Client Case Study

Case Study Case Study Assignment
Describe your proposed engagement and assessment process with the client, Pamala Brown, described in the case study provided. Please number your answers 1-20 and include the original question stem. See Blackboard Learning Module Homepage for more details.

Engagement
1. What stage of change do you think the individual in?
2. Why do you think this so? Give supporting evidence using person first non-stigmatizing language when describing the client.
3. What barriers to engagement might you encounter with this client?
4. How will you address these barriers? (
What cultural, environmental, and developmental factors may be impacting the individual’s substance use? Discuss both protective and risk factors.
5. Cultural factors
6. Environmental factors
7. Developmental factors
8. Protective factors
9. Risk factors
10. How may these factors impact her recovery?
11. What assessment instrument(s) would you utilize with this client? Consider the individual’s characteristics, DSM V criteria including groupings of symptoms, the drug of choice, and the evidence-base for the assessment.
12. Why did you select this instrument(s)? (think about drug of abuse, age, pregnancy status, gender, of the client when selecting an instrument)
13. Using a bio-psycho-social perspective, what additional information would it be important for you to have to effectively intervene that is not present in the case study?
14. Why is that information important?

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Intervention and Evaluation
Describe your proposed intervention and treatment goals. Specifically:
15. What level of care would you recommend using the ASAM criteria as a guide? Why did you select that level of care?
16. Use NIDA commonly abused drugs chart as a guide and determine what intervention would you apply and why (CBT, MI, contingency management, MAT, SBIRT, 12 step)? Consider the individual’s characteristics and drug of choice.
What treatment goals would you identify (name 3 goals)?
17. Goal 1:
18. Goal 2:
19. Goal 3:
20. How will you know that treatment is successful? What indicators or assessments would you utilize?
Case Study Assignment
Describe your proposed engagement and assessment process with the client described in the case study provided, Pamala Brown.

Pamala Brown is 25 years old. She grew up in Cleveland living with her mother and her mother’s boyfriend and her two slightly older siblings. She felt love from her neighbors growing up in a tight knit Polish community where she attended an after school programs at a nearby church. Growing up her mother had a serious mental illness and Pamala was physically and sexually abused by her mother’s boyfriend. She was never a strong student, but she confided in a teacher from the after school program when she was 14 years old about what was happening at home. Her mother admitted to the physical abuse, but did not believe her about being sexually abused by her boyfriend. Pamala was removed from her home by child protective services and parental rights were terminated when she was 15 years old.

Pamala initially was placed in a series of foster homes and then moved in with her 22-year-old boyfriend when she was 17 years old. She works at a fast food restaurant working her way up to shift manager over a period of 7 years. Her and her boyfriend had their first child together when she was 19 and their second child when she was 22 years old. When she was 23 she was in a serious car accident. The car accident left her with an injury that crushed her leg and permanently damaged her back. She required physical therapy, and occupational therapy following the accident. Following the injury, she received a prescription opioid, Vicodin, for pain from her medical doctor. When she took Vicodin, she noticed that she slept better and that her pain (physical and mental) was much better. Her prescription was renewed by the health clinic for a year then was abruptly discontinued. By the time her doctor stopped prescribing her the medication, she was physically addicted. At that time, she began taking heroin because it was less expensive and easier to get. Three months after she started taking heroin she realized she was pregnant with her third child. Her boyfriend started taking heroin around the same time she started and died of an overdose 1 month ago. She is now 25 years old, and nearly homeless caring for her two children due to the loss of income from her boyfriend’s death. She is highly motivated to get off drugs, but is scared to tell anyone that she has a problem. She is a very loving mother and is worried that her children will be taken away. She is 8 months pregnant, but has not received any prenatal care because she is scared to go to the doctor. Due to the added weight from the pregnancy, the pain from her accident has gotten much worse impacting her ability to work and take care of her children.

Discuss:
What stage of change do you think the individual in? (Learning Module 6) ______________________________________________________
Why do you think this so? Give supporting evidence using person first non-stigmatizing language when describing the client (learning Module 2) __________________________________________________________________________________________________________________

What barriers to engagement might you encounter with this client? (Learning Module 4) __________________________________________
How will you address these barriers? (Learning Module 4) __________________________________________________________________
What cultural, environmental, and developmental factors may be impacting the individual’s substance use? Consider both protective and risk factors. (Learning Module 4)
Cultural factors____________________________________________________________________________________________________
Environmental factors_______________________________________________________________________________________________
Developmental factors ______________________________________________________________________________________________
Protective factors __________________________________________________________________________________________________
Risk factors _______________________________________________________________________________________________________

How may these factors impact her recovery? _____________________________________________________________________________
What assessment instrument(s) would you utilize with this client? [Consider the individual’s characteristics, DSM V criteria including groupings of symptoms, the drug of choice, and the evidence-base for the assessment.] (Learning Module 3 and 4) _______________________________
__________________________________________________________________________________________________________________
Instrument selected______________________________________________________________

Why did you select this instrument(s)? (think about drug of abuse, age, pregnancy status, gender, of the client when selecting an instrument) _________________________________________________________________________________________________________________
Using a bio-psycho-social perspective, what additional information would it be important for you to have to effectively intervene that is not present in the case study? ___________________________________________________________________________________________
Why is that information important? ______________________________________________________________________________________

Intervention and Evaluation

Describe your proposed intervention and treatment goals. Specifically:
What level of care would you recommend using the ASAM criteria as a guide? (Learning Module 4) _________________________________________________________________________________________________________
Why did you select that level of care? ____________________________________________________________

Use NIDA commonly abused drugs chart as a guide and determine what intervention would you apply and why (CBT, MI, contingency management, MAT, SBIRT, 12 step)? Consider the individual’s characteristics and drug of choice.
https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/nida_commonlyuseddrugs_final_printready.pdf
______________________________________________________________________________________

What treatment goals would you identify (name 3 goals)? (Learning Module 4)
Goal 1: ________________________________________________________________
Goal 2: _________________________________________________________________
Goal 3: _________________________________________________________________
How will you know that treatment is successful? What indicators or assessments would you utilize? (Learning Module 4) _________________________________________________________________________________________________________

Assessment and Intervention Rubric
Please assign a rating on a scale of 1-5 for each competency, with 5= Advanced Competence and 1= Pre-Competence.
The below rubric is intended to assist in anchoring your rating.

Advanced Competence
High Competence
Competence
Emerging Competence
Pre- Competence
Competency 1: Ethical &
Professional Behavior

CAP, V
Effectively manages personal biases, uniformly uses a strengths-based perspective, and person-first, non-stigmatizing language.
Manages personal biases, identifies multiple strengths and protective factors, and uses person-first, non-stigmatizing language.

Manages personal biases, identifies some strengths and protective factors, uses person-first and pre-dominantly non-stigmatizing language.
Limited application of strengths perspective, evidence of attempt to address personal biases, and uses some stigmatizing language.
Does not identify any strengths or protective factors. Personal bias evident. Uses stigmatizing language or projects information not present in case scenario.
Competency 2: Engage Diversity and Difference-Assessment

K, CAP, S
Comprehensively considers developmental, cultural, and demographic factors in assessment process and clearly connects to relevant considerations for substance use intervention.
Good consideration of developmental, cultural, and demographic factors in the assessment process. At least one of the factors are connected to treatment planning.

Sufficient consideration and explication of developmental, cultural, and demographic factors in the assessment process.
Limited developmental, cultural, or demographic factors are considered, but not connected to the assessment or treatment planning process adequately.

Does not consider developmental, cultural, or demographic factors in assessment or recommends assessments that are not appropriate for the client.
Competency 2: Engage Diversity and Difference-Intervention

K, CAP, S
Comprehensively applies knowledge of cultural, developmental, and demographic factors to selection and delivery of intervention, and support of recovery.
Substantial application of knowledge of cultural, developmental, and demographic factors. Connects at least two of these to selection and delivery of intervention
Identifies most significant cultural, developmental, and demographic factors and relates at least two of these to selection or delivery of intervention.
Limited identification of relevant cultural, developmental, and demographic factors and no connection to selection and delivery of intervention.
Does not consider developmental, cultural, or demographic factors in selection or application of intervention.
Competency 3: Human Rights

K, CAP
Comprehensive identification of cultural, environmental and economic factors that promote or inhibit substance use and recovery and explication of connection to these processes.
Above average identification of many cultural, environmental, and economic factors that promote or inhibit substance use and recovery. Connection of principle factors to substance use and recovery.
Satisfactory identification of principle cultural, environmental, and economic factors. Connects at least two factors identified to substance use or to recovery.
Limited identification of cultural, environmental, and economic factors. Factors are not clearly connected to substance use and recovery.
Does not identify cultural, environmental, or economic factors that promote or inhibit substance use and recovery.
Competency 4: Research-Informed Practice-Assessment

K, CAP, S
Selects an appropriate standardized instrument that matches well individual and presenting problem. Critically reflects on psychometric properties, and strengths and weaknesses of assessment for the individual. Additional factors explored during assessment process are empirically linked to intervention.
Selects an appropriate standardized instrument that matches individual and presenting problem. Rationale is presented for selection that includes strengths and weaknesses of the assessment for the individual. Some additional factors explored during assessment are empirically linked to intervention.
Selects an appropriate standardized instrument that matches individual and presenting problem. Some evidence-supported rationale is presented for selection. At least one additional factor for exploration during assessment is selected and empirically linked to intervention.
Selects an intervention that is not best fit for either individual, or presenting problem, or is not standardized. Rationale for selection is presented does not make use of research base. Additional factors explored during assessment are not empirically connected to intervention.
Rationale for selection of assessment is not addressed. Assessment selected is not standardized or inappropriate for case scenario.
Competency 4: Research-Informed Practice-Intervention

K, CAP, S
Skillful application of peer-reviewed literature to identify and apply evidence-supported intervention. Intervention is evidence-supported, with clear summary of theory and research base. Critical reflection on strength of evidence and applicability for case scenario.
Substantial application of the peer-reviewed literature to select an evidence-supported intervention. Theory of intervention is addressed. Explication of suitability for case scenario (individual and presenting problem) is present.
Satisfactory summary of theory of intervention and research that supports efficacy of intervention and its application to presenting problem of case scenario.
Limited explication of theory. Some peer-reviewed citations are included, but do not appear to be thoughtfully gathered or applied.
Theory of intervention and/or research base is missing
Competency 6: Engage

K, CAP, S
Comprehensively identifies potential barriers to engagement and provides potential responses. Demonstrates knowledgeable application of principles of motivational interviewing (MI) to engage client and enhance motivation.

Identifies multiple potential barriers and offers more than one tool for responding. Demonstrates good application of principles of MI to significant features of case scenario.

Demonstrates awareness of some potential barriers to engagement and offers at least one response. Demonstrates knowledge of MI principles and evidences some application to case scenario.
Demonstrates awareness of one potential barrier that may be present, but does not offer any responses. MI is addressed, but principles are not applied to case scenario.
Does not identify potential barriers to engagement or pathologizes barriers present and does not present responses. Application of MI principles is missing or not explicated.
Competency 7: Assess

K, CAP, S
Identifies standardized assessments that are best fit for substance and individual characteristics. Clear application of DSM criteria to symptoms and grouping of symptomology (i.e. Big 5). Identifies clinically significant additional information that may be needed and how it may be used in treatment planning.
Identifies standardized assessment that is best fit for substance and individual characteristics. Clear application of DSM criteria to symptoms and some grouping of symptoms. Identifies at least one clinically significant additional area for assessment and provides rationale for assessment.
Standardized assessment selected is good fit for substance and individual characteristics. DSM criteria are applied, with some identification of types of symptoms.
Assessment selected is not the best fit for the substance and individual characteristics. DSM criteria are addressed minimally without grouping of symptoms. Limited additional information that may be needed is identified but clinical significance is not explicated. Clear connection of assessment data to be collected to intervention planning is not made.
Assessment selected is not appropriate for substance or individual characteristics; and/or student confuses screening and assessment functions. DSM criteria are missing and problem severity is not addressed or not supported by case information. No connection is made between assessment and intervention planning.
Competency 8: Intervene

K, CAP, S
Intervention is culturally and developmentally appropriate, matched to problem severity, drug of choice, and individual’s risk and protective factors. ASAM criteria are clearly linked to appropriate level of care recommendation.
Intervention is culturally and developmentally appropriate, matched to problem severity and drug of choice. All critical risk factors are addressed along with at least one modifiable protective factor. ASAM criteria are linked to appropriate level of care recommendation.
Intervention is culturally and developmentally appropriate and is satisfactorily matched to problem severity and drug of choice. Most individual risk factors are addressed. Level of care recommendation is on target.
Intervention is not matched to at least one of the following: culture/ developmental stage of individual, problem severity, or drug of choice. There is limited consideration of individual risk and protective factors. ASAM criteria are minimally addressed.
Intervention is not matched to individual, problem severity, or drug of choice in critical ways. ASAM criteria are not addressed and/or level of care recommendation is not appropriate.
Competency 9: Evaluate

K, CAP, S
Treatment goals address critical risk and protective factors, are aligned with the intervention selected, recovery-focused, and measurable. Uses a combination of subjective and objective indicators to assess treatment progress.
Treatment goals address all critical factors and at least one protective factor. Goals are aligned with the intervention, and are concrete and measurable with at least two indicators identified.
Treatment goals are clearly stated and satisfactorily address all critical risk factors of case presentation. At least one form of measurement is clearly described, along with indicators.
Treatment goals are identified but may not address at least one critical risk factor of case presentation. Measurement is minimally addressed, but greater specificity is needed.
Treatment goals are not clearly identified or do not address critical concerns of case presentation. Measurement is absent or inadequately matched to treatment goals.

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