Assignment 1: Policy Identification

According to the Counsel on Social Work Education, Competency 5: Engage in Policy Practice:

Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation.

To prepare: Identify a social problem that is common among the organization (or its clients) and research current policies at that state and federal levels that impact the social problem. Then, from a position of advocacy, identify methods to address the social problem (i.e., how you, as a social worker, and the agency advocate to change the problem). You are expected to specifically address how both you and the agency can effectively engage policy makers to make them aware of the social problem and the impact that the policies have on the agency and clients.

The Assignment (2-3 pages):

· Identify the social problem

· Explain rational for selecting social problem

· Describe state and federal policies that impact the social problem

· Identify specific methods to address the social problems

· Explain how the agency and student can advocate to change the social problem

References (use 2 or more)

Assignment 2:
Comprehensive Assessment

A comprehensive understanding of a client’s presenting problems depends on the use of multiple types of assessment models. Each model gathers different information based on theoretical perspective and intent. An assessment that focuses on one area alone not only misses vital information that may be helpful in planning an intervention, but may encourage a biased evaluation that could potentially lead you to an inappropriate intervention. When gathering and reviewing a client’s history, sometimes it is easier to focus on the problems and not the positive attributes of the client. In social work, the use of a strengths perspective requires that a client’s strengths, assets, and resources must be identified and utilized. Further, using an empowerment approach in conjunction with a strengths perspective guides the practitioner to work with the client to identify shared goals. You will be asked to consider these approaches and critically analyze the multidisciplinary team’s response to the program case study of Paula Cortez.

For this Assignment, review the program case study of the Cortez family.

In a 2- to 3-page paper, complete a comprehensive assessment of Paula Cortez, utilizing two of the assessment models provided in Chapter 5 of the course text.

· Using the Cowger article, identify at least two areas of strengths in Paula’s case.

· Analyze the perspectives of two members of the multidisciplinary team, particularly relative to Paula’s pregnancy.

· Explain which model the social workers appear to be using to make their assessment.

· Describe the potential for bias when choosing an assessment model and completing an evaluation.

· Suggest strategies you, as Paula’s social worker, might try to avoid these biases.

Support your Assignment with specific references to the resources. Be sure to provide full APA citations for your references.

References (use 3 or more)

Congress, E. (2013). Assessment of adults. In M. Holosko, C. Dulmus, & K. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions (pp. 125–145). Hoboken, NJ: Wiley.

Cowger, C. D. (1994). Assessing client strengths: Clinical assessment for client empowerment. Social Work, 39(3), 262–268.

Mental Measurements Yearbook. (n.d.). Lincoln, NE: Buros Institute of Mental Measurements.

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

· The Cortez Family (pp. 23–25)

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.

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. 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.

The Cortez Family

David Cortez: father, 46

Paula Cortez: mother, 43

Miguel Cortez: son, 20

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. 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. 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.

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.

Key to Acronyms

AIDS:

Acquired Immunodeficiency Syndrome

HAART:

Highly Active Antiretroviral Therapy

HIV:

Human Immunodeficiency Virus

IVDU:

Intravenous Drug User

SNF:

Skilled Nursing Facility

SSI:

Supplemental Security Insurance

WIC:

Supplemental Nutrition Program for Women, Infants, and   Children

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.

(Plummer 23-25)

Plummer, Sara-Beth, Sara Makris, Sally Brocksen. Sessions: Case Histories. Laureate Publishing, 02/2014. VitalBook file.

For your Final Paper, you will demonstrate your knowledge of psychopathology and apply your skills to a realistic scenario. Throughout this course, you have developed unique knowledge and skill sets that will allow you to critically analyze depictions of psychopathology in popular media and historical case examples from an informed point of view.

Your Final Paper will be a psychological report that may be based on a character from a movie or a historical case study. Review the provided lists of movies and historical case studies that are approved for use in this assignment.  You must choose from these lists. You may not use examples from your personal life in the psychological report since doing so would be unethical (see Standards 2.04 and 9.01a in the Ethical Principles of Psychologists and Code of Conduct).

As you create this report, you will be taking on the role of a clinician who is conducting an assessment and providing treatment recommendations for a patient (a character from your selected film or historical case study). Please note that a psychological report does not follow the same structure for reports you may have used in other courses. Your report must follow the format below and it must include each of the sections and their headings listed in this order:

1. Identifying Information
   Within this section, you will describe basic information on your patient, including the person’s name, sex, gender, sexual orientation, age, race, occupation, and location of residence (country, state, and region).
2. Chief Complaint/Presenting Problem
   Within this section, you will include the patient’s primary complaint verbatim to identify the main source of his or her distress and/or concerns. If there is no verbatim complaint, include observable information to create an overall picture of the presenting problem.

   Typically, this section within a psychological report seeks to address the following question (further elaboration within this section is encouraged where possible):

   • What are the patient’s complaints? (e.g., the patient might complain about “feeling on edge” or experiencing stress)
3. Symptoms
   Within this section, you will interpret specific behavioral issues and intrapsychic conflicts as they relate to abnormal behavior, behavior patterns, maladaptive thought processes, and potential unconscious conflicts. Interpret and comment on the patient’s chief complaint and/or presenting problem in the context and language of the symptoms found in the DSM-5. (e.g., the patient who complains about “feeling on edge” might actually be experiencing symptoms related to post-traumatic stress disorder or generalized anxiety disorder)
4. Personal History
   Within this section, you will analyze your patient’s personal background and history of abnormal behavior(s) that inform your diagnostic impression. You will also gather information about the patient’s cultural background and cultural norms.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • Where did the patient grow up?
   • What cultures did the patient experience throughout life?
   • What was the patient’s school life like?
   • What were his or her grades? What is his or her highest level of education?
   • What is the patient’s interpersonal relationship history?
   • What was/is the patient’s romantic relationship history?
   • What was/is the patient’s friendship history?
5. Family History
   Within this section, you will analyze the patient’s familial relationship(s) and identify any abnormalities that might affect future treatment. You will also integrate information about the patient’s family and cultural background to identify any maladaptive behaviors and relational patterns.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • How old were the patient’s parents when the patient was born?
   • Who were the patient’s primary caregivers?
   • What was/is family life like? (Include any information relevant to your diagnostic impression.)
   • Did the family move often?
   • What was/is the patient’s relationship with their siblings (if applicable)?
   • What culture did/does the family come from?
   • What belief systems are attached to that culture?
6. Therapy History
   Within this section, you will describe the patient’s therapy history to inform your diagnostic impression. Analyze the patient’s therapy history to identify the effectiveness of previous treatment(s). Analyze previous treatment interventions based on information and knowledge of the patient’s cultural background.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • Who was the previous therapist (if applicable)?
   • How long did the previous therapy/therapies last?
   • What was the patient’s diagnosis?
   • What interventions did the therapist(s) use?
   • Were those interventions appropriate for the patient’s culture?
   • Was treatment successful?
7. Medical Conditions
   Within this section, you will analyze the patient’s medical history and comment on any possible medical conditions that could influence your diagnostic impression. Interpret specific behavioral issues as they relate to salient medical conditions. If the person has any medical conditions, indicate that in this section. Integrate information and knowledge about the patient’s cultural background as it affects treatment options for medical conditions.
8. Substance Use
   Within this section, you will analyze and comment on the patient’s substance use to identify any potential issues that could influence your diagnostic impression. Interpret specific behavioral issues as they relate to substance use. If the person misuses specific substances, indicate that in this section. Integrate information and knowledge about the patient’s cultural background to inform your interpretation of substance misuse in this patient’s case.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • Which substances does the patient use? (Include any over-the-counter, herbal, and/or prescription medications.)
   • For how long has the patient used the substance?
   • What is the patient’s quantity and frequency of use?
9. Collateral
   Within this section, you will interpret specific collateral information as it relates to your patient’s abnormal behavior and behavior patterns. You will also integrate information and knowledge regarding the patient’s culture in your evaluation of the maladaptive behavior as reported by the collateral sources.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • What do other people have to say about the patient’s behavior?
   • Are there any commonalities between the collateral sources’ reports?
   • Do the collateral sources have any psychological issues that might exacerbate the patient’s problems?
   • Are there any police reports?
   • Are there any personality testing or intelligence testing reports available?
10. Results of Evaluation
    Within this section, you will analyze the patient’s behavior and mental processes. There are two parts to this section. To begin your analysis, you will write a brief evaluation of each theory of personality development that you learned about in this course and determine whether or not each theoretical orientation can be used to conceptualize the patient’s current situation and treatment goals. Next, use one major theoretical orientation to write an in-depth analysis for your results of evaluation section. Within the context of this theoretical perspective, you will analyze all of the information from the previous sections. Analyze specific behaviors, cognitions, and intrapsychic processes as they relate to your diagnostic impression. Integrate knowledge of the patient’s cultural background and norms within that culture as you prepare your supporting evidence.

    Typically, this section within a psychological report seeks to answer the following question (further elaboration within this section is encouraged where possible):

    • Based on the information you gathered in the previous sections, what led to the patient’s current state?
11. Diagnostic Impression With Differential Justification
    Within this section, you will provide your diagnosis for the patient. To demonstrate your understanding of diagnostic procedure and justification, specifically address each symptom that the patient displayed and relate each symptom to a diagnostic criterion in the DSM-5. Analyze the patient’s behaviors and mental processes within your differential justification. Clearly demonstrate that the patient meets criteria to be given a diagnosis. If the patient does not meet criteria for any diagnosis based on your assessment, explain why. Also, explore any alternative diagnoses and explain why these were not chosen.
12. Recommendations
    Within this section, you will you provide treatment recommendations for the person to help them improve his or her quality of life. These recommendations must be based on the theoretical orientation you used in your Results of Evaluation. Explain why you chose your treatment intervention(s) and include peer-reviewed articles that support your choice(s). If treatment is not necessary, explain why. Pay close attention to the person’s culture since some treatment options may be insensitive to his or her culture or way of living.

Writing the Final Paper

The Final Paper:

1. Must follow the report outline provided above with the requisite headings and be formatted according to APA style as outlined in the Ashford Writing Center.
2. Must include a title page with the following:
   1. Title of paper
   2. Student’s name
   3. Course name and number
   4. Instructor’s name
   5. Date submitted
3. Must address the assessment with critical thought.
4. Must use at least five peer-reviewed sources that were published within the last ten years, in addition to the text, a minimum of four must be from the Ashford University Library.
5. Must document all sources in APA style as outlined in the Ashford Writing Center.