HSE FINAL PROJECT ((12-15 HOUR TURN AROUND))

FINAL PROJECT: CARE PLAN 2

Final Project: Care Plan

HSE 315

Meg Weiland

Southern New Hampshire University

Case Analysis

I. Impact of Physical Trauma:

The most significant short-term impact of the physical trauma is the separation of the family. Because of the physical abuse, Eloni was removed from the home and put into foster care. The family was also evicted from their apartment because Eloni was seen as a threat to safety. Along with the physical injuries, the family is most likely experiencing the effects of a crisis such as stress, anxiety, and sleep disturbances (SAMHSA, 2016).

The long-term effects of the physical trauma may be expressed differently in different individuals. Kolomalu may experience lasting psychological effects due to the trauma such as triggers, feelings of self- blame, intrusive flashbacks, behavioral issues, emotional reactions such as attachment issues and more (SAMHSA, 2016). The long-term effects will depend on the services he receives, emotional support, and his resiliency. It is important to note that Eloni may be experiencing long-term effects from the abuse he experienced, which may be contributing to his abusive behavior.

The long and short-term impacts differ because the short-term impacts are generally alleviated once the crisis is dealt with successfully. The long-term impacts may take much more time to go away, or they may never fully go away. The severity of the impacts varies greatly depending on age, environment, culture, support received, resiliency, and other traumas (SAMHSA, 2016). Each family member may experience a difference in the severity of impact.

Kolomalu, Eloni, and Anamalia all share the same culture, the same environment, and the same resources. Therefore, there could also be similarities in the type of reactions or effects that they experience.

II. Needs Due to Physical Trauma:

The needs of the family are trauma-related because the physical abuse is the main point in which the crisis began. The physical trauma is what caused the family to be separated and evicted from their home. Their needs such as counseling, parenting classes, legal assistance, and food assistance were all identified once the crisis occurred. Not only will counseling be necessary to heal from the trauma, but it is also needed to get Eloni help and find out what is causing his abusive behavior.

The short term needs for this family are legal assistance to keep their housing and financial assistance for groceries. Once the family is able to regain housing and Anamalia is able to secure a job, those needs will go away. The short-term goals are focused on the most basic needs such as housing and food. The mental health counseling, substance abuse counseling, and parenting classes are more long-term needs that will need to continue overtime in order to be effective. The goal is that eventually Eloni will be able to live with his mother and brother again and will stop using substances. Another long-term goal is that the family will heal from the trauma they endured and have healthy relationships moving forward. In order to do so, Anamalia will attend parenting classes and the children will attend mental health counseling. Eloni will also attend substance abuse counseling for his drug use.

The long-term and short-term needs for this family are similar because they are all stemming from the crisis situation that the family is in. They are also similar because they build off each other. For example, the family will not benefit from counseling or parenting classes if they do not have a safe home or food. Maslow’s hierarchy of needs tells us that it is important for one to have their most basic needs met so that they can successfully reach their psychological needs such as healthy relationships (Maslow, 1943).

III. Impact of Psychological Trauma

The crisis that this family is currently in can cause significant short-term psychological trauma. The physical abuse could cause Kolomalu to suffer from anxiety, triggers, and behavioral issues (SAMHSA, 2016). Being in foster care and separated from his family is probably a very frightening experience for Eloni. It could also cause him to experience anger and resentment. Anamalia is under a great amount of stress and has had her child separated from her. She could be experiencing anxiety, fear of losing both her children, and guilt from not being able to keep her children safe.

There may be long-term psychological effects for everyone in the family. Being placed in foster care could cause Eloni to have anxiety, resentment, and or emotional detachment from his family. Kolomalu may suffer from flashbacks, attachment issues, relationship issues, or avoidance (SAMHSA, 2016). Anamalia could experience effects such as lasting anxiety from worrying about her kids or long-term feelings of inadequacy and guilt.

The long and short term psychological effects differ because the short-term effects may go away on their own or once the crisis is managed. They have similarities and differences, but the biggest difference is severity. Some of the long-term effects may be the same as the short term, but they differ due to the level of impact on the individual. The severity greatly depends on age, resiliency, history of trauma, services received, etc. (SAMHSA, 2016). For example, Anamalia and Kolomalu may both be suffering from anxiety, but Kolomalu’s anxiety may be more severe and long-term due to his age and the physical abuse he experienced.

IV. Needs Due to Psychological Trauma:

The psychological trauma that the family is experiencing calls for mental health counseling in multiple areas. The physical abuse has caused Kolomanu to need counseling. Eloni needs counseling to heal from his past trauma as well as the trauma of being separated from his family. The whole family needs counseling in order to repair their relationships that have been damaged.

The long-term needs are different from the short-term because some effects need more intensive therapy than others. It is going to take a long time for the family to repair their relationships through counseling. Eloni’s trauma has impacted him severely and hs contributed to his abusive behaviors. It will take intensive therapy to get him back to where he needs to be. Kolomalu’s psychological effects such as triggers and anxiety may stay long-term, but the short-term effects such as sleeplessness and behavior issues may be resolved quicker.

The short-term and long-term needs require different levels of therapy, but in the end the goal is the same. All of the services in the care plan are aimed at recovering from the trauma and reuniting the family. Each family member will need counseling to deal with the trauma they have faced.

V. Risk and Resiliency Factors:

There are multiple risk factors present in this case. The history of abuse in the family is a risk factor for continuing abuse and trauma. Eloni’s problem with substance abuse is a risk factor for developmental issues and other risky behaviors. Being removed from his home is also a risk factor. The physical abuse that Kolomalu has experienced is a risk factor for future developmental issues, psychological issues, PTSD, and behavioral issues (American Trauma Society, 2018). The family’s financial struggles and strained relationships have created an unstable home which is another risk factor to consider. The resources available in the community such as counseling and financial assistance are resiliency factors for the family. Anamalia’s willingness and determination to take parenting classes and repair the family is another protective factor.

These factors are specific to the case because all of the problems are intertwined. Many of the issues that the family faces are caused or influenced by each other. For example, the physical abuse that Eloni experienced is a risk factor for substance abuse. The substance abuse is a risk factor for developmental and behavioral issues. Many of these factors are connected and lead to one another. Some of these risk factors may have a more profound effect of Eloni and Kolomalu because they are still maturing and developing. Risk factors such as substance abuse may have a greater effect on a youth compared to an adult because of the developmental risks. With that being said, children are very resilient and have a good chance at being able to recover from their trauma.

Care Plan: Interventions

I. Legal Standards

The interventions in this care plan align with legal standards by separating Eloni from his brother for the time being. It is mandatory for human service providers to report cases of child abuse so that Child Protective Services can investigate and take the necessary steps (NASW, 2018). Other legal consideration for this case include eligibility standards for emergency financial assistance and standards for transferring clinical documents. A human service provider must be careful to know the laws and eligibility standards when assisting a client in applying for assistance. Filing fraudulent claims would be against the Falsifying Claims Act and could result in high penalties and fines (CCMC, 2012). When coordinating a care plan for a client, one must be sure to comply with HIPAA and get written informed consent before releasing health records to clinicians and mental health facilities (Brooks & Savage, 2012).

II. Ethical Standards

The interventions in this care plan align with the ethical guidelines of human services. The care plan was put together with the goal of eventually reuniting the family once it is safe to do so. Other ethics that need to be considered include cultural competency and trauma informed care (Frankel & Gelman, 2016). The goal of the mental health counseling is to help the family cope with their trauma and screen for PTSD. The family therapy and parenting classes need to consider the cultural context of the family. In order to align with ethical guidelines, the counselors should research the Pacific Island culture and consider using their strong ties with the community as a tool for building a network and promoting resilience. Other ethical guidelines to consider are confidentiality and “do no harm”. The provider needs to use best practice and make sure that practices and services are not doing any further harm to the client. All records and personal information must be kept confidential between the client and the provider (NASW, 2018).

III. Primary Crises

The primary interventions for this case are legal advocacy and financial assistance for groceries. The primary interventions are aimed at the most urgent needs and making sure that the family has all of their basic needs met. Maslow’s hierarchy of needs tells us that it is important for one to have their most basic needs met so that they can successfully reach their psychological needs such as healthy relationships (Maslow, 1943). Once the family has secure housing and food, they can address the issues that lead to crisis.

IV. Secondary Crises

The secondary interventions in this case address the issues within the house hold that lead to the crisis. These interventions include; substance abuse counseling and mental health counseling. These interventions will address the crisis and benefit the family in a number of ways. Mental health counseling will help the family to deal with the stress and trauma and heal their relationships. Substance abuse counseling will help Eloni to become clean and able to start coping in healthy ways. Although these interventions can help to rebuild the family, they have still endured a significant amount of trauma. Because Eloni had to be separate, that is an additional trauma that he will have to learn to cope with and heal from. Another secondary intervention that could benefit the family is a support groups for domestic violence. This could help Eloni deal with his trauma in a different way and help to end the cycle of abuse in the family (SAMHSA, 2016).

V. Tertiary Crises

The tertiary interventions in this case address the ongoing issue caused by the crisis and prevent further crises. For example, counseling will help Eloni and Kolomalu learn coping skills for the trauma they have experienced and help them build resilience. Parenting classes will help Anamalia to control her home and build a healthier environment for the family. The trauma cannot be taken away, but tertiary interventions such as trauma counseling and parenting classes can help to lessen the impact that the crisis has on their lives. Another tertiary intervention that could benefit this family is long-term family counseling. Trauma within a family system will have ongoing effects on the relationships (SAMHSA, 2016). Long-term family counseling could help to slowly rebuild those relationships.

VI. Importance of Primary, Secondary & Tertiary

Primary, secondary and tertiary interventions all address the crises at different levels. Each is important because crises do not occur from just one source. There are many factors that lead to a crisis. Primary interventions address the most urgent issues such as housing, food, safety, etc. Secondary interventions consist of services to address the issues that are causing the crisis. For example, mental health counseling, family therapy, substance abuse counseling, etc. Lastly, tertiary interventions are aimed at addressing the ongoing issues such as parenting skills and the effects of trauma. In this case it would be counseling to help build resilience and coping skills for the trauma (Crisis Connection Inc, 2018).

Care Plan: Needs

I. Children’s Needs & Gaps in Service

The care plan addresses both children’s needs. The care plan addresses their most basic needs using primary interventions such as legal assistance for housing and financial assistance for food. The ongoing needs are addressed through counseling services. Eloni will attend substance abuse counseling to help his addiction. Both Eloni and Kolomalu will attend mental health counseling to heal from the trauma they have experienced. Kolomalu is at an age where there is a lot of development going on. Immediate interventions are needed to make sure that the trauma does not affect his early development. Eloni is also still developing, but he is at a different stage. He has been impacted by past trauma and is now struggling with substance abuse and behavioral problems. Eloni’s issues will require more intensive and long-term care, but recovery is possible. Children have a high level of resiliency and can recover from trauma, especially because Kolomalu is young (SAMHSA, 2016). Eloni is well liked by his peers which provides a social network and acts as a resiliency factor. Kolomalu has a strong parental relationship with his mother which acts as a protective factor as well (American Trauma Society, 2018).

The care plan includes mental health counseling for both children, but it does not include family counseling. The trauma that this family has experienced can have a significant effect on their ability to have healthy relationships (SAMHSA, 2016). The interpersonal violence and removal from the home has created an unstable home environment. Family counseling can help to restore a healthy environment and heal the family relationships.

II. Family Needs & Gaps in Service

The care plan addresses the family needs through immediate interventions as well as long-term interventions. The care plan first addresses the family’s most basic needs such as housing and food through emergency assistance and legal advocacy. The care plan then addresses the contributing factors to the crisis by removing Eloni from the home and providing him with counseling for mental health and substance abuse. The plan also includes mental health counseling to help Kolomalu deal with the long-term effects of the trauma he experienced. Lastly, the plan includes parenting classes to address ongoing needs and to help prevent future crisis.

There are some gaps in the care plan because there are not many services suggested specifically for Anamalia. Anamalia has experienced trauma as well and could benefit from counseling. She could also use assistance with finding and securing a job. A recommendation that I would make to address gaps in services is to look into community agencies that help with job placement. For example, job fairs, resume workshops, training programs, etc. This can help to address Anamalia’s long-term need of securing a job and help prevent future crisis.

III. Contingency Plan

There a few steps in place in case crisis reoccurs. The parenting classes for Anamalia will help to equip her with the skills she needs in case problems arise with her children again. People who have experienced trauma are at a higher risk of engaging in dangerous behaviors and substance abuse (SAMHSA, 2016). The goal of the substance abuse counseling and mental health counseling is to provide healthy coping skills for to help deal with their trauma and avoid falling back into negative behaviors such as substance abuse. Parenting classes and education on healthy coping will help to build the family’s resiliency. The recommendations for family counseling and job placement services can help as well. If Anamalia has a stable job and the family is able to restore their relationships, they will be at a lower risk level for crisis to reoccur.

Practitioners

This case deals with traumas such as physical abuse, substance abuse, and family separation. As with most human services cases, there is significant risk for issues such as compassion fatigue, secondary traumatization, and burnout (SAMHSA, 2016). Working in the human services field and continuously dealing with traumatic situations can be emotionally draining. If professionals do not take the right precautions, they may experience the effects of trauma themselves, and could eventually run out of the compassion and patience that the job requires. Short term effects could be stress symptoms, anxiety about going to work, sleeplessness, or depressive episodes. Long term effects could be burnout, compassion fatigue, and secondary traumatization (SAMHSA, 2016). In order to avoid these effects, human service professionals need to use self-reflection, work through personal traumas, and develop a well-rounded self-care plan. It is important for professionals to seek counseling if necessary, find support in coworkers, and develop healthy coping skills (SAMHSA, 2016). A helpful tool for human service providers is the PRoQOL Scale Compassion Fatigue and Satisfaction Evaluation (Stamm, 2012). This tool is recommended by the Substance Abuse and Mental Health Administration to measure compassion fatigue and satisfaction. Another suggested intervention is mindfulness and meditation. A recent study showed that mindfulness and meditation training produced positive results among a group of social workers. The study found that this training decreased stress and increased the use of healthy coping skills and self-care practices among the social workers (McGarrigle & Walsh, 2011). These evaluation tools and self-care techniques will help to address short term effects of trauma work and avoid long term problems such as compassion fatigue and secondary traumatization.

References

American Trauma Society. (2018). Trauma Survivors Network - provided by ATS. Retrieved from https://www.traumasurvivorsnetwork.org/traumapedias/777

Brooks, A., & Savage, L. (2017, March 01). The Real HIPAA: Care Coordination, Care Planning, and Case Management Examples - Health IT Buzz. Retrieved from https://www.healthit.gov/buzz-blog/privacy-and-security-of-ehrs/real-hipaa-care-coordination-care-planning-case-management-examples/

Commission for Case Manager Certification. (2012). Ethical and Legal Issues: Ten guidelines the professional case manager cannot afford to ignore (Vol. 3). Health 2 Resources.

Crisis Connection Inc. (2018). Primary Prevention. Retrieved from https://crisisconnectioninc.org/primary-prevention/

Frankel, A. Gelman, S. (2016). Case Management: An Introduction to Concepts and Skills. New York, NY: Oxford University Press.

Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review, 50(4), 370-96.

McGarrigle, T. & Walsh, C. A. (2011). Mindfulness, self-care, and wellness in social work: Effects of contemplative training. Journal of Religion & Spirituality in Social Work: Social Thought, 30, 212–233.

NASW. (2018). Code of Ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Stamm, B. H. (2012). Professional Quality of Life: Compassion satisfaction and fatigue version 5 (ProQOL). Retrieved on November 21, 2013, from: http://proqol.org/uploads/ProQOL_5_English.pdf

Substance Abuse and Mental Health Services Administration. (2016). Treatment Improvement Protocol: Trauma Informed Care in Behavioral Health Services. HHS Publication.