Clinical Intervention I-System Theory In class, we reviewed Systems Theory and the Life Model to help us understand how the individual impacts their enviro

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 In class, we reviewed Systems Theory and the Life Model to help us understand how the individual impacts their environment, and how the environment impacts the individual, communities, and organizations. You will use the literature provided and other pertinent literature to respond to the following:Using the Esperanza case and citing the literature providing and using the APA 7th Edition writing style, you will respond:

  1. How might systems theory or the life model serve as a tool to help social workers create strategies to build trust with a client who explicitly shares their legitimate disappointment with how institutions have responded to their prior needs? What skills would you use to prioritize your engagement with the client? 
  2. Social workers might work under policies and political climates that perpetuate injustice. What conflict might this raise for you? How will you support yourself should this occur?
  3. Using your understanding of ACE, what might be some of the preventive measures you would work on with Esperanza to decrease her depression and anxiety? 
  4. What would be some strategies you would use to work with the school and Children’s Services to advocate for Esperanza and her infant? How would your strategies gain her trust? 

Must be completed in English and your ideas and critical thinking must be supported by literature. Will be 3 pages in content and length (this does not include the first page and reference page).  

163© Springer Nature Switzerland AG 2021
R. P. Dealey, M. R. Evans (eds.), Discovering Theory in Clinical Practice,
https://doi.org/10.1007/978-3-030-57310-2_12

Chapter 12
Systems Theory: The Case of Esperanza

Madeline Pérez De Jesús, Enitzaida Rodríguez, and Gladis Anaya

Introduction to Systems Theory

Systems theory calls practitioners to examine the relational dynamics between
individuals, and between and within groups, organizations, or communities, as well
as mutually influencing factors in the environment (Leighninger, 1977). While
systems theory is commonly used in social work, the authors argue that the profes-
sion would benefit from expanding its scope to intentionally explore issues of
diversity and the impact of trauma. This chapter demonstrates how systems theory
supports culturally informed clinical practice by highlighting the case of
“Esperanza,” a 16-year-old ninth-grade student who, with thousands of others,
migrated from Puerto Rico to urban cities in the Northeast and other areas in the
United States after being displaced by Hurricane Maria in 2017. Two Latinx social
workers enter Esperanza’s life in her new high school setting in Hartford,
Connecticut.

The authors’ overview of systems theory includes a perspective on how problems
arise, how systems theory facilitates understandings of the change process, and
implications regarding complementary interventions that are can be used based on
this theory. The case study of Esperanza details her demographics, family dynamics,
and various ecological factors that influence her situation. Theoretical integration

M. P. De Jesús (*)
Department of Social Work and Equitable Community Practice, University of Saint Joseph,
West Hartford, CT, USA
e-mail: madelineperez@usj.edu

E. Rodríguez
School Social Worker, University of Saint Joseph, West Hartford, CT, USA
e-mail: erodriguez@usj.edu

G. Anaya
University of Saint Joseph, West Hartford, CT, USA
e-mail: ganaya@usj.edu

164

follows the case example, with the authors demonstrating how systems theory
informed social workers approach to treating the client and understanding the
client’s response. Important considerations regarding intracultural and intercultural
factors that influenced clinical intervention effectiveness are described. The authors
note that systems theory also served as a tool for resolving a practice conflict for the
social workers. In the concluding section, the authors pose discussion questions to
support readers in thinking critically about the usefulness of systems theory and the
process of integrating theory into clinical practice.

The overarching premise in systems theory is that there is reciprocity in the inter-
locking relationships between people, families, social networks, neighborhoods,
and other related systems (Leighninger, 1977). This reciprocity includes elements in
the environment such as nature, encompassing physics, chemistry, biology, and
social relationships. While the origins of systems theory come from Charles
Darwin’s notion of “the survival of the fittest,” the theory has broadened and sup-
ports social work by offering a balance between biological, psychological, and
sociological roots. Systems theory had a significant impact on social work during
the 1970s, when its contributions included general systems theory, and family ther-
apy developed into ecological theory and the importance of networking (Payne,
2002). This theory is particularly useful to social workers, as they are trained to have
a person-in-environment lens.

Leighninger (1977) identified three main contributions of systems theory to the
field of social work: (1) it expands the practitioner’s focus beyond the client to the
client and their environment, (2) it allows for a better account of social change, and
(3) it has the potential of having social workers reflect on issues of power and con-
trol. Social workers are not strangers to examining ourselves as agents of social
change, and in his discussion of the applicability of systems theory, Leighninger
reminds us that we must also examine the other side. In other words, just as we
explore how social workers are agents of change, it is also central to look at how we
might operate as agents of social control or even social oppression.

Systems theory offers a specific perspective on how problems arise. This per-
spective is evident in a definition of social work that was put forward by the
International Federation of Social Workers in 2000, and subsequently reinforced by
the International Association of Schools of Social Work (as cited in Hutchings &
Taylor, 2007, p. 382):

The social work profession promotes social change, problem-solving in human relation-
ships, and the empowerment and liberation of people to enhance well-being. Utilizing theo-
ries of human behavior and social systems, social work intervenes at the points where
people interact with their environments. Principles of human rights and social justice are
fundamental to social work.

Systems theory assumes individuals are part of overlapping or intersecting mul-
tiple networks and defines problems within this overlap. No individual lives in a
bubble; our families, our communities, the related systems with which we engage,
and the broader sociopolitical and economic climate impact us all. Just as the prob-
lem is found in these overlapping systems, this is also where potential solutions lie.

M. P. De Jesús et al.

165

Payne’s (2002) reminder of the importance of networking is applicable to our cli-
ents, as the people in their systems shape the types of information they receive and
their beliefs, which in turn impact their actions. For instance, a client may have
access to accurate or inaccurate information, and may operate in the world with a
sense of entitlement or a sense of despair.

Various interventions emerge from the foundational principles of systems theory.
Visual aids provide a concrete way for clients and those who work with them to
digest how systems theory helps make meaning of a client’s life. Ecomaps and
genograms are examples of visual aids that can be particularly useful during the
early stages of rapport building and assessment. Ecomaps are visual representations
of the interconnected systems of an individual’s life that show the relationships
between the client and their environment (Hartman, 1995). Whereas ecomaps dis-
play a more comprehensive arrangement of systems, genograms fix the gaze specifi-
cally on family dynamics across generations, allowing client and practitioner alike
to examine family dynamics with particular focus on behavioral patterns and quality
(Altshuler, 1999). The relationships between systems, people, and the client are
represented by lines drawn on the visual aid. A thick solid line represents a mean-
ingful positive connection. A broken line symbolizes a weak connection. Lines
drawn with crosses through them indicate stress. Some lines might also include
arrows to suggest that a relationship appears to be mutually beneficial, mutually
toxic, or one-directional. Pope and Lee (2015) are a good starting point for further
direction on the creation of genograms.

Systems theory helps social workers understand that it is not only individuals
who serve as stressors or supports to a client; the processes of bureaucratic institu-
tions that represent education, religion, political, and economic entities can stress or
support a client, as well. Understanding the client’s supports and stressors is a pre-
requisite to engaging with the client therapeutically.

Cognitive behavioral therapy (CBT), a psychological treatment model in which
the treatment provider helps the client become aware of their thought processes,
belief systems, and antecedent behaviors, is one approach being increasingly used
by social workers to treat clients with a range of problems, including but not limited
to anxiety, depression, and post-traumatic stress. CBT as an empowering model
aligns well with systems theory, as clients from underrepresented groups are fre-
quently subjected to discrimination and intergenerational trauma. CBT can be
trauma-focused, and typical techniques for child and adolescent survivors of trauma
include cognitive reprocessing and reframing, exposure, stress management, and
parental treatment (Cohen, Mannarino, Berliner, & Deblinger, 2000).

Mutual aid groups, another intervention model, situate individuals who are
undergoing similar social problems as providers of support to each other, in the
context of a group working on solutions. Such groups provide opportunities for
clients to share their lived experiences while witnessing each other’s accounts of
interactions with various systems, and subsequently influencing each other
(Gitterman, 2004).

Social workers frequently engage in a role traditionally referred to as case man-
agement, a process of assessing the client’s needs and then securing (in some cases

12 Systems Theory: The Case of Esperanza

166

advocating for) a package of services. Consistent with a focus of engaging clients
with institutional actors, resource referral is an intervention in which social workers
secure assistance for clients to supplement supports that are limited or unavailable
from their personal agency standpoint. All the heretofore mentioned types of inter-
ventions help ground understandings of the case study of Esperanza.

Introduction to the Case of Esperanza

Esperanza is a 16-year-old Puerto Rican heterosexual female. All names and identi-
fiers of this case have been changed to maintain the confidentiality of the client. A
ninth-grade student at her local urban high school, Esperanza lives with her 7-month-
old baby, 34-year-old mother (Ms. Colon), and two adolescent siblings in an apart-
ment in Hartford, Connecticut. While neither Esperanza nor her family currently
attend church services, they identify as Catholic and were all baptized as infants.
Ms. Colon, the primary income-earner, works as a home health aide for the elderly.
Both of Esperanza’s parents stopped their formal schooling after eighth grade. The
family unit receives some public assistance and financial contributions from
Esperanza’s siblings; also high school students, who both hold part-time jobs. The
family’s primary language is Spanish.

Esperanza was referred to the school social worker last year, initially for aca-
demic reasons. As an “over-age student,” Esperanza was required to undergo a
series of educational evaluations. While Esperanza did not have any learning dis-
abilities, she was 2 years behind grade level due to gaps in her school attendance
and limited English-language proficiency. Her social work referral expanded beyond
academics after her classmates informed teachers that Esperanza was pregnant.
Because she was a pregnant minor, a referral to the state child welfare agency was
also made. Despite being polite and cooperative with the social worker, Esperanza
initially refused the involvement of school and state officials, stating she “tenia todo
el apoyo en su familia” (“had all the support she needed within her family”).
Esperanza previously received counseling services from a school social worker as
an elementary school student in Puerto Rico, to support her coping with her parents’
divorce. Counseling services then involved 6 months of weekly individual sessions,
which Esperanza described as supportive. She has since developed and maintained
healthy relationships with both parents, who appear to collaborate well in their co-
parenting of Esperanza and their other children. Esperanza’s relationally healthy
and loving family, as well as her personal resilience, prove to be strengths in her
treatment.

Esperanza’s presenting concern was her increase in trauma-related symptoms,
including increased anxiety, depressive mood, difficulty concentrating, and lowered
frustration tolerance. These symptoms were interfering with her ability to maintain
effective, positive communication with others both in school and with her personal
relationships. Esperanza also stated she was fearful of “engaño” (Spanish for trick-
ery or fraud) from institutional officials such as social workers and teachers.

M. P. De Jesús et al.

167

During the first 5 years of her life, Esperanza lived with both of her parents. At
the age of five, her parents divorced. Although her parents terminated their marriage,
Esperanza reports that her parents speak about each other in cordial ways and
engage in healthy co-parenting. This cooperative co-parenting engagement is a fam-
ily strength, especially since she has gone back and forth living with each in the
years since their divorce. Back and forth is also a larger pattern for Puerto Ricans,
as it references travel between the island and the mainland in a circular motion
facilitated by U.S. citizenship. Despite having legal recognition as U.S. citizens,
Puerto Ricans who have spent time in both places often experience cultural dis-
crimination and feelings of not belonging to the island or the mainland. Acevedo
(2004) references this dilemma as belonging “neither here nor there.”

Between the ages of 5 and 12, Esperanza lived intermittently with each of her
parents and migrated back and forth between Connecticut and Puerto Rico on at
least three separate occasions. When Esperanza was 12 years old, her mother moved
to Connecticut in search of employment with two of her children (the eldest and the
youngest). Esperanza remained in Puerto Rico with her father for three years until
her mother could “send for her” to move to Connecticut.

When Esperanza was 15  years of age and still living with her father in Puerto
Rico, she experienced the devastating impacts of a hurricane that led to a mass exo-
dus from the island to the United States. Esperanza is a survivor of sexual abuse.
While she described having a “boyfriend,” she clarified that this person was a man
10 years her senior. Despite this being a relationship that felt like a courtship for her
and was approved by her family, it is a situation of abuse. She was not within the
legal age of consent to engage in a sexual or emotional relationship with this adult.

Esperanza’s mother and older sister appear to be affectionate and reliable posi-
tive supports for her. They care for Esperanza’s baby while she is at school. On days
that Esperanza does not have family childcare, she does not attend school. This
accumulation of absences (an average of one  day a week) impacted Esperanza’s
academic progress and was brought to the attention of the state child welfare agency
as potential educational neglect. The engagement with child welfare also revealed
that Esperanza had been impregnated at 15 by a 25-year-old man, which raised
concerns. Esperanza assured social workers that she was not raped and was “in a
relationship” with her child’s father. Despite her description of her child’s father as
an attentive partner and active father to their child, he was arrested on multiple
counts, including statutory rape for his involvement with Esperanza. Esperanza
interpreted her boyfriend’s arrest and her social service involvement as unjust, and
she experienced the state and judicial system as preventing her and her infant from
receiving his emotional and economic support.

Upon migrating back and forth from Puerto Rico to the mainland United States,
Esperanza had to learn to navigate two distinct cultures and languages. She also had
to adapt to two separate family structures and dynamics of interaction. She showed
signs of anxiety and depression and made statements about how she struggled being
a teen mom while desiring to engage in typical adolescent activities, and the ramifi-
cations of those tensions in a social context. For example, the social worker noted
that Esperanza lamented about missing the junior prom and other social activities

12 Systems Theory: The Case of Esperanza

168

due to her caregiver responsibilities. Despite these difficulties, Esperanza stated that
her baby is “mi cariño” (“her love”) and speaks about the child with much affection.

After Hurricane Maria, there was little evidence of support for the mental health
impacts of this natural disaster on the many students migrating and integrating into
mainland American schools. As Puerto Rican students increasingly enrolled in
urban high schools, social workers scrambled to address these challenges and meet
the needs and demands of newly arrived families that had been deeply impacted by
the hurricane. In the scope of this distressing event, the school social worker and her
MSW intern worked with Esperanza.

During the initial phase of working with the client, the workers administered
psychological first aid, a set of support actions aimed at reducing post-traumatic
stress related to natural disasters often offered in schools. Psychological first aid
centers around the core actions of contact and engagement, safety and comfort,
stabilization, information gathering, practical assistance, connection to social sup-
ports, information on those supports, and linkages to collaborative services (Ruzek,
Brymer, Jacobs, & Layne, 2017). Psychological first aid was offered both individu-
ally and in group settings for Esperanza and her classmates, as the enrollment of
displaced Puerto Ricans increased in their high school. The efforts of the social
workers were to help Esperanza feel assured, connected, and supported in her cur-
rent environment. Within a few weeks of working with Esperanza, it was clear that
the experience and aftermath of the hurricane had severely impacted her. She had
reported nightmares and trouble sleeping, and appeared to have decreased frustra-
tion tolerance despite remaining polite to those in authority.

Theoretical Integration

Systems theory was a useful tool both in supporting the social workers with their
treatment of Esperanza and in understanding the client’s response. By focusing on
the notion that there is reciprocity in the relationships between individuals, groups,
organizations, and communities, as well as the larger sociocultural and political
environment, the social workers were not only better equipped to identify factors
that hinder Esperanza but potential solutions, as well.

Esperanza received treatment from the school social worker (a bilingual Latina
of Puerto Rican descent) and a social work intern (a bilingual Latina of Mexican
descent). The clinician (and the clinician in training) approached their work with
Esperanza from a stance of cultural humility, in which they were able to incorporate
Latino cultural values such as personalismo, which refers to the significance Latinos
place on positive rapport with others (Mogro-Wilson, 2013; Mogro-Wilson, Rojas,
& Haynes, 2016). More than merely engaging with Esperanza in her native lan-
guage, Spanish, personalismo involved asking Esperanza about her extended family
members and engaging in informal exchanges to establish rapport.

It is important to differentiate for emerging social workers the differences
between an informal exchange (which facilitates trust) and unprofessionalism

M. P. De Jesús et al.

169

(which diminishes trust). These informal exchanges included brief, playful debates
over whose brand of Puerto Rican coffee is better and who is the favorite participant
in La Voz (the Spanish-language version of the singing competition, The Voice).
Establishing rapport with Esperanza in this way was vital during the engagement
process. Rapport is the entry point to the client–worker relationship. More than
comfort, receptiveness, and respect, rapport is a commitment to display warmth,
interest, and caring in a way that encourages the client’s trust and confidence.
Choosing a highly viewed talent competition as an initial conversational prompt
proved to be an excellent choice, as it provided at least 20 weeks of continuous nar-
rative from which to build a relationship (“Can you believe Tania was eliminated in
week three? Did you text your vote for the semi-finals of La Voz?”). Moreover,
selection of a show that was popular in Puerto Rico allowed for cultural affirmation,
a sense of familiarity, ease of communication in the native language, and joy.
Personalismo sustained and supported the therapeutic alliance, as it built trust, con-
fidence, and respect while diminishing Esperanza’s worry about potential “engaño”
(trickery).

Systems theory allowed the workers to expand their view of trauma as being a
component of the environment for this youth. With this in mind, they continued
their work with Esperanza using ACEs (Adverse Childhood Experiences) screening
to assess how many types of maltreatment a client has experienced prior to the age
of 18. This tool covers ten types of trauma within three categories: abuse, neglect,
and household dysfunction.

Trauma-informed approaches recognize that there have been potential traumatic
experiences in the lives of our clients. Social workers must explain to clients why
they are asking sensitive questions rather than just ask them as a matter of protocol.
These explanations demonstrate mutual respect and cultural humility. Recognizing
that sensitive questions may be misunderstood as “engaño” (trickery), in this case,
the social workers began by informing Esperanza that they needed to ask her some
“preguntas intimas” (intimate questions) to support her in maintaining healthy per-
sonal and academic relationships. They explained this was part of a screening tool
to help people and apologized in advance if they made her feel uneasy. By offering
this apology, the social workers were rebuilding trust with Esperanza. The onus is
on the social workers to create, sustain, and/or repair the client–worker relationship,
and systems theory taught these social workers that they inherited Esperanza’s dis-
trust from previous incidents experienced as betrayals from institutional actors.
These incidents include the involvement of child welfare services because of teach-
ers disclosing “her private life,” as well as a slow relief response from the U.S. gov-
ernment to assist Puerto Rico during and after the hurricane.

Systems theory helped the social workers see how betrayals such as the incar-
ceration of Esperanza’s boyfriend also took place at a macro level. In Esperanza’s
eyes, her relationship was legitimate, and this perspective was further confirmed for
her because she had the consent of her parents. There may thus be traumatic stress
from the hurricane experience coupled with the type of trauma that arises for groups
of people who have experienced disparate treatment (Matheson, Foster, Bombay,
McQuaid, & Anisman, 2019). The apology for asking about intimate matters is one

12 Systems Theory: The Case of Esperanza

170

of several ways the social workers sought to affirm Esperanza’s legitimate feelings
of distrust.

Esperanza agreed to answer the ACEs questions. The MSW intern facilitated the
questionnaire in a conversational tone, rather than administering the tool as a formal
survey. The intern, speaking in Spanish, framed the questions in ways that sup-
ported the therapeutic alliance and empowered Esperanza to respond candidly.
(“Esperanza, we know these questions may make you feel uneasy and we are sorry
for that. We need to know if a parent or other adult in the household often or very
often … cursed at you or insulted you? Think about it. Take your time.”). Here, the
MSW intern sandwiches the ACEs question between a statement that affirms the
client’s feelings and reassurance that she does not have to rush through this process.

Esperanza’s overall score was two out of a possible ten. She scored yes to ques-
tions #4 (feeling unloved or unimportant from her family) and #6 (parents ever
separated or divorced). Esperanza was hesitant about answering question #3 (did an
adult or person at least 5 years older than you ever touch or fondle you or have you
touch their body in a sexual way?). She struggled to understand the age of consent
law in Connecticut (as well as throughout all of the United States and Puerto Rico).
It was incomprehensible to her that the father of her daughter was held legally
responsible for a sexual relationship with her as a minor, resulting in 3 months in jail
and a court order to pay child support after his release. Esperanza struggled with the
conflictual way the court ordered her boyfriend to pay child support, when prior to
his arrest he had been both emotionally and economically supportive of her and
the child.

Her family described Esperanza and her co-parent as a loving couple with joint
plans for the future. Through the conversational facilitation tool of ACEs, the social
work intern learned from Esperanza that she knew many couples with a 10-year age
gap, and early-age pregnancy was an intergenerational pattern in her family. Despite
this, it was critical for the social workers to be mindful of the imbalance of power
between Esperanza and her child’s father. Power imbalance is what allows an adult
to take advantage of an underage person in ways that meet the American
Psychological Association’s definition of sexual abuse. The MSW intern made a
note in the questionnaire about the circumstances of Esperanza’s “relationship” and
the client’s belief that she is not a victim of abuse.

While her ACEs score is relatively low, systems theory helped the workers
explore Esperanza’s perspective and understand that she has experienced more
trauma than her score displays. Additional traumas not represented in this assess-
ment include Esperanza’s displacement from her family/country, her early preg-
nancy, surviving as a teen parent, her status as a sexual abuse victim (related to a
consensual sexual relationship with 25-year-old adult male who was viewed as a
sexual predator), DCF involvement (educational neglect), and her mental health
diagnosis (anxiety, depression, PTSD). For example, Esperanza experienced trauma
in the loss of the person she identified as her boyfriend, whose incarceration was
directly connected to her disclosure to someone that he was the father, as well as
incidents in her macro environment related to surviving a natural disaster and vari-
ous forms of cultural assault from government officials.

M. P. De Jesús et al.

171

As a result of the ACEs assessment, not only have the workers continued their
work with Esperanza through a trauma-informed lens, but they also made the
realization that trauma was a component of the environment for Esperanza. While
Esperanza’s ACEs score was two, the mutually influencing factors in the environ-
ment are trauma-infused, providing a comprehensive understanding of her lived
experience. From a macro lens, understanding Puerto Rico’s commonwealth status
as neither a U.S. state nor an independent country sheds light on the territorial limbo
that migrants experience in their “host” country. Mental health professionals have
highlighted the colonization of Puerto Rican as a factor to consider when treating
Puerto Rican clients (Teichner, Cadden, & Berry, 1981).

As mentioned, ecomaps are visual representations of all the systems at play in an
individual’s life, while genograms show the relationships between a client and their
family members. The MSW intern engaged Esperanza to collaborate on creating
ecomaps and genograms to support an understanding of the interconnected systems
in her life. Before inviting the client to create visual representations of her own life,
the intern first focused on developing trust by collaborating on an ecomap based on
a fictional character. They collectively chose the movie Real Women Have Curves,
a 2002 comedy about a Latina teen and her dynamic with school and family. The
intern’s engagement strategy included the small but significant detail of preselecting
the menu of movies and ensuring that all the films were comedic and based on
Latino culture. Utilizing a Latinx-focused movie both affirmed the client’s heritage
and was a trauma-informed strategy to minimize any potential triggering that might
occur from watching a drama that centrally focused on adverse childhood condi-
tions. Choosing the movie together also temporarily suspended the worker–client
hierarchy. The shared decision making of the therapeutic intervention allowed
Esperanza and the intern to work together to understand the main character and her
relationship to the family and systems around her. In that exercise, Esperanza was
able to see how one is not only influenced by people and systems, but can also take
actions to be the influencer.

Ecomaps and genograms visually demonstrate the relationships between sys-
tems, people, and the client, which are represented by the intensity and direction of
lines drawn on the visual aids. In drawing the relational connections in the …

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