SOCW 6060 Reflection Questions: The Cortez Family

What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?

Skills I used included engagement and repairing relationship, assessment, asking open-ended questions, gathering information, identifying presenting problems and treatment planning, coordination of and collaboration with an interdisciplinary team, and coordination of and collaboration with community resources. Interventions I used included providing support, partializing problems, setting small achievable goals, suicide assessment, and case management. I had knowledge of the hospital system, Medicaid and public assistance, and HIV/AIDS. SOCW 6060 Reflection Questions: The Cortez Family.

Which theory or theories did you use to guide your practice?

My practice was guided by strengths perspective, motivational interviewing, psychodynamic theory, and goal-oriented practice.

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What were the identified strengths of the client(s)?

Paula had many strengths. She was intelligent, completing both high school and college. She was able to create relationships with helping professionals. She was able to rally people around her. Paula was also a survivor and drew on her life experience. She taught herself how to use her non-dominant hand to paint. Even though it took a lot of effort and convincing, Paula was able to get things done.

What were the identified challenges faced by the client(s)?

Paula’s challenges included social isolation, physical illness, mental illness, and limited financial resources.

What were the agreed-upon goals to be met to address the concern?

We agreed that we would address Paula’s domestic violence relationship by creating a safety plan and obtaining a restraining order. I would assist Paula in making a decision about keeping or ending her pregnancy. We would monitor Paula’s mental and physical health. I would help Paula prepare for her baby’s arrival by helping her get baby supplies; arrange for appropriate services such as in-home child care assistance, WIC benefits, baby’s Medicaid; emotionally prepare for how life will change with a baby; and arrange for permanency planning.

Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare?

Some cultural competence issues were addressed. It was important for me to understand Paula’s Catholic background. While Paula claimed that religion was not a big part of her life, her Catholic views did affect her decision to keep her pregnancy. They were also intertwined in her thoughts and feelings about death and dying.

There were also aspects of Paula’s Latino culture that played out in her case. For example, her tendency to give up on mainstream medical interventions and resort to more holistic and home remedies is consistent with Latino culture. In addition, Paula was always resistant to involving outsiders (i.e., community resources, friends, aides, etc.) in her care/life. She held onto the cultural belief that family issues should be dealt with from within. What made this difficult for Paula was the fact that her family was not involved in her life. She did not want to rely on outsiders, but she was alone and really had no choice.

What local, state, or federal policies could (or did) affect this case?

The local and state policies that affected this case include Medicaid, WIC, New York State public assistance, New York City court system, and hospital policies such as length of stay, the Health Insurance Portability and Accountability Act of 1996 (HIPPA), coordination of care across disciplines, etc.

How would you advocate for social change to positively affect this case?

This does not apply to this case.

Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?

The big ethical issue that was present in this case was Paula’s decision to keep her baby. Several of Paula’s doctors held strong feelings that Paula should abort her pregnancy. They felt she was too ill to care for an infant and a child at all. As her social worker, I was not sure what the right answer was. It really did not matter because the decision was hers. My role was to support whatever decision she made and help her reach the best outcome given either scenario.

With regard to legal issues, Paula did obtain a restraining order for the baby’s father. Throughout the course of treatment, the father violated the order once. I helped Paula file a report with the police regarding the violation. We also made sure that Paula’s advance directives were in order and helped Paula file permanency planning paperwork with the courts. When working in a hospital setting, one must always deal with HIPPA and protected health information. SOCW 6060 Reflection Questions: The Cortez Family.

How can evidence-based practice be integrated into this situation?

Evidence-based practice can be integrated into the situation by using appropriate scales to measure depression, such as the Beck Depression Inventory-II, and by using formal suicide assessment, such as the Beck Scale for Suicide Ideation.

Is there any additional information that is important to the case?

There is no additional information.

Describe any additional personal reflections about this case.

Paula’s case is one of the most difficult cases I have encountered in my career. I worked with Paula for a little bit over a year. We terminated because I left my position at the hospital. Paula not only challenged my social work skills, but she also drew me into her case emotionally. Yes, I was Paula’s social worker, but at times I felt like I was her only friend and her caregiver. At the beginning, I felt an enormous sense of responsibility for the outcome of her situation. Paula consumed a lot of my time. She called me often and required a great deal of hand-holding. The irony is that when I did not hear from her, I worried. When I did hear from her, I felt like she was demanding and she drew me right into the chaos of her life and her situation. Eventually, when I realized the extent of my emotional involvement in this case, I had to set boundaries for Paula and myself. This became crucial to our work together. I ultimately realized that the boundaries were actually good for Paula as they demonstrated structure and the limitations of others’ involvement in her life. They forced Paula to take personal responsibility for her situation and take an active role in dealing with it. For me, the boundaries kept me sane. They allowed me to realize my own limitations. Many times, I reminded myself, “You can lead a horse to water, but you can’t make them drink.”

I feel very fortunate that I was able to work with Paula as part of an interdisciplinary team. Working on a team allowed me to consult with colleagues about the direction we should take with Paula. It also helped me cope with the stress and challenges of Paula’s case. My colleagues and I often found ourselves venting our frustrations, concerns, and fears with each other. I truly do not think I would have been as successful as I was in helping Paula if I had been on my own.