Assessment (Hepworth, 2013, p. 192-193)
Client is Ms. Juana Hernandez, though Will County Health Department, made referral to Joliet Area Community Hospice- it increasingly hard to cope with her 9 year old son’s death. As the anniversary of his death comes near, client has thoughts of suicide and finds it unbearable to face the fact that her son is dead. Ms. Hernandez is 38, single mom, and has two daughters, ages 5 and 8. She lives in a two bedroom apartment. * Ms. Hernandez is currently facing legal problems for driving on a suspended license. Client drives to and from appointments; thus raising concerns. Client is currently being treated for suicidal thoughts related to her son’s death. She reports that she’s taking all prescribed medications and has no thoughts of hurting herself and/or others. * Ms. Hernandez also expresses concerns for her other two daughters in the household. The girls are 5 and 8 years old. Recently her daughter (5 year old) had been playing in her room unattended and somehow managed to fall from the second floor window. The daughter told her mother that her deceased brother told her to play with him. The client acknowledges that she and her 5 year old daughter are being medically treated for Bipolar Disorder. Client has also been diagnosed with Schizophrenia. * She was sexually assaulted as a teenager and has not sought counseling to cope with the effects of the assault. Client appears to have the maturity level of a teenager. Client uses inappropriate language and does not comprehend on an adult level. This issue makes it increasingly hard for the client to maintain employment. Client receives welfare and healthcare from the state, and finds it hard to provide for her family based off her limited income. The father of her daughters lives in Mexico and declines communication with her. Financial obligations prohibit her from supervising her children as she should, this raise concern about their safety when she’s not able to be around. * After being sexually assaulted Ms. Hernandez turned to drugs and alcohol in an effort to self-medicate herself. Client was still dealing with substance abuse problems when she was pregnant with her late son. Client believes that her drug and alcohol use subsequently was the cause of her son’s death. Client’s guilt leads to thoughts of suicide and self-degradation. * Every year on the day of her son’s death client falls into depression and begins to have thoughts of suicide. This year marks the second anniversary of her son’s death. Ms. Hernandez reached out to Will County Health Department crisis hotline when she started back using drugs (marijuana) to cope with the upcoming date. Client has been coming to JACH for six months. Throughout this time client has failed to discuss the initial reason for being referred to JACH. When her son is brought up client either deviates from the topic or have an emotional outburst. Client is not coping with her son’s death. Before the client is able to cope with her son death, she must first acknowledge what she experienced as a teenager. * Ms. Hernandez is open to suggestions and exudes a willingness to learn. Her current resources are limited because she doesn’t have any family in Illinois. All resources are through the state (welfare, healthcare, etc.), hospital (therapy, support groups, etc.), and Will County Community Concerns. It is encouraged that client attend support groups for single parents. Client was referred to Catholic Charities Community Classes for parenting class, Addiction Counseling, and Saint Joseph Mental Health to discuss the effects of her childhood Trauma.
Goals/ Case Plan
Given that the client is nearing the anniversary date of her son’s death, we wanted to ensure that she had an appropriate, safe, and effective plan of action. This plan is to be enacted on the day of. Instead of being alone in her room with alcohol and marijuana on that day, the client suggested that she go to her son’s grave. In celebration of his life the client agreed to take her daughters to the grave site to release balloons in remembrance of him. The goal of this is to move through the grieving process in a healthier way. Other tools are given to the client, such as; informative literature that explain the grieving process of a child, crisis hotline to call when and if suicidal thoughts occur, and a list of resources that are specific to her needs. Client’s case plan also outlines the others steps that needed to be taken to begin a more comprehensive healing process.
Proposed Intervention (s) / Course of treatment
It is pertinent that the client completely understands that regardless of the cause, her son is dead. There are other contributing factors that make it difficult for the client to digest that single fact. The first step of intervention for the client is acceptance. Avoiding her son’s grave site kept the client in denial. The client suggestion to visit her son grave site on the anniversary date was accepted and agreed upon (Hepworth, 2013, p. 21). It was then determined that associating her son’s grave site with positive memories would help eliminate the negative association. The client acknowledges that she has some unsettled memories in her past that continues to have a negative impact on her life. Through further counseling it is our hope that a new chapter in her life can began. In our sessions client has shared other concerns/issues that does not align with the focus of hospice. In our direct practice we do not have the capacity to tackle those concerns, but through Catholic Charities, Saint Joseph Mental Health, and Will County Community Concerns the client will receive the appropriate intervention as needed.
Key Strengths and obstacles affecting working toward goals (Hepworth, 2013, p. 191-193)
Strengths and Resources
Quadrant 1- Environmental Factors * Juana has found support through Catholic Charities and continues to work with Will County Resources and Referrals to obtain childcare for her children. * Juana currently has a place of employment and she receives enough income to provide for her household’s basic needs.
Quadrant 2 – Personal Factors * Juana understands the correlation of her past and presence. Juana is willing to seek services to help her cope with her past. Juana acknowledges that her children are not of age to be left at home unattended.
Obstacles
Quadrant 1- Environmental Factors * Juana does not have reliable support system. She does not have anyone to hold her accountable for her decisions. Juana struggles to provide proper care for her children; which has placed the children in harm’s way. * Juana is driving on a suspended license because she can’t afford to pay the fines.
Quadrant 2- Personal Factors * Juana was sexually abused in the past; which led to her substance abuse. Juana blames her substance abuse for the death of her mentally impaired son. This guilt increases as the anniversary of his death approaches. * Juana has the tendency to over share information that could potentially place her in a compromising situation, if brought up around the wrong entity. * Juana is open to learning different coping mechanisms and has proven to be susceptible to all recommended treatments and referrals.
Ethical implications
Ms. Hernandez admitted that she was driving to all of her meetings on a suspended license. In support of confidentiality law enforcement was never alerted, but on the other hand she had two minor children in the car with her. Her license was revoked for reckless driving and she was in court for a DUI. Out of concern for the children and other innocent pedestrians on the road, I wanted to speak to law enforcement. I was instructed by my supervisor that it wasn’t our place to report her, but if we were contacted and asked specifically by law enforcement, we had to disclose the information. Another Concern is by the client’s own admission; she sometimes leaves the children unattended. As a soon to be Social Worker I uphold NASW Ethical Standards. Per our discussions it doesn’t seem that it’s in the children’s best interest to stay with her; or she needs a better support system that can help with child care.
Diversity Issues
From previous education I found it difficult to believe that she didn’t have any strong family ties. According to my understanding of previous teachings, Hispanics value family. After learning that she didn’t have a support system I realized that although studies give ideas, it doesn’t account for every single person that one may encounter within the field of Social Work. It’s also important to acknowledge the stigmas associated with Hispanic women. The National Association of Social Worker’s Code of Ethics (1996, p. 27) states: Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability. (Zastrow & Kirst-Ashman, p.253)
Juana talked with a strong accent which made it difficult to understand her at times. Whenever I was unsure I would ask her to repeat just to make sure I fully comprehended what she was saying.
Evaluation
Without violating confidentiality, client will be evaluated through follow- ups. As the anniversary of her son’s death get closer, client will be monitored to ensure that the suicidal thoughts are not present. Bereavement counseling will continue. She will be responsible for maintaining an open line of communication with bereavement counselor, in hopes to catch any negative thoughts before they flourish into actions. Ms. Hernandez understands the importance of the referrals made on her behalf. She agreed to attend parenting classes and out of concern for the children follow-ups with the counselor in charge of the classes will take places regularly, to ensure that Ms. Hernandez is attending.
Case Summary
Ms. Juana Hernandez was referred to Joliet Area Community Hospice for bereavement counseling. The anniversary of her son’s death was nearing. She was experiencing suicidal thoughts in lieu with depression symptoms. The goal of our agency was to address those suicidal thoughts by providing bereavement counseling, in hopes that she will cope with grief in a healthier way. Client has acknowledged that she doesn’t know how to cope with her son’s death. Acceptance is one of her strengths. Although the goal is for her celebrate his life, it’s a chance that she may not know how to put that plan into actions once that day come. Forgiveness plays a huge role in her situation. Client finds it progressively hard to accept the fact that she made some choices based off what she encountered as a teenager. Client does not have a support system at the moment, so it’s up to her to hold herself accountable to the aforementioned goals. As time passed it became increasingly obvious that Ms. Hernandez was dealing with a combination of barriers that prohibited her from moving forward from her son’s death. Currently Ms. Hernandez is having issues with providing proper care for her two daughters. At times, she reported that she have to leave them alone to go to work. It was determined that Ms. Hernandez would benefit from parenting classes and further counseling to address those needs that don’t fall within the guidelines of our agency. Aside from the counseling, client was given resources for appropriate childcare and safety. Client has been diagnosed with Bi-polar Disorder and schizophrenia. She reported that she is currently taking her mediation. Client continues to attend bereavement counseling and will return on an as needed basis.
References
Code of Ethics (English and Spanish). (n.d.). Code of Ethics (English and Spanish). Retrieved September 24, 2014, from http://www.socialworkers.org/pubs/code/code.asp
Hepworth, D. H., & Rooney, R. H. (2013). Direct social work practice: theory and skills (9th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
Zastrow, C., & Ashman, K. K. (2013). Ethnocentrism and Racism. Understanding human behavior and the social environment (9th ed., pp. 239,253). Australia: Brooks/Cole, Cengage Learning.
