Gay Mans Health Crisis Centre Services - Case Study Example

?CASE STUDY s Introduction Gay Mans’ Health Crisis Centre was initiated in January 1982 and it is located in New York City. Its foundation was triggered after the emergence of reports in New York City and San Francisco declaring that an uncommon form of cancer labeled Kaposi Sarcoma was impacting on the health of young gay men. Eventually, the disease was declared an epidemic by the Centers for Disease Control. Similarly, Gay Men’s Health Crisis (GMHC) was established after eighty (80) men assembled in New York to discuss gay cancer issue and also raise funds for research. The name GHMC has its roots from the fact that the victims to AIDS during the spread of the epidemics were gay men in the early eighties. GHMC has rapidly expanded since 1980s and it is offering numerous services to New Yorkers being affected by HIV/AIDS. The services offered by the centre are such as nutrition and health education, housing, mental health and legal support, case management and vocational training. During my internship, I was privileged to work with this organization. In my internship period, I was able to offer my support to Mr. Alberto who was suffering from anxiety and depression as a result of his HIV status. For the better understanding of the activities I partook during my interaction with Mr. Alberto, I will create an assessment, treatment plan and measurements such as observation or scaling. Background Information of Mr. Alberto Alberto is a 39 year old Latino homosexual. He is HIV positive but unfortunately he has no access to medical cover. He hails from a family of six and he is the lastborn. The family income is low and cannot support them. In that case, he has to act as a breadwinner so that he can support his mother financially. From my interaction with him, he really wanted to seek medical help but he did not possess a medical insurance cover. As a result, he suffered from depression and anxiety as a result of his HIV status. In addition to that, he was very ashamed of his condition and was unwilling to disclose it to her mother. In his narration, he remembered having multiple relationships in her teenage years and never took any precautions to protect himself from conducting the epidemic. In discovering that he was HIV positive, he never had any idea of where or how he would go to obtain help. By good lack, he met a social worker counselor and disclosed his problem to him. The social worker then directed him to Gay Mans’ Health Crisis Centre where he got some assistance from me and other clinicians. In that case, Alberto needs to be diagnosed with by the DSM IV. Assessment The HIV infection prevalence in marginalized subgroups in the United States of America is extreme compared to other settings globally that have poor resources. This has made some individuals to argue that, HIV/ AIDS epidemic has been domestically forgotten (El Sharder et al., 2010). Researchers have noted that HIV/AIDS is affecting the minority ethnic/social groups and the poor individuals as in the case of Alberto. Alberto comes from a poor background making him unable to access a health insurance cover. In addition to that, the health disparities in US are impacting further on his situation because he is an immigrant. This fact has made him suffer from anxiety and depression due to his HIV status. According to Spies (2009, p.1164), HIV diagnosis increases the likelihood of an individual suffering from mental disorders. In addition to that, the HIV progression is often hastened by mental disorders such as anxiety and depression. As in the case of Alberto, there was need to conduct a succinct screening measure accompanied with good specificity/sensitivity for psychiatric diagnosis. From my internship and interaction with HIV clients such as Alberto and other migrants, I learned that, HIV infection Neuropsychiatric effects are relatively frequent and can influence significantly planning for treatment for disorders resulting from substance abuse. In summary, mental disorders among HIV infected individuals can be broadly categorized into three. These are such as HIV-related, substance-induced and medical-related mental disorders. From my interaction with Alberto, he was suffering from anxiety and depression due to substance-induced and HIV- related disorders. On learning that he was HIV positive he got depressed as he was not able to disclose the information to his parents. He got the disease by practicing homosexual in order to provide financial support to his family. The diagnosis and assessment of mental illness among substance-abusing HIV-infected client is an overwhelming challenge. This is because of the client’s problems that are complex. It is thus important for a clinician or social worker to evaluate the behavior of client in context. For instance, acute depression is a common feature among individuals who have realized that they are HIV positive. This type of adjustment disorder that is time-limited can result to severe substance abuse. Consequently, depression can be prolonged or made severe by substance abuse. In the light of the above, it is quite difficult to determine whether a client substance abuse resulted after psychiatric disorder or the other way round. Substance abuse in most cases can be an attempt by an individual to self-medication in relation to the causal psychiatric disorder. Even though substance abuse may be predated by mental disorders, in most circumstances the reverse is true. The main reason is that a complete and an accurate history cannot be retrieved from the client and information sources that are corroborative (such as the former health care provider) that helps in accomplishing a complete assessment. Collaborative sources of idea inquiry mean disclosing the clients’ information with regards to HIV/AIDS status or substance abuse. The information can only be retrieved with a written consent from the client. Treatment plans are essential in handling individuals suffering from anxiety and depression as a result of their HIV status. However, various legal issues can impact on clients infected with HIV/AIDS and treatment of substance abuse operation programs. With the existence of multiple dimensions of rules governing treatment of substance abuse and HIV/AIDS, compliance can be cumbersome. Treatment plan The goal of the treatment plan is to provide Alberto with both substance abuse and mental health services in the similar setting with the same treatment plans and team of health care providers/ clinicians. I being one of the treatment staff in GMHC, I will ensure that I maintain contact with Alberto and continue his treatment after and during the psychiatric referral. In addition to that, I will provide concrete assistance to Alberto such as offering transport services to the referral psychiatric site which will help in Alberto’s success in accomplishing psychiatric services. Since it will be difficult for me to address the client complex counseling and mental health needs, I will have to involve multiple care providers present at GMHC. Since Alberto is enrolled in Antiretroviral Treatment Program, the drugs have adverse effects which are related to most of the anxiety symptoms being experienced by Alberto. Additionally, the treatment side effects negatively affect the emotional well being of clients. As such, I recommend that the health workers at GMHC be vigilant in relation to possible severe side effects of the treatment program (Wounter, et al., 2009). The treatment plan will also establish the correlation between depression and coping strategies (Olley, et al., 2009, Fleishman & Fogel, 1994, Dew et al., 1997, Demanco, et al, 1999). In that case, I will endeavor to identify Alberto’s coping strategies to depression and anxiety. If Alberto is utilizing strategies that are maladaptive, then he will be entitled to therapeutic counseling (Fleishman and Fogel, 1994). To reduce Alberto’s symptom of depression, I will make him participate in a support group. According to the studies conducted in Thailand, it was established that social support low levels is often linked to high depression levels (Lil et al., 2009). Social support is a coping mechanism that is protective and assists HIV positive individuals in solving their problems and expressing their emotions. The outcome is reduced psychological stress (Miller & Kaizer, 2001, Kalichman et al., 2003). If all these treatment plans are adhered to by Alberto, then he will be able to be from anxiety and depression problem and develop strategies to cope up with his HIV status. Measurements As described in the appendix below, data on socio-economic, demographic, behavioral, health and psychosocial variables were collected. Socio-economic variables were such as dwelling type, education level, food supplements and financial statuses of the client. Behavioral variables on the other hand comprised of the use of tobacco, alcohol and engaging in sexual activities. Psychological factors were such as psychological and coping support. Variables related to health were such as quality of life that is health related, the period since the HIV positive test and side effects of antiretroviral treatment program. In the study, depression and anxiety referred to anxiety and depression symptoms that are self-reported. Anxiety and depression symptoms were measured utilizing HADS. This tool was originally developed as a self-administering tool that helps in addressing depression and anxiety in patients that are medically ill. The scale comprises of four options of response and also has two subscales comprising each seven questions. The subscales are effective in measuring depression and anxiety and ranges from 0-21. The greater the scale number, the higher the symptoms of depression or anxiety in a patient. According to earlier psychometric investigations, HADS is effective in achieving both test-retest reliabilities and internal consistency. In addition to that, HADS is extremely sensitive to change and helps in providing valid assessments in populations that are HIV positive and present in settings that are resource limited as in the case of Alberto. Summary In the case of Alberto, therapeutic interventions need to be sensitive with regards to his ethnicity and culture. If possible, support group and therapist leaders, I being one of them should share Alberto’s culture and also speak his language. The compatibility culturally among case managers, therapists, client and service provider is vital in creating an atmosphere field with trust in which issues that are sensitive including group mores and family support can be addressed. As such, I need to take cultural factor into consideration in the psychiatric symptom assessment. Moreover, pharmacologic approaches standards can be used to counter the psychiatric disorders in substance abuse clients that are HIV infected with consideration that are specific. Without any exception, psychiatric and medical diagnosis evaluation needs to be performed before any medication is provided to the client. References DeMarco, F.J, Ostrow, D.G, Di Franceisco, W. (1999). General and AIDS-specific stress, coping, and psychological distress in biracial coping & change study cohort of gay men. AIDS, 57(1):73–92. M.A, Becker, J.T, Sanchez, J, Caldararo. R, Lopez, O.L, Wess, J, Dorst, S.K, Banks, G.(1997).Prevalence and predictors of depressive, anxiety and substance use disorders in HIV infected men: A longitudinal evaluation. Psychol Med, 27:395–409. Fleishman, J.A, Fogel B.(1994). Coping and Depressive Symptoms among people with AIDS. Health Psychol, 13(2):156–169. Kalichman, S.C, DiMarco, M, Austin, J, Luke, W, DiFonzo, K.(2003). Stress, social support, and HIV-status and disclosure to family and friends among HIV-Positive men and women. JBehav Med , 26(4):315–332. Li L, L.S.J, Thammawijaya, P., Jiraphongsa, C., Rotheram-Borus, M.J.(2009). Stigma, social diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDS, 18(8):481–487 Miller, C.T, Kaizer, C.R.(2001). A theoretical perspective of coping with stigma. J Soc Issues Behav, 3(3):177–186. Olley, B.O, Seedat, S., Nei, D.G, Stein, D.J. (2004). Predictors of major depression in recently outcomes after 12 months of public-sector antiretroviral treatment in the Free State Province of South Africa: A longitudinal study using structural equation modelling.BMC Publ Health, 9:103. Spies, G., Kader, K., Kidd, M., & Seedat, S.(2009). Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. Journal of Auds Care, 21(9), 1163-1168. Wouters, E, Heunis, C, Van, Rensburg, D, Meulemans, H.(2009). Physical and emotional health support and depression among people living with HIV in Thailand. AIDS Care, 21(8):1007–1013 Appendix: Detail of Measures Data on socio-economic, demographic, psychological, behavioral and health variables were sampled. Demographic variables were such as gender, age, residence district and marital status. The marital statuses were categorized into cohabiting, single, not cohabiting, divorced, widowed or single. Single is a term used to refer to those individuals without a partner, cohabiting refers to individuals living with a partner regardless they are or not married. Variable not-cohabiting refers to those individuals whose partners were away during the time of interview. Variable of socio-economic were such as dwelling type, education level, food supplements and financial status. Education level consisted of four categories such as primary, none, matric, secondary and post matric. Dwelling type on the other hand was categorized into traditional, informal, formal and other. Under other the options were such as an apartment in a flat or block, hostel or backyard dwelling. Financial support based on how the participants supported themselves financially. Under financial status, there were seven categories such as old-age pension, disability grant, employed, child-support grant, household support, outside household support and other. Under food supplement variable we had options of supplement offered as part of ART program offered by the government. The categories provided were, currently, previously or never. Behavioral variables were such as tobacco use, alcohol use and sexual activity engagement. The tobacco use and alcohol use were variables that are dichotomous. Dichotomous in this case refers to whether an individual is actively engaged in the activity rather than knowing how much a patient has engaged in such an activity. On the other hand, sexual activity in the study referred to whether the participants had engaged themselves in any sexual intercourse six months before the carrying out of the study. In this category the variables were such as, frequent use of condom, condom use inconsistency, and never use of condom. Finally the psychological factors were such as psychosocial and coping support and stigma. . Read More