Case Presentation & Psychosocial Assessment

Introduction and Context:

John is a 46-year old Caucasian male, who was referred to the Providence Palliative Care Connections Partners program for socialization and resource assistance purposes. He identifies his needs as: resolving past-due Medicaid claims, finding supportive housing, and cleaning his home. John experienced a stroke on 9/28/13, and was discharged from Providence Home Health services on 11/28/13, clients’ nurse practitioner indicates his activities of daily living are stable, as clients’ degree of pain was assessed as a 4/10 using the Providence well-being tool. Client received wound care, insulin injections, and steroid injections while receiving coordinated care from his primary care physician and Providence Home Health services. Clients’ diagnoses include: failure to thrive, arthritis, and Type 1 diabetes. John reports his challenges related to what he terms depression, as he further states, “Sometimes I sleep through days, wake up, and go back to sleep.” “I think about taking my life, and then I think about my Mom.” My role as a student intern is to provide socialization, emotional support, active listening, and case coordination with his caseworker at the Department of Human Services.

Presenting Problem/Concern; Precipitating Event:

Upon discharge from Providence Home health services on 11/28/13, Providence Palliative Care Connections Partners program coordinator, Jen Celeste Lawrence LCSW, assessed clients’ biopsychosocial needs and referred client to student intern, Erik Andersen for socialization and resource assistance purposes. Client defines the problem as, “I need help finding housing because my roommate hates me, and I am running out of money.” “I need help figuring out what is going on with my Medicaid claim.” “Sometimes I am depressed, and I think about taking my life but then I think about my Mom and how strong she was, she fought until the end.” Clients’ roommate suggests that he is lonely and isolated. She further states, “I can only help so much, and I have problems of my own.”

John Fredericks Treatment Plan: 30-Day Outcomes-Goals determined by client, and client verbally agrees to complete them in 30-days.

Goal 1: John will learn healthy coping skills to deal with emotional stressors

Objective: to practice mindfulness meditation before bedtime for 5-minutes 2× per week

Tasks:

-John will self-report his degree of stress using the Providence well-being scale, from 1 as low and 10 as severe, prior to meditation and after.

-John will record hours slept, and the number of times he woke up during the night.

-John will openly communicate his efforts to manage stress to his roommate.

Objective: to complete productive home visits 2× per week

Tasks:

  • John will organize past-due Medicaid claims
  • John will present a list for student intern to complete cleaning activities
  • John will share self-report rating of stress pre- and post meditation with student intern

Objective: to communicate 3× healthy activities I complete weekly to my roommate

Tasks:

-John will clean the kitchen on Fridays

-John will let the dogs out on Wednesdays

-John will prepare and share dinner with his roommate on Saturdays

Goal 2: Secure community food resources

Objective: to use Snowcap emergency food resources 1× per month

Tasks:

-John will provide proof of current address in order to access the local Snowcap food pantry

-John will communicate that he is using Snowcap to his roommate and encourage her to utilize the resource

-John will share his experience accessing food resources at Snowcap with student intern during next home visit

Goal 3: Identify and contact caseworkers assigned to Housing and Medicaid claims

Objective: to setup an action plan with caseworkers to secure housing & medical care for the next 18-months.

Tasks:

-John will call Oregon Housing authority and setup a telephone appointment

-John will call DHS and request to speak with his caseworker

-John will record information given by the Oregon Housing Authority, and the Department of Human Services in his blue notebook.

Practice Model: The practice model I choose in approaching this case is an eclectic model. Together, the client and I developed a practice model using: the strengths perspective, cognitive behavioral theory, and the task-centered model. The strengths perspective was used in this case for the purposes of emotional expression & validation, motivation, and encouragement. For example, the client was hesitant to approach his roommate after they had fought continuously for weeks. I validated the clients’ emotions by stating, “It must be frustrating when you feel as though, no matter what you do, your roommate seems to be upset.” I then explored his current emotion; he was contemplative and unsure how to change his circumstance with his roommate. I then determined that the client had not thought about a solution based on his strengths, which he further identified as cleaning, organizing, and listening. After further conversation we decided that she respected the client when he was taking responsibility for household chores. We developed the initial goal to communicate 3× healthy activities that he completes on a weekly basis to his roommate. She responded in a helpful manner, offering to fix meals 2× per week.

The cognitive behavioral theory was used to support the client to manage strong emotions, past traumatic events, and the anticipatory fear that he may experience another stroke. Cognitive behavioral theory supports the practice of mindfulness meditation because the client shared that, “I was able to feel separated from the same thoughts, and focus on just breathing for once.” Mindfulness meditation as he further mentioned improved outcomes, “I have been falling asleep quicker.”

The task-centered model was applied to resolving the Medicaid and Housing authority application. The client was torn between worrying about the future and whether or not he will have a place to live in the next 18-months. I used the strengths perspective to validate his emotions and encouraged him to take action by applying the task-centered model and supported him to complete the phone calls to setup initial consultation appointments.

In conclusion, the strengths perspective model was applied to all aspects of this case, to validate strong emotions, encouragement to take action, and safety to share strong guarded emotions. The cognitive theory practice model was used in conjunction with mindfulness meditation to shift thought patterns from fear and regret towards thoughts of acceptance through the 5-minute focused mediation on the breath. The task-centered model encouraged the client to take action and empowered the client to recognize progress through completed tasks.

Issues/Dilemmas/Questions:

–Suggestions clarifying goals/objectives/tasks?

–Suggestions creating treatment plans for individuals and families who have experienced a stroke?

–Suggestions for interventions with individuals and families who have compromised cognitive functioning? (Strengths focused, in this case client enjoyed using notebook to record medical appointment, encouraging the client to record stressors was a natural transition—did not seem to overwhelm the client).

–Suggestions monitoring/evaluating outcomes?

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