Client Case Study
SWK5026: Foundation Practicum 2
January 30, 2022
The current study would deal with the case study of a client with pseudonym John Coffee. John is 17 years old African American male. His family is poor and receive public assistance. John suffers from schizophrenia paranoia. In response to this scenario, it would be discussed about the diverse background of the client including age, gender, ethnicity, socio-economic status, class, strengths, and other challenges. Along with this, it would also be discussed about the social, economic, and environmental justice issues. Mezzo, micro and macro practice skills would be implemented while working with the client or the client system. The client has been provided with a pseudonym to maintain confidentiality to eliminate legal issues.
Discuss the Diverse Background of the Client or Client System
The client’s name is John Coffee, age 17 years, African American male. John’s family is poor, socio-economic class. He is a senior in high school. John has been diagnosed with schizophrenia paranoia. He hears good and bad voices. His self-esteem is low which causes him difficulty to engage with his peers. John has terrible hygiene. The other males in the group home make comments about how John smells. Also, they like to agitate John by excluding him from group conversations and whispering to each other. John begins to hear voices when he gets triggered. The staff work together once they notice that John has been triggered and is having an episode. The steps that are taken during the diffusion process are as follows: one staff stand about two to three feet from John and talk to John, the other staff gets the radio or his phone and plays music, they offer to listen to him vent, the other staff will have John’s medication, water and his guitar. Once John is calm enough to agree to take his medication, the staff give it to him and a bottle of water. The final step is offering him his guitar to play along with the music or to continue to listen to the music.
Due to this condition, John is required to participate in individual and group therapy, strict supervision is conducted upon his noticeable and unnoticeable triggers. John must face different economic, social, and environmental justice issues which are impacting his overall health condition. Like, John cannot be left alone for a longer period among different people as he might get triggered; strict supervision is highly required for him. Another example can be that John hates taking accountability; when other children in the group whispers and discusses anything he considers that they are plotting to get him. John is also concerned and skeptical that someone is out to get him which makes him change his bed to face the door. Finally, John is in the transition/termination process because he must leave the center 6 months from the date that he becomes 18 years old. John will be terminating his services with Sunlight Behavior Center and transitioning to an adult group home.
Person Centered Therapy & Social Learning Therapy
The therapy that is used with John is Person Centered therapy focuses on the individual as a whole and it is a positive approach when dealing with current issues. The goal of person-centered therapy is to teach the individual how to focus on the positives of a situation and to teach coping skills. Once we identify that John is triggered, we immediately begin to implement techniques to calm him down. According to the case study, John is schizophrenic as he has been abused in his childhood.
Also, we use the social learning theory. It is one of the most used and most effective theories as it involves the learning process and social behavior acquired from his environments. This can only be done through imitating as well as observing others. It is expected that social learning theory could be to a great extent addressed effectively (Rumjaun & Narod, 2020). This theory has suggested the social behavior of others and limiting the behavior of others.
Social Learning is the most effective one since this involves learning and driving motivation for the concerned person from its social surroundings. It is expected that the people around him could influence him into becoming involved with normal daily life activities. With this, the difference in John’s behavior could be understood and help the caregiver to understand the issue he is facing.
Micro Practice, Mezzo Practice, and Macro Practice Skills used in Working with the Client or Client System
John participates in a work/study program at his high school. This program was implemented to assist in the process of helping John become independent and to develop skills that would allow him to maintain his life once he becomes an adult. He goes to McDonald’s to work twice out of the school week. The on-the-job training allows John the opportunity to work and interact with his peers. This is a goal that is on his IEP and on his Person Center Plan necessary for him to have control over his behavior and paranoia episodes to take his own care. Micro practice skills mainly include teaching basic communication skills like reflecting feelings, summarizing, asking open and closed questions with information along with body language which can help in demonstrating facial expressions and listening (Lombard & Viviers, 2020). In response to this, the staff can help John in enhancing his communication skills as this would be highly helpful for him at his job. It is important to make John deal with anger, being assertive, taking care of basic needs like hygiene, grooming and bathing. John participates in group therapy. The topic that we are focusing on during group therapy is proper hygiene. During, the group therapy the clients watch videos of implementing and maintaining hygiene which can be highly helpful for them. These skills would allow the client to improve his skills while serving the customers at his workplace. Also, it would boost his confidence to become sociable with his peers. John working at McDonalds would require higher concentration towards maintaining hygiene and self-care. Being assertive will help John to express himself which can reduce conflicts and his aggressiveness.
In addition to this, mezzo social practice skills are all about development and implementation of social service initiatives at community levels. The mezzo social work practitioners would help John to deal with people directly and socialize with them. Most importantly these skills would allow the clients to focus on community development and interpersonal relations (Matz et al., 2020). Although John loves his job at McDonalds, he only goes to work on Tuesdays and Thursdays for only two hours, this would help him to maintain consistency. In response to the case of the client, it can be mentioned that conducting discussion sessions with John would help him to open with others which can help him enhance his socializing skills as well. This type of coordination is effective for helping to assess mental as well as physical problems of the client.
We incorporate mezzo social work practice skills by working with the Department of Health and Human Services. This department comes every 6 months to audit the group home to make certain that we are following the guidelines and procedures mandated. They check the client’s books to make certain that he is going to his medical appt, they ensure that they are having family and child team meetings once a month. Department of Social Services representative conducts the meeting, Guardian at litem, Qualified Professional. The client must be reauthorized monthly to continue to stay in the group home. The Qualified Professional has the task of submitting a reauthorization for the client to remain in the group home every 20 days. He must be evaluated every month by a psychiatrist, the client’s Person-Centered Plan must be uploaded, crisis prevention sheet that provides information about, what triggers him, what makes him happy and his medication log.
Pawar and Nixon (2020), mentions that macro practice skills are referred to speaking, listening, reading, and writing mainly in English Language, this is also linked with enhancing the communication skills of the concerned client. The social work practitioners are active in organizing the activist group or advocating social policy change. At the macro-level social work, the focus is on the community at a large scale undertaking different systems-level functions. The social workers are responsible for supporting John at a large scale of communities, cities, and people (Applewhite et al., 2018). Collectively, this would help John to improve his active listening which is very important for his job. John must be supported to understand the activities which are linked with his comfort within social and environmental levels. Altogether, the mezzo, macro and micro practice skills can be implemented in the context of John Coffee as this is beneficial for supporting the client on an overall basis including his basic development which can help him manage the social and other challenges outside the center.
Problems and Issues faced by the Client or Client System
Referring to the case scenario, it has been observed that the client John Coffee often suffers from certain triggers which result in behavioral disruptions resulting in the requirement of constant supervision. John was on probation when he was admitted into the center because he would get angry and vandalize property. His parents were not knowledgeable enough to provide him with the coping skills that he needs to implement into his life. Hence, through local services he was referred to Sunlight Behavior Center. His parents expressed their concerns about his welfare, as well as their welfare. They were scared that he would possibly harm them and his siblings. We had to ensure that the client met his requirements while on probation. We met with juvenile court counselor and provided the client with consequences. The main goal that Sunlight Behavior Center wanted to implement was assisting John in learning coping skills when he becomes triggered. We wanted to him to implement breathing techniques, thinking and/or doing an activity that calms him. We have designated cool off area for John when he becomes triggered. He is encouraged to go to the cool off area opposed to vandalizing the property at the center. John is aware that if he vandalizes any property at the center law enforcement will be called. John has a clear understanding that there are consequences for making bad decisions. We provide praise and reward when goals are accomplished.
John is allowed the opportunity to choose who he would like to converse with when he is triggered. The goal is to let him feel empowered. He implements use of his breathing techniques and other techniques to deescalate the client. The other person would be there with the medication and water. The individual that he is talking to can simultaneously give him the water and medication while talking. He always must be within eyesight. I have built rapport with John by learning his interest is music and playing the guitar. I was able to establish a relationship with John by consistently displaying that I am interested in his hobbies and him as a human being, I ask him every day, “How did your day go?”, “What was the best part of your day?”,” What is the worst part of your day?”. These open-ended question lead to conversations that allow me to actively engaged with him and build upon his interest.
Also, the goal was to build his confidence to become sociable. This can be socially challenging for John as he feels that other children at the center are plotting against him. He also has environmental fear which is that he feels someone is coming to get him at night. The staff had to change his bed to face the door. Another goal that had to be modified in his intervention plan was providing him with the skills to be independent and to transition from the group home into his own apartment.
Unfortunately, John displayed behaviors at the work/study program that led the IEP team to suggest that he may not be ready to live on his own and provide for himself. This information was provided to the site supervisor. The site supervisor suggested that we get him test at the Haymount Institute to assist with him getting assistance beyond the age of 18. The results from the test have determined that John cannot live independently and should transition to an adult group home. The next step to assist John with his transition from the group home was to assist him in completing his Social Security Disability paperwork and submitting it. John has been approved for the disability income. John getting approved for disability helped secure him residency at the adult group home. It is difficult for him to understand that he must leave Sunlight Behavior Center just because of his age. He got quite comfortable with his current living condition. He now lives the life of a middle -class individual. Fortunately, two of the staff at Sunlight Behavior Center, also, work at the adult group home that he will be transitioning.
Most importantly, he finds it consistent and comfortable with the old staff. John would also face behavioral issues within a new place. From these instances, it can be mentioned that individuals like John might suffer from severe issues if their environment is changed, they might require time to get accustomed with the people at the new place. John had begun to act out in school. He thought that if he failed his grade that would eliminate him having to transition to a new group home. His understanding was that as long as he was a high school student, he could continue to reside at Sunlight Behavior Center and receive services. However, during an individual therapy session we discussed that he would have to transition because of his age. He has reached the age requirement for transition/termination of service. Hence, we have begun the termination process to make the transition seamless. We discuss how he feels about transitioning and we provide him information on what to expect. The discharge paperwork states that they have either completed the program or they would not comply with the program. An email or letter has been sent to the Department of Social Services office to inform them the client will be discharged within 30 days. and list the reasons as to why, and provide information of diagnosis discharge paperwork states that they have completed the program, or they will not comply with the program: an email or letter has been sent to the DSS officer to let them know they will be discharged within 30 and list the reasons as to why (he turned 18 on Jan 1, 2022), and provided information of diagnosis (schizophrenia paranoia). Also, we will be checking in on him for the first 30 days to offer comfort and assisting him get accustomed to his new environment.
In response to the above study, it can be concluded that people with schizophrenia paranoia are required to be provided with support and supervision so that they work upon eliminating their issues and focus upon social development. The study has discussed the implementation of macro, mezzo, and micro practice skills to support the client, John Coffee in his basic development to eliminate social, environmental and economic issues.
Applewhite, S.R., Kao, D. & Pritzker, S., 2018. Educator and practitioner views of professional competencies for macro social work practice. International Social Work, 61(6), pp.1169-1186. https://journals.sagepub.com/toc/isw/61/6
Lombard, A. and Viviers, A., 2020. The Micro–macro nexus: Rethinking the Relationship between Social Work, Social Policy and Wider Policy in a Changing World. The British Journal of Social Work, 50(8), pp.2261-2278.
Matz, C., Sabbath, E. and James, J.B., 2020. An integrative conceptual framework of engagement in socially productive activity in later life: Implications for clinical and mezzo social work practice. Clinical Social Work Journal, 48(2), pp.156-168.
Pawar, M. and Nixon, M., 2020. Social policy practice preferences by social work students: Implications for macro practice education. The British Journal of Social Work, 50(8), pp.2279-2297.
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