Treatment Plan/Psychosocial Narrative

| January 30, 2016

Treatment Plan/Psychosocial Narrative

In this assignment you are required to apply knowledge of this course to a given case study. Please refer to “Treatment Plan” document for more detailed information on treatment plans.
Submit this assignment to your instructor by the date given in the course outline. Late assignments must be negotiated with your course instructor prior to due date – see course outline for details. Late assignments will result in a deduction of 2% per day. Late assignments after five days will not be accepted.

Assignment Details
The objective of this written assignment is for you to apply your knowledge of screening, intake, orientation and assessment, types of treatment, crisis intervention and treatment planning. The intent is to create a treatment plan for Alice following Yalisove’s model.
Read the following case study carefully and then develop your treatment plan.

Outline was adapted from: Yalisove, D. (2010). Developing clinical skills for substance abuse counseling. Alexandria, VA: American Counseling Association.
Exhibit 13.1 Outline for a Typical Psychosocial Narrative

First sentence

Alice Yellowbird is a divorced, 32-year old First Nations’ woman with 3 children; ages 7, 10 and 14. She presented to the clinic disheveled, smelling of alcohol and her eyes were very dilated. Alice was very cooperative.

Presenting problem

Alice reported that she is here to get help with her alcohol and methamphetamine addiction so that she can get her children back from Child Welfare.

Current pattern of use of substance
• Substance used: Alice reports abusing both alcohol and methamphetamine.
• Amounts: The client reports drinking anywhere from 5-10 ounces of alcohol on occasion which generally adds up to 1 or 2 26 oz. bottles of vodka or gin per week. Alice injects 4-6 grams of methamphetamine per week.
• Frequency: Alice reports drinking pretty much every day and using meth on weekends.
• Effects: Client claims that alcohol helps with her anxiety and confidence when she goes out to the bar. She states that the meth “makes me feel alive.”

Effects of substance use
• Physical dependence (acquired tolerance or withdrawal): Alice reported that if she does not drink alcohol during the week she has tremors and her heart races.
• Psychological dependence: Client reports feeling significant anxiety and depression and states she does not feel normal until she has had a few drinks. She has not noticed any lasting psychological effects from the meth, but acknowledged a deep depression when coming down.
• Medical consequences: Alcohol withdrawal symptoms, several falls, abscessed injection site, and Hepatitis C.
• Work impairments: Currently not employed; has lost jobs in the past due to drinking and acknowledges lack of motivation to find a job or go back to school.
• Family disruption: Marriage break up 15 months ago, children in care, has allowed some dangerous people around her children, has left her children to fend for themselves when she has been under the influence. Children may have some FASD effects (suspected but so far undiagnosed).
• Legal problems: Received an assault charge against ex-husband and his new partner 3 months ago. She needs money to pay for lawyer to fight the charges. Client also acknowledges that the legal problems she had as a youth were often related to alcohol use.
• Financial problems: Alice is presently on social assistance, and is supporting her substance use by selling off her valuables. Alice is currently in debt to the dealer for $300.

History of drug and alcohol use
• First use: Started using alcohol at age 16 and meth 6 months ago.
• Increases in amounts or frequency, circumstances of increases, and consequences of increases: She reported drinking approximately 2-5 beer or coolers on weekends as a youth and gradually increased her alcohol intake to the levels identified above when she met her ex-husband 10 years ago. She reported her husband to be an alcoholic. Client reports that for the first couple of times she did meth she used less than a gram in one day on both occasions (about ten days apart); however, her tolerance has increased and she can inject as much as half a gram at a time and she will continue to use until she cannot get any more (no more money or the dealer won’t front).
• Efforts to stop alcohol or drug consumption and longest period of abstinence: Longest period of abstinence was with her first child. She quit drinking as soon as she found out she was pregnant (about 10 weeks in). She quit for 7 months total. However, although she tried to cut back she did drink in her other pregnancies and quite heavily on occasion.
• Previous substance abuse treatment and outcome: Has not attended any previous treatment center.

Client’s education, work and criminal justice history (Provide a brief summary for each area.)

Alice reported that she only finished grade 9 and quit high school due to not feeling like she was accepted at the local high school where most of the students were “white.”

Alice went to work as a waitress and chambermaid up until her first child was born; at which point, she did not work again.

As a youth she was “rowdy” and was in and out of youth assessment centers up until age 16. She was charged under the youth assessment act for assault, break-ins, and theft under $5,000.

Current family information
• Description of current family unit: Alice reported that the relationship with her children has deteriorated since she kicked her ex-husband out. The children have always been a handful, and some of this may be related to potential FASD, but the behaviour has gotten worse as structure and supervision have deteriorated.
• Substance use and abuse in the family: Client reports that her ex-husband was an alcoholic and both mentally and physically abusive towards her. She claims that she can be moody and, at times, yells but does not hit her children. She admits that she has neglected them more in the last year.
• Support for recovery: Alice has no family support due to being “cut off” of family contact since she told her mother that she had been sexually abused by her father and his two brothers since the age of 10 years old.
• Relevant atypical features of family (e.g. severe mental illness, homelessness, trauma): Family history of depression, alcoholism, and trauma with both mother and father. Four of her siblings had FASD as a result of mother’s alcoholism. History of family incest and mental, verbal, and physical abuse. Both parents attended residential school from age 5 to 18 years old.

Family history
• Describe siblings: Alice grew up with 9 siblings. Most of her siblings battle with alcohol/drug abuse. All 4 sisters were sexually abused by father, uncles, and her 5 older brothers.
• Describe childhood: History of childhood trauma including sexual, mental, and physical abuse. Alice was made to watch her older sisters being sexually abused by her father and uncles in order that Alice would be able to perform in sexual acts.

Brief assessment of current mental status

Alice presented in a depressed mood with tremors. She reported losing sleep over the recent removal of her children from her care. She reported using more meth than drinking as it takes away the pain of the loss of her children. Alice stated that she has never really had any stability in her life other than when she was in her past relationship with her ex-husband. She reported even then, things were chaotic due to his alcoholism and the physical abuse. Alice reported that she was on the antidepressant, Zoloft, before using meth and that the Zoloft did help improve her mood swings. However, she quit taking it once she started using meth on a regular basis as she was afraid what might happen with the combination of two drugs. Alice reported that she has tried in the past 3 months to get help by joining AA/NA, however, did not find it helpful as she feels she needs to work through the trauma from her past.

Clinical impressions (Provide your best judgment about the following)
• Diagnostic impression: (Does the client show substance abuse or dependence? Indicate whether the client should have a psychiatric evaluation.)

It is this counsellor’s belief that Alice would benefit with a psychiatric referral to rule out depression and help elevate the mood swings should she decide to quit using both the alcohol and methamphetamine.

• Current status: (Indicate the client’s current mood and attitude and the overall impression he/she gave in the session.)

Alice reported feeling very depressed since her children were taken away 2 weeks ago. To cope with this loss, she has been using meth daily but is finding it hard to purchase the drug. She has resorted to prostitute herself to the dealers in order to obtain enough meth for daily use.
• Stage of change:

At this point, Alice is in the preparation stage of change. She acknowledges she has a problem but does not know what to do about it.

• Client’s reaction to interview:

Alice is open to attending counselling appointments and would welcome a referral to a treatment center to help get her on track and off both the alcohol/drugs.

Treatment recommendations

(Students to write what they would recommend for treatment plan. Refer to “Treatment Plan” document. Page 153 Exhibit 13.3)

Date: February 4, 2016
_____________________________________________
Signature of interview and credential earned
Marking Guide for Written Assignment

Written Assignment Possible Marks
Step 1: Develop a problem list. 10
Step 2: Create a long-term goal for each of the problem areas. 20
Step 3: Prioritize issues to be dealt. 15
Step 4: Break down each goal into objectives (smaller goals). Prioritize again. 20
What types of assessment tools were used; i.e. MAST, DAST, etc. 15
In one or two paragraphs explain how you felt about completing this assignment. 10
Spelling, grammar, formatting, etc. should include proper APA formatting; i.e. title page, running header and reference list. 10
Total 100

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