EVALUATION OF PRACTICE

Evaluation of Practice: The Case of Angel Sanchez

Kritzia M. Rosas-Feliciano
Wayne State University

SW 4997

Evaluation of Practice: The Case of Angel Sanchez

Techniques to evaluate practice effectiveness
Techniques and methodologies are essential to evaluate practice effectiveness in social
work practice. According to Weiss (2005), evaluation is an elastic word that stretches to cover
judgments of many kinds (p. 2). In particular the social workers job performance is often
judged by the outcome of the patient treated. The social workers job performance is measured
by the goals achieved during the patients stay at the facility and by the characteristic of making
life better and more rewarding for the patient (Weiss, 2005, p.2). Evaluation is usually done
upon termination. The results of the treatment are examined when the treatment ceases and the
patient is ready to move on to the next step in their treatment plan. Termination in StoneCrest

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Behavioral Center happens during the discharge of a patient. Every patient being discharged has
a discharge plan in place. Within the discharge plan are housing arrangements and follow up
appointments with outpatient clinics, therapists, or other facilities of their choice to follow up
with their treatment and progress.
According to Howard, Moras, Brill, Martinovich, and Lutz (1996), treatment-focused
research is concerned with the establishment of the comparative efficacy and effectiveness of
clinical interventions, aggregated over groups of patients (p.1). Group therapy interventions,
such as cognitive-behavioral therapy, fall under the treatment-focused research evaluation
methodology. The social worker is able to measure the progress of the individual in a group
participation setting. Howard, Moras, Brill, Martinovich, and Lutz (1996), state that patientfocused research is concerned with the monitoring of an individual's progress over the course of
treatment. All the methodologies are focused on the improvement and progress of the individual
in different settings and aspects of their treatment. Research is often necessary to be able to
efficiently evaluate the social workers practice performance.
According to Hepworth, Rooney, Rooney, Strom-Gottfried, and Larsen (2010), there are
different ways to evaluate practice effectiveness such as: goals and objectives achieved, client
self-monitoring, and benchmarks in which progress can be measured (p. 569). Whatever method
is used, evaluations focus on three dimensions of service: (1) outcomes, (2) process, and (3)
satisfaction (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2010, p. 569). StoneCrest
utilizes all three dimensions of service as measurements of practice evaluation. Outcome
evaluation involves assessing the results achieved against the goals that were formulated during
the contracting phase of work (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2010,
p.569). During the contact phase at StoneCrest the patient is assessed by the social worker and

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different goals are established for that specific patient. In the case of Angel Sanchez, a
schizophrenic Hispanic male, the goals set during his admission were to receive treatment and
find transitional housing for him upon discharge to continue with his treatment and recovery.
Another aspect of evaluation involves identifying the aspects of the helping process that were
useful or detrimental (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2010, p.571).
The aspect that was identified as a helping process was providing an interpreter for Angel during
his stay at StoneCrest Behavioral Hospital. Providing an interpreter helped Angel get the full
therapeutic treatment aspect of his treatment as well as have open communication, interaction
and understanding with staff members, other patients and most importantly his doctor. No
aspects of the evaluation were considered detrimental to the patient. Feedback about techniques
and incidents that enhanced or blocked progress will help you to hone certain skills, eliminate
others, and use techniques with greater discrimination (Hepworth, Rooney, Rooney, StromGottfried, & Larsen, 2010, p. 571). The feedback received from the patient concluded that phone
interpreters were not as affective as in person interpreters. It was difficult for Mr. Sanchez to
understand what was happening when he was going through a crisis having to speak with
someone in person and on the phone was confusing and at the time was not helpful for his
recovery. Dealing with mental health patients can be more challenging to accommodate their
language barrier than dealing with medical patients in a hospital with a language barrier. Having
an interpreter in person made a huge difference in Angels treatment and his approach and
compliance with group therapy and pharmacotherapy. According to Hepworth, Rooney, Rooney,
Strom-Gottfried, and Larsen (2010), another measure in the increasingly competitive and
consumer-conscious practice environment seeks information about client satisfaction; this data
can be gathered through consumer feedback forms (p. 571). StoneCrest Behavioral Center is a

EVALUATION OF PRACTICE

hospital that is very conscious about patient centered care treatment. StoneCrest Behavioral
Center is known for offering programs for many different populations with a variety of mental
illnesses. Therefore, client satisfaction is one of StoneCrests priorities when evaluating the
social workers practice. Client satisfaction is measured upon patient discharge, at this time they
are asked a series of questions about their treatment and their overall stay at StoneCrest.
According to Hepworth, Rooney, and Larsen (1997), evaluation consists of three different
dimensions: (1) outcome, (2) process, and (3) the practitioner (p. 608). The only difference in
this source is the practitioner, which evaluates the satisfaction of the client with the practitioner
and structural experience during treatment as well. According to Hepworth, Rooney, and Larsen
(1997), structural issues include appropriateness of the waiting room, convenience of parking,
time elapsed between request and first appointment, friendliness of reception staff, and so on (p.
611). Practitioner and structural satisfaction are addressed in the series of questions upon patient
discharge as well.
Case outcome
Evaluation of outcome involves assessing the results achieved against the goals
formulated (Hepworth, Rooney, & Larsen, 1997, p. 609). Realistic goals stated at admission are
to be met by the time of discharge at StoneCrest Behavioral Center. To assess general progress,
refer to the goals that were agreed upon and elicit clients views as to the degree of progress they
achieved on each goal (Hepworth, Rooney, & Larsen, 1997, p. 609). At StoneCrest Behavioral
Center goals for the patients are usually measured in a quantitative determination of outcome,
because measures are made of the incidence of problem or target behaviors during the
assessment process (Hepworth, Rooney, & Larsen, 1997, p. 609). Behaviors such as group
participation and being compliant with taking their medications are measured throughout the stay

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and treatment duration of the patient. Time spent in group therapy sessions is documented
jointly with notes and observations made by the social worker on the patients progress, quotes,
attitude, behaviors, and overall group participation. During the beginning phase of the treatment
Angel was not compliant with taking his medication and neither was he compliant with attending
group therapy. Angels language barrier and a mental disorder made him very confused and he
was unable to understand the treatment process.
Hepworth, Rooney, Rooney, Strom-Gottfried, and Larsen (2010) concluded the
following:
Changes may be measured in the frequency of difficulties (e.g., experiencing negative
conditions, forgetting to take medications, no attending group therapy) or the frequency
of target behaviors, such as exercise, use of I statements, or positive interaction with
others. Another way to assess outcomes is by looking at the changes in the severity of
problems (e.g., anxiety as measured by a self-anchored rating scale, sleep disturbance as
measured by a clients journal or distractibility as measured by observation). (p. 569570).
Once I was able to clarify the social workers objective to Angel, he was more prone to
participate in his treatment and he became more compliant with taking his medication, because
he now had a better understanding of the treatment he was receiving. After Angel became fully
compliant with cognitive-behavioral therapy and pharmacotherapy, the next step was to find
transitional housing for him to have a place to live upon discharge. The social worker found a
group home that was fit to meet Angels needs. Once Angel was discharged by his psychiatrist,
his discharge planning indicated that he was going to live in a group home and transportation

EVALUATION OF PRACTICE

would be provided to his new residence. A follow-up appointment was made for Angel at the
nearest psychiatric clinic for continuing outpatient treatment.
Agencys feed-back loop
StoneCrest has a feed-back loop. The social workers at StoneCrest Behavioral Center
follow up with the indicated outpatient therapists that the patients have set appointments with
upon discharge. Another feed-back loop are the follow up calls made by the social workers to
the patients or the patients guardians to ensure the well-being of the patient, to ensure treatment
effectiveness and to assess durability of intervention. According to Hepworth, Rooney, Rooney,
Strom-Gottfried, and Larsen (2010), social workers may assess the durability of changes in
these sessions-that is, determine whether clients have maintained gains beyond the immediate
influence of the helping relationship (p. 580). Knowing the outcome of the intervention after
treatment has been finalized allows the worker to learn what worked well and what did not work
so well for that specific patient. In the case of Angel Sanchez he continued with his treatment.
According to Richey, Blythe, and Berlin (1986), studies show that routine practice evaluation by
social workers can enhance treatment outcomes and agency decision making, planning, and
accountability (p. 14). The staff members in the group home where Angel now resides helped
him stay on track with his outpatient appointments and his pharmacotherapy. The new therapist
at the outpatient clinic was able to communicate with Angel with an interpreter as well. The new
therapist reports that Angel has not displayed any aggressive behavior and that seems to be
adjusting well in his new place of residence.
Program evaluation- formal or informal
StoneCrests program evaluation is both formal and informal. There are many aspects of
their practice evaluation that are formal and some that are informal. For example, cognitive-

EVALUATION OF PRACTICE

behavioral therapy and pharmacotherapy program evaluations are formal. There is data gathered
and measured in a quantitative method. The data gathered from follow-up calls to the patients
outpatient therapist are also a formal way of program evaluation, because date is collected in a
qualitative method. Questionnaires given to the patient or patients guardian can be considered
informal due to the lack of expert and non-bias opinion given. At times questionnaires are
conducted by volunteers, interns, or clerks with little or no knowledge of the patients situation,
therefore they are considered informal.
Methodology appropriate to case
Both quantitative and qualitative methodologies are appropriate to evaluate Angels case.
The most helpful and accurate would be the quantitative measurement methodology of
evaluation. According to Hepworth, Rooney, Rooney, Strom-Gottfried, and Larsen (2010),
quantitative evaluation embodies the use of procedures that measures the frequency and/or
severity of target problems (p. 333). In Angels case his goals were to be compliant with
treatment as far as attending group therapy and receiving pharmacotherapy. The frequency in
which he attended group therapy and his compliance with taking his medications were measured
with the quantitative methodology. The quantitative measurements showed major improvement
once an interpreter was provided to Angel. The quantitative improvement was the first step
made toward one of his goals which was to be discharged from the facility.
According to Hepworth, Rooney, Rooney, Strom-Gottfried, and Larsen (2010),
qualitative measures are consistent with narrative and social constructivism approaches (p. 338).
Follow up calls to the patients outpatient therapist, the patients guardian and/or the patient
himself, are all measured with qualitative methodology. Qualitative measures focus on the
subjective experience and personal stories (Hepworth, Rooney, Rooney, Strom-Gottfried, &

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Larsen, 2010, p. 338). Therefore the experience can be measured in the degree of satisfaction
and also in a narrative for improvement or aspects of the treatment to continue practicing that
worked well.
Also formative evaluations are used at StoneCrest Behavioral Center. According to
Patton (1987), formative evaluations are conducted for the purpose of improving programs (p.
28). The social workers want to know what they could have done better in order to achieve a
better and longer lasting outcome for the patient. According to Patton (1987), utilizing
qualitative methods, formative evaluations can be highly descriptive. They can provide depth
and detail about the programs strengths and weaknesses (Patton, 1987, p.29). All evaluations
are analyzed by management and the supervisors in order to implement better forms of practice
when the agency is performing poorly in a certain aspect of their treatment and or treatment
outcomes.
Values and ethics regarding evaluation
StoneCrest Behavioral Center values the patients opinion about their treatment. The
faculty takes the patients care and recovery very seriously. In Angels case he needed an
interpreter in order to receive and take advantage of the treatment that all of the other patients
were receiving. The management staff provided Angel Sanchez an interpreter in order for him to
receive the treatment needed to have a speedy recovery. The ethical issue in this evaluation
would be equality. Angels language barrier should not have prevented him from receiving equal
treatment as other patients in the facility. Thankfully I was fluent in Spanish and was able to
help Mr. Sanchez with his issue, but if I was not there I wonder how long it would have taken for
Mr. Sanchez to receive equal treatment as the other patients. The other patients being native
English speakers were aware of their care, the cognitive-behavioral group therapies, and their

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medication information. Angel on the other hand was deprived of this care for a few days. The
facility did provide an interpreter over the phone, but Angels mental illness impeded him from
understanding what was happening at the time and created more confusion for Angel instead of
providing clarification. According to Cantor (1994), ethical considerations arise, however, in
that equal care is not provided to all of the population due to cost (p. 259). I believe this
statement to be true because StoneCrest Behavioral Center has yet to change his telephone
interpreters. The only interpreters that come to the facility are those who speak sign language.
The main issue with having language interpreters to come to the facility is due to the high cost of
bilingual interpreters. At StoneCrest Behavioral Center any suggestions or complaints are
addressed and properly handled with management and other supervisors. For such big change to
occur in a facility like StoneCrest it would take a considerable amount of time.
Conclusion
In conclusion, Angel Sanchez treatment was delayed due to his language barrier. Since
the patient was having difficulties using their telephone interpreting services, StoneCrest
Behavioral Center did everything possible to provide the patient with an interpreter who was
present in the facility. Once Angel Sanchez was able to understand the situation he was in and
what the purpose of his treatment was, he became compliant with his cognitive-behavioral
therapy and his pharmacotherapy. After he was compliant wit treatment he was then able to
achieve the goals he stated upon admission. Angels goals were to be discharged. Not only was
Angel Sanchez discharged after being compliant with his treatment but he was able to continue
with his treatment as outpatient with a different therapist. Angels new therapist reports that
Angel continues to be compliant with his care and seems to be adjusting well in his new home.

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10

The evaluation of practice was very broad in this situation. Many methodologies were
used to measure the level of practice effectiveness. The quantitative measurement method is
often used within the facility to view the patients progress and compliance with treatment in
order for them to be discharged. The qualitative measurement method is used when follow up
calls are made to the outpatient therapist, the patients guardian and/or to the patient. Formative
evaluations are also used in StoneCrest Behavioral Center to use as a tool for improvement in
practice programs. Some of these methodologies are formal as well as informal depending on
how the data is gathered. Also an ethical issue was equality. Angel Sanchez was not being
treated equally by having his treatment be delayed to his language barrier. It cause Angel to have
a longer stay at the facility due to failure to comply with treatment for the time that he did not
have an interpreter present. Overall StoneCrests social worker was effective in providing an
interpreter for Mr. Sanchez as well as finding transitional housing to fit his needs in order for him
to continue with his treatment after discharge. The evaluation practice was effective for Mr.
Sanchez who remains stable and compliant with his continuing treatment.

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References
Cantor, S. B. (1994). Cost-Effectiveness analysis, extended dominance, and ethics: A
quantitative assessment. Med Decision Making, 41 (3), 259-365.
Hepworth, D. H., Rooney, R. H., & Larsen, J. (1997). Direct social work practice: Theory and
skills (5th ed.). Pacific Grove, CA: Brooks/Cole.
Hepworth, D. H., Rooney, R. H., Rooney, G. D., Strom-Gottfried, K., & Larsen, J. (2010).
Direct social work practice: Theory and skills (8th ed.). Pacific Grove, CA: Brooks/Cole.
Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of
psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51
(10), 1059-1064.

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Patton, M. Q. (1987). How to use qualitative methods in evaluation. Newbury Park, CA: SAGE
Publications, Inc.
Richey, C. A., Blythe, B. J., & Berlin, S. B. (1987). Do social workers evaluate their practice?
Social Work Research Abstracts, 23 (2), 14-20.
Weiss, C. H. (2005). Evaluation research. Methods for assessing program effectiveness.
Englewood Cliffs, NJ: Prentice Hall, Inc.