Case Study

you will apply HBSE theoretical perspectives and will answer/complete the questions at the end of the case. Please remember to use more than 3 sources, add a cover sheet, and check grammar before submitting. The main idea is to evaluate your knowledge and application of theory of person and environment to this case study.

Dave is a 38-year-old small-parts factory worker who came into the treatment center after being arrested for drinking and driving (DUI/DWI). His attorney has suggested that he quit drinking and enter treatment, at least until his trial which is scheduled in two months. Dave does not anticipate serving jail time, but he believes that treatment could strengthen his legal case. After his first arrest for DUI two years ago, he simply paid a fine and attended a special driver’s education program for six weeks. Dave found the program to be “a waste of time.”

Dave has been married for 10 years and has two sons aged 8 and 6 years. He has had numerous arguments with his wife, Melanie, concerning his drinking. He gets very angry and defensive when she confronts him about his heavy drinking, and asserts that he is not an alcoholic. He knows this is true because his father was an alcoholic and Dave says that he is not like his father. His father died as the result of a fight that occurred in traffic when he was drunk. Dave says that his father used to “beat the tar out” of him and his brother when he was drunk, and that his father always belittled, taunted, and threatened their mother, whether he was drunk or sober.

Dave’s work history is very good; he misses less than one day per year. He works the day shift on weekdays, putting in time-and-a-half overtime on most Saturdays. He is well regarded by his supervisors and peers at work. He is fearful that his employer will find out about his treatment (it is being covered by his HMO), and that people at work will learn about the second DUI arrest.

Dave drinks with his buddies from the plant, and does not think that his drinking is any more than what they do. He was just “unlucky” and got caught doing what everyone else seems to get away with. Dave’s drinking is very predictable: he drinks 8 or 9 beers on a weeknight. Several of these are consumed at the bar with friends, the remainder at home over the course of the evening. He usually falls asleep in front of the television. On weekends, he often drinks 3-4 twelve packs between Friday and Sunday. A typical Saturday involves getting up at 10:00 a.m., playing soccer with friends, and going to the bar for the rest of the day and night. This pattern leads to arguments with Melanie, who calls him a “lousy father.” At times, Dave has had unsettling episodes of being unable to recall what happened while drinking. He has commented to friends that “maybe I overdo it a bit.” Several times, he has attempted to cut down on his drinking, especially after the last DUI. He once attended a few AA meetings, but did not feel that it was helpful: “It was listening to a lot of guys whining” and he especially did not care for the prayers.

Despite these attempts, Dave has experienced increased consumption levels over the past two years. He admits that, as a result of the drinking, he has become increasingly estranged from his wife and sons. Dave feels that his marriage has been basically good, but that he would not blame Melanie for leaving him, the way things have been going lately. She will no longer “sleep” with him while he is intoxicated, which occurs regularly. She complains that the house is “falling apart” because Dave does not keep up with his chores. He believes that his marriage would become solid again, if he stopped over doing the drinking. But, he complains about her hassling him about the alcohol.

Dave is not close to his remaining family members. His mother is very religious and wishes Dave would see religion as a way out of his problems. His siblings live in other communities and they rarely get together. His wife and sons regularly attend his mother’s church, but Dave only attends on Christmas Eve and Easter Sunday.

Dave is distraught about having to remain abstinent in preparation for the trial. He has trouble getting to sleep without alcohol. He also “gets jumpy” when he tries to stay away from drinking, feeling “closed in” or “like he is suffocating.” He also cannot imagine how to explain to his buddies why he is not joining them in the bars.

BEFORE YOU ANSER ALL THE QUESTIONS BELOW, MAKE SURE YOU COMPLETE THIS AND ALSO INCLUDE IT AS PART OF YOUR PAPER:

Current issues:_______________________

Illnesses: _________________________

Suicidal/Homicidal Ideation Is there a suicide risk? ___ No ___ Yes ___ Previous attempt (When: _____________________________________________) ___ Current plan ___ Means to carry out plan ___ Intent ___ Lethality of plan Is the patient dangerous to others? ___ Yes ____ No Does the patient have thoughts of harming others? ___ Yes ___ No If yes: Target: __________________________________________________________ Can the thoughts of harm be managed? ___ Yes ___ No ___ Current plan ___Means to carry out plan ___ Intent ___ Lethality of plan High risk behaviors ___ None ___ Cutting ___ Anorexia/Bulimia ___ Head Banging ___ Self injurious behaviors ___ Other: _____________________________________________________________ Abuse Assessment In the past year has the patient been hit, kicked, or physically hurt by another person? ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ Is the patient in a relationship with someone who threatens or physically harms them? ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ Has the patient been forced to have sexual contact that they were not comfortable with? ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ Has the patient ever been abused? ___ Yes ___ No. If yes, describe by whom, when and how. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________ Family/Social History Born/raised ________________________________________ Siblings ___ # of brothers ___ # of sisters What was the birth order? ____of ____ children Who primarily raised the patient? ___________________________________________ Describe marriages or significant relationships: ________________________________________________________________________________ ____________________________________________________________ Number of children: _____________________________________________________ Current living situation: __________________________________________________ Military history/type of discharge: __________________________________________ Support/social network: __________________________________________________ Significant life events: ________________________________________________________________________________ ____________________________________________________________ Family History of Mental Illness (which relative and which mental illness): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ______________________________ Employment What is the current employment status? ___________________________________ Does the patient like their job? _____________________________________________ Will this job likely be done on a long-term basis? _______________________________ Does the patient get along with co-workers? __________________________________ Does the patient perform well at their job? ____________________________________ Has the patient ever been fired? Yes No If yes, explain ________________________________________________________________________________ ____________________________________________________________ How many jobs has the patient had in the last five years? ________________________ Education Highest grade completed: ________________________________________________ Schools attended: _______________________________________________________ Discipline problems: _____________________________________________________ Current Legal Status _____ No legal problems _____ Parole _____ Probation _____ Charges pending _____ Previous jail _____ Has a guardian Developmental History Describe the childhood: ___ Traumatic ___ Painful ___ Uneventful Describe the childhood in relation to personality, school, friends, and hobbies): _____ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Describe any traumatic experiences in the childhood: (List the age when they occurred) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ What is the patient’s sexual orientation? ___ Heterosexual ___ Homosexual ___ Bisexual Spiritual Assessment Religious background: ___________________________________________________ Does the patient currently attend any religious services? Yes No If yes, where. ______________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________ Cultural Assessment List any important issues that have affected the ethnic/cultural background. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________ Financial Assessment Describe the financial situation. ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ ________________________________________________________________________________ ____________________________________________________________ Coping Skills Describe how the patient copes with stressful situations. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________ Is the patient’s coping methods: ___ adaptive ___ maladaptive Interests and Abilities What hobbies does the patient have? ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ What is the patient good at? ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ What gives the patient pleasure? ________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________ MENTAL STATUS ASSESSMENT (Describe any deviation from normal under each category.) Arousal/Orientation ___ Alert ___ Sleepy ___ Attentive ___ Unresponsive ___ Oriented to person ___ Oriented to place ___ Oriented to time ___ Confused ___ Other: _____________________________________________________________ Appearance ___ Well groomed ___ Good eye contact ___ Poor eye contact ___ Disheveled ___ Bizarre ___ Poor hygiene ___ Inappropriate dress ___ Other:____________________________________________________________ Behavior/Motor Activity ___ Normal ____ Restless ____ Agitated ___ Lethargic ___ Abnormal facial expressions ___Tremors ___ Tics ___ Other:____________________________________________________________ Mood/Affect ___ Normal ____ Depressed ___ Flat ____ Euphoric ___ Anxious ___ Irritable ___ Liable ___ Indifferent ___ Careless ___ Inability to sense emotions ___ Lack of sympathy ___ Other:_____________________________________________________________ Speech ___ Normal ___ Nonverbal ___Slurred ___ Soft ___ Loud ___ Pressured ___ Limited ___ Incoherent ___ Halting ___ Rapid ___ Other: ____________________________________________________________ Attitude ___ Cooperative ___ Uncooperative ___Guarded ___ Suspicious ___ Hostile ___ Other: _____________________________________________________________ Thought Process ___ Intact ___ Flight of ideas ___ Tangential ___ Concrete thinking ___ Loose associations ___ Unable to think abstractly ___ Circumstantial ___ Neologisms ___ Racing ___ Word Salad ___ Other: _____________________________________________________________ Thought Content ___ Normal ___ Phobia ___ Hypochondriasis ___ Delusions ___ Obsessive ___ Preoccupations ___ Other: _____________________________________________________________ Delusions ___ None ___ Religious ___ Persecutory ___ Grandiose ___ Somatic ___ Ideas of reference ___Thought broadcasting ___Thought insertion ___ Other: ____________________________________________________________ Hallucinations ___ None ___ Auditory hallucinations ___ Visual hallucinations ___ Command hallucinations ___ Other: _____________________________________________________________ Describe: ______________________________________________________________ ______________________________________________________________________ Impulse Control ___ Normal ___ Partial ___ Limited ___ Poor ___ None ___ Frequently participates in activities without planning or thinking about them Judgment (What would you do if there was a fire in a crowded movie theater?) ___ Normal ____ Poor Cognition/Knowledge Orientation ___ Person ___ Place ___ Time Attention Can the patient spell W-O-R-L-D backwards? ___ Yes ___ No Memory Immediate recall of 3 objects ___/3 Recall after 5 minutes ___/3 Naming Point out three objects. How many can the patient name? ___/3 Visual-spatial Can the patient copy intersecting pentagons? ___ Yes ___ No Praxis Can the patient follow a three step command? ___ Yes ___ No Calculations Serial 7’s (how many times can the patient correctly subtract 7 from 100): __________ Abstractions ___ Comprehends ___ Does not comprehend Insight ___ Normal ___ Poor Is the patient able to meet their basic needs (e. g., food, shelter, medical): ___ Yes ___ No If no, Describe: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________ Functional Ability Check the area of concern ___ None ___ Activities of daily living ___Work ___ Finances ___ School ___ Family relationships___ Social relationships ___ Safety ___ Legal ___ Cognitive functioning ___ Physical health ___ Housing ___ Impulse control ___ Social skills

QUESTIONS: (NOTE: use essay format NOT Q&A)

1. Identify and sort through the relevant facts presented by Dave’s situation. What tools or interviewing strategies would you use to assess his drinking and its impact? What do you assess his drinking risk to be? Why?
2. Identify the problems, issues, and concerns that arise with Dave’s situation.
2a. What information should you be certain is shared with Dave? Why?
2b. What is your advice to Dave concerning his drinking? Why?
2c. How would you assess motivational issues prior to and during the course of intervention with Dave?
3. Identify the positive and strengths aspects of Dave’s situation.
4. Analyze the issues in terms of knowledge presented in the training modules.
5. Use training materials to develop a list of options and an initial plan of action for social work intervention with Dave. What are reasonable outcomes to be expected with Dave? Who should be involved in the intervention for Dave? Why?
6. Identify any additional information, research knowledge, and resources that are needed to develop and select options; identify ways to gather what you need; gather what you can.
7. Develop a strategy for social work practice with Dave. Be sure that you have a concrete and specific strategy for how you would address alcohol issues. What are the intervention goals? What kinds of referrals in your practice community would you make and why?
7a. What measures and procedures would you employ to formulate and negotiate goals with Dave?
7b. How would you apply motivational, cognitive behavioral, and relationship therapy approaches with Dave?
8. Identify methods for evaluating outcomes of your plan and next steps/revisions of the plan, depending on various possible outcomes.
9. Discuss implications for community intervention, prevention planning, social policy reform, and advocacy that are associated with Dave’s situation.
10. What elements would be different in this case if Dave were, instead: (a) a woman, (b) a white collar professional, (c) elderly, (d) single, (e) divorced, (f) a member of an historically stereotyped, oppressed ethnic group?