Treating Trauma in Children

Effects of Trauma

Part 1

1. What observations have you made regarding ways in which oppression, discrimination, poverty, marginalization, and alienation impact clients in clinical social work contexts?

Oppression, discrimination, poverty, marginalization, and alienation tend to modify how the clients view themselves and how others view them. There are certain common traits that society has placed on these individuals, like inferiority, fatalism, dependency, and apathy (Bubar et al., 2016). With these feelings, it becomes hard for the clients to have a different view of themselves and even harder to try and change their outlook on life. When these clients interact with social workers, they assume that the image portrayed by society regarding themselves is the same view held by the social worker making it hard to get through to them or interact and assist them. Clients tend to avoid interacting with social workers because the solution offered often focuses on correcting their behavior to fit the mainstream, which goes against their beliefs and often blames the victims. Therefore, there is continued oppression, discrimination, poverty, marginalization, and alienation because the focus is not on assisting the individual. Instead, the focus is on changing their behavior to conform to what we believe is right.

Clients seeking services tend to be defeated because they have faced numerous challenges, and they are hanging on by a thread. Society has battled them, and they cannot see how they can overcome their life challenges. Attempting to implement changes in their lives is difficult because we are trying to change the client, not society. The client does not see how the social worker can assist them if there are no changes in society and people’s views of these individuals. Therefore, the solutions offered are ineffective because once the person leaves the confines of the care facility, they face the harsh reality of their life, making it hard to overcome these challenges (Bubar et al., 2016). Clients lose confidence in themselves and struggle to see options available that can assist them. There is a massive tsks given to social workers as they attempt to help the clients overcome the negative image they hold of themselves.

2. Discuss the ways you have explored the power and privilege you have as a clinician. What are factors to be mindful when working with vulnerable populations?

Clinicians hold power over their clients because they are placed in a position of power from the beginning of their interaction with the client. We tend to ask the questions and expect the client to respond appropriately. Clinicians have the privilege of defining the rules to be followed during the interaction with the client, collecting payment from clients, and determining when the time is up. Therefore, the client has to abide by what we say and advise them to do. Clients will look up to a clinician for assistance and expect the clinician to tell them what to do without questioning them. There are power and privilege differentials between the client and clinician that we must accept and recognize. Since we have the power, we might be limiting our clients from having power in their lives. For example, imagine a white therapist seeing a black woman who attends therapy weekly. The black woman speaks about stress at work and family but never mentions racism at work. The black woman might be assuming that the therapist might reject her thinking because she is white. It is the therapist’s work to bring up the differences because they have the power, and they should inform the client it is okay to bring up issues related to racism in their sessions.

When working with vulnerable populations, one should be mindful of the privilege and power they have over these individuals. We should understand that it is uncomfortable for clients to speak about certain things because they are uncertain of how the clinician will perceive them. Therefore, it is the clinician’s work to empower their clients so they can speak about issues like race, gender, language, religion, or sexual orientation without fear of discrimination by the clinician. The clinician should recognize their privilege and bring up the differences between themselves and the client during their session.

Part 2

1. What stands out to you about this case? Was there anything more the intact worker could have done to prevent the child’s death?

Ella Marshall was overwhelmed with her recovery, and the death of her son and sister increased her depression. She struggled to handle the challenges of her addiction recovery, and she needed a support system. Ella found she had a support system provided she remained in intact family services where her case was open. Ella’s reluctance to have her case closed should have demonstrated her need for additional support beyond what was offered by the intact worker. Ella followed the advice of the intact case worker, and she remained drug-free. Despite the additional loss in her life, she still pushed through, demonstrating resilience amidst her challenges. What stands out is that Ella felt she needed to keep her case open so she could receive support and counseling services. Ella might have been afraid of relapsing if her case had been closed since there would be no one checking up on her.

The intact worker noted she was aware of the safe storage of the drug in the house, and Ella had shown her the locked container where the drug was stored. However, since Ms. Opal visits the house often, she could have noted where Ella kept the drinking bottle and advised her of the risk involved. The intact caseworker could have insisted on using a childproof bottle and not mixing methadone in other water bottles in the house. Ella should have been educated on the risks of using bottles that a child can easily open so she could take extra precautions. Also, Ms. Opal could have pushed Ella to start her mental health services to address her depression. Depression causes a person to have poor concentration. Ella could have been having trouble concentrating, so she failed to pay attention to the water bottle she had used to mix her methadone. Her depression could have been the cause of her poor concentration and failure to rinse the bottle correctly after mixing her methadone.

2. What should a Child Protection Specialist, Intact or Placement Caseworker do to ensure clients are safely storing methadone and other medications?

They should educate the client on the best way to store the drugs and to always keep them away from children. In the case of drugs that should be mixed with water, the equipment used should be washed thoroughly immediately after mixing to avoid accidental usage by another person. The mixing and splitting of methadone should be communicated, and the parent should be advised of the risks. In most cases, clients can assume it is safe to do something since they believe their child cannot reach a certain point or cannot consume something they have stored in the fridge. The best precaution is always to assume the worst and not try to justify how a child cannot reach a certain point or drink something. Without proper cleaning of the equipment used to mix doses, there are risks of some of the drug being left in the bottle, and a child can drink it unknowingly.

Clients should be advised only to use childproof bottles to mix and store the mixed medication. Safe storage education is the major focus of most prescribed take-home medication. In most cases, patients are not educated on the risks of leaving utensils that have touched medicines in the sink or elsewhere in the household. As was the case with George, Ella had followed all the guidelines and training on safe medication storage. However, she failed where it mattered the most, leaving a water bottle she had used to mix the medication where a child could easily reach and use it. Therefore, patients should be taught to properly clean all utensils/equipment that have touched medication immediately after use. Medication education should include accidental ingestion of a drug by a child and noted ways of unintentional ingestion. Surfaces that have come into contact with the medication, equipment, and storage containers should be mentioned in training.

3. What are your feelings about addressing the underlying condition in this case, substance misuse, with an ongoing Methadone maintenance program?

Patients with substance misuse problems should be given methadone to reduce their craving and withdrawal symptoms during drug recovery (Maremmani et al., 2019). Methadone will assist a patient in achieving and sustaining recovery, allowing them to reclaim active and meaningful lives. Ella Marshall has demonstrated that following prescription guidelines can overcome an addiction to opioids and lead a meaningful life. Her ability to still avoid using drugs even after the losses she suffered proves the medication is effective and allows addicts to overcome their opioid addiction. The methadone maintenance program is effective in addressing the underlying condition of substance misuse, and clients in this program can make a full recovery. Methadone is safe, provided it is taken as prescribed (Maremmani et al., 2019). The patient must follow the practitioner’s guidelines to ensure the drug’s effectiveness. The drug is tailored to patients’ needs based on their addiction level and withdrawal symptoms.

The use of the drug should be encouraged for substance misuse cases. Methadone offers more advantages for opioid users compared to their reliance on opioid drugs. Since it is a safe medication, patients can gradually be withdrawn from their dependence on illegal substances under the supervision of medical professionals. With continued drug use, the patient’s dosage can be lowered until they no longer have cravings or suffer any withdrawal symptoms. Opioid dependence death rates are significantly reduced since patients are offered a safe alternative to their addiction. Patients taking methadone can be productive community members because the medication does not have similar adverse effects as the opioids consumed (Maremmani et al., 2019). Patients do not need to spend most of their time trying to score a fix. The consistency of methadone is well known, and the prescribed drug can be controlled compared to using an unknown purity of heroin. To note is that methadone can be addictive like other opioids because it is an opioid.

Part 3

1. Where do your thoughts lead you? What are some questions or areas of concern?

My thoughts lead me to question why the parents would not ensure their daughter takes a bath daily. Based on the information presented, the parents have an intellectual disability based on their FSIQ scores. However, Bob should be aware of his daughter’s lack of cleanliness and act upon it if adequately guided. There have been multiple reports regarding the daughter coming to school dirty, but no action has been taken to improve the situation. Therefore, one wonders if the parents are given any support or guidance. Considering their intellectual disability, the parents should be monitored constantly to ensure they meet their children’s needs, including cleanliness. The caseworker assigned to the family should have advised the parents on the need to keep the children clean and how to care for the children. If the advice is not followed, the caseworker should not have given up. Instead, they should have insisted and demonstrated to the parents the impact of dirt in a manner they would understand.

The area of concern is how safe are the children if allowed to stay with their parents? Considering they seem unaware of their daughter’s cleanliness, do they notice anything that could potentially harm the children in the house? The two boys have been noted to be developmentally delayed, indicating they might have faced challenges growing up. The parents might have been unable to offer the appropriate love and care during the critical stage of development, causing the children to have developmental disabilities. Therefore, the parents should be further investigated to determine their ability to offer care to their children. There might be challenges the family is facing that are not uncovered, limiting the parenting ability of Bob and Lynn. What kind of relationship do the parents have now compared to how it was in the past? We can use this question to understand if there have been changes in the relationship between the parents to establish if it could be causing the issues with the children.

2. Is there additional information you need or do you have additional questions?

The first question will be to determine if Bob has anger issues. Parents face many challenges, leading to anger problems that would negatively impact the family. Having multiple reports regarding a child and no change indicates something is wrong at home. Maybe Bob chases the child away from the house due to anger issues, or the child runs away from home. Another question to ask is, does Bob have a mental illness? Using this question, we can determine the root cause of the problem with the children. The two boys are of different ages and, shockingly, have the same conditions. There is an indication that something is lacking in the family, and we should determine what it is to assist the family. There might also be domestic violence in the house, and the children and mother are scared of reporting it.

Additional information should be sorted to determine if Lynn has been given a mental health examination. Lynn could have a mental condition that we’re unaware of, causing her to behave the way she does with the children. There is a concern that Lynn could be neurotic or depressed, making it hard for her to care for her children. The developmental delay observed in the two boys could signify a lack of care in the formative years when their brain neurons were forming. The mother could have neglected the children due to irritability, which may be caused by their crying and inability to soothe them. Finally, we should seek information to determine the kind of relationship Lynn was in that resulted in her giving birth to her oldest child at 15. Lynn was young when she got her first child. Understanding her relationship would offer better insights into how she became pregnant and her feelings when she discovered she was pregnant.

3. What underlying conditions may be present for Bob and Lynn? Should IQ be considered? If this were your case what might a next step be?

There is a possibility that Bob and Lynn have mental health challenges or intellectual disabilities. Considering their inability to notice their daughter is dirty, we can assume they have self-care challenges. We cannot say that Bob and Lynn can take good care of themselves and not do the same for their children. Also, we should determine if the challenges the parents have are due to economic conditions or inability to parent. There is a possibility that the parents might be struggling economically, making it hard for them to offer their children the care needed. To determine the parents’ intellectual disability, we should consider their intelligence quotient (IQ). It is impossible to establish the level of support the parents need without determining their IQ. We can use their IQ to understand how to create a relationship with the parent since we know how to communicate with them at their level of understanding.

The next step would be to offer support to the parent. Support is determined based on the intellectual disability, so we can assist them where it matters the most. We must increase the parent’s potential for success through education and skill development. There is no attachment between the parents and the children. Therefore, we should assist the parents in developing skills that will enable them to build a trusting relationship with their children. We understand that we can reverse the effects of developmental delays by having loving bonds between the caregivers and the child. Parental education will include training on raising children, caring for the children, and reducing abuse or neglect. Failure to thrive is a sign that the children are neglected and did not form the necessary connections during their formative years. Therefore, our goal is to equip the parents with the skills needed to reduce the neglect of children.

Part 4

Ecomap

Strong Connection _________

Tenuous Connection -----------Stressful Connection __/___/__/

Flow of Resources

Family Name: ______________________________

Date Completed: ____________________________

Completed By: _____________________________

Family Address: ____________________________

Extended Family Members

Father

Mother

Brother

Sister

Health Care

Work

Hiking

Hobby

Social Welfare

Friends

School

Exercising

Church

Best Friend

Mentor

Part 5

Share the types of questions you will ask to determine what stage of Alzheimer’s his mother is in.

What type of symptoms have you noticed in your mother? The question allows one to get a rough idea about the presenting symptoms and could assist in establishing the stage of Alzheimer’s the mother is in. Early-stage Alzheimer’s does not have any symptoms and will mostly go unnoticed.

The second question will be when did these symptoms begin? Using this question, we can speculate how long the patient has suffered from the disease and estimate the stage they might be in.

What is the frequency of the symptoms? We can determine the stage of Alzheimer’s disease based on the frequency of symptoms. In the early stages, the patient will not demonstrate significant changes, making the symptoms hard to recognize. However, in the later stages, the symptoms become frequent, and one can easily identify the memory loss, numerous questions, and forgetfulness.

Have the symptoms been getting worse? As a person ages, they might become forgetful, which might be a normal occurrence due to age. However, Alzheimer’s disease causes the patient to have multiple memory loss episodes, which they see to be worsening with each passing day.

Is your mother able to perform everyday household chores? When the person has moderate decline, they will find it hard to perform tasks with multiple steps like cleaning the house. We use this question to determine their level of functioning.

Can your mother tell me the day of the week? The moderately severe decline is determined by determining if the patient can tell the time or the day of the week.

Does your mother need assistance picking out clothes to wear? With the continued decline, the patient will find it hard to pick out something to wear and might tend to wear what they had yesterday.

Provide resources on how he can learn more about being a caretaker for his mother. Locate any resources you think would be helpful to him and include references to how others can locate them (include the link).

Some caregivers might need assistance in the early stages of Alzheimer’s disease, while others might need it later. It does not matter at what point a person seeks help. What caregivers need to understand is that, as the person moves from one stage to the other of the disease, they will need more care. Therefore, they should be prepared to offer more care as the disease progresses. Caregivers should not feel ashamed or fear asking for help.

NIA Alzheimer’s and Related Dementias Education and Referral (ADEAR) Center. The ADEAR Center provides information on diagnosis, treatment, caregiver needs, patient care, long-term care, and research related to Alzheimer’s disease. The center is part of the Federal Government’s National Institutes of Health, aimed at offering information regarding aging. All information regarding Alzheimer’s disease can be found on their website. https://www.nia.nih.gov/alzheimers

Alzheimers.gov (https://www.alzheimers.gov/) offers information and resources for caregivers on Alzheimer’s disease and how to care for your loved ones. The website is managed by the National Institute on Aging, the U.S. Department of Health and Human Services, and the National Institutes of Health. They offer information regarding the disease, what to expect from your loved ones, and how to support and care for them. Support is also offered to caregivers where they can have someone to talk to when they have questions or when they get overwhelmed with caring for their loved ones.

Eldercare Locator (https://eldercare.acl.gov/Public/Index.aspx) provides caregivers with information on community resources like home care, nursing homes, and adult day care. These resources are essential for caregivers, especially when their loved one has reached a critical level of the disease. The Federal Government funds the Eldercare Locator, which is managed by the Administration on Aging.

The Alzheimer’s Foundation of America (https://alzfdn.org) offers information on caring for people with Alzheimer’s. The website lists services that can be used for people with the disease. Caregivers can access information about member organizations that can provide them with the assistance they need. There is a hotline, educational materials, and publications that can be beneficial to caregivers and their families.