There are limited resources in a number of communities for individuals who are struggling with the disease of addiction and dual diagnosis. Despite the threat that untreated substance abusers there are barriers (Pullen, & Oser, 2014). Jose is an individual who has been struggling with substance abuse, homelessness, unemployed, and criminal charges. Jose informed the social worker right away that he has no income, he is homeless and is struggling with the disease of addiction (Plummer, Makris, Brocksen, 2014).
A policy that can empower Jose and others who are experiencing the same or similar issues is a transition substance abuse policy (TSA) instead of expecting people to be involved with a treatment facility. According to the case study there was a law passed that required the judicial system to guide those who are struggling with substance abuse problems out of or away from incarceration to a community-based drug treatment programs (Plummer, Makris, Brocksen, 2014).
Trade-offs involve policy advocates who identify their options, weigh options and develop a decision-making process (Jansson, 2018). After the options have been weighed and processed then policies are implemented. This policy can be implemented to create change to the inmate population oppose to hoping that they are able to receive the appropriate treatment. This is a realistic proposal that can be beneficial for inmates and possibly reduce recidivism.
Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice (8th ed.). Pacific Grove, CA: Brooks/Cole Cengage Learning Series.
Plummer, S.-B, Makris, S., Brocksen S. (Eds.). (2014). Social work case studies: Concentration year.Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
Pullen, E., & Oser, C. (2014). Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective. Subst Use Misuse, 49(7), 891–901. doi: 10.3109/10826084.2014.891615
Respond to at least two colleagues who chose a different assessment tool and explain whether you think your colleagues’ choices would offer more insight in choosing the appropriate intervention for Emily. Discuss any differences between the diagnoses by you and by either of your colleagues.
Colleague 1: Jennifer J.
Emily, a 62-year-old female, reports needing treatment for anxiety and states she often hears a female voice. Emily reports that tweezing her hair eases her anxiety, and she suffers from arthritis of the spine and knee. Emily lives alone, but down the hall from her sister, in a subsidized apartment. Prior to living alone, Emily resided with her sister, until her sister began dating, and preferred to live alone. Emily states she felt began to feel very anxious when her sister began dating, and she began tweezing once they separated. Emily relies on her sister for transportation and social connections.
Emily meets the DSM criteria for the following:
F23 Brief Psychotic Disorder
· A1 – Presence of delusions
· B – Duration of an episode of the disturbance is at least 1 day but less than 1 month (this would be reevaluated if Emily continued to or has been hearing voices for longer than a month, however, per the case study it appears if the voices are recent)
· C – The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia
· Marked specifier would include: stressors – symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture.
· A – The recurrent pulling out of one’s hair, resulting in hair loss
· D – Hair pulling is not attributed to another medical condition
· E – Hair pulling cannot be explained by the symptoms of another mental disorder
F93 Separation Anxiety Disorder
· A1 – Recurrent excessive distress
· B – Symptoms lasting longer than 6 months (since childhood)
· C – Disturbance causes significant distress to social and other areas of functioning
· D – Not explained by another condition
Z59.6 – Low Income
Z60.2 – Problem related to living alone
Z62.29 – Upbringing away from parents
Because those with increased anxiety report a general decrease in their quality of life assessments are essential in ensuring treatments are effective in helping clients develop the coping mechanisms necessary to decrease symptoms related to anxiety or psychosis (Olatunji, Cisler, and Tolin, 2007). To properly assess the episodes of psychosis Emily is experiencing, the assessment in the DSM-IV, Dimensions of Psychosis Symptom Severity could be used to not only evaluate Emily’s current condition but used also as a means to evaluate the effectiveness of treatments (APA, 2013). To measure the severity of separation anxiety Emily is encountering the Severity Measure for Separation Anxiety Disorder-Adult could be utilized (APA, 2013). This self-report survey provided by the DSM-IV can provide an effective means to not only measure the severity of symptoms of the disorder, and define effective treatments, it can also be used regularly as a measurement tool to assess the stability of the client (APA, 2013).
Colleague 2: Jennifer T.
Based on the information provided from the case study it appears that Emily struggles with symptoms of anxiety, audio hallucinations, tweezing her hair to ease her anxiety, compulsive thoughts and separation issues. Emily appears to be struggling with attachment issues as evidenced by the Emily shared an apartment with her sister for thirty years, five years ago her sister became involved in a romantic relationship, Emily cried often when this began (Plummer, Sara-Beth, Makris, & Brocksen, 2013). After Emily established her own apartment it is noted that Emily began to tweeze her hair. Emily mentioned that she would like to integrate her treatment goals with the female voice and trichotillomania (Plummer, Sara-Beth, Makris, & Brocksen, 2013).
Symptoms and other conditions
It is noted that Emily is a 62 year old female who is being directed by a female voice that is commanding her to discipline herself by pulling out her hair or by scrubbing her house clean (Plummer, Sara-Beth, Makris, & Brocksen, 2013). These symptoms present with psychotic features with compulsive thoughts. Emily has been diagnosed with anxiety disorder in the case study. This brings be to the conclusion that the underlying issues with her symptoms stems from the hallucinations that are causing her persistent obsessive behaviors. Other conditions such as include Obsessive-Compulsive Disorder code F42 with psychotic features.
The person-in-environment approach is utilized to assess the individuals presenting problems and strengths than an approach that focuses on positive change or change with environment conditions (Kondrat, 2015). This approach is utilized to assess Emily’s symptoms and discuss her strengths. Emily has insight that pulling her hair is a problem as evidenced by she was able to identify her treatment goals which one of those goals involved the hair pulling. Obsessive Compulsive Disorder is different compared to Trichotillomania.
Obsessive Compulsive disorder includes: recurrent and persistent thoughts, urges along with images at some point with intrusive that stems from anxiety or distress (American Psychiatric Association, 2013). Trichotillomania is ruled out as the main diagnosis. The differential diagnosis explains with psychotic disorder, individuals with psychotic disorder may remove hair in response due to a delusion or hallucination, Trichotillomania is not diagnosed with this case (American Psychiatric Association, 2013). This brings be to the conclusion that the underlying issue with her symptoms stems from the hallucinations that are causing her to present the behaviors despite her developmental history.
The Yale-Brown obsessive-compulsive scale is an evidence based scale that measures the obsessive and compulsive behaviors. This scale is utilized to assess several symptoms listed: insight, avoidance, indecisiveness, responsibility, pervasive slowness, and doubting (Rapp, Bergman, Pacientini, & McGuire, 2016). There are two scales for the Yale-Brown scale to measure the severity and the other scale measures the range of the obsessive-compulsive symptoms.
Research has indicated that the Yale-Brown scale is considered the global assessment tool for OCD symptom severity and encompasses psychometric properties (Rapp, Bergman, Pacientini, & McGuire, 2016). This assessment tool is evidenced-based and has strengths and weaknesses. This scale represents good convergence with other ratings that measures the severity, and good discriminant validity that measures worry and impulsivity (Rapp, Bergman, Pacientini, & McGuire, 2016). As a social worker this tool can be utilized to diagnose OCD and the severity. This can allow the client to develop an understand about the OCD mental health concept to develop healthy coping skills.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Kondrat, E. M. (2015). Person-in-Environment. Retrieved from http://www.oxfordbibliographies.com/view/document/obo-9780195389678/obo-9780195389678-0092.xml
Plummer, Sara-Beth, Makris, S., Brocksen, S. (2013). Social Work Case Studies: Concentration Year. Laureate Publishing,VitalBook file.
Rapp, M. A., Bergman, L. R., Pacientini, J., & McGuire, F. J. (2016). Evidence-Based Assessment of Obsessive-Compulsive Disorder. J Cent Nerv Syst Dis, 13–29. doi: 10.4137/JCNSD.S38359