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Part 1- Assessment:

Name: Judith Smith Date: March 17, 2016

Reason for Referral and Presenting Problem


Judith Smith, age 45, was referred to a social worker at Ambulatory Care Center by Dr. Howser
after he suggested that she find other coping methods beside medication to deal to with her lower
back pain. Mrs. Smith has requested an increase in pain medication 12 times, and she was
recently admitted to the hospital after a severe asthma attack according to Nurse McGillicutty.

Physical Functioning (e.g., general appearance, health concerns, substance abuse)


Mrs. Smith reports that she had surgery, but still suffers from lower back pain. She also reports
that she suffers from asthma, and has experienced severe attacks. After I asked her about her
doctor referral to see me, she said, It makes me feel really anxious. I feel nervous, and I have a
hard time breathing. To this, I told Mrs. Smith that stress can make physical symptoms worse,
and they can even trigger an asthma attack. Mrs. Smith responded by crossing her arms and
sighing. She also rotated between crossing her arms, twiddling her thumbs, and placing her
hands between her legs.
She reports that she heard the nurses say something about drug seeking, but states, Im
not an addict, I really hurt and have pain. Throughout the session, I heard Mrs. Smith mention
that she is not an addict multiple times.

Cognitive Perceptual Functioning (e.g., work/school history, judgement, decision making,


reality testing)
Mrs. Smith is employed, but there was no employer listed on her face sheet from the hospital.
She stated, Im worried about losing my job because of my back problems and asthma. She
reported that her care team didnt discuss issues of stress with her. She said, I dont feel
comfortable talking to them, they kind of treat me like a child because they talk down to me.
After I explained the information release form and the limits of confidentiality, she stated
that she understood. When discussing the future meeting with her doctor, Mrs. Smith stated, Id
appreciate it if you would talk to him because just have so much on my plate right now. She is
oriented to time and place.

Emotional Functioning (e.g., range of emotion, appropriateness of affect, depression,


mental illness)
According to Nurse McGillicutty, Judith was visibly upset and yelled at this nurse upon
receiving this news [denied medication] and stormed out of the clinic. During the beginning
portion of my session with Mrs. Smith, she did not make eye contact and slouched in the chair.
She reported that she did not need to be here and did not want to be here. She also said that
she did not want to talk.
During the later portion of the session, Mrs. Smith gave eye contact and responded to my
questions. She also thanked me twice during the session - after I asked if she understood the
limits of confidentiality and after we agreed that I would speak to her doctor alone.
Social and Family Functioning (e.g., composition, extended family roles, power, birth order,
patterns of communication, wider community)
Mrs. Smith and her husband separated earlier this year, and I observed that she wore her wedding
band. According to her face sheet from the hospital, she has two children. During the session, she
said, Of course Im worried about my kids. She stated that she was concerned that I was going
to report her and asked if I was going to take her kids away. After I told her that I was not
going to call child protective services, she appeared relieved as evidenced by the fact that she
heavily sighed and thanked me.

Behavioral Functioning (e.g., problematic issues, power and control, personal habits,
criminal history)
Mrs. Smiths anger management may be problematic as evidence by that fact that Nurse
McGillicuttys note mentioned that she was visibly upset and yelled at the nurse. Also, during
the session, Mrs. Smith said, Damn right, Im pissed.

Motivation (e.g., for services, employment)


At the beginning of the session, Mrs. Smith did not appear interested in using services I could
offer as evidenced by the fact that she stated she didnt want to be here. By the end of the
session, she agreed to sign an information release form that would allow me to discuss her case
with her doctor.

Spiritual/Religious Affiliations (e.g., belief system, church/synagogue/mosque)


Mrs. Smith did not specifically mention any spiritual or religious affiliations.

Environmental Systems (e.g., neighborhood, social service community)


According to her face sheet from the hospital, Mrs. Smith lives on Alta Vista Street in Dubuque,
Iowa. Her face sheet also states that she uses Medicare as her primary insurance and Medicaid as
her secondary insurance.

Cultural Factors (e.g., background, ethnicity, impact of culture)


She is a Caucasian woman, but doesnt not explicitly mention her background or ethnicity. She
also did not specifically mention anything about her community.

Strengths (e.g., interests, hobbies, support system)


Mrs. Smith stated that she is employed. She has two children and seems genuinely concerned
with their well-being as evidenced by the fact that she stated, Im worried about my kids. She
is also insured by Medicare and Medicaid, and has access to a hospital.

Barriers to Service (e.g., personal, societal, family)


A family barrier to service is the separation of Mrs. Smith and her husband. This may be a
potential obstacle down the road. A personal barrier to service is Mrs. Smiths anger outbursts
and amount of stress in her life. Not only may the stress be linked with her asthma attacks, but
stress also impacts her attitude and perhaps her tolerance for pain.
Workers Impression of the Client (e.g., hunches, issues for further exploration)
How Mrs. Smith manages her stress and anger may cause potential problems for her, so they will
ultimately be key to her success. Further exploration will include other support systems that Mrs.
Smith has including additional immediate and extended family. Will also follow up on Mrs.
Smiths attitude about her employment.

Submitted By: Hannah Reinert


Date: March 17, 2016

Part 2 Knowledge/Skill Questions:


1. Our textbook discusses addressing client problems at three different systemic levels.
(6 points)

a. Briefly describe one general goal you would like to help Mrs. Smith pursue
individually (micro system).

One goal Id like to focus on with Mrs. Smith individually is her coping skills,
especially with stress and anger. Her doctor specifically referred her to my service
because he wanted her to explore coping methods other than increased pain
medication to alleviate back pain. By focusing on coping skills, Mrs. Smith may handle
her physical pain more effectively.

b. Briefly describe one general goal you would like to pursue on the
organizational/agency level (mezzo system) within your clinic that could help
Mrs. Smith.

One goal Id like to pursue on the organizational level with Mrs. Smith would be
a support group for those experiencing pain and chronic pain. This support group
would also help Mrs. Smith find coping additional skills and techniques to handle
her lower back pain. The support group will also offer an additional resource for
Mrs. Smith in the future.

c. Briefly describe one general goal you would like to pursue on a


community/societal level (macro system) that could help Mrs. Smith.

A goal that Id like to pursue on the community/societal level would be ensuring


Mrs. Smiths employment either at her current job or at another one. During the
session, she mentioned that shes worried about losing her job. Id like to either
focus attention to her current job or perhaps explore other options that would not
require any situations where Mrs. Smiths back would cause a problem.

2. Consider the following statement made by Mrs. Smith:

I separated from my husband earlier this year, Im worried about losing my


job because of my back problems and asthma, and of course Im worried
about my kids.

A. Write a sentence that you could say to Mrs. Smith that would identify a
strength you see in her life solely based on the statement above. (4 points)

To Mrs. Smith: I can see a selfless quality within you because after you
mentioned the challenges in your life, youre still concerned with your childrens
well-being.

3. Review the practice theories and meta-frameworks discussed in Chapter 3 of the


Cummins text. Aside from the systems theory and ecological framework, which
theories or frameworks provide the most guidance in understanding and working
through Mrs. Smiths presenting problem? Explain why. (5 points)

I believe that the strengths perspective will provide the most guidance in understanding
and working through Mrs. Smiths situation. By focusing on her abilities rather than her
limits, Mrs. Smith will feel more inclined to improve her life. Using the strengths
perspective also allows the complete emphasis on self-determination. The text mentions
the importance of referring to a clients problems as challenges as to not put the
client down further (Cummins, pg. 52). In the session, Mrs. Smith mentioned her many
concerns, including her pain, her access to medication, and her children, but she failed to
realize her abilities. By focusing on the fact that she has access to a hospital with
insurance as well as children to love, Mrs. Smith will feel more motivated to improve her
life.

4. Mrs. Smith has presented as a relatively uncooperative client in your first encounter.
We recently learned about the idea of engaging our clients in Chapter 8 of the
Cummins text. Describe some specific skills and practices that will be especially
important in successfully engaging with Mrs. Smith. (5 points)

First and foremost, rapport should be established as with every other client. During the
session, Mrs. Smith seemed defensive as she claimed that she was not an addict. I think
it is important not to judge the situation or her for the 12 requests for medication.
Instead, I think it is important to validate Mrs. Smiths feelings without assuming
anything about her. It is also important to be empathetic to her, but as Cummins states,
[Empathy is] feeling not as the client, but as if the client (p. 151). Genuinely caring
about Mrs. Smiths pain while validating her feelings will be helpful during this process.
Another skills that must be implemented is encouraging and challenging Mrs. Smith. She
needs guidance and motivation to get her through this current challenge. I will need to
focus on self-determination and allow her to make the decisions in her life.

5. We are all unique. Describe one way in which your personal values differ from the
values that seem to be important to Mrs. Smith. How will you work through this
value conflict to practice effectively with your client? Cite some supportive evidence
from the Cummins text as part of your answer. (5 points)

I did not notice a direct personal value that differed from mine; however, one of Mrs.
Smiths actions did not align or agree with my personal opinions. As Nurse McGillicutty
said, Mrs. Smith had an outburst in the hospital and yelled when the doctor did not refill
her medication prescription. I would have never done this. Having patience all the time is
unrealistic; however, I would not have yelled at anyone in this setting. I believe that it is
inappropriate, especially of someone her age, and she could have handled this situation
differently. Yet, with what I know about her, I cannot say that she does this all the time,
but this one particular action isnt something that I would do.

I will still have to work through this situation with Mrs. Smith. Like I previously
mentioned, I do not know if yelling is a regular occurrence with her. I need to take this
into account as a help her through this challenge. Also, I cannot let my judgements
interfere with this process. On page 24, Cummins states, Accept that the individual and
the persons behaviors can be separatedBy separating the behavior from the person,
you can give yourself permission to despise the behavior without disrespecting the
client. As I help her, I need to focus on who she is as a person, not the actions that shes
done. I will be able to work through this conflict to practice effectively with Mrs. Smith
when I put aside mixed feelings about the motives for her actions, and focus on her
future.