Select a client. The “client” can be an individual, a family or individual in a group.
Develop a concise and full assessment and formulation that incorporates all relevant aspects of a bio-psycho-social approach.
Develop a plan for treatment based on one or a combination of the theories and practice models discussed in the course and in the readings. Identify potential interventions at individual, cultural and systemic levels.
Justify your choice of interventions using theory and evidence-based information as applicable. The work might include a variety of social work roles – e.g. being a case manager, advocate, broker, mediator, counselor and or therapist. Describe and justify the ones you have chosen.
Briefly discuss the main features of the theoretical models that support this choice of intervention (you may be blending several theoretical models.
Selecting a Client
Clinical practices are simply guidelines or statements that are intended to optimize patient care and give an assessment on the benefits and harms of a particular treatment or alternative care options. This research on clinical practices is about a client by the name Lupe Guardiola suffering from post traumatic stress caused due to a road accident that nearly cost him his life. The reports contains detailed assessment and formulation and incorporates a bio-psycho-social approach while providing a treatment plan for him (Workowski & Bolan, 2015). Alternatively, It identifies potential interventions necessary during treatment. Basically the report is about the clinical practices required to treat a trauma patient and the most preferred treatment plan for such a patient.
An assessment in clinical terms, is a way of diagnosing and planning treatment for the patient while clinical formulation or a case formulation is a theoretic explanation on the information obtained from a clinical assessment. The clinical assessment and formulation cannot be easily completed if a bio - psycho - social approach is not taken into consideration during the assessment and formulation process. The human being is believed to a psychological, biological and social being (Arnold & Boggs, 2015). Thus during treatment of anyone in any clinical practice, a bio- psycho- social analysis is mandatory to ensure that all the human needs are met. The above analysis is divided into three stages (as the name suggests) i.e. biological, psychological, and social stages.
Biological assessment deals mainly with the entire physical body of the client. As in our case, Lupe Guardiola was involved in a road accident that almost cost him his life thus the first biological assessment is mainly screening. Guardiola is screened and the body checked to see if there are any injuries that he might have suffered during the predicament. Screening helps to detect whether there are fractured bones or head injuries that may have resulted to the patient suffering from the traumatic stress (Boswell, Kraus, Miller & Lambert, 2015). After the screening assessment, the physicians then provide a formulation that will help to treat the identified problem. The formulation could be to put the client (Guardiola) under medication and regular checkup to see if the problem is getting solved and see if the treatment is working for the patient. This formulation is done by the clinical officer. In our case Guardiola was found to have not incurred any physical injuries during the accident.
Assessment and Formulation
Psychology is simply the study of the human mind and its functions in relation to the mental and attitude characteristics of the person. Psychological assessment simply means the process of conducting tests, using a combination of techniques to arrive to a person’s behavior, personality, and personal capabilities. During a psychological assessment the main means used in the initial testing stages of assessment is interviewing. The information obtained is then used to build a hypothesis and help in the selection of tests (Chow et al. 2015). The next step is testing whereby the formulation obtained after the results are analyzed tested then a report is given out. In Guardiola’s case, the interview helped to identify the type of trauma (whether complex or simple trauma) he is suffering from and then using the data given a formulation is developed on how to treat the patient psychologically. After an interview it was evident that since the accident almost cost him his life, his psychology was greatly affected thus leading to a diagnosis of post traumatic stress leading to an intensive psychological assessment.
Social assessment helps to assess the social state of the human being and his relationship with others in the society. The assessment could range from questions of family to questions about friends relatives and close brothers or sisters. In our case, the assessment could narrow down to questions about family or friends. This helps greatly to learn if the family is contributing or helping in the social relationship of Guardiola. From the assessment it was evident that he became antisocial due to stress thus leading to him being isolated and left to stay by himself spending less time with friends and his family. This therefore formed the basis for the formulation and treatment on the social aspect of the patient.
In order to treat the patient, a treatment plan is necessary. This is simply a guideline which shows how, when, and steps to be followed when treating the patient. It outlines the best medical practices that would be highly recommended for the client to achieve the best treatment possible and help in curing the patients trauma. The process starts from diagnosis all the way to social treatment ( Friedberg & McClure, 2015). Since the trauma of Guardiola is complex trauma, the treatment will not start from the patient’s past history but dwells mainly on the current state of the patient thus calls for a proper and well designed plan to ensure that the client is not overwhelmed. Revision of the plan is very necessary to ensure that every procedure adheres to the optimum treatment of the patient. In short the treatment plan is based on:
- Strength and the esteem of the client
- The mental and physical triggers that affect the patient presently and in the future.
- The plan should not neglect the past events but work on them.
Plan for Treatment
The initial step of the treatment plan is diagnosis. The treatment plan relies heavily on diagnosis. Diagnosis helps to identify the underlying problem it could be through psychoanalysis and screening to determine the type of underlying problem. If there are any physical injuries the treatment administered would be different from the one given to treat the patient’s psychology. Finally a physical exam is used to check physical symptoms that may affect the patient(Meichenbaum, 2017). The criteria used to carry out these analysis is from the diagnostic and statistical manual and mental disorders(DSM-5).
To start with, Guardiola undergoes detailed protocol and since in our case the patient suffers from post traumatic stress the first step is to assess the ability of the client to utilize and maintain resources. These could be events, thoughts or people who had been of positive him. Since treatment is based solely on therapy the first person to create a feeling of serenity and security is the therapist. To enable and identify the negative belief that causes trauma, Guardiola should be taught on how to take the positive side of life and relate it to his positive cognition. All these steps should be followed in the psychoanalysis of the patient by the psychologist (Carrot& Potter-Efron, 2014).
The treatment given is to help the patient regain control over his life. The main treatment allowed for the treatment of the Guardiola’s trauma is by use psychotherapy and sometimes medication. These combinations helps to address his symptoms, cope with the symptoms if they arise in the future, and also help to treat other related experiences such as anxiety and depression (Youngstrom, Choukas-Bradley, Calhoun & Jensen-Doss, 2015).
Psychotherapy forms the main treatment of the trauma. There are many types of psycho therapy which ranges from cognitive therapy to eye movement and desensitization processing(EMDR). Firstly, cognitive therapy helps the patient to recognize their way of thinking and develop relations between their cognitive behavior and their environment. This therapy is commonly used along with exposure therapy. Exposure therapy always works on the behavior so as to help the patient to face situations that make the him face memories that are frightening and to focus on the best memories. These memories could be through flashbacks or even nightmares. Thirdly, the last step for psychotherapy is eye movement desensitization and reprocessing which help to change the traumatic memories and help our client Guardiola, to change how he reacts to them. To conclude he should be taught by the medical practitioner on how to handle the mental health and to develop skills that could help to develop stress management skills and hence overcome trauma ( Fife & Weeks, 2014).
Choice of Interventions
To ensure full recovery for the client, medications are necessary. The first form of medication the client should receive are antidepressants. These medications help to reduce depression and anxiety. They also help to improve his sleep which is a major factor in treatment of post traumatic stress. These medications include; selective serotonin reuptake medications and paroxetine which should be approved by the drug administration for treatment (American Speech-Language-Hearing Association, 2016). The other type of medication required is anxiety mediations to manage his anxiety, and finally prazosin which help to suppress nightmares that may occur while he is sleeping.
Social support forms the final part of the entire treatment plan for the client. For best results the Guardiola must be socially involved. The first important aspect of the social support is to help him follow the treatment plan, to enable the him to learn more about the disorder and finally know how to take care of himself. In our case, Guardiola should be encouraged to spend more time with his family so as to develop good memories that would help him to fully recover ( Miller & Moyers, 2015).
Interventions are attempts made to make a person to seek professional help to address a particular problem. It may also refer to an act of using similar technique to offer therapeutic treatment. At individual level Guardiola could intervene during treatment by ensuring that he strictly sticks to the medical plan and ensuring that he takes the therapeutic treatment with uttermost seriousness. At cultural level, he should engage in social - cultural activities that would enhance his treatment. Finally systemic interventions refers to a pattern in which an event occurs during treatment and have their own effect on the client these systems range widely from medication to therapy (Duncan, 2014). For example the he could volunteer to take part as a social worker to try and enhance his social skills by engaging in community work such as counseling and also giving advice to others in the community who might be suffering from a similar predicament.
To justify the above statement, Guardiola could work as a counselor. Becoming a counselor exposes him to different types of people and by interacting with them he could learn to understand how to cope with the various challenges that he may face during therapy sessions. The client could also become mediator and help in solving wrangles between two people. This would greatly help him to become conversant with the various social set up and thus helping him to develop legit conflict resolution skills that would come in handy to help him overcome self conflicts and condemnation and to develop a high self esteem (Medalia & Bowie, 2016).
A theoretical model is simply an assumption about a system or object. These theories can then be used to fulfill the function of explanation and derivation of principles. In our case the Guardiola is engaged in social work as a therapist . The health belief model, consists basically the following core rules: cues to action, and self efficacy. For example, if the he engages in social work, using an example of a therapist, the rate of exposure to different types of minds is possible thus it helps him to correlate between the trauma he is suffering from and the various problems people encounter during their social life such as stress and depression. This greatly helps since by providing solutions through counseling to the various problems of his clients, he is able to apply it in his everyday life thus overcoming the trauma in the long run (Barlow, 2014), leading to a successful treatment.
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