Chapters 1 & 2: Society History

1. The Worker is thorough, and concise in her writing of the report history. The client revealed a lot to the worker, and was quite willing to do so, which indicates some level of trust and comfort with the worker, regardless if the client was “flat”. 2. The Worker, in my opinion makes little if any assumptions, and any that are made are clear and backed up by a quote from the client or based on facts relayed by the client, and are reasonable in nature. All of her writings are as stated by the client or based on the client’s story. 3. Kate is depressed. She has lost interest in the things that previously used to give her pleasure. She has pulled away from friends, and the church choir, since the passing of her mother 2 years prior, stating not having the energy to add it to the list of things to do. Kate does not recognize the positives in the things she has endured and commanded in her life. It seems to me that she has always been wrapped up in her mom’s problems/life, all of her life, since the passing of her father, and as a result, she has forgotten about Kate! She no longer has her mom to worry about, and it is my opinion that she has lost a big part of who she was, and is depressed due to that as the root problem. 4. Kate has always had to take control or make decisions on behalf of her mother, from the young age of 6 years old, when at that time her father passed away. This has been her identity from this very young age, and now that her mother has passed on, a huge part of her identity is missing, and there is a huge hole in her life and her existence. She no longer has the burden of worrying about her mother, but that is hard to let go of, since it’s been her identity for years; her entire life basically. She accepted and acted accordingly as needed throughout. Now there is a huge void where once there was great worry, and caretaking of her mother.

Chapter 3
Developing Service Plans; P. 63-68, #1, 3 & 4
#1 – 8 Year Old Kevin and Custodial/Biological Mother; Mrs. Moore

Kevin Moore: Kevin’s Mother (Mrs. Moore) brought him in to enquire about putting him on Ritalin for stated hyperactivity. Kevin is 8 years old.
Witnessed woman abuse/violence from birth to 4 years, (Parental violence through his father abusing his mother) at which time his mother and father separated.
Kevin’s custodial parent, his mother, has, on 2 home visits with myself, openly shared her story of abuse by Kevin’s father, to me, in front of Kevin, to which Kevin became hyperactive as described by Mrs. Moore, (His mother), upon our initial meeting.
Mrs. Moore: 8 year old Kevin’s custodial, and biological mother.
Mrs. Moore brought Kevin in to enquire about putting him on Ritalin for stated hyperactivity and uncontrollable behavior.
Mrs. Moore was abused physically by her ex-husband for 4 years, to whom she is now separated, also for 4 years; (from the time her son was born until he was 4 years old.)
Mrs. Moore talked in detail about the abuse she experienced in her marriage, on all 3 occasions that she and the worker attended; once at the office of the worker and twice at the home of Mrs. Moore and Kevin, visited by the worker.
Summary:
After speaking with Mrs. Moore separately, while Kevin played in another room with a member of our
Staff and after also meeting with Kevin’s Grade 3 teacher, as well as attending 2 home visits at the home of Mrs. Moore and Kevin, the worker learned 1 of 2 things; 1, that while in the presence of the other staff member, as well as at school, as observed by his teacher, Kevin acts at average attention levels with no evidence of hyperactivity.

And 2, In contrast, the worker observed the opposite while attending the home of Mrs. Moore and
Kevin; on 2 separate home visits. Both Mrs. Moore and Kevin were present for these home visits. On both occasions, Mrs. Moore retold her story of abuse by her ex-husband and biological father of Kevin, in front of Kevin. On both occasions, Kevin exhibited hyperactive behaviors, similar to those stated by his mother in the initial visit.
Recommendation:

As a result of the worker’s learned knowledge, through prior stated means, it is the worker’s recommendation that Kevin and his mother, Mrs. Moore attend counselling for those subjected to woman abuse, separately, then together through the following:

Vanier Children Services: “Children/Youth Counselling for children exposed to woman abuse or violence,”

London Abused Women’s Centre: “Women’s counselling for abused women,”

Vanier Children Services: “Focused Family Counselling,”

Where: Vanier Children’s Services London Abused Women’s Centre
871 Trafalgar St. 217 York St, Suite 107
London, ON N5Z 1E6 London, ON, N6A 5P9

Programs: 1) Community Group Program for Children Exposed to Woman Abuse; Vanier Children’s Services (Kevin)

2) Individual Counselling/Advocacy Meeting(s), as required; London Abused Women’s Centre (Mrs. Moore)
3) “Making Connections” Group therapy; London Abused Women’s Centre (Mrs. Moore) 4) Focused Family Therapy; Vanier Children’s Services, (Mrs. Moore and Kevin)
Program Overview 1) Individual Counselling Assessment, and Community Group Program for Children Exposed to Woman Abuse: Vanier Children’s Services:
Groups focused on helping participants learn better ways of handling the following issues: managing emotions, coping with a family member's mental health illness, dealing with having been witness to violence or woman abuse, learning positive parenting approaches that work, becoming a caring dad.

Why the worker recommends this program for Kevin: The worker believes that Kevin would greatly benefit by talking about his father, his mother, and the abuse that he witnessed towards his mother, as a very young child; first one on one with a counsellor for full assessment and then in a group setting of children of similar age and with similar issues, further elaborating and teaching on the subject of abuse from the child’s point of view.

Why the worker recommends this program for Kevin: The worker believes that Kevin would greatly benefit by talking about his father, his mother, and the abuse that he witnessed towards his mother, as a very young child; first one on one with a counsellor for full assessment and then in a group setting of children of similar age and with similar issues, further elaborating and teaching on the subject of abuse from the child’s point of view.

2) Individual Counselling/Advocacy Meeting(s), London Abused Women’s Centre:
The woman can meet with the Advocate on an individual basis for a maximum of six to eight sessions. These meetings are one hour long, are scheduled about once every three weeks, and can include the following:
Identifying the nature of the abuse, (from the individual abuser as well as from institutions such as the justice system), and reflect on how the abuse affects the woman's life;

The woman and her advocate working together to create/update a personal safety plan relating to the changes in her situation with respect to her relationship with the abuser;

Assistance in devising and taking steps to seek safety in her life, usually through ensuring that she has access to appropriate information and resources;

Providing information, options, and referrals regarding other helpers, agencies and groups in the community which may be useful to her. The advocate may act as a liaison to the referral on behalf of the woman; and,

Accompanying the woman, when requested and available, to meetings with Crown Attorneys, lawyers, and social service professionals when advocacy is required.
Why the worker recommends this program for Mrs. Moore: The worker believes that Mrs. Moore would greatly benefit by identifying with the abuse she experienced, through talking one on one with a counsellor and then in a group of her peers with similar issues and experiences. The worker believes that identifying what has already happened to her, and putting it into words will help to promote better awareness of what happened to her and to her son, in the effort to facilitate healing, and build and enforce a stronger person and supportive mom for Kevin.

Why the worker recommends this program for Mrs. Moore: The worker believes that Mrs. Moore would greatly benefit by identifying with the abuse she experienced, through talking one on one with a counsellor and then in a group of her peers with similar issues and experiences. The worker believes that identifying what has already happened to her, and putting it into words will help to promote better awareness of what happened to her and to her son, in the effort to facilitate healing, and build and enforce a stronger person and supportive mom for Kevin.

3) “Making Connections” Groups, London Abused Women’s Centre: The Making Connections group program is available to women who choose this option after having had at least one individual meeting with an Advocate. Making Connections meets for 2 hours each week for twelve weeks. An evening and afternoon group during the Fall, Winter, and Spring is usually available.

The Making Connections Group offers women an opportunity to learn from other women who have faced similar abusive situations. The group is based on a popular educational feminist model.

Women are provided with information and engage in discussions about the abuse they are/were subjected to and how this personal abuse connects to the woman abuse that is perpetuated by societal values and community institutions.

It is also an opportunity to connect with other women who have been in abusive relationships, to break the isolation women are subjected to and to work towards building a supportive community.
Why the worker recommends this program for Mrs. Moore: Again the worker believes that Mrs. Moore would benefit greatly by participating in this Group; by sharing experiences, actions and re-actions to those experiences among those who share similar experiences as Mrs. Moore herself.

Why the worker recommends this program for Mrs. Moore: Again the worker believes that Mrs. Moore would benefit greatly by participating in this Group; by sharing experiences, actions and re-actions to those experiences among those who share similar experiences as Mrs. Moore herself.

4) Focused Family Therapy, Vanier Children’s Services: Up to 14 sessions focused on the family's goals for change.

Why the worker recommends this program for Kevin and Mrs. Moore: The worker believes that after Kevin and Mrs. Moore have completed their respective individual counselling, this would be the next and possibly the last step for mother and son to share and discuss what they both learned, and teach them to integrate their new knowledge into everyday life with each other, through promoting understanding of each other, respect, boundaries, individual and mutual goals, and a positive attitude for the future.

Why the worker recommends this program for Kevin and Mrs. Moore: The worker believes that after Kevin and Mrs. Moore have completed their respective individual counselling, this would be the next and possibly the last step for mother and son to share and discuss what they both learned, and teach them to integrate their new knowledge into everyday life with each other, through promoting understanding of each other, respect, boundaries, individual and mutual goals, and a positive attitude for the future.

Conclusion
The worker would like to see Kevin and Mrs. Moore for at least 1 session after completion of their respective counselling to discuss what they both learned and assess their current situation, encourage continuity of newly employed strategies, inform of more resources available, and assure them that they can come back anytime if they feel they need to.

#3 – Ardella , Age 2, and Ardella’s mom, Age 19

Ardella: Aredella is a female; 2 years old. Ardella appears to be an average, happy, healthy toddler.
Ardella was brought in by her biological, teenage mother to obtain medication for the child’s “Bad behavior” by her mom.
Biological: The biological mother of Ardella and she is 19 years old.
Mother
Mother gave birth to Ardella at 17 years of age.

Mother quit school before giving birth to Ardella. Mother complains of bad behavior exhibited by daughter Ardella; touching things she is not supposed to or told not to, putting things into her mouth, shredding magazines, despite the mother yelling at Ardella and hitting Ardella in her effort “make her listen.”

Summary
Ardella is a 2 year old female, brought in to the agency by her biological, teenage mother; 19 years old. The mother is asking for medication for Ardella; complaining she does not listen. The mother states that she believes there is something wrong with Ardella; that she “not right” as she will not listen; Ardella touches things she is told not to touch, she puts things in her mouth, she gets into drawers and cupboards, she tears magazines up that her mother has laid out on her coffee table in the home. The mother states that she has told the child not to touch the things that are on the coffee table numerous times and has yelled at the child and hit the child to try to get her to listen. The worker is concerned of child abuse by the mother towards Ardella.
The mother states she quit school before Ardella was born; she did not like school anyway, due to “All the stuff they make you do.” The mother and Ardella are in receipt of welfare as their primary family income.
Recommendation
Yelling and Hitting of a toddler of 2 years of age is abuse, given the age and capacity of the child to understand instruction, and their natural curiosity to touch, taste and explore their surroundings. The worker believes that this abuse is not malicious, but occurring due to a lack of education and supports in the mother`s current situation. The worker`s recommendation is that the mother and child be assessed through CAS (Children`s Aid Society) and be required to facilitate 2 weekly in home visits by a social worker to teach/promote positive child rearing strategies, lend support and continue to monitor the concerns of abuse and to further require the mother to attend Parenting Classes for the early years in childhood development. The worker also recommends that the mother return to school as a mature student to increase her ability to work outside the home, with the goal of financially supporting herself and Ardella, thus promoting positive, productive contribution to self-sustainment and a positive outlook toward the future and about herself as an individual. The worker recommends the following program for the mother.
Where: Vanier Children’s Services
871 Trafalgar St.
London, ON, N6A 5P9

Vanier's Early Years Program, to 0-6 Years
The Early Years Team provides services to children age 0-6 and their families who may be experiencing serious difficulties including; attachment disorders, anxiety, emotion regulation issues, school failure adaptation, sleep issues, poor peer relationships, anxiety, uncontrolled aggression and tantrums. Children may be hard to serve at home, in childcare or at school. How They Help: * early identification and treatment of emotional, psychological, social and developmental concerns in young children * promote the prevention of more serious issues for children later in life * strengthen relationships between children, their parents and their families * provide strength-based interventions that reflect best practices for children age 0-6 * establish linkages and appropriate supports for the family within the community

What They Offer: * family assessment and therapy with experienced Child & Family Therapists * intensive family services (in-home) * parent support * parent/child therapy * play based therapy for children * parent psycho-educational and children social skill groups * parent skill building and support * educational workshops for parents and professionals * specialized assessment (psychiatry, psychology, occupational therapy, speech and language) * community school support

Who is eligible? * residents of London-Middlesex * experienced staff go to Elgin, Oxford and Lambton counties to provide services in children's mental health agencies
There are no fees for Early Years services.
Conclusion:
The worker would like to see the mother and Ardella back in six months to discuss what they both learned and assess their current situation, encourage continuity of newly employed strategies, inform of more resources available, and assure them that they can come back anytime if they feel they need to.
Intake Form will be handed in, in person.
Chapter 4 – Assessing Lethality, P 131-132
No way, I would definitely discourage Annette from going to pick up her things alone. Her boyfriend has a gun, (Means), He has demonstrated in the past that he is violent, and serious when he threatens to kill both himself and Annette, by the use of the gun as a threat, if she ever leaves, (Motive). As far as Annette knows her boyfriend still has said gun. Her boyfriend has used this gun on her before when Annette intended to leave, and he confined her to the house until she said she would stay. A very recent positive change in attitude of the boyfriend is suspicious at best. I would stress the danger she would be putting herself in should she go over to pick up her stuff by herself. I would strongly discourage Annette. I would advise that she must take a police officer with her when she goes to retrieve her belongings for her own safety and that of her boyfriend as well.

Carla’s situation is lethal. Her husband is extremely controlling, rarely letting Carla be out of his company, for fear that she will be with another man. He exhibits irrational violent behavior at the thought of his wife being with another man. Carlas husband has a small hand gun he keeps in his bedside table. He has told her that she belongs to him. I do not think it would be a good idea to tell Carla to leave on the night she calls. Firstly the baby is at home, and she must leave with the baby. I would advise of what she wanted to know, then I would stress to her that we are hare for her and her baby, and I would instruct her on an escape plan, for her and her baby to leave safely and come to our shelter, or to find a time where she can call back to plan out an escape plan, because if she stays out too long as she stated, her husband would be enraged when she got home and things would go from bad to worse. Definitely advise her to leave as soon as possible, but she would have to be ready at a moment’s notice to leave, with her baby in tow, due her husband’s controlling her actions of when she can come and go. Opportunities do not come up often so she would have to be ready, and I would work with her to come up with a safe escape plan.
Barriers to Leaving:
#1
* Husband is a well, liked City Official, she feels that no one would believe her over him. * She sounds isolated; nobody in his work knows her. * Her husband has promised to go for help. * She still would like it to work if it’s possible.
#2
* Isolated from her family, when she moved with her husband. * She just moved there so she doesn’t know anyone except those at the shelter. * Threatening to take the kids if she goes through with separation. * She cares about him; she doesn’t want him to lose his job.
#3
* Low self esteem * Partner is very controlling and jealous * She left once before and he convinced her to go back; now she wants to do the same thing. * He has isolated her from family and friends. * Doctor did not take her seriously or misdiagnosed her. * She’s hundreds of miles from her family.
Intake Forms – P 137 * All of the things listed on the intake form are all helpful in giving a detailed profile of the victim and the perpetrator, for therapy reasons as well as for legal reasons. All tell a history of persons involved, including the perpetrator. All of this can be used in statistical reporting as well.

Chapter 5 - Assessing Tolerance, Dependence, and Withdrawal, P174-175

#1 - Tolerance – Mr. Preston is a functioning alcoholic only drinking enough to “scratch the itch.”
#2 - Withdrawal – Mrs. Borden is fidgety, anxious and feels like she will crawl out of her skin, due to not having a drink for 24 hours.
#3 - Dependence – This alcoholic is dependent on alcohol to stop the pain he feels when he doesn’t have a drink.
Chapter 6 - Assessing for Lethality in Suicide:
#1
The risk is high. Although Carl has never attempted suicide, or felt like he wanted to before, He has been through a life altering traumatic event; the loss of his high powered job, and reputation. He and his family have suffered great embarrassment through the press. He has a gun readily available, and he has thought about how and when specifically to do it within the last week, which was preceded by just thoughts of suicide as a means of a way out of the mess his life had become and as stated has escalated to the point of thinking of how , when and where to do it.

I would not let Carl go home because he has the means, the intention, and a plan to commit suicide; in the morning, in the garage, where the he keeps his handgun, when his wife and children have left the day. #2 The risk here is moderate. Given the history of depression, the scars from prior attempts, and the statement that she has saved up pills that she can take, “if and when she feels there are no other alternatives” is very concerning and shouldn’t be taken lightly, but she is indicating that she wants to try something to make herself better, by suggesting she has not exhausted all alternatives yet. To me that is saying I don’t really want to die, I just don’t want to live depressed anymore, please help me.
I would talk with her more to make sure that I felt comfortable that we can together come up with a plan for her recovery that helps her to see a future without depression, and that she is committed to coming back regularly until that is realized. I would send her home of course with the suicide hotlines and emergency numbers, with the promise that she will not make a permanent decision for a temporary problem, and come back to see me the next morning to start our plan for her. I would have to feel ensured I have engaged her attention to the plan we both come up with and I would have to feel that she will be back the next day .

Intake Forms – Mental Status Exam P 249-258
Identifying Information: Covers all basic personal information about a person, Name, Address, Phone Number, Work Number, Gender, Date of Birth, Social Security Number, Language, Interpreter needed? Marital Status, Maiden Name, Primary Source of Income. All identifiers that are listed and can be verified with a government authority or business authority.
Insurance: Yes or No? Does this apply in Canada? I didn’t think that it did.
Other Agency Involvement: Tells the current agency where the client has been before, which can be helpful, to get feedback of what happened while the client attended the other Agency.
Description of Presenting Problem: This is highly important for obvious reasons. It tells the issues that the client has come to you for.
Education/Work: Helps to show the functioning level of the individual.
Home: Shows the relationships the client is involved in at home and any significant other living outside of the home. Shows support what the client’s support system is.
Transportation Used: Identifies how the client navigates the community in which they live.
Social/Recreational: Shows what level the client is at socially and what capabilities they have through their interests, and participation in Clubs, Hobbies, Sports, Activities with Friends, and religion.
Medical History: Obvious reasons, prescribing pharmaceuticals, being aware of any accomplishments/improvements and or complications etc.
Psychiatric History: Again, as above, prescribing pharmaceuticals, being aware of any accomplishments/improvements and or complications etc.
Mental Status Examination: Helps to assess the client at that point of entry.
Affect: Recording of the clients facial expressions, body language, speech deliverance.
Impact of Problems: Helps to show the difficulties that arose and how the client is affected because of the problem.
Psychosis, Thought Process, Speech, Memory, Insight, Intelligence, Motivation, Other Behaviors: All designed to get a clear picture of the client and their needs.
Present Mental Health Treatments: A must to know this, to proceed with treatment in conjunction with.
Past Mental Health Treatments: Again needed to help proceed with treatment today.
Chemical Dependency Issues: Always need to know this with every client.
Legal Issues: Must be aware what the client’s legal past is.
Abuse issues: If abuse is present, this must be revealed in order to be treated correctly.
Client’s Family: Important to know who the client is dealing with in their lives. Not all families are the Cleavers.
Client Response to Interview: Good for us to know how the client feels about the interview and good for statistical data.
Impressions and Recommendations: Good for obvious reasons. We are the ones doing the assessment,; our impressions and recommendations are based on the whole picture.
And again all of the above can be used for statistical reporting and data, to better understand any particular type of case.
Chapter 7 - Developing Service Plans P 294-297
#3
Sachiko; 3 years old – Set the family up first with medical testing to see if there is something physically wrong that is causing the frailty of the child, her failure to grow. possible cognitive delays and she’s described as listless. Then set the family up with all the resources they will need immediately depending on the diagnosis. Things such as daycare, schooling, counselling & support groups, in home assistance, Respite, etc.
John; 52 years old – Complete testing, physical and psychological. Depending on the diagnosis, perhaps a Group Home for independent living for those who are developmentally challenged. Perhaps his own apt with regular in home care? But before that, educate John and the Parents to what level of independent participation John is at in his life, then proceed from there, with plans for John.
#5
Annette (Pregnant) – Find out how far along she is to estimate how long the fetus has been exposed to alcohol. Send Annette to a Substance abuse program, parenting classes, self -esteem classes, promotion of healthy living.
#6
Bud & Christy and baby makes 3 – I would send Bud and Christy to classes for parents of premature babies to learn all the facts they need to know about the development and care of their child. Set them up with information on daycare, peer support groups, local agencies, respite.

Chapter 8 – Making good assessments P339-344
Mrs. Rodriguez – Cause: Side Effect of the Blood Pressure Medication. Medical testing/medical history needed. Mrs. Rodriguez is a volunteer at a Senior’s Home. According to staff at the senior’s home, Mrs. Rodriguez suddenly had difficulties functioning or focusing on task, when she never had difficulties before. Because of this I would guess at side effect of the blood pressure meds.
Elderly Man – Emergency Room – Stroke – Slurred speech and unsteady movements, briefly losing consciousness, “this feeling in his head” Medical testing needed to confirm.
Mrs. Perkins - Possible Pneumonia. The freezing all the time, can’t get warm leads me to think pneumonia.
Mr. Kramer – Depression – brought on by “getting old;” losing sight in his eyes: pulling away from things that previously made him happy, unkempt, unwashed, irritable around others.
Mr. Pierce - Alzheimer’s – Onset of – or a bad reaction to the tranquilizer prescribed.