Medical Social Work in Chronic Illness Care and Management

Advances in medical technology have altered the trajectory of illness in our society. Many illnesses that were once considered acute or terminal are now considered chronic. The trajectory of advanced chronic illness, thus, has shifted from a brief period of time to longer periods with impaired quality of life. Patients and/or families living with chronic illnesses are often forced to adjust their aspirations and lifestyle. They also are vulnerable to protracted distress and developing psychiatric illness.

Optimal care and management of chronic illness is significant because it is likely to minimize distress, prevent psychiatric illness, and improve health outcomes and quality of life (Wagner, 2000). A professional team including a medical social worker can deliver optimal care for chronic illness (Wagner, 2013).

To prepare for this Discussion:

Review this week’s resources. Consider a chronic illness that is of interest to you. Think about how the following medical social work practice skills might apply to the illness you chose:

· Assessment

· Crisis intervention

· Case management

· Education and counseling

· Advocacy

· Team collaboration

· Community-level intervention

Assignment

Post a brief description of the illness you selected and the psychosocial effects of the illness on patients and families. Analyze the issues and concerns surrounding the care and management of the illness. Choose three medical social work practice skills, and explain how a medical social worker might implement them to improve the care and management of the illness. Explain challenges that might arise for families or caregivers caring for a patient with your chosen illness. Explain how you as a medical social worker might address the struggles or challenges experienced by families or caregivers.

Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style.

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Intervention Treatment Plan

According to the Counsel on Social Work Education, Competency 4: Engage in Practice-informed Research and Research-informed Practice:

Social workers understand quantitative and qualitative research methods and their respective roles in advancing a science of social work and in evaluating their practice. Social workers know the principles of logic, scientific inquiry, and culturally informed and ethical approaches to building knowledge. Social workers understand that evidence that informs practice derives from multi-disciplinary sources and multiple ways of knowing. They also understand the processes for translating research findings into effective practice.

The MSW program expects students in their specialization year to be able to:

· Critically evaluate evidence based and “best practice” treatment interventions.

· Compose clinical intervention plans that are grounded research-based knowledge

This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.

To Prepare: Review the agency’s intervention/treatment plan used to engage clients. After reviewing the agency’s intervention/treatment plan, consult the literature and conduct extensive research, with the goal of finding best practices that supports or adds to the agency’s current intervention/treatment plan. The purpose of this assignment is to find research that supports or adds to the agency’s current intervention/treatment approach.

Assignment

Submit a 1-2-page paper in which you:

1. Briefly describe the agency’s intervention/treatment plan (Student agency is a short term inpatient mental health/substance abuse hospital. On the treatment plan the agency assess client strengths and deficits. The agency sets goals and interventions for each client’s treatment plan).

2. Briefly discuss best practices about interventions identified in the literature

3. Briefly discuss how the agency can incorporate those best practices into the current intervention/treatment plan

4. Provide a brief summary of the similarities and differences between the intervention/treatment plan used at the agency and the suggested practices in the literature

Note: If no formal process is used in the agency, discuss the agency’s current process and compare it to the suggestions in the literature. You are expected to present and discuss this assignment with your agency Field Instructor. Your field instructor will be evaluating your ability to demonstrate this competency in the field evaluation. 

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Introduction to Research Proposals

Just because you thought of an interesting research question and have a desire to conduct research does not mean that your research will automatically be supported by faculty or funded by an organization. In order to gain stakeholder approval, you must submit a research proposal. Much like an outline of a paper or a treatment of a movie script, the research proposal contains several parts that begin with a research question and end with a literature review. For this Assignment, you compile a research proposal that includes a research problem, research question, and a literature review.

For this Assignment, choose between the case studies entitled “Social Work Research: Couple Counseling” and “Social Work Research: Using Multiple Assessments.” Consider how you might select among the issues presented to formulate a research proposal.

Be sure to consult the outline in Chapter 14 the Yegidis et al. text for content suggestions for the sections of a research proposal. As you review existing research studies, notice how the authors identify a problem, focus the research question, and summarize relevant literature. These can provide you with a model for your research proposal.

By Day 7

Submit a 5- to 6-page research proposal stating both a research problem and a broad research question (may be either qualitative or quantitative). Use 6–10 of the most relevant literature resources to support the need for the study, define concepts, and define variables relevant to the question. Include a literature review explaining what previous research has found in relation to your problem and question. The literature review should also include a description of methods used by previous researchers. Finally, be sure to explain how your proposed study addresses a gap in existing knowledge.

Cite from resources below

 

Yegidis, B. L., Weinbach, R. W., & Myers, L. L. (2018). Research methods for social workers (8th ed.). New York, NY: Pearson.

• Review Chapter 4, “Conducting the Literature Review and Developing Research Hypothesis” (pp. 71-99)

 

Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

• Social Work Research: Couples Counseling
• Social Work Research: Couples Counseling Social Work Research: Using Multiple Assessments

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1. Social Work Research: Couples Counseling

Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.

 

Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.

 

Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.

 

I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.

 

I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.

 

The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on treatment and delivery style.

 

I informed Kathleen and Lisa that both measurement tools were obtained from the National Registry of Evidence-Based Programs and Practices. We use these tools in the agency to assess the experience of the client and whether the goals of treatment are being achieved. Lisa questioned how the information would be used, and I told them that this information would be shared with them weekly and would only be in their chart.

 

Lisa and Kathleen came every week for 15 weeks. In that time, we charted each week using both tools. The chart demonstrated significant progress and then began to level off. During that time, Kathleen and Lisa worked on effective communication strategies to discuss the presenting issues. The arguments had become less frequent and shorter in duration as both Kathleen and Lisa learned to appreciate the other’s perspective. They expressed that some members of their families of origin were not supportive of their sexual orientation, and this was the main challenge for them as a couple. They were able to identify their strengths and not let family or societal opinions inform how they wanted to live. They were able to see that this was their decision.

 

During treatment there were times when the measurement tool indicated that they felt we were not connecting on certain issues. As I could pinpoint when that was and the topic we discussed, we were able to address it in the next session to clarify and get back on track.

 

2. Social Work Research: Using Multiple Assessments

Lucille is a 68-year-old, Caucasian female. Her husband of 43 years passed away 4 years ago after a long and debilitating illness during which Lucille was his primary caregiver. During their marriage, he worked at the sanitation department, and she was a homemaker. She continues to live in the house where she and her husband raised their three children. Lucille receives a limited income of approximately $2,100/month from her husband’s retirement pension and Social Security; she owns her home and has no major outstanding debts. She receives Medicare to cover her major medical expenses and a small supplemental health plan to cover any outstanding medical costs. Her physical health is good, and she has not had any major illnesses or surgeries, although she has not had a complete physical in over two years. Her favorite hobbies are gardening and cooking. Lucille has two sons and one daughter, each living away from home with their own families. Lucille’s daughter and one son reside in the local area; her other son lives in another state.

 

Lucille’s major concern is about her daughter, Alice (33), who has battled substance abuse and alcoholism since adolescence. At present, Alice is not employed and has had several encounters with law enforcement for drug possession and intent to sell illegal substances. Alice has admitted that she has used cocaine as well as other substances in the past. She has made several attempts to go into drug rehabilitation, but she has never completed a program. Her siblings have essentially disowned her. Alice has three children, Michael (6), Rachael (4), and Randy (18 months), who was recently diagnosed with fetal alcohol effects (FAE). Lucille is not certain who is the father of her grandchildren; it is a subject Alice refuses to discuss. Alice has repeatedly left her children alone for several hours in their tiny apartment, and once she was gone for several days. Child Welfare has interceded, but Alice continues to have custody of her children. Whenever Lucille visits her daughter and grandchildren, the living conditions are filthy, there is little food in the house, and there is talk of constant “visitors” to the house well into the night. Because of Alice’s instability, Lucille has taken physical custody of her grandchildren without any redress from Alice. Lucille’s family members are not aware of the stress Lucille is feeling about possibly having to spend the rest of her life raising her grandchildren, including one with a disability. This causes Lucille to often feel “down in the dumps,” resulting in overeating because, as she stated, “comfort food makes me feel better.” Within 2 months, she gained 15 pounds.

 

Lucille heard about a counseling program at the local community center for grandparents raising grandchildren. The program provides support, group meetings, parenting classes, individual counseling sessions with a social worker, and referrals for other supporting services. At first, Lucille was skeptical about attending the program. She was embarrassed to tell others about her family circumstances; she was particularly fearful that others would blame her for her daughter’s lifestyle and wonder how she could now care for her grandchildren if she could not raise her daughter properly. She already blamed herself for her daughter’s actions, which made her bouts of depression more frequent and difficult to overcome.

 

Eventually, Lucille came to the community center after some encouragement from her neighbor. Lucille is quite concerned about the fate of her daughter. Fearing the worst, she is constantly worried she will get a late night phone call that her daughter was found dead somewhere from a drug overdose or something related to her drug life. She once believed caring for her grandchildren was a temporary arrangement but more recently believes this will become permanent. Although Lucille loves her grandchildren, she is afraid that she will have to raise them alone and is angry with her daughter for putting her in this position. She does not know if she can do it at her age. Her youngest grandchild will need many resources over the years, and she does not even know where to begin to access them. She admits feeling overwhelmed and depressed frequently, but she does not have a wide circle of family or friends to talk to about her concerns. She spoke to her church minister once about her family circumstances but did not feel she got much out of it. “He just did not seem to understand what I was talking about,” she stated, “so I never went back.” She stated she was feeling unable to manage her family needs and that “I just want to get control of the ship again.”

 

After a thorough psychological assessment, the agency psychiatrist determined that medication was not necessary for her bouts of depression. After our initial talk, I administered a series of baseline measures on her emotional and physical functioning, specifically the Center for Epidemiologic Studies—Depressed Mood Scale (CES-D), Family Resource Scale, Family Support Scale, and the Medical Outcome Survey, SF-12v2. Our plan is to administer these measures at 3-month intervals for 1 year to assess her emotional functioning and social progress. Using a strengths-based approach to problem solving, I collaborated with Lucille on a biweekly basis to define personal goals that focused on helping her address feelings of depression and broaden her support network for managing family challenges. She attended monthly support group meetings with other grandparents who discussed their challenges and celebrated their triumphs. Lucille never missed a meeting. I made two home visits per month to observe Lucille in her home environment. Our individual sessions included assessing strengths, defining/redefining needs, targeting problems and goals, identifying resources to address needs, and monitoring goal progress. A nutritionist also conducted two home visits to help her with food options for herself and her grandchildren. Lucille is an excellent cook, and the nutritionist showed her how to reduce calories without sacrificing taste. Within four weeks, Lucille was able to make small changes in her everyday life. She began walking her grandchildren to the local park for playtime, preparing her front yard for spring flowers, and preparing Sunday dinners to reengage her family. She also visited her family physician and learned that she has high blood pressure, which can be controlled with proper diet and exercise, and she has asked her son and daughter-in-law for respite once per month so she can have some “down time.”

 

After 6 months, I facilitated a family group conference with Lucille and her sons and their wives. The focus of the meeting was to plan how the family would support Lucille as the primary caregiver for her grandchildren and to define the role other family members would play in assisting in raising Alice’s children. There was family agreement that it was in the children’s best interest for Lucille to seek legal counsel so she could establish temporary custody for her grandchildren, as well as learn the options for a more permanent relationship, such as adoption. She also applied for disability benefits for her youngest grandchild. Later, the family would meet to conduct permanency planning for the grandchildren. After 9 months, Lucille’s emotional health improved, and we decided to suspend individual counseling, but she continues to participate in the weekly support group meetings where she can have her blood pressure checked by the program nurse. After 12 months in the program, Lucille has a positive perception of her support network, including her family; familiarity with community resources and how to access them; a positive emotional state; and she has lost 10 pounds and her blood pressure is normal. Lucille has even initiated a grandparent mentoring service for new custodial grandparents who want to partner with a “seasoned” grandparent caregiver. Last week, Lucille found out her daughter Alice, who she has not seen in nearly a year, is 6 months pregnant.

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THE STORY WE TELL ABOUT POVERTY

Many people view poverty as a circumstance of one’s own making. Consider this reasoning: Homeless people must not have worked hard enough, tried hard enough, or conformed to society enough. They did it to themselves. Is this perspective accurate, or is it just another way to separate out the worthy and the unworthy?

In this week’s resources, you hear activist Mia Birdsong examine the prevailing story society tells about poverty, how it needs to be adjusted, and how this adjustment could lead to societal change. For this Assignment, you reflect on the story of poverty that you know.

2-3 pages

• Identify two societal beliefs of the poor presented in the video.
• Explain the speaker’s strategy for addressing poverty.
• Apply the speaker’s strategy to a social work interaction you have had or have read about.
• Determine whether you agree or disagree with the presenter’s premise, and explain why.

References

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Application of Systems Theory to a Case Study

Selected Case :  Tiffani Bradley

 

• 1- Focus on the identified client within your chosen case.
• 2- Analyze the case using a systems approach, taking into consideration both family and community systems.
• 3- Complete and submit the “Dissecting a Theory and Its Application to a Case Study” worksheet based on your analysis.

In this course, you will be asked to select one case study and to use it throughout the entire course. By doing this, you will have the opportunity to see how theories guide your view of a client and the client’s presenting problem. Although the case may be the same, each time you use a different theory, your perspective of the problem changes, which then changes how you go about asking the assessment questions and how you intervene.

The first theoretical approach you will use to apply to a case study is systems theory. In other words, your theoretical orientation—your lens—will be systems theory as you analyze a social work case study.

Different theories can be used to take a systems approach. For example, Bertalanffy’s General Systems Theory considers how a system is made of smaller subsystems that influence each other and seek homeostasis, whereas Brofennerbrenner’s Ecological Systems Theory focuses on how an individual’s experience is influenced by different system levels (micro, meso, exo, macro, and chrono). Systems theory is commonly used to understand the interrelationships of the systems (e.g., family, community, organizations, society) of the client. If you are working with families, communities, and organizations, it is also beneficial to use systems theory to get a holistic picture of all the interrelated parts of the system.

To prepare: Select and focus on one of four case studies listed in the Learning Resources. You will use this same case study throughout the course.

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Theory Into Practice: Four Social Work Case Studies

 

 

In this course, you select one of the following four case studies and use it throughout the entire course. By doing this, you will have the opportunity to see how different theories guide your view of a client and that client’s presenting problem. Each time you return to the same case, you use a different theory, and your perspective of the problem changes—which then changes how you ask assessment questions and how you intervene.

 

These case studies are based on the video- and web-based case studies you encounter in the MSW program.

 

 

 

 

Table of Contents

 

Tiffani Bradley ………………………………………………………………………………………………….. 2

 

Paula Cortez ……………………………………………………………………………………………………. 9

 

Jake Levey …………………………………………………………………………………………………….. 10

 

Helen Petrakis ………………………………………………………………………………………………… 13

 

 

 

Tiffani Bradley

 

Identifying Data: Tiffani Bradley is a 16-year-old Caucasian female. She was raised in a Christian family in Philadelphia, PA. She is of German descent. Tiffani’s family consists of her father, Robert, 38 years old; her mother, Shondra, 33 years old, and her sister, Diana, 13 years old. Tiffani currently resides in a group home, Teens First, a brand new, court-mandated teen counseling program for adolescent victims of sexual exploitation and human trafficking. Tiffani has been provided room and board in the residential treatment facility for the past 3 months. Tiffani describes herself as heterosexual.

 

Presenting Problem: Tiffani has a history of running away. She has been arrested on three occasions for prostitution in the last 2 years. Tiffani has recently been court ordered to reside in a group home with counseling. She has a continued desire to be reunited with her pimp, Donald. After 3 months at Teens First, Tiffani said that she had a strong desire to see her sister and her mother. She had not seen either of them in over 2 years and missed them very much. Tiffani is confused about the path to follow. She is not sure if she wants to return to her family and sibling or go back to Donald.

 

Family Dynamics: Tiffani indicates that her family worked well together until 8 years ago. She reports that around the age of 8, she remembered being awakened by music and laughter in the early hours of the morning. When she went downstairs to investigate, she saw her parents and her Uncle Nate passing a pipe back and forth between them. She remembered asking them what they were doing and her mother saying, “adult things” and putting her back in bed. Tiffani remembers this happening on several occasions. Tiffani also recalls significant changes in the home’s appearance. The home, which was never fancy, was always neat and tidy. During this time, however, dust would gather around the house, dishes would pile up in the sink, dirt would remain on the floor, and clothes would go for long periods of time without being washed. Tiffani began cleaning her own clothes and making meals for herself and her sister. Often there was not enough food to feed everyone, and Tiffani and her sister would go to bed hungry. Tiffani believed she was responsible for helping her mom so that her mom did not get so overwhelmed. She thought that if she took care of the home and her sister, maybe that would help mom return to the person she was before.

 

Sometimes Tiffani and her sister would come downstairs in the morning to find empty beer cans and liquor bottles on the kitchen table along with a crack pipe. Her parents would be in the bedroom, and Tiffani and her sister would leave the house and go to school by themselves. The music and noise downstairs continued for the next 6 years, which escalated to screams and shouting and sounds of people fighting.

Tiffani remembers her mom one morning yelling at her dad to “get up and go to work.” Tiffani and Diana saw their dad come out of the bedroom and slap their mom so hard she was knocked down. Dad then went back into the bedroom. Tiffani remembers thinking that her mom was not doing what she was supposed to do in the house, which is what probably angered her dad.

 

Shondra and Robert have been separated for a little over a year and have started dating other people. Diana currently resides with her mother and Anthony, 31 years old, who is her mother’s new boyfriend.

 

Educational History: Tiffani attends school at the group home, taking general education classes for her general education development (GED) credential. Diana attends Town Middle School and is in the 8^th grade.

 

Employment History: Tiffani reports that her father was employed as a welding apprentice and was waiting for the opportunity to join the union. Eight years ago, he was laid off due to financial constraints at the company. He would pick up odd jobs for the next 8 years but never had steady work after that. Her mother works as a home health aide. Her work is part-time, and she has been unable to secure full-time work.

 

Social History: Over the past 2 years, Tiffani has had limited contact with her family members and has not been attending school. Tiffani did contact her sister Diana a few times over the 2-year period and stated that she missed her very much. Tiffani views Donald as her “husband” (although they were never married) and her only friend. Previously, Donald sold Tiffani to a pimp, “John T.” Tiffani reports that she was very upset Donald did this and that she wants to be reunited with him, missing him very much. Tiffani indicates that she knows she can be a better “wife” to him. She has tried to make contact with him by sending messages through other people, as John T. did not allow her access to a phone. It appears that over the last 2 years, Tiffani has had neither outside support nor interactions with anyone beyond Donald, John T., and some other young women who were prostituting.

 

Mental Health History: On many occasions Tiffani recalls that when her mother was not around, Uncle Nate would ask her to sit on his lap. Her father would sometimes ask her to show them the dance that she had learned at school. When she danced, her father and Nate would laugh and offer her pocket change. Sometimes, their friend Jimmy joined them. One night, Tiffani was awakened by her uncle Nate and his friend Jimmy. Her parents were apparently out, and they were the only adults in the home. They asked her if she wanted to come downstairs and show them the new dances she learned at school. Once downstairs Nate and Jimmy put some music on and started to dance. They asked Tiffani to start dancing with them, which she did. While they were dancing, Jimmy spilled some beer on her. Nate said she had to go to the bathroom to clean up. Nate, Jimmy, and Tiffani all went to the bathroom. Nate asked Tiffani to take her clothes off and get in the bath. Tiffani hesitated to do this, but Nate insisted it was OK since he and Jimmy were family. Tiffani eventually relented and began to wash up. Nate would tell her that she missed a spot and would scrub the area with his hands. Incidents like this continued to occur with increasing levels of molestation each time.

 

The last time it happened, when Tiffani was 14, she pretended to be willing to dance for them, but when she got downstairs, she ran out the front door of the house. Tiffani vividly remembers the fear she felt the nights Nate and Jimmy touched her, and she was convinced they would have raped her if she stayed in the house.

 

About halfway down the block, a car stopped. The man introduced himself as Donald, and he indicated that he would take care of her and keep her safe when these things happened. He then offered to be her boyfriend and took Tiffani to his apartment. Donald insisted Tiffani drink beer. When Tiffani was drunk, Donald began kissing her, and they had sex. Tiffani was also afraid that if she did not have sex, Donald would not let her stay— she had nowhere else to go. For the next 3 days, Donald brought her food and beer and had sex with her several more times. Donald told Tiffani that she was not allowed to do anything without his permission. This included watching TV, going to the bathroom, taking a shower, and eating and drinking. A few weeks later, Donald bought Tiffani a dress, explaining to her that she was going to “find a date” and get men to pay her to have sex. When Tiffani said she did not want to do that, Donald hit her several times. Donald explained that if she didn’t do it, he would get her sister Diana and make her do it instead. Out of fear for her sister, Tiffani relented and did what Donald told her to do. She thought at this point her only purpose in life was to be a sex object, listen, and obey—and then she would be able to keep the relationships and love she so desired.

 

Legal History: Tiffani has been arrested three times for prostitution. Right before the most recent charge, a new state policy was enacted to protect youth 16 years and younger from prosecution and jail time for prostitution. The Safe Harbor for Exploited Children Act allows the state to define Tiffani as a sexually exploited youth, and therefore the state will not imprison her for prostitution. She was mandated to services at the Teens First agency, unlike her prior arrests when she had been sent to detention.

 

Alcohol and Drug Use History: Tiffani’s parents were social drinkers until about 8 years ago. At that time Uncle Nate introduced them to crack cocaine. Tiffani reports using alcohol when Donald wanted her to since she wanted to please him, and she thought this was the way she would be a good “wife.” She denies any other drug use.

 

Medical History: During intake, it was noted that Tiffani had multiple bruises and burn marks on her legs and arms. She reported that Donald had slapped her when he felt she did not behave and that John T. burned her with cigarettes. She had realized that she did some things that would make them mad, and she tried her hardest to keep them pleased even though she did not want to be with John T. Tiffani has been treated for several sexually transmitted infections (STIs) at local clinics and is currently on an antibiotic for a kidney infection. Although she was given condoms by Donald and John T. for her “dates,” there were several “Johns” who refused to use them.

 

Strengths: Tiffani is resilient in learning how to survive the negative relationships she has been involved with. She has as sense of protection for her sister and will sacrifice herself to keep her sister safe.

 

Robert Bradley: father, 38 years old

Shondra Bradley: mother, 33 years old

Nate Bradley: uncle, 36 years old

Tiffani Bradley: daughter, 16 years old

Diana Bradley: daughter, 13 years old

Donald: Tiffani’s self-described husband and her former pimp

Anthony: Shondra’s live-in partner, 31 years old

John T.: Tiffani’s most recent pimp

   

Paula Cortez

 

Identifying Data: Paula Cortez is a 43-year-old Catholic Hispanic female residing in New

York City, NY. Paula was born in Colombia. When she was 17 years old, Paula left Colombia and moved to New York where she met David, who later became her husband. Paula and David have one son, Miguel, 20 years old. They divorced after 5 years of marriage. Paula has a five-year-old daughter, Maria, from a different relationship.

 

Presenting Problem: Paula has multiple medical issues, and there is concern about whether she will be able to continue to care for her youngest child, Maria. Paula has been overwhelmed, especially since she again stopped taking her medication. Paula is also concerned about the wellness of Maria.

 

Family Dynamics: Paula comes from a moderately well-to-do family. Paula reports suffering physical and emotional abuse at the hands of both her parents, eventually fleeing to New York to get away from the abuse. Paula comes from an authoritarian family where her role was to be “seen and not heard.” Paula states that she did not feel valued by any of her family members and reports never receiving the attention she needed. As a teenager, she realized she felt “not good enough” in her family system, which led to her leaving for New York and looking for “someone to love me.” Her parents still reside in Colombia with Paula’s two siblings.

 

Paula met David when she sought to purchase drugs. They married when Paula was 18 years old. The couple divorced after 5 years of marriage. Paula raised Miguel, mostly by herself, until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula maintains a relationship with her son, Miguel, and her ex-husband, David. Miguel takes part in caring for his half-sister, Maria.

 

Paula does believe her job as a mother is to take care of Maria but is finding that more and more challenging with her physical illnesses.

 

Employment History: Paula worked for a clothing designer, but she realized that 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 fulltime job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Disability Insurance (SSD) and Medicaid. Miguel does his best to help his mom but only works part time at a local supermarket delivering groceries.

 

Paula currently uses federal and state services. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children. Given Paula’s low income, health, and Medicaid status, Paula is able to receive in-home childcare assistance through New York’s public assistance program.

 

Social History: Paula is bilingual, fluent in both Spanish and English. Although Paula identifies as Catholic, she does not consider religion to be a big part of her life. Paula lives with her daughter in an apartment in Queens, NY. Paula is socially isolated as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood.

 

Five (5) years ago Paula met a man (Jesus) at a flower shop. They spoke several times. He would visit her at her apartment to have sex. Since they had an active sex life, Paula thought he was a “stand-up guy” and really liked him. She believed he would take care of her. Soon everything 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 and thought her past behavior with drugs and sex brought on bad relationships with men and that she did not deserve better. After a couple of months, Paula realized she was pregnant. Jesus stated he did not want anything to do with the “kid” and stopped coming over, but he continued to contact and threaten Paula by phone. Paula has no contact with Jesus at this point in time due to a restraining order.

 

Mental Health History: Paula was diagnosed with bipolar disorder. She experiences periods of mania lasting for a couple of weeks then goes into a depressive state for months when not properly medicated. Paula 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 the past 5 years. Paula accepts her bipolar diagnosis but demonstrates limited insight into the relationship between her symptoms and her medication.

 

Paula reports that when she was pregnant, she was fearful for her safety due to the baby’s father’s anger about the pregnancy. Jesus’ relentless phone calls and voicemails rattled Paula. She believed she had nowhere to turn. At that time, she became scared, slept poorly, and her paranoia increased significantly. After completing a suicide assessment 5 years ago, it was noted that Paula was decompensating quickly and was at risk of harming herself and/or her baby. Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula remained on the unit for 2 weeks.

 

Educational History: Paula completed high school in Colombia. Paula had hoped to attend the Fashion Institute of Technology (FIT) in New York City, but getting divorced, then raising Miguel on her own interfered with her plans. Miguel attends college full time in New York City.

 

Medical History: Paula was diagnosed as HIV positive 15 years ago. Paula acquired AIDS three years later when she was diagnosed with a severe brain infection and a Tcell count of less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function in 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. After being in the skilled nursing facility 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 semi-paralyzed 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.

 

Paula began treatment for her HIV/AIDS with highly active antiretroviral therapy (HAART). Since she ran away from the family home, married and divorced a drug user, then was in an abusive relationship, Paula thought she deserved what she got in life. 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 a new 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. 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. When she stops her treatment, she deteriorates quickly.

 

Maria was born HIV negative and received the appropriate HAART treatment after birth. She 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.

 

Legal History: Previously, Paula used the AIDS Law Project, a not-for-profit organization that helps individuals with HIV address legal issues, such as those related to the child’s father . At that time, Paula filed a police report in response to Jesus’ escalating threats and successfully got a restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a temporary sense of control over her life.

 

Paula completed the appropriate permanency planning paperwork with the assistance of the organization The Family Center. She named Miguel as her daughter’s guardian should something happen to her.

 

Alcohol and Drug Use History: Paula became an intravenous drug user (IVDU), using cocaine and heroin, at age 17. David was one of Paula’s “drug buddies” and suppliers. 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.

 

Strengths: Paula has shown her resilience over the years. She has artistic skills and has found a way to utilize them. Paula has the foresight to seek social services to help her and her children survive. Paula has no legal involvement. She has the ability to bounce back from her many physical and health challenges to continue to care for her child and maintain her household.

 

David Cortez: father, 46 years old

Paula Cortez: mother, 43 years old

Miguel Cortez: son, 20 years old

Jesus (unknown): Maria’s father, 44 years old

Maria Cortez: daughter, 5 years old

 

 

 

       

Jake Levy

 

Identifying Data: Jake Levy is a 31-year-old, married, Jewish Caucasian male. Jake’s wife, Sheri, is 28 years old. They have two sons, Myles (10) and Levi (8). The family resides in a two-bedroom condominium in a middle-class neighborhood in Rockville, MD. They have been married for 10 years.

 

Presenting Problem: Jake, an Iraq War veteran, came to the Veterans Affairs Health Care Center (VA) for services because his wife has threatened to leave him if he does not get help. She is particularly concerned about his drinking and lack of involvement in their sons’ lives. She told him his drinking has gotten out of control and is making him mean and distant. Jake reports that he and his wife have been fighting a lot and that he drinks to take the edge off and to help him sleep. Jake expresses fear of losing his job and his family if he does not get help. Jake identifies as the primary provider for his family and believes that this is his responsibility as a husband and father. Jake realizes he may be putting that in jeopardy because of his drinking. He says he has never seen Sheri so angry before, and he saw she was at her limit with him and his behaviors.

 

Family Dynamics: Jake was born in Alabama to a Caucasian, Eurocentric family system. He reports his time growing up to have been within a “normal” family system. However, he states that he was never emotionally close to either parent and viewed himself as fairly independent from a young age. His dad had previously been in the military and was raised with the understanding that his duty is to support his country. His family displayed traditional roles, with his dad supporting the family after he was discharged from military service. Jake was raised to believe that real men do not show weakness and must be the head of the household.

 

Jake’s parents are deceased, and he has a sister who lives outside London. He and his sister are not very close but do talk twice a year. Sheri is an only child, and although her mother lives in the area, she offers little support. Her mother never approved of Sheri marrying Jake and thinks Sheri needs to deal with their problems on her own. Jake reports that he has not been engaged with his sons at all since his return from Iraq, and he keeps to himself when he is at home.

 

Employment History: Jake is employed as a human resources assistant for the military. Jake works in an office with civilians and military personnel and mostly gets along with people in the office. Jake is having difficulty getting up in the morning to go to work, which increases the stress between Sheri and himself. Shari is a special education teacher in a local elementary school. Jake thinks it is his responsibility to provide for his family and is having stress over what is happening to him at home and work. He thinks he is failing as a provider.

 

Social History: Jake and Sheri identify as Jewish and attend a local synagogue on major holidays. Jake tends to keep to himself and says he sometimes feels pressured to be more communicative and social. Jake believes he is socially inept and not able to develop friendships. The couple has some friends, since Shari gets involved with the parents in their sons’ school. However, because of Jake’s recent behaviors, they have become socially isolated. He is very worried that Sheri will leave him due to the isolation.

 

Mental Health History: Jake reports that since his return to civilian life 10 months ago, he has difficulty sleeping, frequent heart palpitations, and moodiness. Jake had seen Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-traumatic stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms of anxiety and depression and suggested that he also begin counseling. Jake says that he does not really understand what PTSD is but thought it meant that a person who had it was

“going crazy,” which at times he thought was happening to him. He expresses concern that he will never feel “normal” again and says that when he drinks alcohol, his symptoms and the intensity of his emotions ease. Jake describes that he sometimes thinks he is back in Iraq, which makes him feel uneasy and watchful. He hates the experience and tries to numb it. He has difficulty sleeping and is irritable, so he isolates himself and soothes this with drinking. He talks about always feeling

“ready to go.” He says he is exhausted from being always alert and looking for potential problems around him. Every sound seems to startle him. He shares that he often thinks about what happened “over there” but tries to push it out of his mind. Nighttime is the worst, as he has terrible recurring nightmares of one particular event. He says he wakes up shaking and sweating most nights. He adds that drinking is the one thing that seems to give him a little relief.

 

Educational History: Sheri has a bachelor’s degree in special education from a local college. Jake has a high school diploma but wanted to attend college upon his return from the military.

 

Military History: Jake is an Iraqi War veteran. He enlisted in the Marines at 21 years old when he and Shari got married due to Sheri being pregnant. The family was stationed in several states prior to Jake being deployed to Iraq. Jake left the service 10 months ago. Sheri and Jake had used military housing since his marriage, making it easier to support the family. On military bases, there was a lot of social support and both Jake and Sheri took full advantage of the social systems available to them during that time.

 

Medical History: Jake is physically fit, but an injury he sustained in combat sometimes limits his ability to use his left hand. Jake reports sometimes feeling inadequate because of the reduction in the use of his hand and tries to push through because he worries how the injury will impact his responsibilities as a provider, husband, and father. Jake considers himself resilient enough to overcome this disadvantage and “be able to do the things I need to do.” Sheri is in good physical condition and has recently found out that she is pregnant with their third child.

 

Legal History: Jake and Sheri deny having criminal histories.

 

Alcohol and Drug Use History: As teenagers, Jake and Sheri used marijuana and drank. Both deny current use of marijuana but report they still drink. Sheri drinks socially and has one or two drinks over the weekend. Jake reports that he has four to five drinks in the evenings during the week and eight to ten drinks on Saturdays and Sundays. Jake spends his evenings on the couch drinking beer and watching TV or playing video games. Shari reports that Jake drinks more than he realizes, doubling what Jake has reported.

 

Strengths: Jake is cognizant of his limitations and has worked on overcoming his physical challenges. Jake is resilient. Jake did not have any disciplinary actions taken against him in the military. He is dedicated to his wife and family.

 

Jake Levy: father, 31 years old

Sheri Levy: mother, 28 years old

Myles Levy: son, 10 years old

Levi Levy: son, 8 years old

 

Helen Petrakis

 

Identifying Data: Helen Petrakis is a 52-year-old, Caucasian female of Greek descent living in a four-bedroom house in Tarpon Springs, FL. Her family consists of her husband, John (60), son, Alec (27), daughter, Dmitra (23), and daughter Althima (18). John and Helen have been married for 30 years. They married in the Greek Orthodox Church and attend services weekly.

 

Presenting Problem: Helen reports feeling overwhelmed and “blue.” She was referred by a close friend who thought Helen would benefit from having a person who would listen. Although she is uncomfortable talking about her life with a stranger, Helen says that she decided to come for therapy because she worries about burdening friends with her troubles. John has been expressing his displeasure with meals at home, as Helen has been cooking less often and brings home takeout. Helen thinks she is inadequate as a wife. She states that she feels defeated; she describes an incident in which her son, Alec, expressed disappointment in her because she could not provide him with clean laundry. Helen reports feeling overwhelmed by her responsibilities and believes she can’t handle being a wife, mother, and caretaker any longer.

 

Family Dynamics: Helen describes her marriage as typical of a traditional Greek family. John, the breadwinner in the family, is successful in the souvenir shop in town. Helen voices a great deal of pride in her children. Dmitra is described as smart, beautiful, and hardworking. Althima is described as adorable and reliable. Helen shops, cooks, and cleans for the family, and John sees to yard care and maintaining the family’s cars. Helen believes the children are too busy to be expected to help around the house, knowing that is her role as wife and mother. John and Helen choose not to take money from their children for any room or board. The Petrakis family holds strong family bonds within a large and supportive Greek community.

 

Helen is the primary caretaker for Magda (John’s 81-year-old widowed mother), who lives in an apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family dinners and driving herself shopping and to church. Six months ago, she fell and broke her hip and was also recently diagnosed with early signs of dementia. Helen and John hired a reliable and trusted woman temporarily to check in on Magda a couple of days each week. Helen would go and see Magda on the other days, sometimes twice in one day, depending on Magda’s needs. Helen would go food shopping for Magda, clean her home, pay her bills, and keep track of Magda’s medications. Since Helen thought she was unable to continue caretaking for both Magda and her husband and kids, she wanted the helper to come in more often, but John said they could not afford it. The money they now pay to the helper is coming out of the couple’s vacation savings. Caring for Magda makes Helen think she is failing as a wife and mother because she no longer has time to spend with her husband and children.

 

Helen spoke to her husband, John (the family decision maker), and they agreed to have Alec (their son) move in with Magda (his grandmother) to help relieve Helen’s burden and stress. John decided to pay Alec the money typically given to Magda’s helper. This has not decreased the burden on Helen since she had to be at the apartment at least once daily to intervene with emergencies that Alec is unable to manage independently. Helen’s anxiety has increased since she noted some of Magda’s medications were missing, the cash box was empty, Magda’s checkbook had missing checks, and jewelry from Greece, which had been in the family for generations, was also gone.

 

Helen comes from a close-knit Greek Orthodox family where women are responsible for maintaining the family system and making life easier for their husbands and children. She was raised in the community where she currently resides. Both her parents were born in Greece and came to the United States after their marriage to start a family and give them a better life. Helen has a younger brother and a younger sister. She was responsible for raising her siblings since both her parents worked in a fishery they owned. Helen feared her parents’ disappointment if she did not help raise her siblings. Helen was very attached to her parents and still mourns their loss. She idolized her mother and empathized with the struggles her mother endured raising her own family. Helen reports having that same fear of disappointment with her husband and children.

 

Employment History: Helen has worked part time at a hospital in the billing department since graduating from high school. John Petrakis owns a Greek souvenir shop in town and earns the larger portion of the family income. Alec is currently unemployed, which Helen attributes to the poor economy. Dmitra works as a sales consultant for a major department store in the mall. Althima is an honors student at a local college and earns spending money as a hostess in a family friend’s restaurant. During town events, Dmitra and Althima help in the souvenir shop when they can.

 

Social History: The Petrakis family live in a community centered on the activities of the Greek Orthodox Church. Helen has used her faith to help her through the more difficult challenges of not believing she is performing her “job” as a wife and mother. Helen reports that her children are religious but do not regularly go to church because they are very busy. Helen has stopped going shopping and out to eat with friends because she can no longer find the time since she became a caretaker for Magda.  

 

Mental Health History: Helen consistently appears well groomed. She speaks clearly and in moderate tones and seems to have linear thought progression—her memory seems intact. She claims no history of drug or alcohol abuse, and she does not identify a history of trauma. More recently, Helen is overwhelmed by thinking she is inadequate. She stopped socializing and finds no activity enjoyable. In some situations in her life, she is feeling powerless.

 

Educational History: Helen and John both have high school diplomas. Helen is proud of her children knowing she was the one responsible in helping them with their homework. Alec graduated high school and chose not to attend college. Dmitra attempted college but decided that was not the direction she wanted. Althima is an honors student at a local college.

 

Medical History: Helen has chronic back pain from an old injury, which she manages with acetaminophen as needed. Helen reports having periods of tightness in her chest and a feeling that her heart was racing along with trouble breathing and thinking that she might pass out. One time, John brought her to the emergency room. The hospital ran tests but found no conclusive organic reason to explain Helen’s symptoms. She continues to experience shortness of breath, usually in the morning when she is getting ready to begin her day. She says she has trouble staying asleep, waking two to four times each night, and she feels tired during the day. Working is hard because she is more forgetful than she has ever been. Helen says that she feels like her body is one big tired knot.

 

Legal History: The only member of the Petrakis family that has legal involvement is Alec. He was arrested about 2 years ago for possession of marijuana. He was required to attend an inpatient rehabilitation program (which he completed) and was sentenced to 2 years’ probation. Helen was devastated, believing John would be disappointed in her for not raising Alec properly.

 

Alcohol and Drug Use History: Helen has no history of drug use and only drinks at community celebrations. Alec has struggled with drugs and alcohol since he was a teen. Helen wants to believe Alec is maintaining his sobriety and gives him the benefit of the doubt. Alec is currently on 2 years’ probation for possession and has recently completed an inpatient rehabilitation program. Helen feels responsible for his addiction and wonders what she did wrong as a mother.

 

Strengths: Helen has a high school diploma and has been successful at raising her family. She has developed a social support system, not only in the community but also within her faith at the Greek Orthodox Church. Helen is committed to her family system and their success. Helen does have the ability to multitask, taking care of her immediate family as well as fulfilling her obligation to her mother-in-law. Even under the current stressful circumstances, Helen is assuming and carrying out her responsibilities.

 

John Petrakis: father, 60 years old

Helen Petrakis: mother, 52 years old

Alec Petrakis: son, 27 years old

Dmitra Petrakis: daughter, 23 years old

Althima Petrakis: daughter, 18 years old

Magda Petrakis: John’s mother, 81 years old

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Worksheet: Dissecting a Theory and Its Application to a Case Study

 

Most theories can be dissected and analyzed. All theories will tell you something about their focus or unit of analysis. A theory will identify its major or key concepts. It will also point to the definition of the problem and its cause. This then guides how the social worker assesses and intervenes, because the theory will also articulate the role of the social worker and how change occurs.

 

Basic Assumptions of the Theory   Directions: For each section, respond in 2 to 3 sentences to the following prompts. Where relevant, provide citations to support your claims.

Name of theory

Name of theorist

What are the major assumptions of the theory?

What are the theory’s key concepts?

What is the theory’s focus or unit of analysis?

What is the theory’s overall explanation for the cause of problems?

Application to a Case Study <insert the name of the client>   Directions: For each section, respond to the following prompts. Where relevant, provide citations to support your claims.

In 1 to 2 sentences, how does the theory define the client’s presenting problem?

In 1 to 2 sentences, how does the theory explain the cause of the client’s presenting problem?

In 1 to 2 sentences, how does the theory explain the role of the social worker for this client?

In 1 to 2 sentences, what does the theory say about how this client will improve or how change will occur?

Using the theory, list 2 to 3 assessment questions to ask this client to explore the client’s goals and how they will get there.

According to the theory, identify 2 to 3 specific practice intervention strategies for the client relative to the presenting problem. For each, explain in 1 sentence how it will help meet the client’s goals.

Based on the theory, list 2 to 3 outcomes when evaluating whether an intervention is effective.

What is one strength and one limitation in using this theory for this client?

Questions to Consider When Evaluating the Theory   You are not required to answer these questions for this assignment. However, these questions could help stimulate thinking whenever you are asked to evaluate a theory.

To what extent does the theory apply widely to diverse situations? Or does it apply narrowly to particular situations?

Is the theory ethical? Is it consistent with the NASW Code of Ethics?

Is the theory congruent with the professional value base of the social work field?

How cost effective would it be to implement interventions based on the theory?

To what extent does the theory fit within the organization’s or agency’s philosophy?

What do research studies say about how effective the interventions are?

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