Homework Writing Help on Social Work: Case Overview

Social Work: Case Overview

Overview of Client Case

D: Overview of Case

D1.

V.D is a 79 year old Caucasian female who lives independently in a senior citizen building owned by the Catholic Charities in Baltimore County. The building hosts an in-house therapist as well as the client’s primary physician. V.D has been married four times and has two sons, and a granddaughter who assists her. Currently, the client is very ill, suffering from various serious conditions for which she takes medication. V.D has been diagnosed with illnesses, which include Chronic Obstructive Pulmonary Disease (COPD), Heart Disease, Hyperkipidemia, Hypertension, Paget ’s disease, Diverticulitis, Degenerative Disc Disease, and Type II Diabetes Mellitus. She is constantly on medication, an issue that brings about the current problem. V.D’s primary physician does all the prescriptions for her medication.

D2.

Her primary physician referred V.D to Baltimore County Adult Protective Services. This was due to her frequent abuse of medication. According to the physician, Ms V.D abuses her medicine, finishing them a week or two earlier than she was supposed to. When the physician refused to refill her medicine, she would either call an ambulance and go to the emergency room or make appointments with different doctors to get prescriptions for pain medicine. The physician referred her to the Baltimore County adult Protective Services because of self-neglect, and the potential to cause harm to the self due to the continued abuse of medication. The aim of doing this was to assist her to be able to obey the prescription directions, and thus achieve the desired well-being without having to take either over-the-counter medication or to overdose.

E. Application of Social Welfare Policy to the Case

E1.

The Maryland State Adult Protective services are a program designed to help adults who are deemed incapable of providing for their personal needs (MDHR, 2015). It’s purpose is to address the needs of individuals over 18 years of age without mental and/ or physical capacity to cater for their needs by attending to allegations of abuse, neglect and self-neglect of adults who are either at risk of harming themselves or who are unable to protect their own interests. According to the program, neglect refers to the willful withholding of necessary resources from an adult incapable of providing own needs such as food, medication, clothing and therapy (Wobensmith & Morris, 2015). Self-neglect is when a vulnerable adult is incapable of providing for herself/ himself the relevant needs in a beneficial way like in the case of V.D. It is required that anyone who recognizes the tendency of neglect or abuse of an adult should report the same to the Adult Protective Services.

Any human service provider, health practitioner or police officer that contacts an adult and recognizes vulnerability to neglect, exploitation or abuse should report the same to the adult protective services (Wobensmith & Morris, 205). For any person who makes a report to the Adult Protective Services, the Annotated Code of Maryland provides for the person’s immunity from any civil liability that may be associated with the case (MDHR, 2015). After making the report, the program makes contact with the adult in question for the provision of intervention services, which last a maximum of 6 months. The program is mandated to make contact with the said individual within 5 days after the reception of a report or within 24 hours after establishing that a state of emergency exists. The investigation procedure begins with an investigation, which involves face-to-face interviews with the client, and gathering information from other related sources such as relatives. The determination of whether the individual is vulnerable and the establishment of whether there has been an abuse, neglect, exploitation or neglect (Wobensmith & Morris, 2015) then follow the investigation. In the case of self-neglect related to the abuse of prescription medication like in the case of V.D, the program works in collaboration with the Prescription Drug Monitoring Program for the well-being of adults under its care.

The Prescription Drug Monitoring Program (PDMP) is mandated to collect and store information regarding drugs that contain controlled substances, which are prescribed and/ or sold to patients over the counter. Healthcare practitioners, pharmacies and dispensers report the data obtained from electronic databases stored by PMDP. In cases such as V. D’s it is possible to obtain this information prior to prescription of new dosages.

E2.

PDMP was started by the Maryland Department of Health and Mental Hygiene in collaboration with the Alcohol and Drug Abuse administration in order to support the effective administration and usage of prescription drugs. While the program aims at ensuring public safety and health by investigating inappropriate dispensing, prescription and use of prescription medication, there are no policies that have been laid down for handling confirmed cases of drug misuse (MOOPP, 2013). ADAA provides PMDP training about prescription drug misuse and overdose. The purpose of the training is to make information regarding the possible impacts of prescription medication overdose on the life of a patient and thus create awareness on how to handle a client with problems (MOOPP, 2013).

E3.

Various studies on the efficacy of the PMDPs in various states, confirm that there was a significant reduction in the number of opioid overdose admissions in states where PMDPs were active (Paullozzi et al., 2011). The effectiveness of PMDP extends to its ability to reduce the time consumption during investigations into drug diversions, changing the prescription behavior, reducing the abuse of prescription medication and reducing the instances of doctor shopping by enabling a patient to visit any prescribing doctor due to the availability of prescription history to all doctors (Finklea et al, 2014).

While the effectiveness of PMDP is undeniable, some of the possible unintended impacts are that the program may limit access to needed medication and push diversion of medication to neighboring states (Finklea et al, 2014). For instance, in the case of V. D, a prescriber may deny access to medication based on existing history yet the patient requires the medication for the underlying illnesses. Consequently, the patient ends up visiting doctors in the neighboring states who have no access to her medical history.

Despite the effectiveness of the PMDP, some issues are pertinent in its applicability. For instance, Paullozzi et al (2011) is of the opinion that, overdose related deaths are minimally affected by the presence of PDMP.  Due to factors such as; some prescribers fail to refer to the PDMP data on client histories before drug administration, deaths related to overdose result due to acquisition of prescription medication from neighboring states, which do not have access to client prescription history, and restriction of data access by some prescribers.

In order to improve the effectiveness of the program, it is necessary that various features of the data be adjusted for the benefit of all program stakeholders. The program could benefit a lot by making the data more timely, consistent and complete about every patient on record. The data should also be made more accessible to the prescribers as well as to dispensers. This will help prevent the push of drug diversions across state borders.

F. Theoretical Framework and Context for Analyzing Client System’s Situation

F1. Theoretical Framework

The nature of the client’s presenting problem can be described as drug dependence, which leads to drug misuse. In this context, the drug refers to prescription medication, particularly pain medication. The existential theory of drug dependence asserts that the emotional and phenomenal state of an individual dictates his/ her involvement in drug dependence behavior. V.D has medical issues, which cause emotional and physical pain undoubtedly. This explains why on denial of a medication refill, she goes for pain medicine only. This is in accordance to the existential theory framework in which humans are motivated by the desire to fulfill a strenuous basic need. In the event that the presenting need is satisfied, the individual obtains a feeling of well being while failure to satisfy the need results in behavioral adjustments, which may be destructive like in the case of V.D. The need experienced by V.D is due to the pressing desire to avert her illnesses; the availability of medication makes it possible for her to misuse it in a bid to avert the pain. For such a case, the intervention must comprise of aspects of cognitive behavioral therapy. Individuals with certain unhealthy conditions are vulnerable to drug dependence if exposed to certain drugs with the kind of psycho-activity that presumably addresses their presenting condition. It has been observed that older individuals are particularly prone to prescription drug misuse and abuse (Fernandez, 2011). This further explains the behavior of V.D.

F2.

Although the residence of V.D i.e. the senior citizen building brings together individuals with similar characteristics in that they are all significantly aged, the autonomy of each resident is paramount. In addition, the client resides in the building independently, this is without any company. These environmental conditions also predispose the client to misuse and dependence on medication.

Apart from the residential aspects, the ease of access to medication also makes the client vulnerable to abuse of medication. For instance, the client can easily call for an ambulance in case of excessive pain when the primary physician fails to refill her medication. In addition to this, she may also seek prescription from an alternative doctor. These factors provide the confidence required by V.D in order to abuse medication on the principle that she will still obtain additional drugs.

On the cultural perspective, there was no evidence for the existence of any form of alienation that may hinder V.D from requesting for assistance in dealing with drug misuse. However, the cultural differences between the primary physician and V.D may have played a role in her inability to change from the negative habit. Moreover, at her age, the lack of information regarding the dangers of overdosing on prescription medicine may also have contributed to her misuse of the drugs as well as refusal to adjust and seeking additional medication from other sources. Following the importance placed on family ties within Caucasian families, it was possible to make use of the available family members to encourage behavior modification.

F3. Ethical Considerations

In working with V.D, the main guiding principles were the Maryland State code of ethics for social workers. According to this code, the responsibilities of the social worker to the client are varied. In this case, the basic responsibilities held by the social worker towards the client include maintaining documentation with respect to the client’s records, maintaining the privacy of the client and facilitating the continued delivery of service until the time that the case is terminated (DHMH, n.d).

In documenting the client’s records, it was necessary that the records kept be legible in order to be used by any person who may desire to do so for the benefit of the client. This was particularly important in case a referral is deemed necessary during the treatment process. Secondly, the documentation had to describe the nature of the services rendered, and the specific times and dates when those services were delivered. It was also required that the documentation be made available and accessible over the period outlined by the Health General Article after the termination of the treatment.

In maintaining the privacy of the client, it was required that only information relevant to the client’s assistance be made available via documentation. Any other information that was not relevant to the well being of the client at that particular time was held in confidentiality. Apart from this, the documentation of the client’s interactions with the social worker was only made accessible to those who were relevant in the solution of the client’s problems. The reason behind this was to protect the client’s interests.

Since the aim of therapy is to assist the client in addressing pertinent issues in her life, it is the responsibility of the social worker to keep close contact with the client, facilitate interactions with the client until the termination of the case. The case can only be terminated once the initial objective of the treatment has been achieved. For instance, in the case of V.D, the treatment was terminated once the drug misuse behavior had been checked. The determination of whether the objective of treatment has been achieved in based on the social worker’s report. It is important that the social worker pay attention to client development.

F4. Diversity Consideration for the case

Since the case involved a single individual, the issue of diversity was not of intense importance.

F5. Human Rights and Social Justice Considerations for the case

In handling the case of V.D, the main human rights issues that arose included the right to medication in case of sickness, and the right to social welfare. The right to medical attention was of particular importance regarding the client’s medical conditions. While it was necessary that this right be respected, the issue of abuse of medication transformed it into a dilemma. On the other hand, the right to social justice was hinged to the right to medical attention.

G. Engagement, Assessment, Intervention and Termination

G1. Client Engagement

The engagement process is described by Jacobsen (2013) as the process of collaboration between the social worker and the client. It is further defined as the point when the client begins to see the need for intervention. The engagement process culminates in a definition of treatment objectives and comprehension of the stated objectives by both the client and the social worker. In order to effectively engage a client, it is necessary to first built rapport with the client. It was not easy to accomplish this with V.D due to various reasons. First, the age difference between the client and the social worker proved to be a hindrance. In addition to this, she did not come to the social worker of her own volition. In working with involuntary clients, Chovanec (2012) states the necessity of challenging the client’s outlook and beliefs in order to make substantial changes. By engaging V.D’s family, it was possible to capture her attention and to expound on the dangers of overdosing on prescription medication. From this point, she collaborated with the social worker towards achieving the goal of beating the impulses to overdose.

Client assessment enables the social worker to develop the background theory to a case. This is important in getting an in depth understanding of the nature of the case and thus outlining a process and plan for intervention in the case. The NASW outlines the process of client assessment involves the collection of the relevant theoretical data to the client’s case, the formation of the case concept, outlining the hypotheses and the proposition of the intervention procedure, and application of the propositions (Anastas & Clark, 2013a). This procedure is similar to that given by various social work organizations. In handling V.D, the assessment process enabled the social worker to obtain an insight to the problem background and hence define the problem in its totality. From the assessment, it was confirmed that the origin of V.D’s problem lies with herself and not the family or social background.

Assessment is essential as it enables the social worker to lay down the relevant strategies for handling the case. An important part of the collaborative assessment process is the outlining of the client’s resources and strengths. This goes a long way in directing the client towards regaining control of their lives as it makes them feel empowered. It was important to let V.D know that the social worker considered her age to be an important strength as it meant she was wise and could be counted on to make the right decisions. In assessing the client’s behavior, the most important aspect is to consider the actual problem behaviors rather than diverge to other irrelevant behaviors (Anastas & Clark, 2013c). During the assessment process, the social worker, in unity with the client also lay down the long and short term goals of intervention as well as the conditions for termination of the process.

G2. Assessment of the Client

Name: V.D

DOB:

Reason for Services: The Client’s primary physician referred her to the social worker due to her tendency to abuse her medication.

Household Members: V.D has two sons and a granddaughter. However, they do not live together with the client as she lives in a senior citizen’s residence. They get along well though.

Household Living Conditions: The conditions in the senior citizen’s residence are favorable for good health. There is a live in primary physician as well as a therapist. An ambulance is also available on call. The residence is well maintained and tuned to the living needs of the aged. There are no health risks in the building.

Financial History: The client depends on social welfare although the exact amount received monthly was not availed. The financial histories of the sons and granddaughter are also not available.

Assets and Resources

The resources possessed by the client originate from social welfare, given only once a month. The client also has family members who assist her whenever they are able to. V.D therefore does not have to support the family, as they do not live together. Sometimes the social welfare funds are directed to the building management so that they can organize for the provision of all the needs of the residents such as medication, food, e.t.c. The building is also a resource that makes the client’s life easier.

Social History

Physical Health: Currently, V.D suffers from several physical illnesses, which include Chronic Obstructive Pulmonary Disease (COPD), Heart Disease, Hyperkipidemia, Hypertension, Paget’s Disease, Diverticulitis, Degenerative Disc Disease, and Type II Diabetes Mellitus.

Mental Health: There are no mental health issues reported on the client’s case

Alcohol and Drug use: None

Sexual History: The client has been married four times. She is currently single.

Educational History: The client’s educational history was not reported on, as it bears no relevance to the case at hand.

Employment History: None was made available

Recreational: V.D enjoys knitting and reading books when she is not feeling any pain as a result of her illnesses.

Cultural and Family norms: V.D’s family does not stay with her. However, she enjoys the company of her granddaughter as well as two sons any time they come visiting. It has been a habit for them to eat together and tell stories when the client feels better. This is however becoming rare, as V.D grows more dependent on medication to keep the pain at bay. She thus sleeps most of the time.

Religious/ Spiritual: Christian

Strength and Competencies: The age of V.D is one of her strengths as it enables her to make wise decisions. She is also tolerant and a good listener. Besides this, she is intelligent and understands easily.

Presenting Problems: V.D was referred to Baltimore County Adult Protective Services by her primary physician. This was due to her frequent abuse of medication. According to the physician, Ms V.D abused her medicine, finishing them a week or two earlier than she was supposed to. When the physician refused to refill her medicine, she would either call an ambulance and go to the emergency room or make appointments with different doctors to get prescriptions for pain medicine.

Adult Protective Services Personal Plan                                                     Date:

Consumer: V.D                     Date of Birth:                                                S.S.

Consumer Ma#:

Program: Baltimore Adult Protective Services         CSA Jurisdiction: Baltimore

Phone:

Program Address:                                                     Program MA#:

Case Manager:                                                          Authorization Period Request Start Date:

Consumer Strengths: Age, tolerance, good listening skills and intelligent

Consumer Long Term Goals: To be able to handle illness related pain without abuse of medication

Needs/ WantsMeasurable Short Term GoalsInterventionTarget DateProgress Towards Goal
V.D wants to gain control of impulses to abuse medicationV.D will give the social worker the mandate to only issue the medication required at any timeThe Social worker will be responsible for issuing medication to V.D only when the client should take the medication for a period of time. Task Completed
V.D desires to find ways of dealing with the pain instead of taking medicationV.D will suggest hobbies and activities that make her feel happy or relaxedThe social worker will assist V.D in engaging in the suggested activities to divert her attention from her pain for a while Task Completed

Termination of intervention

According to Social Work code of ethics, it is not desirable for the social worker to terminate contact with the client before the achievement of the client’s objectives (Ledwith, 2011). Termination prior to the accomplishment of the long-term objectives can lead to unfavorable effects on the client (Anastas & Clark, 2013b). According to Berg-Weger (2013), the termination process should involve a review of the previously outlined goals and objectives and evaluation of the outcome, establishing a plan that can help in maintaining the achieved change post intervention, discussing the possibility of continued contact between the social worker and the client and expressing the individual feelings about termination of the case. It is an important stage in the interaction between the social worker and the client and if not handled skillfully, may lead to detrimental effects. In the case of V.D, one of the major potential effects of case termination before the appropriate time is a relapse into detrimental habits, which may make the habit even worse than it was prior to intervention.

Section H

Desired Outcome of intervention

This intervention is aimed at ensuring that the Baltimore Adult protective Services assist the client effectively in achieving her long-term goal of dealing with the dependency on pain medication, which frequently results in abuse of prescription medicine.

Measurement of Outcome

To measure the effectiveness of the process, the client will be monitored closely to determine the achievement of the laid down short-term objectives, and the time management efficacy. This will enable tracking of the overall long-term objective.

Research Approach used and Rationale

To achieve the desired goals, a qualitative research will be carried out to link the effectiveness of the intervention process to the accomplishment of the set objectives. The rationale behind this is that qualitative research takes into consideration highly individualized aspects of data such as client emotions, non-verbal communications and personal behaviors.

Research Design

The research carried out will be experimental, aimed at determining the relationship between the intervention process and the intended outcome. It will be centered on the client, with relevant modifications to suit specific client needs and objectives.

Process of Data Collection

The data collection will be carried out both during client engagement and assessment. The assessment data collection will be carried out at the beginning of the intervention, during ongoing intervention and after the termination of the intervention process. The data collected is to assist in measuring the effectiveness of the process.

Analyzing the Data

The data analysis will also be qualitative, represented through a summary of the key points of the case. This summary will include the status of the client before and after the intervention including reports from the primary physician on the behavior of the client after termination of the intervention process.

How to apply the findings

The findings for this case will assist the organization in assessing its effectiveness in dealing with clients whose presenting problems involve substance abuse. The results will also be used to rate the social worker in charge of the case in terms of effectiveness.

References

Anastas, J., & Clark, E. (2013a). Clients with Substance Use Disorders. National Association of Social Workers. Retrieved from https://www.socialworkers.org/practice/standards/NASWATODStatndards.pdf

Anastas, J., & Clark, E. (2013b). Social Work Case Management. National Association of Social Workers. Retrieved from http://www.socialworkers.org/practice/naswstandards/CaseManagementStandards2013.pdf

Anastas, J. & Clark, E. (2013c). Best Practice Standards in Social Work Supervision. National Association of Social Workers. Retrieved from http://www.naswdc.org/practice/naswstandards/supervisionstandards2013.pdf

Berg-Weger, M. (2013). Social Work and Social Welfare: An Invitation. Routledge.

Chovanec, M. (2012). Examining Engagement of Men in a Domestic Abuse Program from Three Perspectives: An Exploratory Multimethod Study. Social Work with Groups, 35, 362-378.

Department of Health and Mental Hygiene (DHMH). (n.d). Code of Ethics. Board of Social Work Examiners. Retrieved from http://dhmh.maryland.gov/bswe/Docs/Regs/10.42.03CodeofEthics.pdf

Fernandez, S. (2011). Elderly Are Particularly Vulnerable to Both Misuse and Abuse of Prescription Drugs Retrieved from http://www.noozhawk.com/article/092511_sbrx_seniors

Filklea, K., Sacco, L., & Bagalman, E. (2014). Prescription Drug Monitoring Programs. Congressional Research Service. Retrieved from https://www.fas.org/sgp/crs/misc/R42593.pdf

Jacobsen, C. (2013). Social Workers Reflect on Engagement with Involuntary Clients. Clinical Research Papers no. 198.

Ledwith, K. (2011). Beginnings and Endings: An Enquiry into the Attachment Orientations and Termination Approaches Among Clinical Social Workers. Doctorate in Social Work Dissertations Paper 12.

Maryland Department of Human Resources MDHR. (2015). Adult Protective Services. Retrieved from http://dhr.maryland.gov/blog/?page_id=4531

Maryland Opioid Overdose Prevention Plan (MOOPP). (2013). Retrieved from http://bha.dhmh.maryland.gov/OVERDOSE_PREVENTION/Documents/MarylandOpioidOverdosePreventionPlan2013%20%284%29.pdf

Paulozzi L., Kilbourne E., & Desai H. (2011). Prescription Drug Monitoring Programs And Death Rates From Drug Overdose. Pain Med 12:747-754

Wobensmith, J., & Morris, B. (2015). Code of Maryland Regulation. Office of the Secretary of State Maryland Retrieved from http://www.dsd.state.md.us/comar/SubtitleSearch.aspx?search=07.02.16.*