Academics

 

Using Evernote for Clinical Social Work

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Evernote presents a dilemma for me: I love it but it’s not HIPAA friendly. This is how I use the app for things concerning clients and can be helpful for people that practice as therapists, psychologist, and related fields of social work! (more…)

 

Journaling for Professional, Personal, and Academic Development

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I best express myself in written word which works for me as the best way to capture what I am feeling, reflect as I write, and draw some sort of conclusion at the end of this process. It allows me to process my dreams, hopes, aspirations, frustrations. (more…)

 

Observing Your Session Using Tech Tools

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I can’t begin to tell you how envious I am of most of you returning back to school, for I miss it very much!

Rodney Dangerfield: Back to SchoolEach of the four semesters I was in graduate school, my school of social work required us to submit a process recording.

For the unfamiliar, a process recording is a document in which you recollect and process your entire session with a client. Often the recording is a paraphrased account of your psychotherapy (or case management) session with your client. There are five parts of the Cognitive Process Recording that I have used

  1. Dialogue Between the Client and Clinician: A breakdown of what was said between the clinician and the client as well as any non-verbal communication that either party exhibits.
  2. Mood: The mood or emotional reaction to what the client said (or how the clinician is feeling) during the session.
  3. Automatic Thought: Defined as your cognitive/automatic thoughts to what was said (see example below).
  4. Clinician’s Interpretation: At the time of session and at present, this is the clinician’s interpretation of what happened. I use this area to reflect on what is happening.
  5. Supervisor’s Comments: This is left blank until your supervisor completes it.

It often looks like this:

 

Cognitive Process RecordingThe Social Work Tech Way: Overview 

A picture of a light bulb

When I complete my process recordings, I literally record them using the video function of my point-and-click camera on a tri-Pod, unload the session onto my iPad, and tediously transcribe the part of the session that I need. I later provide both materials to my supervisor for review.

What You Will Need

A picture of a camera, tri-pod, SD card, iPad, battery, and iPad Camera Connector

  • Point and Click Camera with video capabilities ~ $200
  • Tri-Pod ~$30
  • SD Memory Card – 16 GB ~$30 (an empty 16 GB SD card at “standard” settings can provide you with enough space for 4 hours of video)
  • GoodReader for iPad App [iTunes link] (or a different app that is passcode protected) ~$5
  • iPad (with Find My iPad enabled)
  • iPad Camera Connection Kit ~$30
  • Fully charged battery (and a spare) ~$15

Process

Pre-Interview

  1. With consultation, determine: Is it appropriate to use this client for observation? Prior to this recording session with your client, discuss with your plan with your supervisor. Also, float the idea to the client to gauge their response. 
  2. Provide client with informed consent, including the option to decline participation at any time [see: “Potential Issues and Ethical Concerns” section later in this post]. Also, obtain signature on your agency’s “Consent to Observe/Record Session” (or similar) form, indicating that the client understands his or her rights.
  3. Technically Speaking, ensure that your camera’s battery is fully charged (see your charger manual) and that you have enough space on your memory card to record for as long as you need to use it. Assemble your tripod and attach your camera and make sure that the lighting is good for the ambiance in the room.
  4. Consider framing. Is the client comfortable with a wide shot (of you and the client both in the frame)? If not, you could default for using a “Reverse Angle” (i.e. over-the-shoulder) filming technique in which the client’s face does not present itself on the camera, but one can still see the face of the clinician.
Reverse-Angle Shot

Image borrowed from: School Video News

Post-Interview

  1. How are you going to discard your video? What is your process to delete the video from your camera, iPad, etc? When will this happen?
  2. Chain of Custody. When and where will you review the contents of the video? How can you prevent the materials from being seen wit What happens if your iPad or video camera is stolen?
  3. Specific Use. What will you be using the film for? If it is solely for your process recording, where will you do your transcription? If for clinical supervision, what parts will you show your supervisor (e.g. the first, middle, or last 20 minutes of video)?

The Social Work Tech Way: In Action

The last time I employed this method, I filmed a client who consented to be video recorded and used a very wide angle to capture only me and not the client’s image. The camera was positioned directly behind the client’s chair and was unnoticeable and the client could be clearly heard.

A picture of Ignacio in a therapy session with a client

When viewing your recording over and over again, you pick up on a few things :)

After transferring the video directly to my iPad using the camera connection kit (and verifying that it was all there), I deleted the video from my camera. After transferring from the Camera Roll app on the iPad to GoodReader, I made sure that the video played in GoodReader before deleting the video (again) from the Camera Roll app.

Transferring from my iPad's Camera Roll to a Password Protected file on GoodReader for iPad

Transferring from my iPad’s Camera Roll to a Password Protected file on GoodReader for iPad

In GoodReader, I created a folder where I password protected the file and pulled it up for my supervisor. When she was ready to see it (which happened two minutes prior to a different counseling session I was scheduled for). My supervisor and I reflected on this recording during our clinical supervision later that same day. After transcribing it for my Process Recording, I deleted all files right away. Had my iPad been stolen or gone missing, I could delete all content securely and remotely using the free Find My iPad service from Apple.

Why Consider This Method

image of a one-way mirror with caption: "Shh. We're being watched".

One Way Mirror Observation: Scary

  • One-way mirror is scary: Video recording is less scary (potentially). Personally, public speaking does not strike the terror into me that being observed in doing my job does. With public speaking, I generally have several ideas in my head, and quite frankly, after rehearsing my dialogue, I tend to present myself in a positive manner – a myrad of professional, charm, and wit. One cannot rehearse in the same manner to prepare with a session with a client.
  • You can look back on your performance. Once you have your recording on video, you can watch it straight through however many times that you need to so that you can rehash the positive and need areas of your session. If appropriate, you can watch it with colleagues to gain feedback prior to destroying/deleting the session.
  • Verbatim transcription: I have sat for a few hours (up to 3) to transcribe verbatim, a certain/meaningful part of the session for my process recordings. From what I have heard from supervisors, the warts and all transcriptions I have submitted have been more honest and less clean than what most trainees and interns submit. I worked so hard to transcribe the conversation verbatim because I want to be a better social worker. I included notations about inappropriate laughter, scatterbrained thinking, honest reflection (during the session and after) and really challenge myself to be a better as a helping professional while also acknowledging my strengths.
  • No Editing. On this blog, I have demonstrated some advanced video editing techniques that use images and subtitles in videos I have produced. Assuming that your battery did not drain all the way and that your SD card captured everything, From beginning (pressing the shutter and sitting down) to end (with getting up and pressing the shutter again), there is no fuss with editing your video.
  • On-Demand and Mobility. As with any recording, you can access it on demand, which is great when you and your supervisor are swamped with other duties. And if you can trust your supervisor to hang on to your iPad while you are at work, s/he can review your session and process your process recording at a time s/he has available if you are not (e.g. you are in session).

Potential Issues and Ethical Concerns 

NASW Code of Ethics

This approach to recording session is addressed by the NASW Code of Ethics under the section for “Social Workers’ Ethical Responsibilites to Clients” and the subsection for “Informed Consent” which states that “social workers should obtain clients’ informed consent before audiotaping or videotaping clients or permitting observation of services to clients by a third party” (NASW 2008, 1.03(f)).

Furthermore, ethical standards should be considered to avoid harm. Relevant standards to reduce risk of harm may include commitment towards clients (1.01), client self-determination (1.02), your own technological competence (1.04) in relation to privacy and confidentiality of the client (1.07), and access to records (1.08).

Other Ethical Concerns

I want to thank my fellow blogger, Ms. Karen Zgoda, contributed to this section.

  • Client Harm: For your client, recording the session may or may not be appropriate. The way I have asked clients for permission previously is by stating: “I have a favor to ask and you can say no at any time if it makes you feel uncomfortable” [Although now I would re-frame it as “If it is okay with you, I would like to record our session (today or in the future) so that I can be a better therapist to you and others” and then ensure that the client understands that that they can decline participation at any time].
  • Authorization/Consent to Record Session form: The form that I use [and am not linking to due to intellectual property concerns] has a line that states that “You have the right to refuse being recorded and/or observed. In addition, you have the right to submit written notification at any time rescinding prior permission to be recorded and/or observed.” Rights are spelled out and the client can opt (yes or no) to be video or audio recorded, as well as observed – If the client opts to be recorded, I instruct them to check yes for all three criteria. Dates of consent are outlined (I usually select the date of observation through one-month later). The clinician also signs the document under a statement that states that these conditions have been explained to the client. Your agency may have a similar form.
Image of text for a Permission to Record Session release

One snippet of a release form I found (click for higher resolution)

 

  • Data Security: As previously mentioned, GoodReader (by GoodiWare) is recommended for your file management needs. The app has excellent password protection and enterprise-level file security built into it. As with stolen laptops, be sure that your iPad has various passcodes (i.e. to unlock the device, to get into GoodReader, and to access the file) and activate Find My iPad. Karen points out that it is also a good idea to enable (in the iPad’s settings) the ability to wipe your data from the device after 10 unsuccessful passcode attempts.
  • If Data Security Fails: This is a conversation to have with your supervisor upon agreement to pursue this technique to answer: What happens if there is a breach of security in protecting the content of the videos? Each agency may handle security differently.

The Social Work Tech Way: Potential Awesomeness

I have used this method to improve my skills as a psychotherapist and social work clinician. To look at and cringe at the way I conduct myself and to also evaluate where I have strengths of note.

If from great discomfort comes growth, then this exercise provides an avenue for both to occur.

A Final Word

For those of you who may not have access to the aforementioned materials, I would recommend discussing the ideas presented here to your supervisors. At the agency I previously worked for, my supervisor saw the work that was accomplished with my video camera. When my agency came across surplus funds in their budget, they purchased their own equipment with the intention of utilizing it for the same use.

I want to say thank you to Karen Zgoda for helping me brainstorm other Potential Issues and Ethical Concerns I had not thought about. Check out her website at: karenzgoda.org. Karen also writes the “SW 2.0″ column for The New Social Worker Magazine.

 

If You’re an MSW/BSW Student, You Need To Be Using Dropbox

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A digital tragedy fell upon one of my Social Work colleagues today and it broke my heart. I have been absent from this blog because I was working diligently on a process recording, community project paper, and first draft of my final-year research paper – the latter assignment being a casualty of my friend’s digital tragedy due to losing their USB thumb drive. (more…)

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