Social Work Assessment and Intervention Plan - Case Study Example

RUNNING HEAD: SOCIAL WORK ASSESMENT AND INTERVENTION PLAN. CASE ANALYSIS: MELINDA Social work assessment and intervention plan. Case analysis: Melinda Name Course: Tutor: Date SOCIAL WORK ASSESSMENT AND INTERVENTION PLAN: MELINDA Introduction Social work assessment is an integral process in determining the problems and needs of clients service users (or as consumers) of mental health services and in designing effective social work interventions. This essay will provide a report on social work mental health assessment in the case of Melinda, a 30 year old woman referred to a community mental health service from a local drugs and alcohol services counsellor. The essay will analyse Melinda’s case and develop an assessment and intervention plan by applying Collingwood’s three stage framework or “Kit” theory for social assessment. The essay will use Collingwood’s three stage framework to discuss issues and concerns for assessment in Melinda’s situation, highlight the information that needs to be collected for assessment and intervention and outline the theories underpinning the assessment and intervention plan. The essay will also provide a reflective account of some of the social work assessment practice guidelines, professional values and personal values and how they may affect the assessment and intervention plan in the case of Melinda. Case Analysis: Melinda. Application of Collingwood’s Three Stage “Kit” Framework Stage One: Service User Profile The first stage of Collingwood’s framework is constructing a service user profile which would help identify some of the issues that will be important for current as well as subsequent assessments (Collingwood 2005). It is important for the social worker to have extensive and comprehensive knowledge about the client and the numerous economic, legal, social, interpersonal, religious, medical and psychological systems which may impinge on them (Hepworth et al 2010). Therefore, the primary concern from the information provided in the referral and from client engagement in Melinda’s case is that she has been dually diagnosed with co-occurring substance abuse (alcohol) and mental illness (Kessler 2004). She has also provided information that hints at schizophrenia (hearing voices in her head). Therefore, the primary concern is her physical and mental health status due to the combined effects of successive miscarriages and alcohol abuse. Melinda has also been the victim of sexually abuse by her uncle and an abusive relationship with her father and has recently experienced a break-up of her seven year marriage which indicates that she has several psychological problems such as grief and trauma. Her history of alcohol abuse and her current cohabitation with a friend who is a heavy drinker are also since alcohol abuse appears to have compounded her situation. Another issue of concern is her economic status in terms of employment or employability due to her mental health condition and alcohol abuse which would have to be addressed in the intervention plan. However, the most significant concern is her mental health state as she has been diagnosed with bipolar and borderline personality disorders and has even confided that she harbours suicidal thoughts due to grief and a feeling of worthlessness. These issues of concern as developed in the service user’s profile are important as the effectiveness of the intervention plan will be determined by the extent to which it addresses the root causes of Melinda’s problems. In additional to mental health assessment, other assessments necessary in Melinda’s case include grief and bereavement assessment in preparation for grief and trauma counselling, alcohol and substance abuse assessment to help identify the most effective intervention strategy and personality and skills assessment to assess her employment prospects, her ability to earn a regular income and subsequently to afford accommodation in a safe and supportive environment (Parrish 2010). Another assessment that may be required is a medical gynaecological examination to assess the effects of the miscarriages she has experienced. These assessments are also important in determining whether the social worker is suitable or appropriately skilled to meet Melinda’s needs or whether they need to make a further referral (Parker and Bradley 2007, Hepworth et al 2010). Social Work Assessment Practice Guidelines In conducting the first stage of the assessment, there are several social work assessment practice guidelines and professional values which are important. Significantly, in making first contact and conducting the mental status exam, the social worker must show respect, empathy and authenticity towards the client (Egan 2009, Milner and O’ Bryne 2009). They should also be non-judgmental and actively encourage the client to participate in the assessment and volunteering information. For instance, in a mental status exam, the social worker could use screening questions such as whether she has trouble sleeping or reflexive questions such as whether she thinks she drinks too much which would indicate her own assessment of her problem (Milner and O’Bryne 2009). This information would provide valuable input to the intervention plan. Assessment is also best conducted as dialogue rather than interrogation, allowing the social worker to pick up on cues such as body language, mood, appearance and temperament which would help to construct a more comprehensive service user profile (Collingwood 2005, Egan 2009). Second Stage: Theory Circle The second stage of Collingwood’s framework is the theory circle where the social worker identifies al the theoretical bases that might help achieve a better understanding of the client and the environment in which they inhabit (Collingwood 2005). This stage includes identifying both the theories to inform and explain Melinda’s world and the theories to intervene which shape the intervention plan. In Melinda’s case, the theories to inform include attachment theory which is used to explain the consequences of childhood sexual abuse on adults (Alexander 1992, Cole and Putnam 1992). Using the attachment theory, Melinda’s psychological problems such as bipolar and borderline personality disorders that she has been diagnosed with, her mood swings, interpersonal problems (in her marriage), symptoms of Schizophrenia (nightmares, voices in her head), low self esteem, suicidal tendencies and her drinking problems are symptoms of insecure attachment with her father and her uncle due to physical and sexual abuse (Brennan et al 1991, Alexander 1992). Another theory to inform would be psychoanalytic theory which would trace Melinda’s mental disorders such as schizophrenia (hearing voices in her head), drinking and marital problems to early childhood trauma or negative childhood experiences as revealed by Melinda- physical and sexual abuse (Braun and Sachs 1987, Healy 2005). Systems theory could also be used to understand how Melinda’s family, friends and social networks have shaped her current situation such as abusive parents and relatives (uncle) and living with a friend who has a tendency to drink heavily further complicating her drinking problems (Healy 2005). On the right hand side of the theory circle, theories to intervene in Melinda’s world would include systems theory which would help identify whether Melinda’s social supports are positive for her mental recovery and in helping her overcome her alcohol abuse problems (Healy 2005). Good social work practice would use this theory to recommend interventions that address the role of Melinda’s work and home environment in stabilizing her mental condition and helping her deal with alcohol dependency and abuse (Braun and Sachs 1987). Another theory to intervene would be social learning life skills theory which would help address Melinda’s employability and income status since she desires separate accommodation and her personality problems. This theory would recommend interventions to help Melinda handle stress, low self esteem (feelings of worthlessness) or the traumatic effects of grief (Parrish 2010). Proposed Intervention Plan Based on the theories of intervention identified in the theory circle, there are several intervention strategies which would be recommended for Melinda based on the results of the mental status exam and on psychoanalytic and systems theory. In the immediate short term, Melinda should be referred to a welfare support services officer for grief counselling and enrolment in an alcohol rehabilitation program. The support services officer should help Melinda by giving her advice on how to resolve her concerns over disclosure of her mental health status with her employer by outlining the implications of her disclosure and her rights not to be discriminated against as outlined under the Mental Health Act 2007. Due to the information revealed in the client engagement which suggests suicidal tendencies, Melinda should also be put on suicide watch where a mental health social worker should be immediately mandated to make regular interactions and visits with Melinda to curb any suicidal tendencies. Furthermore, a medical assessment should be conducted on Melinda with the aim of establishing whether she is eligible for anti-depressant and sleeping medication which would help with her sleep deprivation which appears to be a consequence of depression. The medical assessment would also help establish if there is any link between her alcohol abuse and her miscarriages and any potential lasting effects which may pose future complications. In addition, it is recommended that Melinda be assigned a social mental health worker either at the community mental health services centre or a private mental health practice that is convenient to her in terms of accessibility. The mental health social worker should also provide support in terms of providing advice on how Melinda can find affordable accommodation for herself and help her to identify a stable and supportive environment that can facilitate Melinda’s rehabilitation from alcohol abuse. The recommended long term care options for Melinda are the identification, by the social worker, of groups for victims of childhood sexual abuse and alcoholics anonymous groups which Melinda should join to scaffold counselling and recovery efforts. Based on systems theory, these support groups will help Melinda share her experiences and greatly facilitate resolution of any psychological problems related to childhood sexual abuse. The Third Stage: Knowledge, Skills and Values The third and last stage of Collingwood’s framework is identification of the knowledge, skills, values and ethical considerations that might enter into the practice situation for the mental health social worker (Collingwood 2005). The theory circle developed in the second stage helps the social worker to identify the skills required by the social worker for effective assessment and intervention with Melinda. For effective mental health assessment, the social worker needs effective communication and interpersonal skills that would help collect the relevant information to identify Melinda’s problems and needs. In conducting a mental status exam, the social worker should observe Melinda’s appearance, her mood and other non-verbal aspects such as her orientation during the client engagements (Egan 2009, Parrish 2010). The social worker should also explore other areas that might be of concern by asking screening questions that may shed light on more information about Melinda. The social worker also needs special face to face interviewing skills and quantitative data collection, analysis and report writing skills to be able to record and present Melinda’s information and recommendations for interventions clearly and concisely which could also be used for future referral (Collingwood 2005: Hepworth et al 2010). Social Works Ethics and Practice Standards In conducting the assessment, the social worker should be guided by social work ethics and practice standards. They should: show respect for the client, empathy, authenticity to their concerns, engage them in manner that is consistently professional, remain detached from their situation and be non-judgemental manner without impinging on their right to privacy (Hepworth et al 2010, Parker and Bradley 2007). This is important to uphold objectivity of the assessment. The worker should also be aware of the legal responsibilities under legislations such as the Mental Health Act 2007 and its provisions for involuntary hospitalization should the client display symptoms of causing harm to themselves due to mental illness. Personal Values There are several personal values that a social worker carries into the assessment which may affect the priorities, direction and the interventions recommended in the assessment (Milner and O’Byrne 2009). For example in Melinda’s case, as a social worker I may have a predisposition to believe that clients suffering from mental disorders are unstable and unpredictable and this may impede objectivity in interviewing and collecting information as I may fill informational gaps deductively on my own or discount the importance of some of the information provided. I may also tend to be over-sympathetic with Melinda and as a result attempt to initiate personal contact and/or support outside of my role as a social worker. However, through self reflection, a social worker should discount for this influence by being non-judgemental in their engagement with the client since preconceptions of persons suffering from mental illness as inherently unstable negatively affects purposeful and objective collection of information for the service user profile. Conclusion In Melinda’s case, the issues and concerns raised from first engagement and referral basically collect in-depth information about her mental, social, interpersonal, medical and psychological history or circumstances. The assessment would be guided by social work assessment practice guidelines and standards such as respect and empathy for the client and professional values such as confidentiality (Parker and Bradley 2007). Based on systems, psychoanalytic and developmental theories, the assessment proposes that Melinda be referred to a welfare support services officer with regular support from a mental health social worker. The interventions proposed are that she undergoes further psychiatric and medical assessment, be provided with grief counselling and enrolled in an alcohol rehabilitation program. The personal values that may affect the objectiveness of this assessment include preconceptions of people with mental illness as unstable and a tendency to establish personal relationships with the client out of sympathy. References Alexander, P.C. (1992). Application of Attachment Theory to the study of sexual abuse. Journal of Consulting and Clinical Psychology 60 (2), 185-195. Brennan, K. A., Shaver, P. R., & Tobey, A. E. (1991). Attachment styles, gender, and parental problem drinking. Journal of Social and Personal Relationships, 8(2), 451– 466 Braun, B. G., & Sachs, R. G. (1987). The development of multiple personality disorder: Predisposing, precipitating, and perpetuating factors. In R. P.Kluft (Ed.) Childhood antecedents of multiple personality . Washington, DC: American Psychiatric Association. Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60 (4), 174– 184. Collingwood, P. (2005). Integrating Theory and Practice: The Three Stage Theory Framework. Journal of Practice Teaching 6 (1), 6-23. Egan, R. (2009). Developing the Helping Relationship: Engagement. In Maidment, J. & Egan, R. (Eds). Practice Skills in Social Work and Welfare: More than Just Common Sense ( 2nd Ed). Crow’s Nest: Allen and Unwin. Healy, K. (2005). Social work theories in context: creating frameworks for practice. New York: Palgrave Macmillan. Hepworth, D. H., Rooney, R. H., Rooney, G.D., Strom-Gottfried, K. & Larsen, J.A. (2010) (8th Edn). Direct Social Work Practice: Theory and Skills. Belmont (CA): CENGAGE Learning. Kessler, R.C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry 56 (10), 730– 737. Milner, J & O’Byrne, P. (2009). Assessment in Social Work. Basingstoke, Hampshire: Palgrave Macmillan. Parrish, M. (2010). Social Work Perspectives on Human Behaviour. New York: McGraw Hill. Parker, J. & Bradley, G. (2007). Social Work Practice: Assessment, Planning, Intervention and Review 2nd Ed. Southenhay East (UK): Learning Matters. RUNNING HEAD: CASE REPORT FOR SOCIAL WORK ASSESMENT AND INTERVENTION PLAN: MELINDA. Case Report for Social work assessment and intervention plan: Melinda Name Course: Tutor: Date Case Report for Social Work Intervention Plan: Melinda 1.0 Summary of Case Analysis The social work mental health assessment was conducted on Melinda, a 30 year old woman who was referred to the Community Mental Health Service by a local drugs and alcohol counsellor for mental health assessment. The referral had indicated what appeared to be a chronic alcohol abuse (binge drinking) as an issue of concern and also provided more information about the client who had a history of mental disorders having been diagnosed with bipolar and borderline personality disorders. Therefore, from the referral, the client was dually diagnosed with co-occurring mental illness and alcohol and substance abuse or addiction problems. From the first sessions of client engagement, more information about the client’s personal history emerged as she confided that she had been a victim of childhood sexual abuse by a relative, her uncle, and an abusive relationship with her father who suffered from post traumatic stress disorder. It also emerged that the client had suffered successive miscarriages and had experienced the breakup of her seven year marriage where her mood swings were cited as the precipitating factor. The client confided that she was prone to heavy drinking as a coping mechanism for grief and feelings of desertion. In conducting the mental health assessment, other issues of concern that emerged from construction of the service user profile about the client’s physical and mental health included symptoms of clinical depression, schizophrenia, sleep deprivation, suicidal tendencies due to feelings of worthlessness and grief and cohabitation with a friend who had a tendency to drink heavily which negatively compounded the client’s situation. In conducting the assessment and developing the intervention plan, several theories were employed to inform the social worker of the client’s circumstances. The theories to inform as used in Collingwood’s three stage theory framework included attachment theory. Using attachment theory, the client’s mental and psychological problems and alcohol abuse were traced to her abusive relationship with her father and being a victim of sexual abuse by her uncle. Psychoanalytic theory was also used to understand the client’s mental disorders, marital and alcohol abuse problems to early childhood trauma or negative childhood experiences as revealed by the client herself. Systems theory was used to explain how the client’s family, friends and social network have contributed to her current situation by either providing or failing to provide a supportive environment. This includes her current living arrangement where she lives with a friend who has a tendency to drink heavily. Several theories were also employed in developing the intervention plan based on the mental health assessment. Significantly, systems theory was used to suggest that the client needed social supports which are positive or conducive for her mental recovery and in addressing what appears to be a chronic alcohol addiction and abuse problem. Another theory to intervene used was the social learning life skills theory which was used to understand and address the clients’ economic status with relation to their employability and ability to pursue her desired living arrangement. Consistent with best practice in social work mental health assessment, these theories helped to identify the client’s problems, needs and strengths and to prioritize the necessary intervention strategies by helping the client cope with or handle stress, low self esteem, nightmares, sleep deprivation and other traumatic effects of grief due to her failed marriage and successive miscarriages. 2.0 Recommendations for Action 2.1 The case analysis by the social worker first recommends that the client be subjected to further assessments such as grief and bereavement assessment, alcohol and substance abuse assessment and medical assessment. These assessments would to help establish whether there are any emergent medical issues or long term physical effects due to alcohol abuse and her successive miscarriages and the client’s eligibility for anti- depressant or other medications. 2.2 The social worker’s assessment and intervention plan also recommends that as a precautionary measure and contingent on the outcome of medical and alcohol and substance abuse assessment that the client be put on suicide watch as a high risk candidate dually diagnosed with co-occurring mental illness as well as alcohol abuse. 2.3 The social worker further recommends that the client be referred to a welfare support services officer. The referral should be made with recommendation that the support officer facilitates grief counselling, enrols the client into a suitable alcohol rehabilitation program and provides consultation and advice on how the client can find suitable and affordable accommodation which is consistent with their interests and provides a supportive environment for rehabilitation from alcohol (unlike their current living arrangement). 2.4 The report also recommends that in light of the long term care options as determined suitable by the assessment that the client be assigned a mental health social worker preferably from a private mental health practice to provide continuous monitoring and support for the client by identifying and recommending support groups that might help the client cope with her mental, alcohol abuse, marital and medical problems. 3.0 Advocacy The social worker as the case manager would advocate for the client by consistently representing the best interests of the client and responding to changes or challenges by making decision that continue to represent the client’s best interests in the course that may arise in the course of the interventions as recommended by the report. As the case manager and social mental health worker, I would first advocate for the client by providing a referral to the welfare support services officer and to the social worker assigned to the client based on the assessment and intervention plan. In addition, as a social worker, I would advocate for the client by assuming decision making under the Mental Health Act 2007 as the social mental health worker for the client in the event that subsequent mental health assessment determines that they are at risk of committing suicide or are facing a deterioration in mental health status. With regards to the Act as best interest advocacy for the client as a vulnerable client , this would include recommending involuntary hospitalisation or medication and treatment as a social work professional should it be deemed necessary to do so (Moore 2009). In addition, as the social worker, I would advocate for the client on legal issues surrounding their employment under legislation such as the Mental Health Act 2007. This would imply acting as the consultant for the client on issues such as whether they feel they should disclose their mental health status to their employers and advising them on their rights not to be discriminated against under the Act. As the social worker, I would also advocate for the client through being a referee for their mental health status in the event that the client is applying for employment or for financial assistance and support from both private and public institutions. Consistent with best practice in advocacy, I would engage the client on a regular basis to ensure that their best interests are continuously represented throughout the intervention (Moore 2009). References Moore, E. (2009). Case Management for Community Practice. Oxford: South Melbourne. Read More