Treatment Plan

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Capella University *

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Feb 20, 2024

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Treatment Plan Jessica M Watts Capella University SWK 5013 Dr. Jennifer Agelidis 06/04/2023

Case History Identifying Information : Olivia Pepper is an African American Woman, age 30 years old. She is petite with brown eyes and medium-length brown hair. She is wearing baggy clothes and appears to be unkempt. Her behavior seems to be on edge and nervous. Referral Source : Olivia was referred to the University Counseling Center by her professor. Her referral was due to concern over her behavior and an overall decline in academic performance. Presenting Problem : Olivia's professor referred her due to her erratic behavior, spotty attendance in class, and tardiness. Olivia is described as a "bright student" by her professor but is failing two classes. Olivia's peers have reported she has a disinterest in her coursework assignments and has "smelled of alcohol" on more than one occasion. Olivia states she "has no desire to get out of bed." She shares that these feelings have increased over the past six months and says she feels "worthless." She has no support system as she hasn't communicated with her mother since she was 14, her father passed away, and she does not talk to her sister. Olivia's husband does not understand her mental health struggles and will yell at her to get out of bed. He is not a support for Olivia. Olivia is concerned about her children and how her mental health impacts their development. Olivia has a concern regarding turning into her mother. History of Problem : Olivia's erratic behavior has been seen since she was about 14 years old. Around this age is when her mother left, and her father became the sole parent in the household. Olivia began drinking alcohol around the time her mother left. She got her first DUI at 16 years old. This was when she first received treatment at a facility, but she states, "she did not have an issue drinking." Olivia started drinking again after the birth of her first child. She says, "her baby had colic and her coping mechanism was drinking." She got her second DUI

when she was 22. Olivia lost her job because of the second DUI. After the birth of her second child, Olivia states, "it all became too much," and she attempted suicide by overdose and alcohol consumption. Due to this attempt, Olivia was hospitalized and decided to seek treatment with AA to help her get better. Olivia finds that church and AA are essential to her life and have motivated her to return to school to help children like herself, and everything seems to be going fine. Olivia admitted that she started drinking again throughout the school day and would sneak drinks at home so her family wouldn't see. Olivia feels pressured to leave school because her husband recently got laid off from work, and he wants her to work to help with bills until he can find a job. Olivia feels overwhelmed by her situation at home, affecting her academic performance. Olivia's stressful situation is also contributing to a mental health decline. Olivia presents to my office in baggy, loose-fitting clothes. Her hair is messy but pulled back. She comes off defensive and appears to be anxious. Olivia seemed distracted and was constantly fidgeting and biting her nails. Her thought process appeared disorganized, and she needed help to stay on topic. There seems to be some denial and avoidance surrounding alcohol use. Olivia harbors guilt about her drinking, parenting, academic performance, and who she is becoming. She has considerable depression that can be seen physically in her appearance. Her anxiety is present in her mannerisms. Olivia feels her family is financially vulnerable, and she does not know how she will help and continue her education. Olivia is feeling overwhelmed in all aspects of her life currently. Throughout the session, Olivia avoided and excused talking about her alcohol use. More discussion will be had regarding her enrollment with the University. Depending on what Olivia decides, a conference will be held with the school's dean and school board to help her academically proceed with the following steps. With continued enrollment, Olivia will be

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encouraged and supported to reach out to the University's Disability Services to obtain accommodation for her classes that may alleviate some of her feelings of being overwhelmed. Previous Counseling Experience : Family Counseling in her teens. Individual counseling after hospitalization. Family Background : Mother, Mrs. Gloria Louis, age 49. Gloria grew up in a religious household where they attended church every Wednesday night for bible study and every Sunday for mass. Gloria was the oldest of 5 siblings. Her dad ran a construction business, and her mother stayed home with the kids. They lived comfortably. Gloria started exhibiting symptoms of severe depression when she was 13. By the time she was 15, she was experiencing frequent highs and lows in mood, negatively impacting her decision-making. She started stealing money from her parents and running away to spend nights with her boyfriends. Gloria's parents feared for her safety and future and decided to put her in an all-girls boarding school. She was prescribed lithium, doxepin, and diazepam. She was officially diagnosed with bipolar disorder, major depressive disorder, anxiety, and PTSD. Gloria did not maintain a relationship with her family once she aged out of the group home (at 18). Gloria met Tony at a bar in a small town, and they fell in love quickly. They had only dated for three months before they got married. At 19 years old, Gloria gave birth to her first child Erin (Olivia's older sister). When Gloria was 24 years old, she had Olivia. Olivia was a quiet baby, easy to take care of. However, Gloria suffered from severe postpartum depression and required hospitalization. When Olivia was two, her mother relied on help from her father often. Gloria had a habit of starting and stopping her medications frequently, which consistently altered her mood and behavior. Gloria was not a present parent during Olivia's childhood. She was either out for days at a time or home sleeping. By the time

Olivia was in her teens, Gloria had left and did not return. Olivia has not talked to her since by choice. Father, Mr. Tony Louis, died at 54 from liver cirrhosis directly related to alcoholism. Tony grew up in an abusive household at the hands of his alcoholic father. They lived in poverty and never knew where their next meal would come from. Tony started acting out in his early teenage years. He was 12 when he started drinking. His drinking continued to worsen, and he frequented the bars daily. Tony met his wife, Gloria, at one of his regular spots. Tony had two children, Erin and Olivia. Tony and Gloria had a difficult marriage between Gloria not maintaining stability on her medication and Tony's continued drinking. Eventually, Gloria left, and Tony became a single father. His drinking never stopped. Husband, James Pepper, 32 years old. Oliva and James were high school sweethearts and married when she turned 18. They have three children together. Olivia and James frequently argue about her drinking and his struggle with keeping a steady job. James recently lost his position in his current career. He pressures Olivia to step up to help but is unsupportive regarding her mental health struggle. James does not know how bad it's been for Olivia recently, and she hides her drinking from him. Olivia has three children, aged 2, 6, and 8. We did not discuss her children in detail at this time. Personal History : Olivia was born to Gloria and Tony Louis with no birth complications. Olivia was a quiet baby, easy to care for. She met all her developmental milestones throughout childhood. When she was around six, she noticed her mother would leave for long periods without communication. Olivia often sat on her front porch and waited to see if her mother would come home. Eventually, this became so common that Olivia stopped waiting

around. Olivia's relationship with her father was strong, and they spent much time together. Olivia was a good student and performed proficiently for the grade level. When she was 14 years old, her mother left, and that's when Olivia's academic performance started to decline. Olivia would often skip school to go drinking with her friends. Olivia's father struggled with his drinking problem while trying to figure out how to be a single father. At 16, Olivia got her first DUI and stayed at a center for drinking. Her dad thought it to be the best option. Throughout her adulthood, Olivia often turns back to drinking when things get hard to deal with. She earned her second DUI when she was 22 years old. Medical History : Olivia's overall health has been good. She goes to yearly physicals. However, Olivia struggles with mental health and has done a stay in the hospital for a suicide attempt. Olivia was referred to a treatment program and individual therapy. Educational History : Olivia completed her GED. She is currently at university, and her academic performance is in decline. Social Class : Olivia's family is considered working class. Cultural History : Olivia is an African American woman. Both of her parents are African American. She was born and raised in the South. Olivia married a Caucasian man, and they have three children. Spirituality : Olivia grew up Baptist. Currently practices no religion. Mental Status/Current Functioning : Appearance : Olivia is dressed in baggy clothing, her hair unkempt and overall messy. Attitude : Olivia is not aggressive or belligerent. She is cooperative throughout the interview. Motor activity : Olivia has no tremors, tics, or muscle spasms. She appears to be discouraged. Affect : Olivia's tone is appropriate for conversation.

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Mood : Olivia presents as overwhelmed and discouraged. She is conflicted regarding circumstances at home. She is disappointed by her drinking but maintains it is not an issue. She is vocal about being uncomfortable with turning into her mother. Speech : Olivia speaks at appropriate volumes, and her tone is maintained throughout the conversation. She has no stutter. Thought process : Olivia is coherent. She can form logical thoughts. Perception : No evidence of depersonalization or derealization. Olivia's thought process about drinking is distorted. Denial that there is a drinking problem. Orientation : Olivia is aware of time, day, and place. Olivia is exhibiting symptoms of depression which are evident when looking at her. She appears to be down and has feelings of sadness and disappointment. Cognitive function : Cognitive function intact. Abstraction : Olivia is an abstract thinker. Judgment : Olivia's issues cause disturbances in her academic performance and mental health. Olivia does not realize the severity of this decline and the role alcohol plays in the situation. Insight : Olivia has difficulties admitting she has an alcohol problem. Olivia seems unaware that other circumstances enable drinking, and if both things are not addressed (mental health and drinking), she will be stuck in the cycle. In the case of Olivia, I would use the DSM-5-TR Self- Rated Level 1 Cross-Cutting Symptom Measure Adult. I would then assess using Level 2 Cross- Cutting Symptom Measures for depression and substance use. F33.2 : Major Depressive Disorder, Recurrent, current episode severe without psychotic symptoms. F10.20 : Alcohol Use Disorder, Moderate.

Demographical Information Name: Olivia Janine Pepper Address: 17 Aspen Street-Connecticut. Phone#: 2034447485. Email: OPepper30@yahoo.com Birthdate: January 13 th , 1993 Age: 30 Gender: Female Gender Pronouns: She/her Allergies: None Language spoken/Preferred Language: English Relationship status: Married Occupation: unemployed – university student. Presenting Problem & DSM-5-TR Diagnosis Identification of main problems is the foundation for treatment planning (Nakash et el., 2018). Olivia is showing a significant problem with alcoholism, mood regulation, and the pressure of not turning into those that have negatively impacted her life. While it can be observed that her alcohol disorder can be linked to a genetic variable, it also shows a pattern related to Olivia's moods. Olivia self-medicates when she is faced with anything complicated. Her negative self-talk, lack of support, and self-image highly contribute to Olivia's depression. Without proper intervention, Olivia will have a difficult time breaking this cycle. Olivia Pepper suffers from Depressive Disorder, Recurrent (F33.2), and alcohol use disorder (F10.20). Depressive Disorder, Recurrent, is a disorder characterized by repeated

episodes of depression, the current episode being severe without psychotic symptoms. Alcohol Use Disorder involves heavy or frequent alcohol drinking, even when it causes problems, emotional distress, or physical harm. Assessments & Mental Health Theories Olivia's depression was assessed by using the Hamilton Depression Rating Scale. The Hamilton Rating Scale for Depression, abbreviated HDRS, HRSD, or HAM-D, measures depression in individuals before, during, and after treatment. The scale is administered by health care professionals and contains 21 items, but is scored based on the first 17 items, measured on either 5-point or 3-point scales. It takes 15 to 20 minutes to complete and score (Hamilton, 1960). Olivia scored a 21 on the test, indicating severe depression. This test focuses on emotional and psychiatric symptoms and symptoms that can cause physical distress. It is always essential to re-test using this method once feeling stable on treatment. The Alcohol Use Disorders Identification Test (AUDIT) contains 10 multiple-choice questions about how much and how often you drink alcohol and if you have any alcohol-related problems or reactions. The answers are scored on a point system. A score of 8 or more may indicate AUD (NIH, 2021). Olivia scored a 9, which means AUD. These can be done by a PCP or mental health care professional. One theory to connect to Olivia's case would be behavioral theory. The behavioral theory holds that psychological events can be described and explained regarding observable behavior and its associations with environmental stimuli and occurrences (Angell, 2023). The behavioral theory links Olivia's current behaviors directly back to some of her experiences in life. Thus, those experiences create a coping behavior, negative in manner, that leads to other mental health symptoms. With this theory, it leaves a lot to explore. For example, is Olivia's AUD directly

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linked to genetics or learned behaviors from seeing her father struggle with alcoholism? Or is Oliva's AUD a coping behavior due to her mother's abandonment and Olivia's trauma surrounding that occurrence? Using this theory gives more room for exploration to pinpoint further where the problem is and how to address it appropriately. Treatment Intervention Plan F33.2: Major Depressive Disorder, Recurrent, current episode severe without psychotic symptoms. Short-term goal: Olivia will attend in-person therapy once a week for the next three months. Long-term goal: Olivia will focus on self-care and reducing symptoms of depression. Objective: Olivia will take antidepressant medication as prescribed and therapy once a week for the next three months. Intervention: I/We will use Cognitive Behavioral Therapy (CBT). It is a combination of two therapeutic approaches known as cognitive therapy and behavioral therapy (NIH, 2016) to address symptoms of depression. It is recommended that Olivia keep a journal of her symptoms to focus on communication. Olivia will be connected to a psychiatrist for medication adjustment/management and is advised to follow up once a month. F10.20: Alcohol Use Disorder, Moderate Short-term goal: Olivia will reduce alcohol use weekly for the next two months. Long-term goal: Olivia will maintain abstinence from mood-altering substances, and consensual drug screens will be done every three months for the first year. Objective: For the next eight weeks, Olivia will focus on maintaining a balanced lifestyle. Eating healthy, being active, getting adequate sleep, sustaining work/life relationships.

Intervention: I/We will use Cognitive Behavioral Therapy (CBT). It is recommended that Olivia go to the AUD support meeting once every two weeks or once a month. It is advised that Olivia continues therapy at least twice a month. Counselors should work with all clients to decide what incentives will best motivate them. Motivational strategies in treatment involve several approaches, including assisting the client in understanding better the intrinsic rewards of a sober lifestyle and the negative consequences of continued use (Substance Abuse and Mental Health Services Administration, 1998). Realistically, treatment should never end for mental illness and substance abuse. For the sake of treatment planning, timelines are essential. The purpose of treatment planning timelines is to review progress. In some cases, the treatment plan needs to be revised and updated to meet better the needs of where the client has made progress. Applying the systems theory perspective to include Olivia's family at the micro, mezzo, and macro level as follows on a micro level, Olivia and her husband will participate in couples therapy using DBT for the family system. By doing this, it will allow them to have better communication with one another. Once individual therapy moves in the right direction for Olivia, moving into couples counseling will be vital. Once couples counseling moves in the right direction, Olivia and her husband can decide if they want to do family counseling with their children. On a mezzo level, Olivia will start working with someone in support groups for alcohol use disorder. Perhaps someone in a 12-step program. Olivia is encouraged to contact support groups to help with her sobriety. On a macro level, Olivia will be working with a psychiatrist to help with medication management and treatment. Once she has maintained sobriety, Olivia may want to speak on the dangers of alcoholism to other people in the 12-step program, but that's something for her to decide throughout her treatment.

Ethical Dilemmas & Diversity Needs Olivia suffers from an alcohol use disorder. Working with clients such as Olivia, who have substance addictions, can be complicated for the client and the social worker. Sobriety does not come easy and requires work. An ethical dilemma that can be in question is that, as a Social Worker, there needs to be an understanding of self-determination. Olivia will make her decisions all on her own and pushing her to make decisions she is not ready to make can do more harm than good. Countertransference is the therapist's emotional reaction to the client. As the Social Worker, caution must be taken when projecting one's feelings onto the clients. Olivia may not be successful with her sobriety the first go, which is why treatment plans are usually made to go back and revise them based on progress. In the NASW Code of Ethics, 1.02 Self-Determination - Social workers respect and promote clients' right to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' right to self- determination when, in their professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others (NASW, 2023). When working with Olivia or her family as the social worker, it is essential not to make assumptions about her or her family's life just based on how we interpret something from one quick meeting. Allowing her to build a relationship with the social worker and having the social worker see who she or her family is. By doing this, it avoids stereotyping. As the social worker learns the honest Olivia, it helps with diversity. Because Olivia struggles with depression and addiction but still wants to continue her education, some needs must be addressed academically. A mental health provider will help Olivia fill out paperwork to submit to Olivia's universities disability services. By doing this, they will provide Olivia with accommodation for her schoolwork so that she can efficiently complete it and still get a good grade. Mental illness is

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considered a disability, and many individuals feel ashamed to ask for help when it comes to accommodations as they think their struggles aren't physical. Disability associated with mental illness significantly contributes to the global disease burden, as per the National Sample Survey Organization (Chaudhury et el., 2006). Evaluate Client Progress In therapy, measuring progress, effectiveness, or outcomes, and using the information to help guide or adjust treatment, has been shown to significantly improve therapy outcomes. Measuring progress or effectiveness during therapy allows a client and therapist to discuss what seems to be working, what doesn't seem to be working, and any need for adjustments to the treatment (Walton, 2012). Social workers should track client progress. That can be done through goal attainment scaling. Goal attainment scaling (GAS) was initially introduced by Kiresuk and Sherman in 1968 as a means of examining outcomes in mental health trials and has subsequently been widely used in rehabilitation settings. Goal setting is an accepted way of empowering patients to achieve better health outcomes (Clarkson et el., 2021).

References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 Angell, B. Behavioral Theory. Encyclopedia of Social Work. Retrieved 11 Jun. 2023, from https://oxfordre.com/socialwork/view/10.1093/acrefore/9780199975839.001.0001/ acrefore-9780199975839-e-30. Center for Substance Abuse Treatment. Substance Use Disorder Treatment For People With Physical and Cognitive Disabilities. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1998. (Treatment Improvement Protocol (TIP) Series, No. 29.) Chapter 3—Treatment Planning and Service Delivery. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64875/ Chaudhury PK, Deka K, Chetia D. Disability associated with mental disorders. Indian J Psychiatry. 2006 Apr;48(2):95-101. doi: 10.4103/0019-5545.31597. PMID: 20703393; PMCID: PMC2913573. Clarkson K, Barnett N. Goal attainment scaling to facilitate person-centred, medicines-related consultations. Eur J Hosp Pharm. 2021 Mar;28(2):106-108. doi: 10.1136/ejhpharm-2019- 002040. Epub 2020 Feb 25. PMID: 33608439; PMCID: PMC7907701. Cooper, M., & Lesser, J.G. (2015). Clinical Social Work Practice: An Integrated Approach (5th ed.). Pearson Learning Solutions DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure Adult. Retrieved April 22, 2023, from https://www.psychiatry.org/psychiatrists/practice/dsm/educational- resources/assessment-measures

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23 , 56-61. http://dx.doi.org/10.1136/jnnp.23.1.56 Nakash O, Cohen M, Nagar M. "Why Come for Treatment?" Clients' and Therapists' Accounts of the Presenting Problems When Seeking Mental Health Care. Qual Health Res. 2018 May;28(6):916-926. doi: 10.1177/1049732318756302. Epub 2018 Feb 7. PMID: 29415635. National Association of Social Work (2023) About , NASW, National Association of Social Workers . Available at: https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/ Social-Workers-Ethical-Responsibilities-to-Clients (Accessed: 07 June 2023). NIH (2021) Alcohol use screening tests: Medlineplus medical test , MedlinePlus . Available at: https://medlineplus.gov/lab-tests/alcohol-use-screening-tests/ (Accessed: 07 June 2023). NIH (2016). Cognitive behavioral therapy - informedhealth.org - NCBI bookshelf, Cognitive behavioral therapy. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279297/ (Accessed: 20 May 2023). Walton, R. (2012) Measuring therapy progress, effectiveness and outcomes , Measuring Therapy Progress, Effectiveness and Outcomes | Colonial Behavioral Health . Available at: https://www.colonialbh.org/about-us/news-and-events/measuring-therapy-progress- effectiveness-and-outcomes.aspx (Accessed: 07 June 2023).

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