain is that I cannot disclose her information. OK. Thank you. Thank you. OK, thanks. AJIA MEUX: You’re ve ry polite. You’re very polite. I’m learning from you. So there are no confidentiality laws out here. ANNA SILVA: We should be walking on the street. As soon as they say hello again, I’m at the door. AJIA MEUX: What time is it? We have 19 minutes. You wan t to just walk down there? ANNA SILVA: That’s what I was going to do. AJIA MEUX: With the money? You got your passport? I have mine. I don’t know if they’ll be able to use it. So it seems like you need to have a meeting with the banks. I’m learning a lot about Belizean criminal justice system. It’s nowhere near ours. I’m also learning a lot about just resiliency and people who have nothing, absolutely nothing. You know when our folks are poor in the US, they have TANF, they have food sta mps, they have things like that. There’s no such mechanism here in this country. So the women are poor, and they don’t have any money to feed their children. They just don’t have any money to feed their children. And they have to be creative. And a lot of them turn to making food to sell, in order to generate a little income to feed their children and pay their bills. So I will try to video blog every day, because I haven’t been because I’ve been running, and running, and running. But yeah, see you later. © Laureate Education, Inc.
Crises at Every Level of Service
HUMN 8110 Advance d Social Work Theory and Practice Week 3 – Crisis Theory – Part 2 (CT2) AJIA MEUX: We had two students that were dating. One of them has a history of serious mental illness. And she felt as if the male student “carried” her, carried meaning, dissed her or disrespected her in front of a roomful of their peers. And when they went out for lunch she became angry. She chased him around the parking lot. He came back upstairs, went in the classroom. I was in my office and saw her walk down the hallway yelling loudly. I go outside and ask her why is she yelling, and she has a rock in her hand that’s about this big, about that thick. And I said, “What are you getting ready to do with that?” And she’s like, “I’m getting ready to — you know — bleep him up.” I grab the rock out of her hand. She goes into the classroom. At that time we had a teacher who was probably six -three, six -four, a good 270. I don’t know. She went in the classroom after the boy. The teacher stepped in. She became violent to ward the student. She picked up a stapler, threw it at him. It was at that point that they removed her out of the classroom. They had to physically remove her. We shut the school down, closed all the doors. We formed a triangle around her, myself and two of the staff members who she had better relationships with. We got her to the end of the hallway. All the teachers went back, but they stood by the front door. She found her way into the supply closet and sat in the supply closet for probably 20 minutes sc reaming at the same pitch and tone and intensity, rocking back and forth, scratching her face, pulling her hair. So I instructed the staff to call the mobile crisis unit. There was not anything that we were going to be able to do for her. So we called the mobile crisis unit; called the police, called her — she had a wraparound service provider through — she’s a CFSA client — wraparound service provider to come in so that that end of her team can be aware. And what I did is identify the person who she felt most comfortable with, who was our administrative assistant, Ms. T. I sent Ms. T into the closet with her, and Ms. T just sat there with her. Now, probably in any other crisis we would not have sent anyone into a small space with someone who was screaming . But recognizing what tool is most useful in your toolbox at that moment, I knew that that’s what she needed. You know, this was a girl who was hurting because she felt like the man who she liked and was interested in her — or who she was interested in — was not interested in her. And in that moment she needed someone she identified as a mother or a big sister. This is a girl whose mother died, who’s been in foster care the majority of her life. So that’s what she looks for — female relationships with peop le– and that’s what she got that day to help bring her down. She was very angry with me when she came out of the closet because I called the police and the mobile crisis unit on her. But I stayed with her. I told her I would do it again if she lost it li ke that. But that’s what we have to do. It was important to lock the school down. It was important to make sure that other students were safe. It was important to get her away from everybody else so that we could have everybody focus on their work and not focus on her. Because then we had students hanging out the door like, what’s going on, what is she doing? It was important to surround her with people that she felt safe with, not people who she didn’t like because then she could have become aggressive t owards them. Now, she should not have found her way into the closet, and that actually became a big deal afterwards. How did she get into the closet? Why was the closet door unlocked? I’m actually glad she did end up in the closet because it gave her a saf e space where she can get out all of the emotion that she needed to get out. Because the student was so elevated and so excited, we weren’t able to put time restraints into play. She would have not been receptive if we had said, “You have 10 minutes to ge t out of the closet. You have 20 minutes to get out of the closet.” At that point, when someone is at the point of bashing someone’s head in with a brick, we can’t put time limits on them. As far as rapid assessment is concerned, I think initially we didn ‘t realize how fast the situation was escalating in the classroom. That’s why she got to the point where she was able to throw a stapler at someone and almost kick him before she was moved out. But the reason why I stepped in is because I had assessed that she had escalated pretty fast, and that the people that were around her didn’t have the relationship that I was able to have with her at that moment. The high level of practitioner activity to me seems more like being really, really involved, and just having a number of different roles in the crisis. So you are managing the crisis, you are directing people, you are making the necessary referrals and pho ne calls. So actually, our CEO came upstairs during the whole thing and tried to get in what was going on. He had no clue what was going on. And I told him, “You can go back downstairs. We got this.” When there’s a crisis in the school, I become the perso n in charge. And so in that role, I had to call the mobile crisis unit, call the police, direct the teachers, make sure the student was safe, and make sure that the conference room was clean so that when everybody got in there, make sure the inciden t report is done, make sure that everybody is notified of the outcome, send the student home, have the conversation about the program director about what the consequences will be. © Laureate Education, Inc.
Crises at Every Level of Service
Crisis Intervention and Crisis Team Models in Schools Karen S. Knox and Albert R. Roberts The need for crisis intervetition plans and programs in schools has become more evident during the past decade with the increased incidence of school violence and other traumatic situations experienced by students, educators, school personnel, parents, and relatives of those involved. This need has resulted in an increase of professional literature, curriculum, and resources that address crisis intervention in school settings. Much has been learned from tragic school incidents in tbe 1990s, and tbat knowledge and experience bas contributed to more comprebensive planning and development to meet tbe needs of tbe scbool community. Tbis article presents an overview of tbe literature on scbool crisis intervention and discusses scbool crisis team models and interventions used in a variety of traumatic situations. KEYWORDS: crisis intervention; natural disasters; school crisis team; school violence; trauma H istorically, students, teachers, and their families and relatives have experienced cri- ses in schools, but recent incidents of school violence have made it clear that being pre- pared for crises and their aftermath is today’s reality. This article presents a review of the professional literature on school crisis intervention and types of crises that can occur. A school crisis response model is presented that addresses the different levels of organization and intervention for macro and micro service delivery. A case example illustrates how the model can be applied in a school crisis. It must be remembered that each incident is unique, and even the most comprehensive plans cannot anticipate all the possible scenarios and ef- fects of crises in schools. However, crisis planning and preparedness can help address the traumatic effects and provide short-term treatment for those affected. Although more empirically based studies on the effectiveness of school-based crisis inter- vention programs are needed, the experiences and efforts of those directly involved in school crises have helped develop the current knowledge base and intervention models. LITERATURE REVIEW Those with personal experience with school cri- ses and tragedies have contributed much of the pro- fessional literature over the past 10 years. One of the first school crises to receive national media at- tention was the Chowchilla school bus kidnapping in California in 1976, in which the children were buried underground and missing for 27 hours be- fore escaping from the kidnappers. The children received no school or local mental health services, and a study found that five years later, all of the children evidenced posttraumatic stress disorder (PTSD) symptoms (Terr, 1983). Other research studies and articles during the late 1980s presented experiences of school violence and how the schools responded to increase awareness about the effects on those involved and the need to be prepared (DiUard, 1989; SandaU, 1986; Watson, Poda, Miller, Rice, & West, 1990). Watson and colleagues (1990) discussed their experiences with an off-campus crisis involving an overturned bus accident with 47 students and teachers returning from a field trip and a campus incident in which an armed intruder shot several students and teachen, killing two third-graders.The authors presented a practical training guide and rec- ommendations on how to plan for the manage- ment of school emergencies. Their book includes information on using technology to meet com- munication needs, dealing with the media, parent reactions, counseling services, school safety plans. CCC Code: 1532-8759/05 $3.00 O2005 National Association of 5ocial Workers 93 and staff training. The authors also provide sample school and district emergency safety plans as guides for those who want to develop response systems in their schools. The Stockton school shooting, which resulted in five student deaths and 29 wounded students, was discussed in a symposium at the meeting of the National Association of School Psychologists in San Francisco in 1990, bringing attention to the need for school crisis planning. Before this incident, the school had conducted crisis drills on the playground where the shooting occurred that resulted in saved lives (Poland, 1994). Poland, who chaired the sym- posium, has written many articles on crisis inter- vention in schools on training crisis team mem- bers, communication issues, media policies and procedures, security and law enforcement person- nel, transportation and evacuation strategies, and crisis drills and readiness activities. He also offered practical examples of school crises such as bomb threats, gang activity, fights, natural disasters, youth suicide, and gun or shooting incidents (Pitcher & Poland, 1992; Poland, 1989; 1993,1994; Poland & Pitcher, 1990). Another major contributor to this field is Schonfeld, who is with the Department of Pediat- rics and Institute for Child Study at Yale University School of Medicine and director of the Regional School Crisis Prevention and Response Program of New Haven, Connecticut. His professional lit- erature in journals and books includes school-based crisis intervention, bereavement services, and death issues (Kline, Schonfeld, & Lichtenstein, 1995; Lichtenstein, Schonfeld, Kline, & Speese-Linehan, 1995; Newgass & Schonfeld, 1996,2000; Schonfeld, Kline, & Members of the Crisis Intervention Com- mittee, 1994).The Regional School Crisis Preven- tion and Response Program was formed in 1991 to address how schools might best prepare for crises and had three goals: • to develop a systematic organizational pro- tocol to respond to school crises • to train school staff to deliver crisis interven- tion services • to increase collaboration between schools and community mental health and social services providers (Newgass & Schonfeld, 2000). As of 2000 the program had trained more than 7,000 school and community staff, consulted with more than 300 district- and school-level crisis re- sponse teams, and provided technical assistance to schools during more than 175 crises (Newgass & Schonfeld, 2000). Other literature presents the need for crisis plan- ning for school counselors and teachers (Allen et al., 2002; Callahan, 1998; Eaves, 2001; Kennedy, 1999) and addresses school crises such as death and loss in the school community (King, 2001; Klicker, 2000), school violence (MacNeil & Stewart, 2000; Trump, 2000; Wanko, 2001; Watson & Watson, 2002), and students with emotional and behavioral difficulties (Rock, 2000; Thome & Ivens, 1999). The most current and comprehensive sources of- fer school crisis prevention and intervention mod- els and best practices with a variety of crisis situa- tions, such as sexual harassment or assault, children of divorce and remarriage, bullying, dating violence, illness and disabilities, moving and relocation, hate crimes and attacks on gay, lesbian, and bisexual youths, eating disorders, and parent-adolescent cri- ses (Brock, Lazarus, & Jimerson, 2002; Brock, Sandoval, & Lewis, 2001; Sandoval, 2002; Schonfeld, 2002). These references are similar to the earlier literature in that the authors presented their own professional experiences or reported from their research.There is limited empirical evidence docu- menting the effectiveness of school crisis interven- tion programs. Establishment of evidence-based procedures is critical, and evaluation procedures should be included in a school crisis response model to improve planning and intervention at the macro and micro levels. SCHOOL CRISIS RESPONSE MODELS From the literature review, we found similarities among the authors’ recommendations on how to plan for and respond to a school crisis that can be integrated into a model for intervention.This model addresses the levels and types of intervention and presents a framework for development and imple- mentation of a crisis response plan that involves the school system and local community. Poland (1994) recommended that schools organize crisis inter- vention models on three levels: • Primary prevention—activities such as con- flict resolution, gun safety and safe driving courses, alcohol and drug awareness programs, teenage parenting resources, and suicide pre- vention programs 94 Children & Schools VOLUME 27, NUMBER 2 APRIL 2005 • Secondary intervention—steps in the after- math of the crisis to minimize its effects and to keep the situation from escalating, includ- ing evacuating students to safety, immediate crisis intervention to address the emotional and physical safety needs of those involved, notification to parents, and the media re- sponse • Tertiary intervention—more long-term counsehng and assistance. These three levels of intervention require par- ticipation and support from key personnel at dif- ferent levels or divisions of the school system, from the administration to school principals and other campus faculty and staff. Key contributors and their tasks and responsibihties may vary depending on the needs of the community and the size and num- ber of school districts and campuses involved. Nev^fgass and Schonfeld (2000) recommended a hierarchical model: • Regional resource teams comprise a multidisci- plinary team with representatives from school administration, mental health staff, pohce, academic staff, and social services staff that meets quarterly to review programs, proto- cols, and policies; to provide support and train- ing to district-level teams; and to act as an information clearinghouse. • District-leuel teams provide crisis response over- sight for the school system and should in- clude central office administrators and men- tal health staff who oversee district policies and procedures, resource allocation, staff train- ing and supervision, and technical assistance to the schools in the district at the time of crisis. • School-based crisis teams consist of the school administrators, school nurse, social workers, school counselors, support staff, and teachers who provide direct crisis intervention ser- vices and ongoing counseling services. The advantage of having a combination of the three is to address different levels of crises, from incidents involving only one school campus to those involving more than one school in a district or the entire community. A comprehensive model must incorporate all levels of intervention and resources to adequately plan for and respond to the diverse school crises that could be anticipated. Coordinat- ing and implementing the many needs involved in a school crisis can be confusing and cause response delays if previous planning has not been established. (Table 1 shows how to organize the needs, tasks. Levels of Jitterv«tttion Primary prevention Secondary intervention ^Tertiary intervention Table 1: School Crisis Response Model Regional Level Community-level crisis response plan and team policies and procedures Support and resources Networking Activate community response team and plan involving school, emergency medical personnel, police, and mental health and social services providers Technical assistance Networking with community resources Policy and procedures evaluation Ongoing planning and needs assessment for the region District Level Emergency response policies and procedures Safety and security issues Training and education Communication systems Activate district-level plan and procedures Coordinate school crisis teams Link to regional level Communication and media Resource allocation for schools Ongoing support and resources Program and response plan evaluation District team meetings to improve procedures and prevention strategies Sch(M>l Levei Emergency and evacuation plans and drills Prevention programs Support services Crisis intervention team Activate school crisis plan and teams Emergency and evacuation procedures Notification/communication Debriefmg/demobilization Short-term crisis counseling Referral for long-term counseling or other services Memorialization needs Follow-up with school crisis team members Practice evaluation of interven- tions and programs KNOX AND ROBERTS / Crisis Intervention and Crisis Team Models in Schools 95 and roles of school systems in a comprehensive model.) AlthoughTable 1 does not include all of the tasks and activities involved at each level, it gives a frame- work for how to distribute and organize the steps and procedures to be implemented for a timely and coordinated response. Other pertinent issues regard- ing the unique needs of each school and the sur- rounding community need to be addressed. For example, larger metropolitan areas with several school districts may have more problems coordi- nating services and personnel because of student body size and geographic considerations, whereas smaller school districts may have limitations in re- sources and technical assistance. SCHOOL-BASED CRiSiS TEAiViS The purpose of the school-based crisis team is to delegate the roles and duties during and after a cri- sis. Team size varies depending on the size of the school district and individual schools within the district, but typically ranges from four to eight members. If the team is too large, it can be unman- ageable and difEcult to schedule meetings and trainings. If the team is too smaU, there may not be enough members to cover critical tasks. It is rec- ommended that teams be multidisciplinary, includ- ing school administrators, school counselors or so- cial workers, the school nurse, teachers, and support staff. There should also be alternates or members that serve as backup or on a rotating basis to address problems with members being unavailable or suf- fering burnout. Suggested roles for the school-based crisis team include a team leader who is responsible for plan- ning and presiding at team meetings and oversees the functioning of the team and its members, and an assistant team leader who assists in these tasks and is responsible if the team leader is unavailable. Other important roles include a media coordinator who serves as the contact person for media inquir- ies, and a staff notification coordinator who estab- lishes and initiates a telephone tree to notify team members and other school staff after school hours. The purpose of a telephone tree is to communicate with people affected by the crisis, such as students, families, and staff, in an organized manner.The tele- phone tree is designed like a pyramid, with the prin- cipal at the top.The principal notifies the vice prin- cipal, who then notifies the designated group leaders, who then call other people, and so forth. No per- son should call more than 10 people, and the fol- lowing information should be given: • the facts of the crisis as currently known • the date, time, and place of the team or staff meeting • a request not to speculate about the crisis while carrying out phone tree duties • a reminder to maintain confidentiality (Edu- cational Service District 105,1997). Also needed is the in-house communication coordinator who screens incoming calls, maintains a phone log, assists the staff notification coordina- tor, and maintains a phone directory of regional- and district-level teams and staff and community resources. A crowd management coordinator col- laborates with the school security personnel, local law enforcement, and emergency departments for supervising evacuation and crowd control proce- dures and ensuring the safe and organized move- ment of students and staff to minimize the risk of harm (Schonfeld et al., 1994). Brock and colleagues (2001) recommended as- signing a team member to the role of evaluator, whose main responsibilities include conducting drills and readiness checks, designing questionnaires and structured interviews, and collecting data on crisis team performance and outcome.They advise that the evaluator should have a budget and be fa- miliar with program and practice evaluation meth- ods. Other options would be to partner with a local university or social services agency that could pro- vide consultants for research projects. The evalua- tor can also be responsible for the demobilization and debriefing with crisis team members after a crisis response. Demobilization refers to evaluative information gathering and can be done through written sur- veys or structured interviews with individuals or in a group setting. Information on the process and procedures, problems with implementation of the crisis response plan, and unforeseen circumstances or factors affecting the efforts are examples of the types of information gathered during demobiliza- tion. Debriefing refers to stress-relieving activities and processing of the incident. Typically, debrief- ing occurs between 24 and 72 hours after the criti- cal incident and can be done individually or with the team as a group. Debriefing entails activities that encourage team members to ventilate their Children & Schools VOLUME 27, NUMBER 2 APRIL 2005 feelings and emotional reactions to the crisis and its effects. Debriefing meetings should encourage team members to support each other and not be critical. The evaluator works for successful resolu- tion of the trauma experienced during the crisis and the team’s response. Some crisis team mem- bers may need referral for professional counseling, and there should be a plan for recruiting or rotat- ing team m^embers to minimize burnout. It is important to have a building plan to provide space for medical triage, safety, shelter, communi- cation, and other emergency needs for law enforce- ment and medical personnel while dealing with the immediate crisis. There also should be desig- nated support rooms adequately staffed by quali- fied counseling personnel and district team mem- bers to provide mental health triage, referral, and brief time-hmited interventions. School crisis team members need to develop guidelines for referring students and monitoring their status, as weU as pro- cedures for getting parental permission for treat- ment, referrals for ongoing treatment or school- based support groups, and other foUow-up services as needed (Schonfeld et al., 1994). The school crisis team also may need to deal with issues of memorialization, which may include how to convey formally the condolences of the school or class; how to handle personal belongings; appropriate displays of memorials such as flowers, candles, photos, and the hke; attending funeral and school memorial or recognition services. The na- ture and timing of such memorializations need to be given careful thought and planning to ensure that they do not escalate the effects of the crisis or prematurely try to place closure (Schonfeld et al., 1994). TRAINING AND RESOURCES FOR SCHOOL CRISIS TEAMS Training requires time, money, and effort that many financially burdened school districts may be reluc- tant to fund. However, training curriculum, manu- als, and workshops are available to help. School districts may want to cross-train crisis team mem- bers at various levels or provide specialized train- ing relevant to the team members’ roles and re- sponsibilities. In-service trainers who could conduct workshops on a regular basis as needed would be cost-effective and provide continuity in the training, which should be viewed as an ongo- ing need. School crisis team members who provide direct counseling and crisis intervention services would need more in-depth and specialized training on crisis counseling skills and types of crises. Brock and colleagues’ (2001) training manual and inten- sive two-day in-service training has the following modules: • Crisis interuenors: lecture and discussion of experiences, reactions, and motivations • Crisis intervention: theory, models, PTSD, child developmental issues, and psychologi- cal traumatization • Group aisis intervention: lecture and role plays • Psychological first-aid: lecture, demonstration, and role plays. Appendix A of the manual provides the entire training curriculum, complete with the presenta- tion lectures, experiential exercises, and handouts. The only item not included is a video on PTSD in children that can be purchased, but the infor- mation on how to purchase it is provided. Also in- cluded in the appendixes is content focusing on tips for teachers and parents, sample letters and announcements, and a questionnaire on the student’s perception of how safe she or he feels on campus. Two other resources that provide training manuals and step-by-step processes to facilitate the devel- opment of school-based crisis teams are available. First, Decker’s (1997) 10-Step Approach incorpo- rates macro-level responsibilities such as appoint- ing a districtwide task force to establish policy, safety, and crisis management plans, conducting assess- ments of school crisis management plans and build- ing security, and identifying the critical compo- nents for implementation and evaluation. Decker (1997) emphasized the importance of prevention programs such as conflict resolution, and student assistance and peer mediation; he also rec- ommended being proactive in dealing with gangs and including parents as partners in prevention ef- forts. The book provides case scenarios of crises with recomniendations for specific steps and ac- tions to deal with these incidents. Examples are provided for accidents, medical emergencies, ex- plosions, fires, gas leaks, hazardous spills, power fail- ures, plane crashes near the campus, and natural disasters such as fioods, hurricanes, and tornadoes. Case scenarios focusing on school violence such KNOX AND ROBERTS / Crisis Intervention and Crisis Team Models in Schools 97 as bomb threats, kidnapping, sexual assaults, gang or cult activities, shootings, weapons on campus, deaths, and suicides are also included. The other excellent resource for school crisis management is the training manual developed by crisis response team members from Educational Service District 105,Yakima,Washington (1997). This training manual is designed to help school personnel develop a crisis management plan and teams; it provides guidelines, checklists, and re- sources for planning before a crisis. Especially help- ful is the Quick Reference Guide that gives ex- amples of crises, identifies the steps and tasks associated with each crisis, and has space available to include local resources and contact numbers for each crisis. It is a flip chart format that lends itself to easy and timely reference information on acci- dents, bomb threats, building destruction, commu- nicable diseases, death and dying, disasters, drug overdoses, gangs, medical situations, mental health situations, missing students, physical and sexual abuse, suicide, and violence. The remainder of the training manual consists of sections for principals, counselors, teachers, and support staff describing their respective responsibilities and roles. Other resources for school crisis management can be found on the Internet at the following Web sites: • www.aaets.com (The American Academy of Experts in Traumatic Stress) • www.schoolcrisisresponse.com • www.keepschoolssafe.org (National Associa- tion of Attorneys General & National School Boards Association) • www.ojp.usdoj.gov/ovc/infores/crt/ pdfwelc.htm (Community Crisis Response Team Training Manual from the U.S. Depart- ment of Justice, Office for Victims of Crime . www.ncptsd.org (National Center for PTSD) • www.compassionatefriends.org (Compas- sionate Friends support groups for bereaved parents) • www.tlcinstitute.org (The National Institute for Trauma and Loss in Children) • www.crisisinterventionnetwork.com CASE EXAMPLE The tornadoes that struckJarrell,Texas,a small com- munity of 800 people, on May 27,1997, killed 27 people, including 13 schoolchildren. The Double Creek Estates subdivision was the hardest hit; houses were leveled, and seven families were killed. The children who were killed ranged in age from five to 17, with three in elementary school and 10 in middle or high school. School had let out for summer just days before the tornadoes struck, leaving everyone wondering if fewer people would have died, be- cause the schools were not hit as hard. This case example shows how a crisis can affect a community and would necessitate crisis inter- vention at the regional, district, and school levels. If school had been in session, the crisis response plans would have been implemented immediately at all three levels. At the primary prevention level, the regional, district, and school emergency plans should include a decision tree on how to respond if torna- does hit the local area. Preventive measures, such as emergency procedures and drills, identification of rooms and spaces where students and staff should go for safety in the event of tornadoes or other disasters, and notification and evacuation procedures, should already have been addressed. At the secondary intervention level, regional team members would coordinate with community emer- gency response units, such as EMS, fire, and police. Any regional team members on the scene would liaison with school crisis team members as well. Technical assistance or resources critical to safety, notification, evacuation, and other emergency pro- cedures would be initiated also. District team members would coordinate with the schools to assess which emergency procedures to activate.With weather and building damage con- siderations, the schools would either be used as emergency shelters and for medical triage or be evacuated. With either option, resources would need to be mobilized, and the emergency com- munication and notification systems would begin. The district level would also coordinate and serve as a link between the regional level and the school level. School crisis team members would initiate their respective school crisis plan and proceed with emer- gency procedures as necessary. The team leader would oversee the team functioning and coordi- nate with local emergency responders and the dis- trict-level team contact. The staff notification co- ordinator would initiate the telephone tree, and the in-house communication coordinator would moni- tor incoming communications and serve as a link Children & Schools VOLUME 27, NUMBER 2 APRIL 2005 between the district level and the school.The crowd management coordinator would assist local authori- ties and emergency personnel in evacuating or moving students to safer areas if possible. Other team members and counselors would participate in the emergency procedures, but also would begin crisis intervention services. If the school is to be used as an emergency shelter, students and staff will need basics such as water, food, places to sit or be comfortable, and bathroom accessibility. Crisis re- actions among the survivors would need to be dealt with both individually and with groups. This type of disaster draws the media’s attention, so the media coordinator would need to take charge and might need assistance from the in-house com- munications coordinator and the crowd manage- ment coordinator. After the incident, the school crisis response teams would need demobilization and debriefing services, and the team evaluator would be responsible for implementing interviews and meetings on a regular basis.The evaluator would also implement the evaluation process so that the teams would be able to give and get feedback on their eflFectiveness and on improvements that can be made. The ongoing crisis counseling would entail set- ting up the support rooms and recruiting profes- sional counselors experienced in this type of counseling to volunteer to assist school crisis team members. With additional help from social work- ers, psychologists, psychiatrists, and clergy, school crisis team members would not be so over- whelmed. In natural disasters, resources such as the Red Cross and the Federal Emergency Manage- ment Agency can help the community.Victim ser- vices counselors fix)m local law enforcement agen- cies also are involved in such critical incidents. Another factor to consider is vicarious traumati- zation affecting these volunteers, who would also need debriefing sessions and support. At the tertiary level of intervention, foUow-up services would need to be provided for certain times and events, such as when the schools reopen and classes resume, anniversaries of the disaster, graduations, and other school activities that remind survivors of those who were killed. The local schools would also need to deal with memoriali- zation services and provide support groups and community referrals as needed for the students, their families, and school staff and faculty. Evalua- tion of the crisis response plans and procedures would take place at the regional, district, and school levels to revise or improve services and outcomes for the future. Six years later, the town has rebuilt physically, but not emotionally. Residents say they wUl never forget—It will always be a part of JarreU. Residents StiU have problems with the way the police and emergency workers responded and with how the disaster relief and donation funds were distributed. However, healing is evident. The town now has a population of 1,200 with most of the survivors stay- ing in the community. Most of the homes have been rebuilt. JarreU Memorial Park is on land do- nated by one of the deceased family’s survivors.The park has a community center, two underground shelters, a playground, and two baseball fields. A pink granite memorial in downtown JarreU com- memorates those who died. Residents say that sport- ing events have been healing and bonding experi- ences for the town, given that eight of the children kiUed were involved in school athletics. Both the school district and the community have learned from this experience and have made changes to meet crisis response needs more effectively in the future. RECOMMENDATIONS AND CONCLUSION Literature and resources for school crisis manage- ment have increased over the past decade, and edu- cators and school districts are better prepared for crises.With heightened alerts more common in the United States, being lax or complacent about cri- sis management plans for schools, governments, and businesses is a thing of the past. What is most needed is empirical and evaluative research on the effectiveness of crisis management plans and ser- vices. The crisis intervention field has historicaUy evaluated and tried to learn from and improve ser- vices to those in crisis. Because school crisis man- agement has increased in attention and need over the past decade, we hope the research needed to validate the knowledge base and interventions wiU be forthcoming. With increased federal funding in this area, we recommend that school districts seek those resources to implement and evaluate school crisis response plans and procedures to be prepared for future emergencies. We also hope that this ar- ticle has provided insight and interest in social workers and other professional counselors to con- tinue their learning and experience with school crisis intervention. ^3 KNOX AND ROBERTS / Crisis Intervention and Crisis Team Models in Schools 99 REFERENCES Allen, M., Burt, K., Bryan, E., Carter, D., Orsi, R, & Durkan, L. (2002). School counselors’ preparation for and participation in crisis intervention. Professional School Counseling, 6(2), 96-102. Brock, S. E., Lazarus, P. J., & Jimerson, S. R. (Eds.). (2002). Best practices in school crisis prevention and intervention. Bethesda, MD: National Association of School Psychologists. Brock, S. E., Sandoval.J., & Lewis, S. (2001). Preparing for crises in the schools: A manual for building school crisis response teams. New York: John Wiley & Sons. Callahan, C. J. (1998). Crisis intervention model for teachers.yowma/ of Instructional Psychology, 25,226— 234. Decker, R. H. (1997). When a crisis hits: Will your school be ready.”Thousand Oaks, CA: Corwin Press. DiUard, H. (1989).Winnetka: One year later. Communique, } 7(8), 17-20. Eaves, C. (2001).The development and implementation of a crisis response team in a school setting. International Journal of Emergency Mental Health, 3(1), 35-46. Educational Service District 105,Yakima,Washington. (1997). Quick response: A step-by-step guide to crisis management for principals, counselors, and teachers. Alexandria,VA: Association for Supervision and Curriculum Development. Kennedy, M. (1999). Crisis management: Every school needs a plzn. American School & University, 7J(11), 25-27. King, K. (2001). Developing a comprehensive school suicide prevention progTzm.Journal of School Health, 7J(4), 132-138. Klicker, R. L. (2000). A student dies, a school mourns: Dealing with death and loss in the school community. Philadelphia: Accelerated Development. Kline, M., Schonfeld, D, & Lichtenstein, R. (1995). Benefits and challenges of school-based crisis response teams. Jowma/ of Sodal Health, 65, 245—249. Lichtenstein, R., Schonfeld, D, Kline, M., & Speese- Linehan, D (1995). How to prepare for and respond to a crisis. Alexandria,VA: Association for Supervision and Curriculum Development. MacNeil, G., & Stewart, C. (2000). Crisis intervention with school violence problems and volatile situations. In A. R. Roberts (Ed.), Crisis intervention handbook: Assessment, treatment, and research (pp. 229— 249). New York: Oxford University Press. Newgass, S., & Schonfeld, D. (1996). A crisis in the class: Anticipating and responding to student’s needs. Educational Horizons, 14, 124-129. Newgass, S., & Schonfeld, D. (2000). School crisis intervention, crisis prevention, and crisis response. In A. R. Roberts (Ed.), Crisis intervention handbook: Assessment, treatment, and research (pp. 209—228). New York: Oxford University Press. Pitcher, G., & Poland, S. (1992). Crisis intervention in the schools. New York: Guilford Press. Poland, S. (1989). Suicide intervention in the schools. New York: Guilford Press. Poland, S. (1993). Crisis manual for the Alaska schools. Juneau,AK: State Department of Education. Poland, S. (1994).The role of school crisis intervention teams to prevent and reduce school violence and trauma. School Psychology Review, 23,175—189. Poland, S., & Pitcher, G. (1990). Best practices in crisis intervention. In A.Thomas &J. Grimes (Eds.), Best practices in school psychology (pp. 259—275). Washing- ton, DC: National Association of School Psycholo- gists. Rock, M. L. (2000). EflFective crisis management planning: Creating a collaborative framework. Education & Treatment of Children, 23, 248-265. SandaU, N. (1986). Early intervention in a disaster:The CokeviUe hostage/bombing crisis. Communique, i5{2), 1-2. Sandoval,J. (Ed.). (2002). Handbook of crisis counseling, intervention, and prevention in the schools. Mahwah, NJ: Lawrence Erlbaum. Schonfeld, D. J. (2002). How to prepare for and respond to a Schonfeld, D, Kline, M., & Members of the Crisis Intervention Committee. (1994). School-based crisis intervention: An organizational model. Crisis Intervention and Time-Limited Treatment, J(2), 155- 166. Terr, L. C. (1983). Chowchilla revisited: The effects of a psychic trauma after a school bus kidnapping. American Journal of Psychiatry, 140, 1543-1555. Thome, H., & Ivens, J. (1999). Brief interventions with students with emotional and behavioral difficulties. Educational Psychology in Practice, 15,122-125. Trump, K. S. (2000). Classroom killers? Hallway hostages? How schools can prevent and manage school crises. Thousand Oaks, CA: Corwin Press. Wanko, M.A. (2001). Safe schools: Crisis prevention and response. Lanham, MD: Scarecrow Press. Watson, R. J., & Watson, R. S. (2002). The school as a safe /lavcM.Westport, CT: Bergin & Garvey. Watson, R. S., Poda,J. H., Miller, C.T., Rice, E. S., & West, G. (1990). Containing crisis:A guide to managing school emergencies. Bloomington, IN: National Educational Service. Karen S. Knox, PhD, LCSVf^ is associate professor and director of field. School of Social Work, Texas State University, 601 University, San Marcos,TX 78666;e-mail: [email protected] Albert R. Roberts, PhD, is professor of criminal justice and social work. Administration of Justice Department, Rutgers, The State University of New Jersey, Piscataway; e-mail: [email protected] net. Accepted January 28, 2004 100 Children &Schoob VOLUME 27, NUMBER 2 APRIL 2005
Crises at Every Level of Service
Using Social Work Theory for the Facilitation of Friendships RICH FURMAN Social Work Program, University of Washington, Tacoma, Washington, USA KATHRYN COLLINS School of Social Work, University of Maryland, Baltimore, Maryland, USA MICHELLE D. GARNER Social Work Program, University of Washington, Tacoma, Washington, USA KAREN LEE MONTANARO W. G. Hefner VA Medical Center, Salisbury, North Carolina, USA GWEN WEBER School of Social Work, University of Nebraska at Omaha, Nebraska, USA Positive friendships are essential to human development and resilience. In spite of the importance of friendships, few social work models have been developed to help clients establish or maintain friendships. This article explores how clinical theories of social work, and their associated practice interventions, can guide social workers in helping their clients improve their friendship relationships. KEYWORDS friendship, social work practice, social support, theory, relationships INTRODUCTION Social work practice emphasizes the interaction between people and their social environments (Devore & Schlesinger, 1991; Payne, 1991; Sheafor, 17 Received March 11, 2005; accepted May 29, 2006 Please address correspondence to Rich Furman, Social Work Program, University of Washington, 1900 Commerce St., Tacoma, WA 98402-3100 USA. E-mail: [email protected] washington.edu Smith College Studies In Social Work, 79:17–33, 2009 Copyright # Taylor & Francis Group, LLC ISSN: 0037-7317 print / 1553-0426 online DOI: 10.1080/00377310802634582 Horejsi, & Horejsi, 1997). Social workers help people adapt to and alter their social context to better maximize their personal strengths, meet their personal and collective needs, and minimize or alter their limitations (Saleebey, 2001; Weick, Rapp, Sullivan, & Kishardt, 1989). Indeed, even more insight-oriented clinicians utilize systems-oriented interventions to bring about intrapsychic changes (Teyber, 2000). Perhaps what separates social workers most from other helping professions is our expertise at helping people create more meaningful social contexts (Germain & Gitterman, 1996). For example, social workers help families improve their individual and collective functioning, as well as engage in advocacy work to change social policies and improve institutions designed to meet familial needs (Carter & McGoldrick, 1999; Janzen & Harris, 1997). Social workers help people develop relationships in the context of small groups as a means of improving their overall social functioning (Henry, 1992; Toseland & Rivas, 2005; Zastrow, 2001), implement interven- tions at the community level to ameliorate personal and community problems, and prevent future incidents of social distress (Homan, 1999; Netting, Kettner, & McMurtry, 1998; Weil & Gamble, 1995). Social supports can provide material aid (tangible things), emotional support, instrumental support (such as services), and a sense of belongingness (Walsh, 2008). Although social workers have developed effective interventions to help families, groups, and communities, a significant social relationship has often been neglected in the social work literature: friendship. This is lamentable, as friendships can be some of the most enduring and supportive relation- ships in our lives. Friendships are essential to human development (Clark & Ayers, 1991; Hartup, 1979, 1983, 1989; Hutter, 2001; Linden, 2003) and contribute to a sense of depth and wholeness for individuals as they move through the life cycle (Burk, 1996). Studies have demonstrated the relationship between friendship and quality of life (Bradburn, 1969; Phillips & Fisher, 1981). Because these relationships are essential to healthy human functioning, social workers would be well served to learn how to help clients develop meaningful and lasting friendships. Further, higher levels of education and being White are positively correlated to the number of individuals people have to confide in and discuss important topics (McPherson, Smith-Lovin, & Brashears, 2006). As a result, friendship facilitation emerges as a more important clinical target for the marginalized populations of clients with whom social workers often work. This article seeks to help social workers meet this objective in two ways. First, we explore the concept of friendship and its importance to human development and health. By doing so, we provide a rationale for why social workers should consider friendships an important practice domain. Second, we discuss the principles of facilitation of friendship that are drawn from several clinical social work theories that can guide social workers in helping clients improve their friendships. 18R. Furman et al. THE IMPORTANCE OF FRIENDSHIPS The need to belong seems to be a fundamental human drive. Although attachment theorists traditionally have explored the importance of parental attachment to infants (Ainsworth, 1989), current research in this area has focused on the central importance of attachment, connectedness, and bonding for adults (Baumeister & Leary, 1995). For some, friendships have become primary vehicles for adult attachment and bonding. As society has undergone rapid transformation over the last 200 years, kinship and community relationships and structures have undergone radical transforma- tions (Postman, 1992). Changes in the very nature of these bonds and the geographic mobility of the population in the United States have often altered the capacity of families to meet individual psychosocial needs. Economic resources that have historically been set aside for social services have increasingly been allocated to other priorities, such as defense and homeland security. Further, it seems that on a national basis, social networks are shrinking. A marked shift in demographic data suggest that more than one half of the respondents from the 2004 General Social Survey indicate that they have no nonkin confidant with whom to discuss important topics, whereas one fourth indicate they have no one (kin or otherwise) with whom to have such discussions (McPherson et al., 2006). Given this reality, it is essential that social workers find ways to help clients develop and connect with friends rather than relying primarily on professional relationships. These shifts in social relationships may influence the mental health of large numbers of people. Isolation and alienation often lead to social dislocation and depression in individuals (Mirowsky & Ross, 1989; Ollman, 1971). Some of those persons who possess extreme difficulties in establish- ing social bonds may have received psychiatric diagnoses of major depression, social phobia, anxiety disorders, or avoidant and/or schizoid personality traits that compromise their interpersonal relations. Fears of intimacy, an inability to trust and depend on others, and insecure attachments may permeate their relationships. Researchers have found the lack of positive friendships correlated with developmental and psychosocial problems (Dunstan & Nieuwoudt, 1994), whereas sustaining friendships is correlated with various strengths and resilience (Norman, 2000.) Indeed, numerous studies have demonstrated the positive impact of social relationships on preventing psychosocial problems (Higgins, 1994; Rutter, 1979, 1987; Werner, 1987; Werner & Smith, 1992; Wolin & Wolin, 1993). For instance, Berndt and Keefe (1995) found a relationship between positive friendships, greater involvement in school, a sense of acceptance by peers, and positive self-esteem among the children studied. Children who have established and maintained friendships demonstrate better scholastic achievement as compared with their peers who lack friendships (Masten, 1994; Shure, & Spivak, 1980). Those adults Social Work Theory and Friendship Facilitation19 who lack close friendships may be vulnerable to feelings of dysphoria and loneliness (Elkins & Peterson, 1993; Williams & Solano, 1983). Crosnoe (2000) sums up the importance of friendship well when he observes, ‘‘friendships provide a forum for the learning and refining of socio/ emotional skills and enduring relationship templates’’ (p. 378). Although the importance of friendship to psychosocial health has been largely neglected in the social work literature, other allied disciplines have ambitiously undertaken the study of friendships during the past 50 years. In his research and development of interpersonal theory, Sullivan (1953) explored the necessity of friendship for socialization. Bronfenbrenner (1979) posited that friendships were essential to human growth and development as essential aspects of human ecosystems. Recently Powdthavee (2008) has even used the 2005 British Household Panel Survey and shadow pricing techniques to put a price on the happiness derived from interacting with friends or family. For example, a frequency of ‘‘once or twice a month’’ is worth £35,000 sterling ($53, 233 USD) whereas ‘‘most days’’ is worth £63,833 ($97, 095 USD). The average actual annual income among respondents was only £9,800 pounds ($14, 908 USD); indicating a huge effect of socializing upon happiness (Powdthavee). What precisely are friendships? From a definitional perspective, Furman, Collins, and Swanson (2003), observe that friendship is similar to love. Both concepts are difficult to define; yet one knows when he or she finds it, and when it is missing. Burk (1996) definesfriendshipas ‘‘a dynamic reciprocal relationship between two individuals’’ (p. 283), whereas Wiseman (1986) definesfriendshipas a voluntary relationship that exists primarily for personal satisfaction and enjoyment rather than the fulfillment of a particular task or goal. Berndt (2002) states that high levels of intimacy, prosocial behavior, self- esteem, support, and loyalty, combined with low levels of conflict, and rivalry dominance characterize high-quality relationships. Similarly, the author notes that friends ‘‘help and share with each other’’ (p. 7). The nature and composition of friendships differs by gender. Rosen (1999) contends that friendships between men are less intimate as compared with men’s friendships with women or friendships between women. She proposed that patriarchy contributes to male competiveness, whereby men become less likely to risk ‘‘the loss of power that closeness with another might create’’ (Rosen, 1999, p. 129). Elkins and Peterson (1993) ascertained that men had lower ideal standards for male–male friendships and reported more satisfaction with their friendships with women than with men. Friendships between women, in contrast, are generally designated as expressive and intimate (Caldwell & Peplau, 1982; Fox, Gibbs, & Auerbach, 1985). Women place great emphasis on self-disclosure, empathic under- standing, and connectedness in their friendships (Parker & deVries, Fox, Gibbs, & Auerbach, 1985; 1993). Davidson and Packard (1981) asked women to explain what aspects of their friendships were beneficial to them 20R. Furman et al. by contributing to personal growth, support, or change. Factors such as reciprocal expression of feelings, altruism, and communion were rated as highly therapeutic. Despite these differences, men and women are about equally likely to have nonkin confidants (2004 data, McPherson et al., 2006) and to identify some of the same aspects as significant in their friendships. Parker and de Vries (1993) examined how people perceive friendships and what they valued most in those relationships. Men and women rated trust and authenticity as the most essential features present in their friendships. Sapadin (1988) also found commonalities among the beliefs shared by men and women regarding friendship. Both genders reported that sharing and enjoying each other’s company are central factors in friendships. When studying the development of friendships, Hays (1985) found that men and women were equally as likely to establish solid friendships after starting college. Although women may undergo and report more intimacy with their friends, men are just as adept at forming new friendships, contrary to some popular gender stereotyping. Men and women also report a comparable amount of time spent with friends, and both place a certain amount of emphasis on intimate friendships (Caldwell & Peplau, 1982). Similarity and proximity also seem to be important aspects of establishing and maintaining friendships. Hays (1985) determined that the geographic distance between residences correlated negatively to the effective development of new friendships. He discovered that the farther apart people lived, the less likely they were to successfully form a friendship. Nahemow and Lawton (1975) conducted a study at a public housing project in New York City with a diverse mix of residents of various ages and races and discovered that the closer people lived to each other, the more likely they were to be friends. In fact, when asked to identify who their friends were, more than 80% of the respondents first reported someone who lived in their building—often on the very same floor. Age and race were also strongly associated with friendship development. However, friends that were reported to be of different ages and races, always lived in the same building, so their proximity to each other seemed to mitigate those differences. Some became friends with residents of other buildings, but only if they were the same race and close in age. The authors subsequently concluded that people are likely to make friends with those that live geographically close to them and will reach out of their immediate space to make friends with others who share commonalities. Verbrugge (1977) also reported a relationship between similarities and the likelihood of developing friendships. He found that friends tended to be similar on such factors as age, occupation, education, and political and religious preferences. Indeed, women and men declare sharing similar values with their friends and report that having congruent values was important to their friendship relationships (Davidson & Packard, 1981). Even Social Work Theory and Friendship Facilitation21 children tend to establish friendships with those that are similar to them in terms of sex, race, and academic achievement (Tuma & Hallinan, 1979). Recent national data confirms that most people’s close confidants are among those similar to themselves (McPherson et al., 2006). FRIENDSHIP FACILITATION AS A PRACTICE APPROACH In spite of the importance of friendship, few helping professionals seem to have examined the actual processes and personal qualities involved in helping clients establish and maintain these relationships (Burk,1996). Although some might assume that these processes naturally happen, the prevalence of loneliness, which may affect as many as one in three adults (DeStephano, 1990), suggests that many might need therapeutic assistance in developing their friendships. Although it is true that little has been written for professionals on helping clients improve their friendships, important work has been done in the area of friendship facilitation for children with disabilities (Oden & Asher, 1977; Schaffner & Buswell, 1992). Schaffner and Buswell (1992) stress the importance of helping provide social contexts through which children with disabilities can meet nondisabled children. They identified the concept of friendship facilitation as part of a broader strategy of including children with a disability into mainstream educational and social situations. They found three elements central to this process: finding opportunities, interpretation, and accommodation. Teachers and other providers often help facilitate opportu- nities for inclusion and social interaction where these children can establish interpersonal connections based upon their strengths and interests. Interpretation stresses the need for providers to help children and those affiliated with them to focus on strengths and resources, thus highlighting the children’s capacities for social encounters and friendships. Accommodation emphasizes the need to structure the environment that children with the disability can maximize their strengths within that environment or social context. This project serves as an example of the potential of developing models and programs designed toward helping young clients develop friendships. Although such models are in the initial phase of development for children, little has been written about facilitating the friendships of adults. Conceptual models need to be further developed and made available for direct practice with adults who seek friendships and additional social supports. The following section explores some of the ways that diverse clinical theories inform the development of practice models aimed to facilitate friendships. FACILITATION OF FRIENDSHIP AND CLINICAL SOCIAL WORK THEORIES As in any practice arena, social workers must first assess the nature of clients’ friendships prior to intervening in this important system. Even when specific 22R. Furman et al. clinical practice theories are employed, such an assessment must be ecological and holistic in nature. This assessment should pay attention to environmental and systemic factors, as well as psychosocial factors such as an individual’s level of functioning, inter- and intrapersonal capacities toward meaningful relationships, the meaning of friendships, as well as psychosocial skills. These factors are expanded upon throughout this section. The social work literature rarely includes the assessment of friendships when identifying the social functioning of the individual. Cowger (1997) does include friendships in his strengths-based assessment model. Understandings based on concepts from an ecological perspective, psychodynamic and interpersonal theory, and existential and cognitive theory offer unique areas for consideration when completing the compre- hensive psychosocial interpersonal assessment that focus on friendship. In keeping with the profession of social work’s unique and historic dual focus on person-in-environment, this article advocates practices congruent with the ecological perspective. This perspective enables one to simulta- neously focus on person and environment and on their reciprocal relationship. According to Germain and Gitterman (1996) social work interventions that adhere to the ecological perspective recognize that causality in social work practice is reciprocal rather than linear in nature. Beginning with the initial contact with a client, social work practitioners have the distinctive ability of assisting clients to understand, explore, and develop friendships with individuals within their social environment to promote health and well-being and to prevent and/or resolve psychosocial problems. For example, throughout the engagement and assessment process of working with individuals, families, groups, and communities, the concepts of friendships, interpersonal relationships, informal/formal net- works, and social support should be examined with the client. This process helps clients begin to realize that facilitating friendships draws upon the strengths that exist within themselves and in their homes, schools, neighborhoods, work environments, and larger communities. Social work- ers, already trained in utilizing the resources of family and community, are advised to increase their ability to help clients understand and employ friendships as a means of encouraging people to meet their needs. Friendships promote self-learning and validation and give us the courage to face life’s challenges. Joe Abbot is a single, 49 year-old, Baptist, African American man referred by his employer for social work services to help him with his depression and anger. Joe is otherwise in good health and has worked for the county as a fireman for the last 20 years. Joe reports not having a significant other, and despite continually dating women, never having had a courting relationship that lasted longer than 6 months, at which Social Work Theory and Friendship Facilitation23 time he usually ends the relationship. After substantial work building rapport with his younger, White, male social worker, Joe admits to feeling isolated and lonely. When asked about his social relationships, and any sources of potential support, he described a family of origin history of substance abuse and conflict. One aunt, who has subsequently also passed away, got more involved with Joe in his teens and helped him stay clean, finish school, and enter his profession. She was the only one among his birth family with whom he maintained a relationship. Joe’s remaining family is a source of stress, not support. When Joe’s clinical social worker asked him if he had friends who were supportive, he expressed surprise, claiming that no one had every asked about his friends in that manner before. The social worker explained that friendships were extremely important and that to some people they were even more valuable a resource than family. Joe related to this and stated that though this was true for him, he also had problems with his friendships. He tended to sabotage his relationships with other men as his friendships become more intimate. When the social worker asked if working on his friendships would be a potential subgoal that might help him with his anger and depression, he agreed that it would. Helping Joe to establish, deepen, and maintain friendships soon became a focus of therapy. Psychodynamic Theory Traditional, psychodynamic-based practice focuses upon the assessment of the early attachment and bonding experiences of individuals with their primary caretaker. However, adults possess the capacity to improve the ways in which they relate to friends and peers throughout the life span, although this process may be difficult for many, especially those who develop major mental illnesses characterized by a disturbance of interpersonal relationships. Contemporary relationally based practice seeks to engage the client in a meaningful helping relationship that creates a corrective and reparative emotional experience for the client. The intention is to purposefully provide corrective experiences to alter relational patterns from early childhood, which without correction continue into adulthood and become core features of an individual’s life (Sullivan, 1953, 1970). According to Teyber (2000): the therapeutic process has metaphorically repeated the conflicted interaction that clients have not been able to resolve in other current relationships, and that they often have experienced in earlier formative relationships. (p. 17) Therapy is an experience where two people influence one another in meaningful ways (Moursund & Erskine, 2004). For example, the 24R. Furman et al. interpersonal therapeutic alliance creates dynamics of transference and countertransference. Within this framework, a social worker can utilize this therapeutic relationship to enhance a client’s ability to create friendships. For example, if an individual has difficulty trusting another in the therapeutic process (reflecting a transference theme), the client may begin to trust the therapist until conflict occurs within the therapeutic encounter as it does within other human relationships. Historically, a client may have experi- enced rejection or abandonment during childhood that then set the stage for a relationship template involving a wish for connection yet a fear of censure and rejection that he enacts regularly with all relationships, including friends. Through modeling a willingness to work through the conflict, and continuing to hold the client in high regard, the therapist starts to be viewed as somewhat trustworthy. Yet hostility expressed toward the therapist may be reflective of the need for self-protection. As clients engage in the treatment process over time, they begin to understand that these adaptations are no longer especially effective nor necessary. Over time, in the context of the safe container of the therapeutic relationship, a client may safely struggle to address painful emotions and change old patterns, experience emotions more directly and practice new behavior. Because even highly skilled and experienced clinicians can behave in a hostile, counterproductive manner with their clients after succumbing to inevitable countertransference enactments, clinicians need to develop the self-reflective capacity to understand how and why clients may trigger their own countertransferential emotional responses (Murphy & Dillon, 2003). The relational dynamics in the treatment process offers clinicians the opportunity to use their own reactions as a means of understanding the client and intervening effectively (Arnd-Caddigan & Pozzuto, 2008; Aron, 1991; Mackey, 2008). Therefore, an important component of helping clients develop nurturing friendships is for clinicians to understand and come to terms with their own issues around friendships. The social worker must carefully monitor their own responses and be cognizant of personal projections. Successful professional use of self during sessions can help a client to repair, restore, or develop the capacity for intimate relationships and thereby enable them to discontinue destructive defense systems and experience new personal meaning in relationships (Mackey). Increased awareness related to the influences of early developmental attachment experiences, residual effects from previous interpersonal relationships or friendships, especially those harmful or fear evoking, and the vital role of defenses are important therapeutic areas to include when facilitating the individual’s capacity to develop meaningful friendships. For some clients, the development of an effective helping relationship may inspire them to develop new friendships. Having experienced a relationship that is safe and supportive, they may contemplate the possibility of new friendships for perhaps the first time. They may begin to wonder Social Work Theory and Friendship Facilitation25 about the roles that friendship will play in their lives, how friendships might enrich their lives, and what meaning such relationships can have. After several weeks of working together, and prompted by the therapist’s suggestion that Joe ask one of his coworkers to watch a game with him, Joe and his therapist began to explore Joe’s fear of being vulnerable in his friendships with men. He said that expressing his feelings, or asking for help and support, made him feel weak. He said that he worried that other men would perceive him as inferior or too feminine—both of these things he perceived as interfering with his job and reputation and clearly did not fit with his self-image. He reported that people always let him down. He said that at this point he doubted whether he would ever be able to trust men or women, and that indeed neither was probably trustworthy. Utilizing the working relationship that they had established, Joe’s worker pointed out that Joe had indeed trusted his social worker with a great deal of personal information. He asked if Joe was worried that he would betray him. Joe became defensive and hostile and reported that their relationship was different, and that indeed the social worker may betray him. Joe even suggested that the manner in which he was challenging Joe at the moment was a sign of betrayal. Joe’s social worker reflected Joe’s feelings of mistrust, fear, and anger and asked if these feelings were indeed what he was experiencing. Joe affirmed that these were his feelings, and the two sat in silence for some time. The social worker then informed Joe that no matter what he felt, that he would still be there to support Joe. Joe clearly was uncomfortable with the intensity of his emotions in response to this statement. After a few more minutes of silence, Joe’s worker asked if these were similar feelings he felt in his friendships, when he was worried about being disappointed. Joe affirmed that they were. The two were subsequently able to process this encounter and utilize it to help Joe understand more fully his role in friendships. Existential Theory Existential theory focuses practitioners on the meaning and importance of relationships to clients’ lives. The theory can be used to assist clients in identifying their own values (Krill, 1969, 1986) and sense of mission (van Deurzen -Smith, 1997) and to help clients achieve these self-directed aims (Willis, 1994). By assessing and asking challenging and thought-provoking questions, clients are pressed, or encouraged, to examine the significance of their experiences and relationships in their lives. Such inquiry may also inspire them to pursue their friendships with clearer meaning and relevance for their life. The following questions assist clients to explore issues related specific to their friendships. 26R. Furman et al. 1. What can we learn about you by (from) the way you treat your friends? 2. How close would you like to be with a best friend? 3. In what ways do your friendships enrich your life? 4. What does your friendship with (name) tell you about yourself as a person? 5. How do your friendships help you be a better person? 6. What do you fear in becoming closer to your friends? 7. What would happen if you told your friends everything you felt you needed to say? 8. What is your fantasy of a perfect friendship and what would it include? Questions such as this can be used to help clients think about the roles they hope friends may play in their lives. Such questions can help facilitate self-determination regarding the development of social relationships and can stimulate motivation to create a friendship system. Perhaps for the first time in years, clients may begin to see the development of social relationships as a conscious choice. Yet once they begin to see their own desires and possibilities, they must honestly appraise their own strengths and deficits in this domain. Over time, Joe began to see his friendships as a source of support and growth. He soon observed that he was able to choose his friendships, and he was entitled to spend time with people who would bring out the best in him. He began to set limits with old friends who were dismissive and unsupportive, or who engaged in behaviors akin to those that Joe was attempting to stop doing himself. Joe began to see his time as valuable and developed an appreciation of the finite amount of time we were given. His therapist supported Joe in making difficult choices around his friendships and supported Joe as an autonomous, self- determining man. Joe began to view friendships as a source of meaning and value in his life. He moved from worrying about how his friends could help him, to being increasingly concerned with how he can support his friends. Cognitive-Behavioral Theory and Practice In this regard, the social worker and client can work together to assess the cognitive frameworks that influence perceptions and thinking regarding friendships. The central notion in cognitive therapy is that the manner in which clients perceive their life situations and challenges is the most significant cause of emotion and behavior. Cognitive therapists hope that their clients will be able to carry newly learned skills and thinking patterns with them throughout the rest of their lives (Beck, 1995). Self-defeating ideas are identified and altered with newly acquired thinking patterns and behavioral skills. The assumptions ascribed to another and the potential for the enduring quality of a relationship greatly influences the individual’s Social Work Theory and Friendship Facilitation27 ability to establish and maintain a friendship. The client’s personal views or perceptions of another may inhibit a friendship. Self-defeating messages such as ‘‘nobody wants to hear from me,’’ ‘‘no one cares about me,’’ ‘‘there are no others who have my interests,’’ ‘‘You can’t trust anyone,’’ or ‘‘I don’t need anyone’’ are a few of examples of this type thinking. Cognitive therapy techniques can be used to encourage new ideas, views, and thinking patterns that will promote the development of friendships. Relationship experiences with therapists serve to change false self perceptions and perceptions regarding others. Rational Emotive Behavioral Therapy (REBT) addresses four primary irrational beliefs: low frustration tolerance, awfulizing, demandingness, and global evaluation of work (Dryden & DiGiuseppe, 1990; Ellis, 1994). These beliefs may inhibit friendship development as well as maintaining and deepening of friendships. For example, when experiencing conflict with a friend, a client may awfulize the conflict, making more of the conflict than really exists, leading to fear or increased anxiety and to future avoidance behavior. In REBT, demandingness is viewed as the source of most anger and many relational problems. Clients who possess cognitions characterized by demandingness believe that others should behave as they wish them too. When others do not meet their rigid expectations, anger and hurt are the result. Such cognitions must be reduced for a reciprocal, mutual adult friendship to ensue. The development of communication skills is also an important aspect to cognitively based theories. Skills such as using ‘‘I’’ statements, affective expressive statements and developing empathy skills, making requests and increasing assertion skills, focusing on one topic at a time, clarifying underlying assumptions or intent, assertion tactics, decreasing fear and taking risks of personal self-disclosure are a few examples. For instance, when a conflict with a friend develops a letter-writing assignment offers a client the opportunity to practice and disclose personal views or feelings in a safe manner. The client may use such an assignment in therapy to work through faculty expectations or patterns, or it may be read to the friend with the added self-protection of writing, or serve to document the friendship experience being considered in treatment. Of particular importance is the development of receptive skills to enhance the ability to receive the communication from others. These skills include active listening, confirming or disconfirming messages, paraphras- ing, seeking additional information, validation skills, and altering one’s nonverbal posture. Joe began to develop a close friendship with a former priest. Joe initially did not see himself as worthy of this friendship. Even though Joe had come far in his treatment, he began to sabotage this friendship. His social worker helped him identity the beliefs that were continuing to plague 28R. Furman et al. him: that was not worthy of support, that he would be hurt, that he would be rejected, and this rejection would be intolerable. Over the course of several sessions, Joe’s social worker helped him dispute these irrational beliefs. Joe was able to talk to his friend about his work in therapy, and how he was attempting to avoid listening to these beliefs which were straining the friendship. Joe demonstrated how far he had come when he was able to ask his friend for patience and hugged his friend in gratitude when his friend stated ‘‘that is what friends do brother, that is what friends do.’’ CONCLUSIONS Friendships are essential for healthy development. They play an important role in helping people create meaningful and fulfilling lives throughout the life cycle. Friends may help us in measurable and less-measurable but equally important ways, while allowing us to learn about ourselves and providing a sense of belonging. Through friendships, we become our best selves possible. In fact, friends reflect our own lives through their love and support. Although this article introduces the uses of clinical theories in helping clients develop and maintain their friendships, the authors hope that social workers and researchers will continue to explore the importance of friendships and will design interventions targeting this important social domain. Frequently, the process of helping clients understand, explore, and develop friendships begins at the first meeting with the social worker. It is interesting that in just about every ‘‘pop culture’’ magazine the topic of ‘‘how to be or make a friend’’ is covered, yet social workers often forget the usefulness of exploring friendship skills within the interventions we provide to clients. Social workers instruct clients on how to network within their community to obtain appropriate services and resources but often do not help their clients find and establish intimate and supportive friendships outside of social service or health care systems. Social workers can institute role-modeling through employing the unique skills of engagement such as empathic listening, attending, and being genuine with clients. The ‘‘therapy office’’ is the microcosm of the broader society involving complex relationships. However, we caution the helping specialist to avoid confusing the professional boundaries of social support with friendship. Social workers realize that as helping professionals, it is not constructive to our clients to try to be their friends if we intend to maintain a supportive therapeutic partnership. Rather, we help to integrate skills of friendship through problem solving about how and where to find friendships, through role-play about how clients may engage potential friends or establish more Social Work Theory and Friendship Facilitation29 meaningful relationships with friends, and through teaching the skills that improve patterns of communicating. This direction for clinical intervention is especially important as Americans become more socially isolated (McPherson et al., 2006) and as fewer social resources are allocated to treating psychosocial problems. 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