Running head: CASE STUDY #2

Case Study #2: Case 7: In Need of Support

Joseph A. Cerniglia
University of South Carolina

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Abstract

Linda Summerfield, BSW has 3 years of experience working in rehabilitative care with a hospital
and has been serving as a case manager for Daybreak, an agency which serves persons living
with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
for 6 months. Set in Casper, in the Southeastern part of North Carolina, forty-five minutes from
Fayetteville, the case centers on six main clients in Frank, Kevin, Jeff, Tim, Jason, and Darrell,
all of whom are Caucasian and gay. The case seeks to address a dilemma in which Linda hopes
to continue group work with the six clients but can no longer do so by telephone. (Scales &
Wolfer, 2006)

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Case Study #2: Case 7: In Need of Support
Problem Statement

Lindas main concern is maintaining the support system she has helped create for the six
men living with HIV/AIDS. The problem is exacerbated by a lack of funding for an adequate
phone conferencing system, reluctance to meet in person on the part of two of the members,
logistical complications, and, most obstructively, a climate of hatred, misunderstanding, and fear
on the part of the regional locational community.
Contextual Analysis
In addition to the medical complications of HIV/AIDS is the far more insidious reality of
discrimination and oppression. Although the Americans with Disabilities Act of 1990 established
legal protections for individuals with HIV/AIDS (DC Chapter of the National Association of
Social Workers), many of these individuals still express stigmatization and fear of discrimination
(Sayles, Wong, Kinsler, Martins, & Cunningham, 2009). Further impacting Lindas intervention
is the climate surrounding Daybreak and its clients which is described as conservative,
biblically based, and view[ing] HIV/AIDS as due punishment for the sin of
homosexuality (Scales & Wolfer, 2006, p. 85).
Alternative Strategies
Concentrate on Phone Group Support
Recognizing the lack of consent from one-third of her clients, Linda would attempt to
seek funding for an upgrade to the agencys phone system from federal or state funds. This
would meet with the ethical standards of informed consent, and right to self-determination
(National Association of Social Workers, 2008). Furthermore, the complexity of organizing a
group among members who live in different cities and locales could prove exclusionary to some

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of her clients. Negatively, it would remove the possibility of face-to-face interaction which the
majority of her clients have expressed interest in and her experience qualifies her to lead.
Terminate the Group
Some of her clients have exchanged contact information and seem willing to coordinate
amongst themselves for continued support with or without her involvement. For those clients
who have established rapport, the support network of friends with similar medical issues and
sexual orientations can prove beneficial in mitigating the negative climate and offer mutual aid.
Conversely, the impact of a social worker on group cohesion should not be ignored and the
mutual aid model is most beneficial when accompanied by a holistic, planned change approach
directed by an experienced professional in Linda.
Coordinate an In-person Group
Linda could offer due diligence to establish a meeting place and time and address the
varying issues of transportation, scheduling, and willingness to meet. The benefit of an in-person
support group is the most direct and effective way to address the variety of risk factors facing the
clients. Although phone groups can be helpful, in-person groups allow for the visible cues that
adequately convey empathetic understanding. However, the possibility of excluding clients must
be wholeheartedly addressed and reasonable accommodations must be made to maximize
participation of all clients.
Recommendation
Despite the complexities, Linda has an ethical obligation to provide services for which
she is most competent, in-person group work. Linda should seek to find a meeting place that
offers both privacy, confidentiality, and an environment conducive to positive growth. Linda
rightfully worried about access declaring, Maybe we need a cover story to disguise the purpose

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of the meetings and although she questions, Is it ethical? (Scales & Wolfer, 2006, p. 93) the
overriding ethical values are privacy and confidentiality (National Association of Social
Workers, 2008). Linda should research transportation options, maybe suggesting ridesharing to
clients or other alternatives.
Additionally, Linda should work with the two hesitant clients to seek to overcome
reluctance to in-person meetings, addressing concerns, and working to ensure reasonable
accommodations. Focusing the discussions on the potential benefits of an in-person group and
the steps being taken to reduce the risk of being outed, Linda should also speak honestly with
the clients about the limitations of her agency and her plan to move forward. These discussions
will establish an appeal to the rational choice perspective and assert that the benefits outweigh
the mitigated risks.
Finally, Linda should continue to offer one-on-one counseling and service to anyone
unable or unwilling to attend an in-person group. It is far better for individual clients to have one
source of support rather than no source of support. For Linda, continuing to address rational
choice, the arduousness of the effort to establish such a group results in an overtly positive
change process that meets with her competence and belief in group work.

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References
DC Chapter of the National Association of Social Workers. (n.d.). Discrimination & HIV/AIDS:
A factsheet for practitioners. Retrieved February 23, 2014, from NASW DC:
http://www.naswdc.org/diversity/lgb/hiv_discrimination.asp
National Association of Social Workers. (2008). Code of ethics of the National Association of
Social Workers. Washington, DC: NASW Press.
Sayles, J., Wong, M., Kinsler, J., Martins, D., & Cunningham, W. (2009). The association of
stigma with self-reported access to medical care and antiretroviral therapy adherence in
persons living with HIV/AIDS. Journal of General Internal Medicine, 24(10), 11011108. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762503/pdf/11606_2009_Article_1068.p
df
Scales, T., & Wolfer, T. (2006). Decision cases for generalist social work practice: Thinking like
a social worker. Belmont, CA: Brooks/Cole, Cengage Learning.