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 peoples 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 therapists 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 clinicians 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 childs 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. Ellas 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 botle 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...…Aging.

The Alzheimers Foundation of America (https://alzfdn.org) offers information on caring for people with Alzheimers. 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.

Part 6

Differential Diagnosis

Differential diagnosis analyzes a patients history and physical examination to determine the correct diagnosis (Keser & Aksu, 2019). The process involves distinguishing a condition or disease from others with similar clinical features. The clinician will look at the patients symptoms and possible disorders with similar symptoms and signs. There might be several tests conducted to rule out one diagnosis over another. Considering that many conditions have similar symptoms and might be confused with each other, it is vital to ask the patient questions like disease history, family history, lifestyle, and previous health problems. A clinician might have a theory of the condition or disease a patient presents with based on the symptoms (Keser & Aksu, 2019). However, they cannot make a conclusive diagnosis until they have conducted several tests.

In most cases, the laboratory tests will not give a definitive diagnosis because numerous conditions share the same symptoms. The clinician will make a list of possible conditions that have the same symptoms. They will then go about ruling out each condition based on the onset of symptoms, family history, previous conditions, and symptoms presented.

The steps for performing a differential diagnosis are to take a medical history, perform a physical exam, conduct diagnostic tests, and send the patient for referrals or consultations. The clinician will take the patients complete medical history when performing a differential diagnosis. The next step will be to perform a physical examination to collect further information, which will assist in ruling out some conditions or diseases. The third step is conducting diagnostic tests that include blood tests, urine tests, CT scans, ultrasound scans, X-rays, or endoscopies. These tests will offer additional information that will assist them in determining the particular condition ailing the patient. Finally, if the clinician feels they are still uncertain of the diagnosis, they will refer the patient to a specialist who can diagnose the exact cause of the symptoms. The goal is to get a second opinion so they can be confident they have made the correct diagnosis.

Differential Diagnosis for Binge Eating Disorder and Bipolar Disorder

When performing a differential diagnosis for binge eating disorder and bipolar disorder, the focus should be on the non-eating aspects of the disorders. Patients suffering from binge eating disorder will have periods where they consume large amounts of food (American Psychiatric Association, 2013). The same can happen with patients with bipolar disorder, where some might be overeating or having an increased appetite. Other patients with bipolar disorder might lose appetite (McAulay et al., 2019), which would make the differential diagnosis much easier for such patients. After overeating, the patient is likely to have depressive symptoms (American Psychiatric Association, 2013), similar to what a patient with bipolar disorder would have. Therefore, our focus should be on the other presenting symptoms to make a correct diagnosis. For a patient to be diagnosed with binge eating, their eating should not be associated with inappropriate compensatory behavior like purging, excessive exercise, or fasting (Hilt & Nussbaum, 2015). Bipolar disorder patients should have other symptoms like losing interest in all activities, diminished ability to concentrate, recurrent suicidal ideation, fatigue, and feelings of worthlessness (McAulay et al., 2019).

The benefits of differential diagnosis arethat we can rule out possibilities and make the correct diagnosis, rule out life-threatening conditions, narrow down the working diagnosis, and guide medical evaluation and treatment. When we conduct a differential diagnosis, we can be confident that we have made the correct diagnosis because we have analyzed all possible diagnoses and determined the appropriate one based on the presenting symptoms and test results. The additional testing needed in differential diagnosis reduces the likelihood of errors ensuring the correct diagnosis is always made. The major challenge identified is that it might be time-consuming to perform a differential diagnosis because of the number of tests needed before a diagnosis is made. The extra time might result in patients losing interest or exasperating their symptoms.…