What does it mean to “start where the client is”? How could Diana have done this?
While working as a medical social worker at Holland Community Hospital, Diana Howard, BSW, received a referral to coordinate home health services for patient Joshua Mitchell. Mr. Mitchell had been admitted to the hospital repeatedly after failing to make use of home health services set up for him in the past. In order for Mr. Mitchell to be released from the hospital he had to have a discharge plan from Diana. However, Diana was unsure what course to take as the medical staff pushed for his release and Diana searched for a way to provide services that Mr. Mitchell would use.
Because of the hospital setting, Diana had only a short period of time to work with Mr. Mitchell and create a discharge plan. Nevertheless, to “start where the client is” she must acknowledge that Mr. Mitchell had unique circumstances that required her to “work with this particular client in this particular situation” (DuBois & Miley, 1999, p. 126). By attempting to understand Mr. Mitchell’s situation from his perspective, she could have avoided pushing her views onto him, and worked with him to create a solution for the problem that he would accept. In addition, Diana should have made sure to approach Mr. Mitchell as a partner in the helping process and tried to learn from him with a sense of curiosity and interest in his personal story.
The issue of considering the medical model versus the strengths perspective in social work was also important for Diana. For example, because Mr. Mitchell had been in and out of the hospital three times over the past year, Diana could have chosen to focus on his losses and deficits and not listen to his story or see him as a partner in planning for his care. By using the strengths perspective and taking the time to listen to Mr. Mitchell’s story (“start where the client is”), Diana may have been able to encourage Mr. Mitchell to join her in the helping process.
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