Discussion 1: Family Assessment

The first step in helping a client is conducting a thorough assessment. The clinical social worker must explore multiple perspectives in order to develop a complete understanding of the situation. From this understanding, the social worker is able to recognize the client’s strengths and develop effective strategies for change. Discussion 1: Family Assessment

For this Discussion, review the “Cortez Family” case history.

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· Post your description of how micro-, mezzo-, or macro-levels of practice aid social workers in assessing families. Assess Paula Cortez’s situation using all three of these levels of practice, and identify two strengths and/or solutions in each of these levels.

· Describe the value in strength-based solutions.

References (use 3 or more)

Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families: Evidence-informed assessments and interventions. Hoboken, NJ: John Wiley & Sons, Inc.

· Chapter 9, “Assessment of Families” (pp. 237–264)

Plummer, S.-B., Makris, S., & Brocksen, S. (Eds.). (2013). Sessions case histories. Baltimore, MD: Laureate International Universities Publishing.

· “The Cortez Family” (pp. 23–25)

Smokowski, P. R., Rose, R., & Bacallao, M. L. (2008). Acculturation and Latino family processes: How cultural involvement, biculturalism, and acculturation gaps influence family dynamics. Family Relations, 57(3), 295–308.

Discussion 2: Circumplex Model

Understanding the level of cohesion of a family system is important in order to determine an effective treatment plan. Olson (2000) developed the Circumplex Model, which has been used in the areas of marital therapy and with families dealing with terminal illness. Discussion 1: Family Assessment

For this Discussion, you again draw on the “Cortez Family” case history.

· Post your description of the Circumplex Model of Marital and Family Systems and how it serves as a framework to assess family systems. 

· Apply this framework in assessing the Cortez family. Use the three dimensions (cohesion, flexibility, and communication) of this model to assess and analyze. Describe how assessing these dimensions assists the social worker in treatment planning. Discussion 1: Family Assessment

References (use 3 or more)

Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families: Evidence-informed assessments and interventions. Hoboken, NJ: John Wiley & Sons, Inc.

· Chapter 9, “Assessment of Families” (pp. 237–264)

Plummer, S.-B., Makris, S., & Brocksen, S. (Eds.). (2013). Sessions case histories. Baltimore, MD: Laureate International Universities Publishing.

· “The Cortez Family” (pp. 23–25)

Smokowski, P. R., Rose, R., & Bacallao, M. L. (2008). Acculturation and Latino family processes: How cultural involvement, biculturalism, and acculturation gaps influence family dynamics. Family Relations, 57(3), 295–308.

Olson, D. H. (2000). Circumplex Model of Marital and Family Systems. Journal of Family Therapy, 22(2), 144–167.

The Cortez Family

Paula is a 43-year-old HIV-positive Latina woman originally from Colombia. She is bilingual, fluent in both Spanish and English. Paula lives alone in an apartment in Queens, NY. She is divorced and has one son, Miguel, who is 20 years old. Paula maintains a relationship with her son and her ex-husband, David (46). Paula raised Miguel until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula is severely socially isolated as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood. Paula identifies as Catholic, but she does not consider religion to be a big part of her life. Paula came from a moderately well-to-do family. She reports suffering physical and emotional abuse at the hands of both her parents, who are alive and reside in Colombia with Paula’s two siblings. Paula completed high school in Colombia, but ran away when she was 17 years old because she could no longer tolerate the abuse at home. Paula became an intravenous drug user (IVDU), particularly of cocaine and heroin. David, who was originally from New York City, was one of Paula’s “drug buddies.” The two eloped, and Paula followed David to the United States. Paula continued to use drugs in the United States for several years; however, she stopped when she got pregnant with Miguel. David continued to use drugs, which led to the failure of their marriage. Once she stopped using drugs, Paula attended the Fashion Institute of Technology (FIT) in New York City. Upon completing her BA, Paula worked for a clothing designer, but realized her true passion was painting. She has a collection of more than 100 drawings and paintings, many of which track the course of her personal and emotional journey. Paula held a full-time job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Insurance (SSI) and Medicaid. Paula was diagnosed with bipolar disorder. She experiences rapid cycles of mania and depression when not properly medicated, and she also has a tendency toward paranoia. Paula has a history of not complying with her psychiatric medication treatment because she does not like the way it makes her feel. She often discontinues it without telling her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for at least five years. Paula accepts her bipolar diagnosis, but demonstrates limited insight into the relationship between her symptoms and her medication. Discussion 1: Family Assessment

Paula was diagnosed HIV positive in 1987. Paula acquired AIDS several years later when she was diagnosed with a severe brain infection and a T-cell count less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function of her right arm and hand, as well as the ability to walk. After a long stay in an acute care hospital in New York City, Paula was transferred to a skilled nursing facility (SNF) where she thought she would die. It is at this time that Paula gave up custody of her son. However, Paula’s condition improved gradually. After being in the SNF for more than a year, Paula regained the ability to walk, although she does so with a severe limp. She also regained some function in her right arm. Her right hand (her dominant hand) remains semiparalyzed and limp. Over the course of several years, Paula taught herself to paint with her left hand and was able to return to her beloved art. In 1996, when highly active antiretroviral therapy (HAART) became available, Paula began treatment. She responded well to HAART and her HIV/AIDS was well controlled. In addition to her HIV/AIDS disease, Paula is diagnosed with hepatitis C (Hep C). While this condition was controlled, it has reached a point where Paula’s doctor is recommending she begin treatment. Paula also has significant circulatory problems, which cause her severe pain in her lower extremities. She uses prescribed narcotic pain medication to control her symptoms. Paula’s circulatory problems have also led to chronic ulcers on her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to ambulate and leave her home. As with her psychiatric medication, Paula has a tendency not to comply with her medical treatment. She often disregards instructions from her doctors and resorts to holistic treatments like treating her ulcers with chamomile tea. Working with Paula can be very frustrating because she is often doing very well medically and psychiatrically. Then, out of the blue, she stops her treatment and deteriorates quickly. I met Paula as a social worker employed at an outpatient comprehensive care clinic located in an acute care hospital in New York City. The clinic functions as an interdisciplinary operation and follows a continuity of care model. As a result, clinic patients are followed by their physician and social worker on an outpatient basis and on an inpatient basis when admitted to the hospital. Thus, social workers interact not only with doctors from the clinic, but also with doctors from all services throughout the hospital. After working with Paula for almost six months, she called to inform me that she was pregnant. Discussion 1: Family Assessment

Her news was shocking because she did not have a boyfriend and never spoke of dating. Paula explained that she met a man at a flower shop, they spoke several times, he visited her at her apartment, and they had sex. Paula thought he was a “stand up guy,” but recently everything had changed. Paula began to suspect that he was using drugs because he had started to become controlling and demanding. He showed up at her apartment at all times of the night demanding to be let in. He called her relentlessly, and when she did not pick up the phone, he left her mean and threatening messages. Paula was fearful for her safety. Given Paula’s complex medical profile and her psychiatric diagnosis, her doctor, psychiatrist, and I were concerned about Paula maintaining the pregnancy. We not only feared for Paula’s and the baby’s health, but also for how Paula would manage caring for a baby. Paula also struggled with what she should do about her pregnancy. She seriously considered having an abortion. However, her Catholic roots paired with seeing an ultrasound of the baby reinforced her desire to go through with the pregnancy. The primary focus of treatment quickly became dealing with Paula’s relationship with the baby’s father. During sessions with her psychiatrist and me, Paula reported feeling fearful for her safety. The father’s relentless phone calls and voicemails rattled Paula. She became scared, slept poorly, and her paranoia increased significantly. During a particular session, Paula reported that she had started smoking to cope with the stress she was feeling. She also stated that she had stopped her psychiatric medication and was not always taking her HAART. When we explored the dangers of Paula’s actions, both to herself and the baby, she indicated that she knew what she was doing was harmful but she did not care. After completing a suicide assessment, I was convinced that Paula was decompensating quickly and at risk of harming herself and/or her baby. I consulted with her psychiatrist, and Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula was extremely angry at me for the admission. She blamed me for “locking her up” and not helping her. Paula remained on the unit for 2 weeks. During this stay she restarted her medications and was stabilized. I tried to visit Paula on the unit, but the first two times I showed up she refused to see me. Eventually, Paula did agree to see me. She was still angry, but she was able to see that I had acted with her best interest in mind, and we were able to repair our relationship. Discussion 1: Family Assessment

As Paula prepared for discharge, she spoke more about the father and the stress that had driven her to the admission in the first place. Paula agreed that despite her fears she had to do something about the situation. I helped Paula develop a safety plan, educated her about filing for a restraining order, and referred her to the AIDS Law Project, a not-for-profit organization that helps individuals with HIV handle legal issues. With my support and that of her lawyer, Paula filed a police report and successfully got the restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a sense of control over her life. From a medical perspective, Paula’s pregnancy was considered “high risk” due to her complicated medical situation. Throughout her pregnancy, Paula remained on HAART, pain, and psychiatric medication, and treatment for her Hep C was postponed. During the pregnancy the ulcers on Paula’s feet worsened and she developed a severe bone infection, ostemeylitis, in two of her toes. Without treatment the infection was extremely dangerous to both Paula and her baby. Paula was admitted to a medical unit in the hospital where she started a 2-week course of intravenous (IV) antibiotics. Unfortunately, the antibiotics did not work, and Paula had to have portions of two of her toes amputated with limited anesthesia due to the pregnancy, extending her hospital stay to nearly a month. The condition of Paula’s feet heightened my concern and the treatment team’s concerns about Paula’s ability to care for her baby. There were multiple factors to consider. In the immediate term, Paula was barely able to walk and was therefore unable to do anything to prepare for the baby’s arrival (e.g., gather supplies, take parenting class, etc.). In the medium term, we needed to address how Paula was going to care for the baby day-to-day, and we needed to think about how she would care for the baby at home given her physical limitations (i.e., limited ability to ambulate and limited use of her right hand) and her current medical status. In addition, we had to consider what she would do with the baby if she required another hospitalization. In the long term, we needed to think about permanency planning for the baby or for what would happen to the baby if Paula died. While Paula recognized the importance of all of these issues, her anxiety level was much lower than mine and that of her treatment team. Perhaps she did not see the whole picture as we did, or perhaps she was in denial. She repeatedly told me, “I know, I know. I’m just going to do it. Discussion 1: Family Assessment

I raised my son and I am going to take care of this baby too.” We really did not have an answer for her limited emotional response, we just needed to meet her where she was and move on. One of the things that amazed me most about Paula was that she had a great ability to rally people around her. Nurses, doctors, social workers: we all wanted to help her even when she tried to push us away. The Cortez Family David Cortez: father, 46 Paula Cortez: mother, 43 Miguel Cortez: son, 20. While Paula was in the hospital unit, we were able to talk about the baby’s care and permanency planning. Through these discussions, Paula’s social isolation became more and more evident. Paula had not told her parents in Colombia that she was having a baby. She feared their disapproval and she stated, “I can’t stand to hear my mother’s negativity.” Miguel and David were aware of the pregnancy, but they each had their own lives. David was remarried with children, and Miguel was working and in school full-time. The idea of burdening him with her needs was something Paula would not consider. There was no one else in Paula’s life. Therefore, we were forced to look at options outside of Paula’s limited social network. After a month in the hospital, Paula went home with a surgical boot, instructions to limit bearing weight on her foot, and a list of referrals from me. Paula and I agreed to check in every other day by telephone. My intention was to monitor how she was feeling, as well as her progress with the referrals I had given her. I also wanted to provide her with support and encouragement that she was not getting from anywhere else. On many occasions, I hung up the phone frustrated with Paula because of her procrastination and lack of follow-through. But ultimately she completed what she needed to for the baby’s arrival. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children, and was also able to secure a crib and other baby essentials. Paula delivered a healthy baby girl. The baby was born HIV negative and received the appropriate HAART treatment after birth. The baby spent a week in the neonatal intensive care unit, as she had to detox from the effects of the pain medication Paula took throughout her pregnancy. Given Paula’s low income, health, and Medicaid status, Paula was able to apply for and receive 24/7 in-home child care assistance through New York’s public assistance program. Depending on Paula’s health and her need for help, this arrangement can be modified as deemed appropriate. Miguel did take a part in caring for his half sister, but his assistance was limited. Ultimately, Paula completed the appropriate permanency planning paperwork with the assistance of the organization The Family Center. She named Miguel the baby’s guardian should something happen to her.

SOCIAL WORK THEORY AND PRACTICE

SOCIAL WORK THEORY AND PRACTICE

Piedra and Engstrom (2009) noted how the life model “remains general and unspecific regarding factors that affect immigrant families” (p. 272). Recall that there will never be one theory or a model that can fully explain a phenomenon or lay out all the steps and procedures when working with complex issues that clients present to social workers. Recognizing this, Piedra and Engstrom selected another theory in the immigration literature—segmented assimilation theory. They identified concepts from segmented assimilation theory to “fill in” the gaps that the life model does not address. SOCW 6060: SOCIAL WORK THEORY AND PRACTICE

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In this Discussion, you examine gaps in the life model by applying it to your field experience.

To prepare:

• Review the life model.
• Review this article in the Learning Resources: Piedra, L. M., & Engstrom, D. W. (2009). Segmented assimilation theory and the life model: An integrated approach to understanding immigrants and their children. Social Work, 54(3), 270–277. http://dx.doi.org.ezp.waldenulibrary.org/sw/54.3.270

By Day 3

Post:

Using an example from your fieldwork experience and a diverse population you encountered at the agency (for example, in Piedra and Engstrom’s article, it was immigrant families), respond to the following:

• Identify and describe the diverse population and the unique characteristics and/or the distinctive needs of the population in 3 to 4 brief sentences.
• Explain how the life model can be applied for the population.
• Explain where the gaps are in applying the life model for this population.
• When looking at the gaps, explain which theory might be helpful in filling the gaps of the life model when working with this population.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 8 Discussion Rubric

Population will need to be (children of inmates)

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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Discussion: Why did the nurse require legal counsel

Discussion: Why did the nurse require legal counsel

LEGAL/ETHICAL

CLINICAL CASE # 1

On a Wednesday morning in 2008 in Lewisville, Ohio, a man walked into Samuels Hardware Store, grabbed an pick-ax, and began swinging at the customers and shouting about the devil.  When he left, one person was dead and two others were critically injured.  Ten days later, police received a call from Mr. T., who was a patient in the 49-bed psychiatric unit at St. John’s Hospital.  Mr. T told the police that his roommate at the hospital confessed to the crime in Lewisville. However, he didn’t know his roommate’s name but they could get it from the nurses.  The police contacted Nurse S. and asked her to identify the patient but she refused to do so.  She told them that she believed his name was shielded by state mental health law guaranteeing the confidentiality of mental patients.  Hospital administrators supported her decision and obtained legal counsel for her. Discussion: Why did the nurse require legal counsel

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QUESTIONS:

1. Why did the nurse require legal counsel?
2. Was the nurse legally correct in her refusal to divulge information? Why?
3. Was the nurse ethically correct in her refusal to divulge information? Why?
4. If she had divulged the identity of the patient, what legal action could be taken against her, if any?
5. Under what circumstances could the nurse be required to divulge information about this case?

Grading Rubric.

Content/answers to 5 questions   10 points each.  Each answer should be detailed and specific.

References used/APA formatting   20 points  2 references required

Student response:                       30 points.  Response must be additional information and substantial (approx 150 words)

Total:  100 points.

NEXTTTTTT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Elle, 39, has come in for treatment for severe panic attacks. Her daughter, Savannah, is leaving for college for the first time and is planning on driving up with a friend who will attend the same college. Savannah does not want her mother to go along. Elle says, “I have nightmares about them crashing somewhere and nobody knowing where they are.” She says she and Savannah have had arguments about this. Elle reports that the panic attacks began “about two weeks ago when Savannah and her dad both agreed that it was okay for her to drive up to the college with Jason.” Elle says that her worries are “not about sex. Jason is her best friend, but they’ve never dated, and in fact, Jason has a girlfriend. I admit the college is not far away, so it won’t be an overnight trip, but I don’t want Savannah to drive up with Jason. A three-hour drive. I want to do it.”
During assessment, you learn that 2 years ago, Savannah and her twin, Sophia, were in an after-prom car accident, in which teens in a car were driving to the next town over to go to the beach. Savannah’s twin was killed. Savannah was in the hospital for months and needed physical therapy for 18 months. As she describes the accident, Elle points out that the driver, Sophia’s date, escaped serious injury. “Funny, isn’t it?” she says. “The drunk driver always escapes injury while he hurts everyone around him.”
Savannah has pointed out that “Jason doesn’t drink. You know this. You’ve known him all his life. You’ve always liked him, even when I get annoyed with him.” Elle admits this, but still says, “I don’t want that boy driving her up there. It’s a long way.” Savannah complains that every time the subject comes up, Elle has a panic attack. Elle tells you privately, and sincerely, “I don’t mean to have these panic attacks. And I don’t want them. This just isn’t me.

QUESTIONS

1.Elle admits Jason doesn’t drink; he isn’t sexually involved with Savannah, and she has known him all his life, and that she’s always liked him. Yet she refers to him now as “that boy.” (1) Her fears aside, what emotional response to this new crisis for Elle is she displaying, particularly toward Jason? Do you think this emotion is directed just at Jason or at someone else as well? (2) What does this tell you about her current perception of this crisis?

2.Now that you have a clearer vision of Elle’s perception of the crisis, what further aspects of Elle’s current status should you assess?

3.While finishing your assessment, you learn that Elle has two very close friends, and a pretty solid marriage. Her husband has avoided the arguments between Savannah and Elle, declaring that “Savannah is a grown-up now, and capable of making such a small choice as who will drive her to school, on her own.” He refuses to get involved, and while he is sympathetic and affectionate during and after Elle’s panic attacks, he says they scare him a little. He wonders if there isn’t medication to control these.You also learn that her best friend is her sister, who lives in town. This sister moved in with Elle right after Sophia’s death and was a “great comfort” during the early stages of grief and also came to the hospital almost every day to sit with Elle and Savannah during those first rough months. Elle’s sister has proposed that they have a “girl time” with Savannah the night before she leaves for college, but Elle has said, “I can’t think about that right now.”You have not quite decided which level of crisis intervention to use just yet, but how could you apply strategies from the first three levels of crisis intervention—environmental manipulation, general support, and generic approach—in tackling Elle’s current situation?

4.How could you apply strategies from the fourth level of crisis intervention—i.e., the individual approach—in tackling Elle’s current situation?

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