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1 Executive Case Summary Samuel Hinze Arizona State University
2 Executive Case Summary Setting/Your Role This reporter is a Master of Social Work intern at Chicanos Por La Causa drug and rehab in Phoenix, Arizona. The agency is a substance use rehab (inpatient) that serves men who are eighteen and older. Some of the services offered include group counseling, individual counseling, case management, help with employment and AA classes. This social worker’s main role is to run psychoeducation classes for residents at the rehab. Some of the topics this social worker teaches are psychoeducation drug classes, recreational therapy, art therapy and anger management to name a few. This social worker also sits in on and has performed intakes and assessments. Demographic information Mr. Woods identity’s himself as a white Caucasian heterosexual male. The client is 49 years old. He has never been married and has no children. He identifies himself as a Christian who believes in Jesus Christ. Presenting Issue/s The client was admitted to CPLC straight from jail. He is on probation for three years. He has had Hepatitis C for over thirty years and has not received any medical attention to address this issue. Mr. Woods has many goals that he wishes to work on which include, maintaining sobriety, completing probation, identifying triggers, finding employment, and obtaining access to health care to address his medical needs and Hepatitis C.
3 Brief History The client was born in Michigan in 1971. Mr. Woods had an extremely difficult childhood. His father was an alcoholic and drug user, and his mother was also an alcoholic and addicted to heroin. The client had two older siblings. Mr. Woods talked about his parents leaving the house for days while leaving him and his two older brothers at home alone. Often when he and his brothers were left alone there would be no food in the house. He grew up in extreme poverty and remembered his father always talking about how worried he was about not being able to make rent. This caused the client to have a fear of being homeless when he was younger. The client talked about how when he was little there would be bags of weed and drug paraphernalia in plain sight. He smoked weed with his father for the first time at the age of nine. The client’s father was an angry drunk and would physically abuse him and his mother. The client talked about his mother overdosing on heroin many times. His father would put her in an ice bath and would be slapping her to try and wake her up. The clients mother died at the age of 11, due to cirrhosis of the liver. At the age of 13 Mr. Woods father committed suicide. After losing both of his biological parents, he and his two older brothers moved in with his stepfather. The client said that his two other brothers were misbehaving so the stepfather had them move out to Phoenix, Arizona. At the age of sixteen the client was diagnosed with depression and was taking an anti-depressant but does not remember which one he took. The client tried Meth for the first time at the age of eighteen when he moved to Arizona and his older brother introduced it to him. Two years later the client would start shooting up Methamphetamine and shortly thereafter developed Hepatitis C.
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4 For many years, the client would smoke or inject meth on a daily basis. At the age of twenty-six, the client was arrested for the first time on charges of forgery and possession of methamphetamine. After being arrested for the first time, Mr. Woods would end up going back to prison numerous times over the years and many of his sentences ended up being two and a half years long. Since moving to Arizona in 1991, the client has spent close to fifteen years of that time being incarcerated. Strengths Mr. Woods has many strengths that can help him maintain sobriety. For one, He is a hard worker and enjoys staying busy. He can often be seen at Chicanos cleaning up in the kitchen or sweeping outside. He has had long periods of sobriety. He was sober from 2010-2015. The client is personable and easy to talk to. The client enjoys reading the Bible and attending a Bible study group at night at CPLC. Mr. Woods loves working out and lifting weights. He has compassion for others and says that he respects and enjoys serving the elderly. He can obtain housing when he graduates CPLC and will be able to move in with his sister-in-law. He attends and enjoys going to narcotics anonymous meetings. He mentioned being on probation as a strength, as random drug tests help him to stay sober. The client’s ex-sister-in-law is willing to let him live at her house upon leaving treatment. The client also says he has five or six friends that are sober. DSM-5 F15.20 Amphetamine-type substance use disorder, Severe Mr. Woods was diagnosed with Amphetamine-type substance use disorder. Since trying Meth for the first time at eighteen, the client would use everyday and his tolerance went up
5 quickly. By the age of twenty, Mr. Woods started to using methamphetamine intravenously. Shortly thereafter the client developed Hepatitis C. The client had difficulty keeping employment and was terminated from many jobs due to his substance use. The client has not used meth since September 9, 2019 due to being incarcerated. The clients Meth use would eventually lead him to homelessness. There were times when the client would try to stop but he was unsuccessful as his tolerance and cravings were too overwhelming. The client would often go to extreme measures to obtain the drug and would be up high for days wandering the streets. Treatment/Case Plan Intervention Problem area: Mr. Woods would like to gain more self-awareness about what causes him to relapse. Goal 1: Mr. Woods will identify 5 triggers that can lead to relapse. Objective A: Mr. Woods will write in his journal every day for ten minutes starting on Monday February 8, 2021 and will do so until he graduation for the program on February 25, 2021. Objective B: Mr. Woods will find a NA group that he will attend 3 times a week prior to leaving CPLC. Mr. Woods will know the time and location of the group that he will be attending by Saturday February 20, 2021. Objective C: Mr. Woods will find a sponsor at his new NA group by Saturday, March 6 , 2021.
6 Evaluation Plan It would be best to use the AB design to help Mr. Woods. The A-B design is the basic single subject design which includes, a baseline phase with repeated measurements and intervention phase that continues the same measures (Lanovaz et al., 2019). Chicanos Por La Causa does a formal evaluation process to better help clients understand where they are in the stages of change. CPLC uses the Change Assessment Scale, URICA to see what stage of change clients are in when they enter rehab. It’s crucial that the client’s treatment plan reflect the stage of change they are in to be affective. Clients are also given an evaluation survey when they leave CPLC to see if clients are satisfied with the services they have received. Theoretical Framework/Theory/Model/Intervention Mr. Woods has experienced many traumatic and difficult events that have led him to where he is at today. Mr. Woods recognizes the errors of his ways and wishes to learn and improve upon them. As a MSW Intern at CPLC, it is my job to educate and guide Mr. Woods in the right direction with the challenges that he is facing. The theoretical framework that this social worker will use in working with the client is the strengths perspective. This social worker will use the five stages of change from the transtheoretical model to best understand how progress can be made in helping the client get to next stage of change. This model will allow this social worker to best understand if the clients motivational level is improving, decreasing, or staying the same. The social worker will use motivational interviewing to allow the client to play a vital role in their treatment plan. Motivational interviewing will allow the client to feel in charge of the conversation and will also decrease the chances of the client feeling judged. The intervention
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7 this social worker will use in helping Mr. Woods is psychoeducation. This will allow the client to gain greater self-awareness and to develop healthier coping skills. Relevant Policies or other Macro Issues Being able to qualify for insurance or being able to receive adequate funding to enter CPLC can sometimes be difficult for clients to obtain. Fortunately, CPLC has access to a couple of different grants and funds to help most clients that come to CPLC be able to enter the program. Clients for CPLC are only allowed to attend the rehab program three times. This is Mr. Woods first time attending CPLC. CPLC has a grant called The Arizona Criminal Justice Commission that pays for clients to be able to enter the program who are unable to qualify for access. CPLC accepts many different types of health insurances including, Mercy Care and United Healthcare. The type of insurance that the client has determines the maximum amount of time that clients can stay at CPLC. For example, with united Healthcare the longest clients can stay is only 45 days, while for Mercy Care insurance clients are often able to stay for 90 days. The type of insurance that Mr. Woods has allows him to be able to stay for up to 30 days. Another major macro issue that affects the client is being able to qualify for health insurance so that he can address his Hepatitis C. Consultation Question What are some other agencies that could help Mr. Woods with his goals of maintaining sobriety and seeking medical attention for his Hepatitis C?
8 References Lanovaz, M., Lanovaz, M., Turgeon, S., Turgeon, S., Cardinal, P., Cardinal, P., Wheatley, T., & Wheatley, T. (2019). Using Single-Case Designs in Practical Settings: Is Within-Subject Replication Always Necessary?  Perspectives on Behavior Science ,  42 (1), 153–162. https://doi.org/10.1007/s40614-018-0138-9
9 Case Analysis Samuel Hinze Arizona State University SWG 621: Integrative Seminar Elizabeth Athens March 19, 2021
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10 Table of Contents Section A: Psychosocial Assessment …………………………………………………… 11 Section B: Treatment/Case Plan ………………………………………………………… 21 Section C: Discussion of Supporting Documentation ……………………………………24 Section D: Framework and Theory ………………………………………………………24 Section E: Best Practice/Evidence-Supported Interventions …………………………… 28 Section F: Impact of Culture, Diversity, and/or Forms of Oppression a=on the Case …. 30 Section G: Ethical Considerations ……………………………………………………… 33 Section H: Evaluation Design and Methodology ………………………………………. 35 Section I: Social and Agency Policies that Impaction the Case …………………………37 Section J: Self-Critique ………………………………………………………………… 39 Section K: Implication for Future Practice …………………………………………….. 43 References ……………………………………………………………………………… 46 Appendices ………………………………………………………………………………50 A. Family Genogram ………………………………………………………. 51 B. Patient Health Questionnaire …………………………………………….52 C. URICA ………………………………………………………………….. 53 D. Assessment Consent Forms …………………………………………….. 57 E. Client Orientation Handbook …………………………………………… 58
11 Psychosocial Assessment Client name: John Woods Date of Report: February 2, 2021 Name of Reporter: Sam Hinze Role/Position of the Reporter: MSW Therapist Intern at substance abuse treatment center Chicanos Por La Causa in Phoenix, Arizona. Setting of Services: Chicanos Por La Causa Date and Start/Stop time of Psychosocial Interviews/Services: Mr. Woods psychosocial assessment was completed on February 2, 2021 with MSW student intern Sam Hinze. The client’s treatment plan was completed on February 5 th , 2021 by this social worker and a CPLC counselor observing. This social worker met with the counselor on a weekly basis. The dates this social worker met with this client are 2/12, 2/19, 2/26, and 3/1. Other information that informed this report: CPLC received a report from 4 th avenue jail in Phoenix. The client has not received many mental health services throughout his life or any mental health services that are recent enough to be used in this report. Purpose of this Report: The purpose of this report is to help Mr. Woods develop a treatment plan towards self- efficacy. This social worker, Mr. Woods and a CPLC counselor will help create an appropriate treatment plan by looking at the clients presenting problems, passed history, diagnosis, and
12 present goals while he is receiving services at CPLC. This report will also help to identify the clients needs and will help the client to maintain those needs after transitioning from CPLC. Demographics Mr. Woods identity’s himself as a white Caucasian heterosexual male. The client is 49 years old. He has never been married and has no children. He identifies himself as a Christian who believes in Jesus Christ. Prior to being arrested and going to CPLC, the client was experiencing homelessness and was using methamphetamine daily. Presenting Problems The client was admitted to CPLC straight from 4 th avenue jail in Phoenix. Mr. Woods is on probation for 3 years due to being arrested for possession of methamphetamine on September 21 st , 2020. Mr. Woods has struggled with methamphetamine use for almost thirty years and has been unable to maintain long periods of sobriety without being incarcerated. He has had Hepatitis C for over thirty years and has not received any medical attention to address this issue. Mr. Woods has many goals that he wishes to work on which include, maintaining sobriety, completing probation, identifying triggers, finding employment, and obtaining access to health care to address his medical needs and Hepatitis C. The client has struggled with homelessness for years, but he will be able to live with his sister-in-law upon leaving CPLC. Client History The client was born in Michigan in 1971. Mr. Woods had an extremely difficult childhood. His father was an alcoholic and drug user, and his mother was also an alcoholic and addicted to heroin. The client had two older siblings. Mr. Woods talked about his parents leaving the house for days while leaving him and his two older brothers at home alone. Often when he
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13 and his brothers were left alone there would be no food in the house. He grew up in extreme poverty and remembered his father always talking about how worried he was about not being able to make rent. This caused the client to have a fear of being homeless when he was younger. The client talked about how when he was little there would be bags of weed and drug paraphernalia in plain sight. He smoked weed with his father for the first time at the age of nine. The client’s father was an angry drunk and would physically abuse him and his mother. The client talked about his mother overdosing on heroin many times. His father would put her in an ice bath and would be slapping her to try and wake her up. The clients mother died when Mr. Woods was 11 years old, due to cirrhosis of the liver. At the age of 13 Mr. Woods father committed suicide. After losing both of his biological parents, he and his two older brothers moved in with his stepfather. This was not the client’s real stepfather but was an old boyfriend of the client’s mother from years past. Although the stepfather was strict, Mr. Woods states that he treated him and his brothers very well and he provided them with all their physical needs. The client said that his two other brothers were misbehaving so the stepfather had them move out to Phoenix, Arizona. At the age of sixteen the client was diagnosed with depression and was taking an anti- depressant but does not remember which one he took. The client tried Meth for the first time at the age of eighteen when he moved to Arizona and his older brother introduced it to him. Two years later the client would start shooting up Methamphetamine and shortly thereafter developed Hepatitis C. For many years, the client would smoke or inject meth daily. At the age of twenty-six, the client was arrested for the first time on charges of forgery and possession of methamphetamine. After being arrested for the first time, Mr. Woods would end up going back to prison numerous
14 times over the years and many of his sentences ended up being two and a half years long. Since moving to Arizona in 1991, the client has spent close to fifteen years of that time being incarcerated. Strengths Mr. Woods has many strengths that can help him maintain sobriety. For one, He is a hard worker and enjoys staying busy. He can often be seen at Chicanos cleaning up in the kitchen or sweeping outside. He has had long periods of sobriety. He was sober from 2010-2015. The client is personable and easy to talk to. The client enjoys reading the Bible and attending a Bible study group at night at CPLC. Mr. Woods loves working out and lifting weights. He thoroughly enjoys having a morning routine. The client likes to get up early and drink his coffee, read the bible, pray, and exercise. He has compassion for others and says that he respects and enjoys serving the elderly. He can obtain housing when he graduates CPLC and will be able to move in with his sister-in- law. He attends and enjoys going to narcotics anonymous meetings. He mentioned being on probation as a strength, as random drug tests help him to stay sober. The client’s ex-sister-in-law is willing to let him live at her house upon leaving treatment. The client also says he has five or six friends that are sober.
15 Social Service Delivery symptoms Mr. Woods is attending and receiving services at Chicanos Por La Causa for his struggles around using methamphetamine. Mr. Woods is currently doing weekly private one hour counseling sessions with a substance abuse counselor. Mr. Woods is currently on probation for three years and speaks with his probation officer every couple of weeks. The client is able to get free health care through AHCCCS while he is on probation. AHCCCS pays for transportation for Mr. Woods and drives him to many important appointments. Legal Issues The client is currently going to be on probation for three years. Mr. Woods will have to take random monthly drug tests. If Mr. Woods ends up failing three drug tests he would most likely go back to jail. After leaving CPLC, Mr. Woods will be required to attend outpatient drug classes. The client also has some felonies from the past which includes drug paraphernalia possession and theft. He has some legal fines to pay and may go to homeless court and get his fees dismissed. DSM-5 F15.20 Amphetamine-type substance use disorder, Severe The client also has experienced many years of homelessness in his life and his z code diagnosis is ICD-10-CM Code Z59.0. Mr. Woods may not have to experience homelessness after leaving CPLC since his sister-in-law is allowing him to move in with her and is a positive influence as she does not use any drugs or alcohol.
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16 Mr. Woods was diagnosed with Amphetamine-type substance use disorder. Since trying Meth for the first time at eighteen, the client would use every day and his tolerance went up quickly. By the age of twenty, Mr. Woods started to using methamphetamine intravenously. Shortly thereafter the client developed Hepatitis C. The client had difficulty keeping employment and was terminated from many jobs due to his substance use. The client has not used meth since September 9, 2019 due to being incarcerated. Prior to being arrested Mr. Woods stated that he was smoking around one gram of methamphetamine daily. The clients Meth use would eventually lead him to homelessness. Using methamphetamine has caused Mr. Woods to lose many jobs in his life. There were times when the client would try to stop but he was unsuccessful as his tolerance and cravings were too overwhelming. The client would often go to extreme measures to obtain the drug and would be up high for days wandering the streets. There are many risks to long term methamphetamine use which include an increase of having a stroke and developing Parkinson’s disease. Other long- term effects include tooth loss and severe tooth decay and sores on the skin due to users picking and scratching. Some long-term mental affects include psychosis, paranoia, and hallucinations. Some other negative mental health affects include deficits in thinking in motor skills, memory loss, an increase in aggressive or violent behavior and severe mood disturbances (NIDA, 2020). When interviewing Mr. Woods, it appears that his cognitive abilities, judgment, and emotional regulation are all particularly good. The client does not appear to be experiencing any physical or mental withdrawals. Even though Mr. Woods appears to be doing particularly good it is this social workers opinion that he should be diagnosed with amphetamine-type substance use disorder. This is because Mr. Woods has not been able to maintain long periods of sobriety in his
17 life unless incarcerated. Mr. Woods has a lot going for him and has a positive support system but needs to prove that he can stay sober when not in jail. Physical Health Mr. Woods appears to be in decent health, but he has some health issues he needs to attend to. The client obtained Hepatitis C over thirty years ago with little treatment. While a patient at CPLC Mr. Woods will be attending numerous doctor appointments to help manage his hepatitis C. The client smokes ½ pack of cigarettes daily. The client states that he often feels fatigued. Mr. Woods is currently not on any medication and is not presenting any withdrawal symptoms currently. The client does not report any other medical concerns. Mr. Woods does not appear to have any major behavioral or emotional concerns. The client is currently in the contemplation stage of change as evidence by choosing to enroll in the CPLC drug rehab program. Mr. Woods has always presented himself as being alert with a relaxed mood and dressing himself appropriately. The client has good insight and judgment and also has a good memory. Current Developmental Stage According to Erikson’s stages of development Mr. Woods is in the developmental stage of intimacy vs isolation. Mr. Woods is a 49-year-old male who has expressed that he would want to get in a long-term romantic relationship but that he wants to make sure that he is sober and will not bring the other person down. When it comes to the transtheoretical model of change around the client’s substance use Mr. Woods is in the contemplation stage. This is exhibited by Mr. Woods checking himself into CPLC and the progress that he has made with working on his goals.
18 Family Functioning/Social Functioning Prior to jail and coming to CPLC the client was experiencing homelessness. Mr. Woods states that he was not hanging out with the best group of people. Since moving to Arizona, Mr. Woods has not had a strong family support system to rely on. For example, Mr. Woods has never even met his grandparents. Mr. Woods parents never introduced him to any extended family, and he chose to move to Arizona when he was 18. For years, the clients main social support system has been meth users living on the streets and those he associated with in jail. Housing and Activities of Daily Living Mr. Woods is currently living at CPLC. He has a roommate that he gets along well with. Mr. Woods attends all his groups and does his chores and homework assignments. Mr. Woods attends a two-hour psychoeducation group in both the morning and afternoon. Mr. Woods attends narcotics anonymous meetings five times a week at night and even reads the bible with other CPLC patients daily. Mr. Woods can often be seen at CPLC doing chores such as sweeping the sidewalks. Mr. Woods enjoys the routine and schedule of the agency. Mr. Woods enjoys going to the park to participate in recreational therapy and watching movies with other patients during down time. Vocational/Educational Training The client is a high school graduate and has not completed any college. The client has made many jobs in his life in the food industry working with his hands and has also had many jobs while in prison. The client used to work at Burger King and at a pizza shop and also stated that he has had some hard labor construction jobs as well. Most of the client’s jobs have been minimum wage. Some of the jobs the client had while in prison were working at Hickman’s
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19 eggs, picking tomatoes, and working at a car auction picking. Over the years Mr. Woods has been able to make thousands of dollars while in jail working but does not currently have any money. The client is a hard worker and is confident in his ability to obtain employment. Financial Well Being The client is currently in a financially difficult place. The only money he has is a $600 stimulus check that he will be receiving upon graduating CPLC. The client recently had all his clothes and belongings stolen out of a storage shed. He also has some legal and court fees to pay and stated that he has some overdraft charges from a bank. The client desperately wants to find a job so that he can contribute to paying rent and it will help him to maintain sobriety and have a daily routine. He considers himself to be extremely blessed as his sister-in-law has agreed to let him live with her in her apartment. Hobbies/Recreational Activities Mr. Woods stated that he loves being outdoors and enjoys flying drones. The client is a strong Christian and uses his faith to cope. He enjoys reading the bible and attending nightly Christian bible study groups at CPLC. The client thoroughly enjoys working out and having a good morning schedule. Client States that it’s important to him to start the day off right. Coping Strategies Mr. Woods has many coping strategies which include being outside, exercising, and flying drones. He enjoys having a morning routine and reading the bible and praying as a daily routine. Since attending CPLC Mr. Woods has started journaling his thoughts and feelings daily. He has also learned some further coping strategies while attending CPLC including
20 psychoeducation groups on the basics of meditation. Mr. Woods enjoys staying busy working and having a schedule to keep him busy. Ethical and Cultural Issues that are present and need to be presented This social worker recommends that the client attend group settings and interventions that incorporate the client talking about God and how he helps him. Mr. Woods is a white Christian Caucasian male, and most institutions are culturally competent to his needs. Christianity plays a huge role and is a coping skill for Mr. Woods. He enjoys attending narcotics anonymous meetings since the meetings incorporate spirituality and talking about God. This social worker recommended that Mr. Woods find a Christian church to attend to help him build a support system. Overall Goals While attending CPLC the client’s goals are to maintain sobriety and address and maintain his overall physical and mental health. Due to having free health care Mr. Woods is extremely serious about getting medical treatment for his hepatitis C. He meets often with his case manager to discuss the next steps in his hepatitis C treatment. Mr. Woods is also serious about maintaining his sobriety. He shows this daily by attending and participating in groups, completing his CPLC homework, and journaling his thoughts and feelings. Mr. Woods is also dedicated to finding employment so that he can contribute to paying food, rent, and having a positive routine schedule. This is exemplified by Mr. Woods meeting with the CPLC employment specialist every week to talk about the next steps and resources to finding a job. Signature: Date:
21 Section B Treatment or Case Plan   Client Name: John Woods Date of Completion: 2/5/21 Client Date of Birth:   5/3/1971 Date of Review: 2/19/21 Social Worker Name: Sam Hinze Presenting Problem Area 1: The clients physical and mental health has been neglected due to methamphetamine use, incarceration, and homelessness. Goal Problem Area 1: Maintain physical, mental, and emotional wellbeing.   Objectives   Intervention used to address specific objective   Who is responsible   Date of completion/review   A).  Attend all doctor appointments to obtain a physical and get treatment for Hepatitis C.  -Client will attend doctor appt. on 2/10/21 to get a physical and blood work done. -Client will then schedule to see a kidney specialist on 2/17/21. -Get on medication to treat Hep C. -Mr. Woods, CPLC case manager, and AHCCCS while on probation. -Client will get a ride to doctor appts through AHCCCS (Veyo). Initiated on 2/5/21 Review on 2/19/21 B).  Continue with a morning routine that includes exercise, prayer, reading, and meditation.   Since entering CPLC program on 2/2/21 the client began a morning routine that consisted of exercise, prayer, reading and meditation. This social worker and CPLC counselor encouraged Mr. Woods to continue with his morning routine. Mr. Woods, CPLC counselor and future sponsor. Initiated on 2/5/21 Review on 2/12/21 C).  Strive to obtain employment   Meet with CPLC employment specialist every Tuesday at 3:00pm to work on resume and obtain employment resources. -Client will seek employment resources from probation officer upon Mr. Woods and CPLC employment specialist, probation officer. Initiated on 2/5/21 Review on 2/19/21
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22 leaving CPLC. Presenting Problem Area 2: Mr. Woods has a long history of methamphetamine use and has often failed to stay sober unless he is incarcerated. Goal Problem Area 2: Mr. Woods will maintain his sobriety. Objectives   Intervention used to address specific objective   Who is responsible   Date of completion/review    A).  Find a Narcotics Anonymous group to attend once a week before leaving CPLC.  -Client will attend CPLC NA groups 5x per week and will ask group leader and other participants about finding a good sponsor. -This social worker and CPLC counselor will look for NA meetings in the Phoenix area for client to choose from. -The client will obtain one sponsor a week and contact them. -Client will choose a sponsor before leaving CPLC program. Mr. Woods, this social worker, CPLC counselor, and NA group leader. Initiated on 2/12/21 Review on a weekly basis until client graduates the program on 3/2/21. B).  Help the client complete a relapse prevention plan.  -The client received a homework packet upon entering the program and one of the sections included a relapse prevention plan, identifying triggers and people to contact when in danger of relapsing. -This social worker and the client’s counselor will review and talk about the relapse prevention plan on a weekly basis. Mr. Woods, CPLC counselor, and this social worker. Initiated on 2/5/21 Review on a weekly basis until client graduates the program on 3/2/21. C).  Journal thoughts and feelings daily.   -Client will bring his journal to group psychoeducation and NA meetings and write down 3 things that stood out to him each day. -Client will strive to journal one page each day while at CPLC about their thoughts and feelings. Mr. Woods, CPLC counselor, and this social worker. Initiated on 2/5/21 Discuss on a weekly basis until client graduates the program on 3/2/21.    Client Signature: John Woods Date: 2/5/21 Legal Guardian Signature: Date:
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23 Social Worker Signature: Sam Hinze Date: 2/5/21 Treatment Plan Summary While attending CPLC Mr. Woods has many goals that he wants to work on. Mr. Woods wants to learn to maintain his sobriety and wants to maintain his physical and mental health wellbeing. Some of the service agencies to help Mr. Woods with his goals include CPLC counseling and group sessions, working with the CPLC employment specialist, and using AHCCCS resources to address the treatment needed for his hepatitis C. AHCCCS will provide transportation to attend important appointments. Some of the expected changes that Mr. Woods should see while working on these goals should be an increase in confidence and an increase in coping skills to address his sobriety. This social worker should see positive growth and awareness in his daily journaling. Attending numerous appointments to address his hepatitis C and getting closer to obtaining medication to treat it. Some of the other changes should be working on his resume and obtaining more resources to find employment.
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24 C. Discussion of Supporting Documentation When a client is admitted to Chicanos Por La Causa for services, the first item that is given to them is a client orientation handbook. This handbook includes all the rules, policies, requirements, and regulations of the agency. The client is then given different consent forms which describes and allows the client to give permission to the agency to release certain information to different groups of people such as, family members, probation officers, health care providers, and other agencies. There are numerous forms for the client to sign and it is important to explain to clients what these forms are as clients will sometimes feel apprehensive signing them if they are not properly explained. Once these forms are signed by the client, an assigned counselor will complete the client’s assessment. The assessment helps the counselor obtain importance information about the client including the client’s history and background. After the client completes the assessment the client takes the University of Rhode Island Change Assessment Scale (URICA). This is to see what stage of change a client is at in regards to their substance use. Having clients take the URICA as it plays a big role in determining the client’s goals and treatment plan. The client will also take the PHQ-9 after being in the program for 2 weeks. Mr. Woods will take the PHQ-9 again prior to leaving the program to compare depression symptomology. D. Framework and Theory Mr. Woods has experienced many traumatic and difficult events that have led him to where he is at today. Mr. Woods recognizes the errors of his ways and wishes to learn and
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25 improve upon them. As a MSW Intern at CPLC, it is my job to educate and guide Mr. Woods in the right direction with the challenges that he is facing. The theoretical framework that this social worker will use in working with the client is the Strengths- Based Perspective. This social worker will use the five stages of change from the transtheoretical model to best understand how progress can be made in helping the client get to next stage of change. This model will allow this social worker to best understand if the clients motivational level is improving, decreasing, or staying the same. This social worker will also use psychoeducation an individual and group setting with the client. The social worker will use motivational interviewing to allow the client to play a vital role in their treatment plan. Motivational interviewing will allow the client to feel in charge of the conversation and will also decrease the chances of the client feeling judged. The intervention this social worker will use in helping Mr. Woods is psychoeducation. This will allow the client to gain greater self-awareness and to develop healthier coping skills. This social worker will also use psychoeducation an individual and group setting with the client. The strengths-based perspective was first developed in the late 80’s and early 90’s by Dennis Saleebey, Charles Rapp, and Anne Weick at the University of Kansas School of Social Welfare. Some of the main principles of the strengths-based perspective are that all people have strengths and the ability to grow and change. Interventions are determined on self-determination and communities and social environments are viewed as resources (Stuart, 2017). The strengths- based perspective will work well with Mr. Woods as it will be helpful to the client to focus on that he has going for him in his life rather than all his problems. This social worker also encouraged Mr. Woods to look for a Christian church to join as this could be a positive resource and support system in his life. A big part of the strength’s perspective is having faith and
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26 believing that people have the capacity to change. A problem that many counselors and mental health workers have is they spend too much time talking about client’s problems and never address the client’s strengths, coping skills, and community resources (Guo & Tsui, 2010). “Often, in traditional practice, the client’s role is often no more than the repository of the disease or the holder of the diagnosis: their personal characteristics or individual decisions are rarely considered, except where these support diagnosis.” (Pattoni, 2019) The strengths perspective is not so much a model as it is a therapeutic principles, ideas, and techniques. Some of the main principles in motivational interviewing include collaboration with the client, client’s self- determination, working with community resources and focusing on the client’s strengths. The strengths perspective believes clients are experts and know and understand their problems better than anyone else (Stuart, 2017). Research has shown that psychoeducation is a treatment modality that helps people understand the basic important facts about their mental illness and is effective in helping those who have a substance use or mental disorder (Ekhtiari et al., 2017). The clients at CPLC receive psychoeducation every day in a group setting. Clients attend two-hour psychoeducation groups twice a day that talk about how to implement effective psychoeducation. Some of the topics include mindfulness a holistic approach, potential triggers, and effective communication skills. The agency has a calendar that a rotates on a monthly basis and often will add new EBP practices. Mr. Woods will learn about many topics that are relevant to him and his substance use struggles with methamphetamine addiction. Psychoeducation will better help Mr. Woods to understand the important things he needs to do to address his substance use disorder. Motivational interviewing was first invented by PhD William R. Miller and was a counseling approach used in behavioral psychotherapy (Motivational Interviewing, 2019). Since
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27 this time motivational interviewing has evolved as a communication style that is used by social workers and many other mental health professionals. It will be effective to use motivational interviewing with Mr. Woods to help the client resolve their ambivalence and to help the client feel empathy and express their self-efficacy. Motivational interviewing will respect Mr. Woods right to client’s self-determination and will allow him to feel that he oversees setting his own goals rather than being forced. CPLC counselors and all other staff are taught to use motivational interviewing when interacting with clients. Motivational interviewing also helps to point out discrepancies that exist in the client’s current behavior as compared to their values and goals (Fisher & Harrison, 2017). The transtheoretical model of intentional behavior change was first developed by James O Prochaska Carlo Di Clemente in 1977 and has since further evolved. The transtheoretical theory model of change and the strengths-based perspective have often proven to be highly effective when working in conjunction with each other. The transtheoretical model focuses on five stages of change. These stages include precontemplation, contemplation, determination, action, and maintenance (Fisher & Harrison, 2017). At the pre-contemplation stage, the client does not acknowledge or act like a problem exists. The job of the therapist in this stage is to try and help the client gain awareness about their problem. At the contemplation stage the client is feeling ambivalence and can see that there may be a problem but it’s not worth it to stop (James et al., 2014). Mr. Woods was in the contemplation stage when he first came to CPLC. The therapist’s role in this stage is to help the client resolve ambivalence about their problem. The third stage is the determination stage. The primary task at this stage is to help the client identify effective coping and change strategies (James et al., 2014). Mr. Woods did this as he attended NA meetings and got phone numbers of
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28 people who could be his sponsor. The fourth stage is the action stage. At this stage it is effective to help the client put into action effective change strategies and to have a plan for relapse risks. The fifth stage is the Maintenance stage. At this stage, the client has achieved some goals and is working to sustain their change (James et al., 2014). It’s always important look at new skills or resources to help maintain recovery. It’s important to help the client heighten motivation and lessen their resistance. E. Best Practice/Evidence This social worker used a few evidence-supported models and interventions when working with Mr. Woods. This social worker strived to help Mr. Woods with his two main goals of maintaining his sobriety and his physical and mental health. Some of the interventions include psychoeducation, the strengths-based perspective and motivational interviewing. This social worker also focused a lot on journaling with the Mr. Woods. Journaling has been proven to be an effective evidenced-based practice in helping clients to obtain more clarity around their thoughts and feelings. This social worker was thoughtful and worked only within the bounds of their educational competency and professional training. To start with, this social worker used a lot of psychoeducation with Mr. Jones in both a group and individual setting. This social worker ran numerous psychoeducation groups with Mr. Woods attending while he was at CPLC. Some of the psychoeducation topics taught by this social worker that Mr. Woods attended include music therapy, denial and defenses, codependency and shame, and socialization skills. Mr. Woods always did a good job of participating in groups as he would ask questions and make useful comments. Research has shown major benefits of attending psychoeducation support groups. “ There is a common experience connecting the group because they share similar feelings, problems, concerns, and
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29 treatment decisions and outcomes. Support groups are a treatment option that gives people a nonmedical opportunity to hear from people in different stages of recovery” (Center, 2019). This social worker also used a lot of psychoeducation when working with Mr. Woods individually. Mr. Woods expressed a lot of interest in learning more about hepatitis C and how to lessen symptoms. This social worker printed out educational forms regarding hepatitis C and talked with Mr. Woods about many important factors such as eating foods that are high in fiber. This social worker also informed Mr. Woods about many important principles related to maintaining sobriety. Some of which include attending groups, accountability, having a relapse prevention plan and finding a sponsor. This social worker also talked about some of the long- term consequences of methamphetamine use such as psychosis, paranoia, mood disturbances, and memory loss (Journal of pharmacology and experimental therapeutics, 2020). When working with Mr. Woods individually this social worker always used the strengths-perspective and motivational interviewing. This social worker used the strengths perspective to better help Mr. Woods understand the positive things that he had going for him in his life. For example, Mr. Woods already has a morning routine, he has good awareness, and he is a hard worker. This social worker used motivational interviewing to better help the client strengthen his personal motivation and to better focus on Mr. Woods’ language of change. For example, Mr. Woods was often excited to talk about many positive things that can help him move forward such as finding employment and getting a sponsor for the first time in his life. Research shows that motivational interviewing is a common evidence-based practice that helps to elicit behavior change (Understanding Motivational Interviewing, 2017). Finally, this social worker and Mr. Woods focused a lot on the journaling goals that they had come up with during his treatment plan. Mr. Woods agreed to write down three things he
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30 learned in group as well as journaling a page of his thoughts and feelings each day. Mr. Woods did an excellent job of writing down three things he enjoyed in group every day and was very consistent in journaling his thoughts and feelings on a daily basis. Mr. Woods expressed that he liked taking notes in groups and that he usually enjoyed journaling a night. He also said that it helped him to better gather his thoughts and feelings with where he was at in his life. Journaling is an extremely effective tool in helping people with their emotional intelligence and mental health. Journaling helps people to be able to better manage their thoughts and feelings. “Also important to effective journaling is expressive writing. You aren’t simply recounting facts but instead expressing a stream of consciousness which involves thoughts, feelings, reactions, and emotions-no matter how random they may seem. Indeed, expressive writing has been shown to be particularly therapeutic” (Bastos, 2018). Numerous studies have shown that people who engage in consistent journaling end up making fewer trips to the doctor. Some studies even show that journaling can help boost a person’s immune system (Newman, 2020). F. The Impact of Culture, Diversity, and other Forms of Oppression on the Case Mr. Woods has experienced different forms of oppression in his life. To begin with, the client has spent years on the streets experiencing homelessness and being addicted to methamphetamine. The client has felt oppression by being homeless. We live in a society where there is much judgment and negative stigma on those who are homeless and addicted to substances. The client states that people have said many mean things to him while he has been on the streets. The client states that he has been called a loser and told that he needs to get a job when he has been on street corners pan handling.
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31 A recent study found that 4.2% of Americans have experienced homelessness for over 1 month sometime in their lives and 1.5% of the population has experienced homelessness in the past year (Tsai et al., 2017). Being homeless is extremely challenging as people will often have poor nutrition and will not eat for days. In Arizona It is dangerous to be homeless due to the extreme hot summers and excessive heat. There are also many dangers to being homeless such as being physically attacked or being robbed. Not having access to health care is also extremely dangerous. Homelessness and substance use often go hand and hand together. Many people experiencing homelessness will use substances to cope. Mr. Woods stated that he often used methamphetamine to cope with the challenges of being homelessness. Being addicted to methamphetamine can often be very time consuming and expensive as the high can often last for days. “The consequences of methamphetamine misuse are terrible for the individual- psychologically, medically, and socially. Using the drug can cause memory loss, aggression, psychotic behavior, damage to the cardiovascular system, malnutrition, and severe dental problems. Methamphetamine misuse has also been shown to contribute to increased transmission of infectious diseases, such as hepatitis and HIV/AIDS” (Journal of pharmacology and experimental therapeutics, 2020). This client has experienced oppression within the criminal justice system. The client states that his health care needs were not being met while incarcerated. The client has been suffering with the negative side effects of Hepatitis C for almost thirty years. While incarcerated the client felt severe itching and rash episodes due to a low fiber diet. The client could not sleep unless he wrapped his arms in wet towels. When speaking to employees within the jail system,
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32 the client felt that his healthcare needs were not addressed and that he was often ignored when trying to seek help. Mr. Woods has also felt that he has been oppressed by living in a halfway house. Upon being released from prison, Mr. Woods has gone to live at halfway houses several times in the past. The client states that halfway houses are a mess. He talks about it being difficult to maintain sobriety as many people in a halfway house are using drugs and other substances. Mr. Woods says that halfway houses are also extremely dangerous due the nature of residents not having money and using substances. He also says that the landlords have been extremely rude and demanding of rent money. He feels that they do not care about his wellbeing at all. Although there are some halfway houses that are decent, many of them are driven more for financial gain than in the interest in helping offenders successfully return to society (Gilna, 2015). “Too many incidents involving poorly-supervised halfway house residents and indifferent, or even criminal behavior by employees have occurred in almost every state as well as the federal prison system” (Gilna, 2015). An April 2014 recidivism report by the Bureau of Justice Statistics, found that 50% of offenders will return to prison within 3 years after being released (Gilna, 2015). This social worker was able to effectively work with Mr. Woods and with his unique individualistic forms of culture, diversity, and oppression. This social worker used empathy and reflective listening to help Mr. Woods as he talked about different forms of oppression that he has experienced in his life. Being that both this social worker and Mr. Woods are white Caucasian males, it allowed this social worker to be able to relate to the client. Christianity plays a huge role in this client’s life and this social worker also discussed some stories they liked in the bible to be able to relate to the client. Mr. Woods really enjoys support groups that embrace
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33 Christianity such as, narcotics anonymous which is offered at CPLC. Mr. Woods did not express that he has felt oppressed with his age, gender, or sexual orientation.
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34 G. Ethical Considerations. There are ethical concerns this social worker needs to consider when working with Mr. Woods. Social workers take an oath to defend the NASW code of ethics. Section 1.01 of the code of ethics is entitled, commitment to clients and it states that, Social workers primary responsibility is to promote the wellbeing of clients. In general clients’ interests are primary. This means that social workers are committed to do all that they can to help serve the best interests of the client within the bounds of the code of ethics. Section 1.02 says that social workers respect and promote the right to client’s self-determination and assist clients in their efforts to identify and clarify their goals. Clients’ self-determination is one of the most important principles in social work and it falls directly in line with many of the theories and interventions used in social work. For example, motivational interviewing and using the strengths-based perspective are directly related to using the clients right to self-determination. Mr. Woods and this social worker worked together as a team to help him come up with his goals and treatment plan. ultimately in the end Mr. Woods gets to decide what actions and goals he wishes to pursue. This social worker honored the client’s self-determination by allowing him to decide how serious he wants to take his sobriety and this social worker respected the clients wishes and was not bias. Section 1.03 (f) states that social workers who use technology to provide social work services should obtain informed consent from the individuals using these services during the initial screening or interview and prior to initiating services. This social worker had Mr. Woods sign a release of information prior to ever working on the client’s assessment and treatment plan. This social worker explained to the client that he would most likely need to ask questions and seek information from other CPLC counselors regarding the client’s case. This social worker also had Mr. Woods sign numerous forms of releases of information that were related to people
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35 such as, the clients probation officer and primary care physician. Section 1.04 (a) of the code of ethics says that social workers should provide services and represent themselves as competent only within the boundaries of their education training, license, certification, consultation received, supervised experience, or other relevant professional experience. When working with Mr. Woods, this social worker received permission to perform the client’s assessment and treatment plan with the supervision of another CPLC MSW therapist. This social worker also worked with the client in a group setting using psychoeducation, conducted private interviews, and was also allowed to sit in and observe some of the clients private weekly counseling sessions. There were times when working with Mr. Woods that this social worker wanted to do a therapy session with the client, but this social worker has not been trained to do this nor is it within the bounds that CPLC would allow. In other words, this social worker respected and worked only in the areas that they were competent and trained in. Section 1.05 of the code of ethics entitled, cultural awareness and social diversity says that social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures. Mr. Woods felt immensely proud to tell this social worker that he is a practicing Christian. Mr. Woods attends a private bible study group at CPLC on a nightly basis, and the client also stated that he prays every morning and night. This client stated that reading the bible and turning his life over to Jesus Christ has helped him to feel immense gratitude and guidance. In other words, Christianity has become a positive coping skill for the client. This social worker respected the client’s cultural awareness by allowing him to freely talk about their Christian faith. Section 1.07 (a) privacy and confidentiality, states that social workers should respect clients’ right to privacy. Social workers should not solicit private information from or about
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36 clients except for compelling professional reasons. This social worker always kept the conversation with Mr. Woods professional and was seeking solicit private information from the client only within the context of the client’s case, goals, and treatment plan. H. Evaluation Design and Methodology It would be best to use the AB design to help Mr. Woods. The A-B design is the basic single subject design which includes, a baseline phase with repeated measurements and intervention phase that continues the same measures (Lanovaz et al., 2019). “The AB design is merely a simple time-series design applied to a single case. The A refers to the baseline phase and the B refers to the intervention phase. Using the same logic as in the simple time-series design, if a shift in the data pattern dramatically coincides with the introduction of the intervention in the B phase, then the plausibility of maturation (passage of time), regression to the mean, and (to a lesser extent) history is reduced as rival explanations for the improvement” (Rubin & Bellamy, 2012). Chicanos Por La Causa does a formal evaluation process to better help clients understand where they are in the stages of change. CPLC uses the Change Assessment Scale, University of Rhode Island Change Assessment (URICA) to see what stage of change clients are in when they enter rehab. “The URICA is one of the most commonly used measures of change readiness and was developed to assess the change process regarding a variety of health and addictive behaviors as well as emotional readiness for change in clients” (Cohen et al., 2012). The URICA is a 32- questionnaire rating scale that asks clients specific questions that help to paint a picture of where the client is at in their readiness to change their addiction. At the end of the test the counselor will add up the patients scores to see what change of change they are in in the transtheoretical model stages of change.
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37 It’s crucial that the client’s treatment plan reflect the stage of change they are in to be affective. After completing the URICA it was determined that Mr. Woods was in the contemplation stage of change. This makes sense as it was reflected in his score and also due to the fact that the client checked himself into the program on his own free will. This social worker used motivational interviewing and the strengths perspective to better help the client understand their strengths and coping skills to help combat their substance use. The main goal when working with people who are in the contemplation stage is to try to help them to resolve the ambivalence they have around their addiction. This social worker did this by asking Mr. Woods what the pros and cons were to his substance use. This social worker also tried to give Mr. Woods more clarity by having the client talk about and see the barriers that he has had to maintaining his sobriety in the past. Mr. Woods also took the PHQ-9 depression scale after being in the program for two weeks. The test is designed to measure depression in two-week intervals to compare the result to see if there have been changes in behavior and mood. The rating scale questionnaire asks 9 simple questions to see if the client is suffering with depression. Many research studies have shown that the PHQ-9 is a reliable and consistent test that has validity and effectiveness in measuring depression (Heerema, 2021). The PHQ-9 has many advantages such as it is shorter than other depression scales, it facilitates accurate diagnosis of depression and it is well validated and documented in a variety of populations (PHQ-9 Depression Scale, 2021). Mr. Woods only stayed for one month, so the test was given to him after two weeks and again two days before he graduated the program. Mr. Woods had a low score on the test indicating that he was not currently suffering with depression. The test results seem accurate as Mr. Woods did not show symptoms of depression when interacting with this social worker and
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38 often talked about what he was happy about and grateful for in his life. Depression was also addressed in the assessment when this social worker asked the client if he was thinking about killing himself and the client said no. Mr. Woods was also given an evaluation survey prior to leaving the program. The survey asked questions on his opinion of the services he received while attending CPLC and what additional services he feels he could’ve received to further help him on his path to his recovery. I. Social and Agency Policies that Impact Your Client and Agency Being able to qualify for insurance or being able to receive adequate funding to enter CPLC can sometimes be difficult for clients to obtain. Fortunately, CPLC has access to a couple of different grants and funds to help most clients that come to CPLC be able to enter the program. Clients for CPLC are only allowed to attend the rehab program three times. Clients can get into the program three times and can stay from 30-90 days each time depending on the type of insurance the client has. If clients are unable obtain public housing upon leaving CPLC, the agency will often make exceptions to ensure that the client has a safe place to go. This is Mr. Woods first time attending CPLC. CPLC has a grant called The Arizona Criminal Justice Commission that pays for clients to be able to enter the program who are unable to qualify for AHCCCS. Sometimes CPLC will accept patients even though they do not qualify for insurance. This is rare but can happen as the authority is given to those who are high up in the chain of command of the agency. Coming from jail, Mr. Woods was able to qualify for AHCCCS and did not have to pay any money to attend the program. The total cost to attend CPLC is $200.00 a day or $6000.00 a month. Services include many things such as room and board, three meals a day, psychoeducational groups and many mental health services and counseling sessions. CPLC has
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39 outside agencies that come in monthly that do many things such as HIV and sexually transmitted disease psychoeducation groups and individual testing. CPLC also holds nightly alcoholics anonymous and narcotics anonymous groups and often has recovering addicts and inspiring individuals come in who have learned to maintain their sobriety. CPLC accepts many different types of health insurances including, Mercy Care and United Healthcare. The type of insurance that the client has determines the maximum amount of time that clients can stay at CPLC. For example, with united Healthcare the longest clients can stay is only 45 days, while Mercy Care insurance clients are often able to stay for 90 days. The type of insurance that Mr. Woods has allows him to be able to stay for up to 30 days. Another major macro issue that affects the client is being able to qualify for health insurance so that he can address his Hepatitis C. CPLC is one of the few substance use rehab programs in the valley that accepts sex offenders into the program. This is fortunate as sex offenders often do not have many options or places to go to receive mental health and addiction services. CPLC realizes that family plays a crucial role in recovery and tries to help them by offering family support groups. These classes offer psychoeducation on many topics such as healthy family communication skills, setting boundaries and better understanding the disease of addiction. The agency is very family friendly and offers an environment where families can come and visit to support loved ones struggling with substance use. Chicanos Por La Causa has had to adapt and make some changes due to the coronavirus pandemic. The agency has been strict on always making sure that clients and staff where masks and that everyone is doing their best to follow the six feet rule. A big change that CPLC has made is that they are currently not taking in any clients who are homeless and coming directly
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40 from the streets. In Mr. Woods case, the client came directly from jail to CPLC even though the client was homeless prior to being arrested. CPLC has also fluctuated how many patients there are at the facility. At maximum capacity, the agency can take in 60 male patients who are 18 or older. Since the pandemic, the agency has only been at half capacity and at one point the total number of attendees in the program was around 25. This extremely unfortunate, as the pandemic has caused an increase substance use due to social isolation and other factors. Covid has also affected clients from being able to participate in recreational therapy. Recreational therapy or going to the park to exercise and play sports is an important part of the CPLC program. Since Covid began, patients still go to the park, but the park has shut down many things such as, the baseball field and basketball court. Patients are only able to walk around the park or do exercises on their own. Many of the patients at CPLC have expressed frustration as they wish that they could play sports at the park. It is unfortunate that sports and exercise options are limited as playing sports is a healthy coping skill, it releases endorphins, and it would allow the other patients to bond with each other. J. Self-Critique of Your Work with the Client This social worker experienced many strengths when working with Mr. Woods. For one, I thoroughly enjoyed my time working with the client and getting to know him. I feel that I did an excellent job of building client rapport. I was non-judgmental and always allowed the client’s right to self-determination take precedence over any of my thoughts, beliefs, or values. I asked many open-ended questions to allow Mr. Woods to elaborate about his life. The client made me a personal copy of his autobiography and expressed to me multiple times that he enjoyed our time together. I used reflective listening and clarification to always try my best to see where Mr.
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41 Woods was coming from. I used psychoeducation with client to help him better understand certain topics that are important and relevant to his life. This social worker also experienced some challenges when working with Mr. Woods. I found it difficult and triggering to hear about the physical abuse that Mr. Woods experienced in his childhood. I felt grateful to being wearing a mask as it probably helped to hide some of the internal struggles I was feeling. I realize that this comes from personal experiences that I had when I was child. I have a difficult time when clients talk about being physically abused in their childhood. I reached out to my field instructor and told him about the experience. My field instructor told me that it was good that I had the self-awareness to realize this and that it may be something that I need to work through personally in counseling. I also struggled with feelings of inadequacy when working with Mr. Woods as I have never had my own client before. I felt insecure when performing the client’s assessment and treatment plan. This is because I asked many questions when completing the client’s treatment plan such as if the client’s goals followed the SMART model. I felt that working with Mr. Woods was challenging at times as I often compared myself to the other counselors. I told my field instructor about the struggle and he assured me that it was normal to feel this way and that I was doing a good job. There are many factors that contributed to Mr. Woods progress while attending CPLC. For one, the CPLC staff is extremely supportive, and Mr. Woods seemed to enjoy the daily schedule, structure, and routine. Mr. Woods expressed to me that he enjoyed attending the daily group classes as well as doing his homework and daily chores. Mr. Woods really likes having a routine in his life, and CPLC was able to offer that to him. I also feel that the client being a probation played a role in his commitment and attitude. Mr. Woods does not want to go back to
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42 jail and has expressed that he has a good relationship with his parole officer. For example, Mr. Woods parole officer made an exception and allowed the client to go live with his sister-in-law as opposed to a halfway house. Most importantly, the biggest contributor to Mr. Woods success was himself. Mr. Woods is in a place of humility as he recognizes the errors of his ways and looks forward to maintaining his sobriety and having a fresh start. Mr. Woods has exhibited that he is serious about his sobriety by doing many things such as, finding a narcotics anonymous group to attend and has also gotten the phone numbers of a couple of people that he may want to use as a sponsor. I have learned many important and valuable things while interning at CPLC. I have learned the importance of being non-judgmental and having unconditional positive regard for this population. Relapse is common as I have seen many clients who have returned to CPLC. Although it caused me many hardships in my life, I am grateful for the experiences I have had in my life when I struggled with my own substance use addiction. This has truly helped me to have more compassion and empathy for this population. Recovery is a journey and not a destination. I have noticed that when people return to CPLC, there are some that seem to feel shame when seeing me again as they feel that they have failed to maintain their sobriety. I always tell clients who have returned that I am incredibly happy to see them and that I think it is great that they are still striving to work on their recovery. While interning at CPLC I have become much more confident in performing assessments and leading groups. My field instructor has been a great example and mentor to me on both a professional and personal level. I have been so impressed with my field instructor as he is an amazing listener to the patients and he often allows them to come into his office and talk to him while he works on the computer. My perceptions and attitudes while interning at CPLC have also
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43 changed. When I began my internship, I had a lot of negative bias toward medication assisted treatment and the harm reduction model as I felt that these were enabling to clients. After talking with CPLC staff and looking at research, I now see the major benefits of incorporating both treatment modalities in a drug rehab setting. I have learned of the difficulty of treating patients with cooccurring disorders. Most patients at CPLC have cooccurring disorders and it seems to be an ever-learning process of trying to figure out the best ways to help each client individually. I have been extremely impressed with the culture and acceptance at CPLC as they are one of the few substance use programs that allows sex offender to attend. I will never forget when I first attended CPLC I was watching a counselor run a group and a patient said, “I love Methamphetamine and will never stop smoking it.” To my surprise the counselor running the group thanked the patient for his participation and honesty. This was a great example to me of unconditional positive regard and it is one that I have strived to incorporate and live up to when interacting with patients at CPLC. The agency has taught me the importance of self-care. The staff can often be seen in the back listening to music, singing and laughing. While this may appear insensitive to an outsider, I realized that the staff does this to cope with the difficult and traumatic stories that they hear from clients on a daily basis. I have learned the importance of using humor with clients as it can often help to lighten the mood and help clients to open up. I have learned of the extremely strong correlation that exists between trauma and substance use. At times it has been difficult to hear some of the client’s life experiences and it is easy to see why they have chosen substances to cope. If I were to do my case analysis over again, I would’ve made sure that I picked a client who was of a different cultural background than myself. While this is no disrespect to Mr.
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44 Woods, I do feel like I missed out on some professional opportunities to learn and grow. I initially had chosen a client who was of Puerto Rican descent, however circumstances came up and I was not able to work with this client. Looking back, I do feel that Mr. Woods came into my life for a reason and that I learned a lot professionally and personally in working with him. I feel that I did a great job of building client rapport with Mr. Woods and that we had a strong connection and understanding of each other. K. Implications of Future Practice Completing this case analysis with Mr. Woods has further confirmed to me that I want to work with this population and help those who are struggling with substance use. Since interning at CPLC I have become extremely confident and efficient at running psychoeducation groups. This is extremely exciting to me due to the fact that when I first started doing groups, I felt extremely nervous. I now look forward to running groups and thoroughly enjoy teaching and interacting with this population. Since interning at CPLC I can honestly say that I have developed a deep love for those who struggle with substance use. I thoroughly enjoy learning about people’s lives and honestly believe that everybody’s life story is unique and beautiful in their own way. As a former addict, I feel that I am doing something to help give back. This social worker also thoroughly enjoyed working with Mr. Woods in a one-on-one setting. It was extremely educational to complete the client’s assessment and treatment plan with the help of a MSW supervisor. Even though I have done many assessments at CPLC, this one felt different to me because Mr. Woods truly felt like he was my own client. In other words, working with Mr. Woods one on one has allowed me to further feel that I am stepping into the role of a MSW social worker and therapist. I feel more confident being able to work with clients in a one on one and private setting.
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45 At the same, there are many areas that I still need to improve upon. For one, I feel that I need to get better with the technology aspect due to zoom and the covid crisis. I feel that I need to get better at using the DSM-5 and learning how to accurately diagnose mental health disorders. Another area I can improve upon is getting better at completing client notes. Although I have greatly improved my writing, I feel that I need to further learn how to write client notes in a social work professional manner. I also feel that I need to get better at creating SMART goals with clients. Even though creating goals in a treatment plan seems easy, I have found it to be quite challenging to set realistic and beneficial goals. I also feel that I need to learn more cultural awareness and how to better serve those who are from diverse cultures, ethnicities and backgrounds that are different from my own. Different populations have different needs and therapeutic modalities that work for them. I also need to better learn to not take on clients’ short comings in a personal manner. For example, if I am working with a client and they end up relapsing or get kicked out of a program, I need to not take it upon myself as a personal failure. I need to practice and better learn the therapeutic techniques that I learned in school in one-on-one counseling sessions. For example, I need to practice doing cognitive behavioral therapy or dialectical behavioral therapy with clients one on one. As a MSW social worker and therapist I plan to always seek continuing education. After graduation I will study for the LMSW exam and take the test in June. After graduation I will also be seeking a job in a drug and rehab setting. I want to be able to have the opportunity to conduct groups, complete assessments and have one on one counseling sessions with clients. The versatility of this work setting sounds very fulfilling and enjoyable to me. My long-term goal is to work somewhere where I have the opportunity to complete the hours required to obtain my LCSW license.
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46 In conclusion, I have thoroughly enjoyed this case analysis and the educational opportunities it has given me. I am grateful that I now feel more comfortable having my own client and conducting assessments and client treatment plans. I am grateful for all the therapeutic modalities and social work terms that I have learned that are related to the field of substance use. Being in the MSW program has helped me further evolve and become a better social worker. I am excited to get out into the social work field and put everything I have learned into practice.
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47 Reference Bastos, F. (2018). The benefits of journaling for your Mental Health and how to start it – MindOwl . Mindowl. https://mindowl.org/the-benefits-of-journaling-for-your-mental- health-and-how-to-start-it/#:%7E:text=Journaling%20is%20an%20incredible %20tool,solve%20and%20manage%20stressful%20events . Center, A. A. R. (2019, September 9). The Benefits of Support Groups . Arizona Addiction Recovery Center. https://arizonaaddictioncenter.org/the-benefits-of-support- groups/ Cohen, Paul & Glaser, Brian & Calhoun, Georgia & Bradshaw, Catherine & Petrocelli, John. (2005). Examining Readiness for Change: A Preliminary Evaluation of the University of Rhode Island Change Assessment With Incarcerated Adolescents. Measurement and Evaluation in Counseling and Development. 38. 45-62. 10.1080/07481756.2005.11909768. Ekhtiari, H., Rezapour, T., Aupperle, R. L., & Paulus, M. P. (2017). Neuroscience-informed psychoeducation for addiction medicine: A neurocognitive perspective.   Progress in brain research ,   235 , 239–264. https://doi.org/10.1016/bs.pbr.2017.08.013 Fisher, G., & Harrison, T. (2017). Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors (6th ed.). Pearson.
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48 Gilna, D. (2015, January 10). When Halfway Houses Pose Full-Time Problems | Prison Legal News . Prison Legal News. https://www.prisonlegalnews.org/news/2015/jan/10/when- halfway-houses-pose-full-time- problems/ Guo, W., & Tsui, M. (2010). From resilience to resistance: A reconstruction of the strengths perspective in social work practice.   International Social Work ,   53 (2), 233– 245.   https://doi.org/10.1177/0020872809355391 Heerema, E. (2021, February 14). The PHQ-9: Patient Healthcare Questionnaire for Depression . Verywell Mind. https://www.verywellmind.com/phq-9-patient-healthcare- questionnaire-for-depression-4149685 James H. Bray, Alicia Kowalchuk, Vicki Waters, Erin Allen, Larry Laufman, Elizabeth H. Shilling. (2014) Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation .  Substance Abuse  35:4, pages 442-449. Motivational Interviewing in Addiction Treatment . (2019, September 4). American Addiction Centers. https://americanaddictioncenters.org/therapy-treatment/motivational- interviewing Newman, K. (2020, August 18). How Journaling Can Help You in Hard Times . Greater Good. https://greatergood.berkeley.edu/article/item/how_journaling_can_help_you_in_hard_tim es
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49 NIDA. 2020, July 20. Overview. Retrieved from https://www.drugabuse.gov/publications/research-reports/methamphetamine/ overview on 2021, March 19 Pattoni, L. (2019, October 17). Strengths-based approaches for working with individuals . Iriss . https://www.iriss.org.uk/resources/insights/strengths-based-approaches-working- individuals PHQ-9 Depression Scale | University of Washington AIMS Center . (2021). AIMS CENTER. https://aims.uw.edu/resource-library/phq-9-depression-scale\ Rubin, A., & Bellamy, J. (2012). Practitioner’s Guide to Using Research for Evidence-Based Practice (2nd ed.). Wiley. Stuart, G. (2017, November 15). What is the Strengths Perspective? Sustaining Community. https://sustainingcommunity.wordpress.com/2012/05/30/what-is-the-strengths- perspective/ Tsai, J., O'Toole, T., & Kearney, L. K. (2017). Homelessness as a public mental health and social problem: New knowledge and solutions.   Psychological services ,   14 (2), 113–117. https://doi.org/10.1037/ser0000164 Understanding Motivational Interviewing | Motivational Interviewing Network of Trainers (MINT) . (2017). MINT. https://motivationalinterviewing.org/understanding-motivational- interviewing
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