Interview with Ali Ballard, MSW on Clinical Social Work

“The clients we serve are adolescents with a mental health diagnosis who are on juvenile probation. The goal of our program is to get the client off probation while ensuring that they have the social services necessary to maintain stability within the home. We work in a treatment court called Collaborative Court, and serve as the mental health liaison between the families and the justice system.” – Ali Ballard, MSW

About Ali Ballard, MSW: Ali Ballard is a Program Supervisor for the Intensive Case Management Program at Seneca Family of Agencies in Oakland, California, where she maintains a clinical caseload while also supervising program staff and overseeing the program’s daily operations. Prior to her role as a Program Supervisor, Ms. Ballard was an Intensive Case Management Clinician at Seneca, where she provided mental health and case management services to children and adolescents involved in the court system. Ms. Ballard earned her Bachelor’s Degree from Boston College in 2006, and her MSW from The University of Chicago in 2013. During her MSW program, she interned at ChicagoQuest Charter School, providing therapy and crisis intervention to teachers and the student body, as well as at Children’s Home & Aid – Family Centered Counseling Services as a Foster Care Therapist. Before enrolling in graduate school, Ms. Ballard worked as a Residential Case Manager for the National Center for Children and Families’ Greentree Adolescent Program. Ali Ballard was compensated to participate in this interview.

[] Could you please elaborate on your role and the types of clients you have counseled and assisted in a clinical social work capacity at the Seneca Center?

[Ali Ballard, MSW] As an Intensive Case Management Clinician at Seneca Family of Agencies in Oakland, I provided community-based services to adolescent wards of the court with mental health diagnoses. My role was to enhance the strength of children and families, accelerating progress towards stability and long-term self-sufficiency. My responsibilities included supervising a treatment team with each case, crisis management, Medi-Cal compliant treatment plans and documentation, maintaining relationships with service providers, accessing community resources, and creating interventions that support symptom management.

After nearly 2 years as a clinician in this program, I was promoted to Program Supervisor, a role that includes facilitating supervision and oversight of the staff and clients within the Intensive Case Management Program. While still maintaining a caseload, I coordinate individual and group supervision with each member of the treatment team weekly. I oversee daily program operations and necessary paperwork, including fiscal reports, treatment plans and Medi-Cal documentation.

The clients we serve are adolescents with a mental health diagnosis who are on juvenile probation. The goal of our program is to get the client off probation while ensuring that they have the social services necessary to maintain stability within the home. We work in a treatment court called Collaborative Court, and serve as the mental health liaison between the families and the justice system.

[] What types of clinical interventions and therapeutic methods have you used with your clients?

[Ali Ballard, MSW] The first step in evaluating clients’ needs comes in the intensive intake process and screening system. While clients may have a diagnosis from another provider coming into our program, we ensure that we have enough information to assess if it is correct and updated. We perform comprehensive risk screening, including (but not limited to) safety plans, Child and Adolescent Needs and Strength (CANS) assessments, runaway risk assessment, weapon screenings, suicide and self-harm assessments, and treatment plans to address presenting behavioral concerns.

Our program is aimed at a cognitive behavioral therapy (CBT) focus, though we individually tailor our interventions based on the client and family need. For example, some families already have a therapist and require more case management-based services, whereas some families have never worked with a therapist and require more extensive therapeutic interventions. Such interventions may include developing non-violent communication between parent and child, teaching the parent how to assess if a child needs hospitalization, and providing psychoeducation around a diagnosis and its symptoms.

My clinical modalities have adapted over the years to my changing roles. My therapeutic treatment approach pulls from numerous modalities, including Acceptance Commitment Therapy (ACT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Dialectical Behavioral Therapy (DBT). ACT encourages psychological flexibility, which helps recontextualize fears and past traumas in order to change current behaviors. TF-CBT helps the child and parent find new skills to address past trauma in order to enhance safety and promote growth. The focus of DBT is to increase distress tolerance and healthy interpersonal relationships by lessening emotional dysregulation through tools such as mindfulness. However, clinical case management requires adapting these treatments to non-traditional therapeutic settings–for example, perhaps you are providing interventions while driving a client to court. Community-based work gives you the opportunity to really meet the clients where they are, and create sustainable interventions throughout all different areas in their lives.

As a Seneca clinician, my role was exclusively out in the communities working with clients and families. I spent a great deal of time finding resources, providing crisis interventions, and writing documentation. As a supervisor, I am much more focused on the bigger picture: what clients are appropriate for our program? How can we make sure our billing reflects the clinical work we do? How can we establish long-standing programmatic relationships with outside providers, including the court? I am learning to evaluate macro issues, while continuing to be grounded in micro issues with individual clients.

[] During your MSW, what specific clinical social work roles did you consider, and why did you decide to work specifically with children and families suffering from severe trauma or mental health challenges?

[Ali Ballard, MSW] I started out my career as a Residential Counselor at the Greentree Adolescent Program in Maryland, a group home for adolescents in the juvenile justice and social service systems, and was soon promoted to Case Manager. For 2 years, I provided case management to 20 adolescents with mental health diagnoses and histories of sexual abuse, criminal and sexual offenses, prostitution, trauma, violence and neglect.

My residential work inspired me to get my Master’s in Social Work at the University of Chicago, on the clinical track. During my internships, I provided individual and group psychotherapy to children and families at ChicagoQuest Charter School, and worked as a foster care therapist at Children’s Home & Aid, with clients ranging from age 3 to 67-years old.

From my first day of work at the group home as a Residential Counselor, I knew that I wanted to work with children and families who struggled with mental health challenges as well as juvenile justice involvement. I fell in love with this work and never looked back! While in my graduate program, I picked specific courses that would train me in areas that related to this population, including trauma-based therapy, TF-CBT for children, and child development.

[] What are some of the most rewarding aspects of your experiences in clinical social work? On the other hand, what are some of the most challenging aspects of clinical social work?

[Ali Ballard, MSW] The joy that I feel when working with these kids is indescribable! To feel like you have moved the needle even a centimeter–maybe a family conflict didn’t erupt into violence due to interventions you provided, or maybe you helped a client get their first state ID. I truly love spending time with these families, and now supervising the awesome staff who feel the same passion I do for this work. I have never struggled to find internal rewards in this work.

As for challenges… The term “self-care” gets thrown around a lot in social work, and begins to sound cliché–however, it is a real challenge to take care of yourself in this field. Some days you won’t have time to eat, or others you will feel so emotionally drained that you feel like a zombie walking into your house at night. Sometimes you can put everything you have into doing this work and something still goes wrong because the problem is just bigger than you, and you can leave feeling defeated. Social work is a vastly underpaid field, which can lead to people feeling undervalued. If you don’t find internal rewards within this work it is unlikely that the external rewards would ever be enough to sustain in the field.

[] What advice do you have for students considering a career in clinical social work? What challenges have you faced in this field, and how would you recommend students manage these challenges?

[Ali Ballard, MSW] Take advantage of the time that you have to learn! There is so much to learn, and it only gets harder to find time to read and attend trainings as you move forward with your work. Be kind to yourself when you’re doing this work. Find people who support your career, both at work and outside of it, people whom you can call on your worst day to vent. Make space in your life for things that bring you pleasure outside of work, and don’t ever feel guilty for needing this time. Like oxygen masks on a plane–take care of yourself first so that you are in a good position to take care of others. Burnout is real, and it is common–we have all felt it at some point. Learn to recognize the signs of what burnout means for you and nip it in the bud. Social workers can be incredibly hard on themselves, holding themselves to a standard of work that they would never impose on someone else. It’s a marathon, not a sprint–do what it takes for you to last in the field.

[] Regardless of their specific field, how important is it for clinical social workers to understand substance abuse and addiction? While some social workers work specifically in substance abuse and addiction counseling, do clinical social workers in other fields frequently encounter this issue?

[Ali Ballard, MSW] With the adolescent population, we encounter a lot of substance use and addiction. While it is not the primary focus of our work, there is a lot of overlap, so we often partner with substance abuse treatment centers to ensure that these needs are being met. Understanding substance abuse has given me a better understanding of why our clients use, and how it is impacting their lives.

Thank you Ms. Ballard for your time and insights into clinical social work.

Last updated: April 2020