Treating Trauma in Children

Effects of Trauma

Part 1

a. How have you applied understanding of global interconnections of oppression and human rights violations to social work clinical contexts?

Within the clinical context, we have implemented awareness campaigns and educational interventions to alert and inform individuals regarding human rights like health equality. One would assume that people are aware of their health rights, but the shocking thing is that most people are unaware of health equality. All citizens should expect the same health care level and health services regardless of economic, race, or sexual orientation (Davis & Reber, 2016). However, due to a lack of information, many disadvantaged people are okay with the minimal health services they receive. The people who visited the clinic received the awareness campaign well, and most of them were surprised regarding their health rights. However, we had to inform them they also needed to advocate for themselves and push for better health services whenever they visited a health facility.

Advocacy was done by giving the community members information about what they should expect regarding health services (Davis & Reber, 2016). With the information we offered, the members could petition for better services from their leaders and push for policy changes. Educational interventions involved gathering community members to inform and educate them about the various health services they could receive at the institution and the benefits. Using health education, we managed to increase the number of patients seen at the clinic and improve community members’ mental health. Low-income areas suffer the most when it comes to the availability of health services, and our goal was to assist those living in those areas in pushing for better services through advocacy. By educating them on services they should be receiving and minimum care requirements, we empowered them with the knowledge they need to petition their leaders to increase services or change policies. We guided the community leaders on how they can perform advocacy and offered them materials they can use when they meet or to get the leaders’ attention.

Part 2

After reading the Elena Hernandez Reasonable Progress and Lack of Reasonable Progress case vignettes, Compare and Contrast the differences in the cases. View the Pathways to Permanency Power Point slide and explain where each case vignette falls.

In the reasonable case, Elena is working hard to ensure she can be reunited with her children, and they can start living together. However, in the lack of reasonable progress case, Elena struggles to overcome her addiction, but she keeps relapsing, making it hard for reunification with her children. Sadly, the caseworker is forced to consider the current caregivers for permanency, which could push Elena to further addiction when she no longer has an option of being reunited with her children. The reasonable case indicates Elena is meeting all the required milestones, and she is working hard to try and be reunited with her children. Though it takes longer than she expected, Elena continues to follow the guidelines and stays sober. Her drug tests return negative, and she is prepared to have her children home with her. The best is that Elena overcoming her drug addiction comes from within herself, and it was not forced on her, making the desire to change easy and long-term.

The lack of reasonable progress case points to a situation where a mother wants reunification with her children but is not working towards reunification. There is a disconnect in that Elena wants to have her children with her at home, but she struggles to meet the requirements of DCFS. It seems she does not understand her decisions’ impact on her life and that of her children. More should be done for Elena, like understanding why she keeps relapsing when moved to outpatient treatment. Elena is not making substantial progress leaving the children in limbo, and a decision must be made. The good thing about both cases is that DCFS believes Elena is committed to reunification with her children. Elena has gained enough skills to mother the children, and DCFS recognizes the efforts made by Elena. Unfortunately, she fails to make reasonable progress in critical areas, making it hard for her to be reunited with her children in the lack of reasonable progress case.

The children have settled with their respective foster placements and are making good progress in both cases. The only difference in the cases is how to handle their permanency placement. For the reasonable progress case, permanency leans towards reunification with the mother. While in the lack of reasonable progress case, permanency leans towards their respective foster placements. Considerations are being made on the mother’s suitability and how she will impact the lives of the children in the lack of reasonable progress case. Concurrent planning differs because children are the center of attention in the case, and their best interests must be considered when determining what is best for them. With Elena making good progress and meeting all her goals, the caseworker deems her fit to be reunited, and there is a push for unsupervised visits, which will lead to the mother and children reuniting. However, the outlook is different when Elena fails to meet her goals. The caseworker is forced to look into how best the children can thrive and what is the best environment and care for them.

The reasonable progress case falls under the “cases with high potential for reunification.” Considering that Elena has made good progress and is meeting all her DCFS goals, her case has the potential for reunification. In the court session, she might be given unsupervised visits with her children. Provided she continues meeting her goals and keeps away from negative influences like William Smith Sr., Elena will be reunited with her children soon.

The lack of reasonable progress case falls under the “concurrent planning.” Elena is progressing in certain areas and relapsing with her addiction, leaving her children in limbo. The caseworker has to decide on what is best for the children, and they are leaning towards concurrent planning due to Elena’s behavior. Sadly, Elena might worsen once concurrent planning is done because her drive to be reunited might be the only hope she has left in her life.

Part 3

1. Why do you think adoption is difficult for families?

Adoption is difficult for families due to the separation that occurs. It is not easy to let go of a loved one regardless of the underlying circumstances (Rolock et al., 2021). Bonds are created between the family members, and being separated develops trauma that can devastate the children or parents. Humans develop bonds from an early age, allowing children to know who to trust and who is family. However, when adoption comes into play, the bonds are broken, and families are separated. The case is similar to divorce, but with divorce, at least the children get to stay with one parent. For adoption, the children might not even get to stay together, let alone stay with one of the parents. One can imagine the disruption when a child is forcefully removed from their home and placed in foster care, where they will eventually be adopted. Loneliness builds as the child has no friends, and everyone they interact with is a stranger. The people they have lived with in their early life are not there, and they must make sense of it all by themselves.

The parents suffer even more since they no longer have access to their children and know they will not be reunited with them. While an adopted child is alive, the parents feel like they have lost the child because the chances of seeing them are eliminated. Due to the nature of adoption, it isn’t easy to allow the parents to keep seeing the child after adoption because it negatively impacts the adoption process. Therefore, the parents will feel they have lost a child, and the trauma it has on them might push them further towards substance abuse or suicide. Siblings will mostly be separated, and they might not see each other again. While attempts are made to keep siblings together, it is usually difficult because of age and the lack of adoption parents willing to take them. The separation creates a void that children struggle to fill because they do not understand why they have been split and could develop negative behaviors.

2. Explain two differences between adoption and guardianship.

The first difference is that of parental rights. In adoption, the parental rights of the biological or legal parent are terminated, while guardianship maintains the parent’s legal rights (Rolock et al., 2018). The birth parents will lose all legal rights over their child in adoption, and there is no way they can get those rights back. In an adoption, the biological parents will lose all rights over the child forever, and they do not get visitation rights or any relationship with the child. However, in guardianship, the biological parents can temporarily select a caregiver who is responsible for the child. The caregiver gets legal custody of the child, but they do not adopt the child. The biological parents retain parental rights and may be given visitation rights (Thompson, 2019). The parent can terminate guardianship at any time and reclaim their parental custody. The same cannot happen in adoption. Once a child is adopted, the biological parents lose all connections and contact with the child.

The second difference regards child support. When a child is adopted, the biological parents are no longer responsible for providing child support because the adopting parents take over that role. However, in guardianship, the birth parents are still required to financially support the child till they attain the legal adult age. The reason behind the biological parents providing child support is because they are still considered legal parents. Therefore, while the child might not be living with them, they still need to ensure they meet all the financial requirements for the child. Adoption breaks all contact between parent and child, and the new parents take over all responsibilities for the child (Thompson, 2019). The child’s legal right is transferred from the biological parents to the adopting parents, ending the legal requirement to provide for the child by the birth parents financially. Once the adoption process is complete, the adoptive parents will have the legal duties to provide financially for the child.

Part 4

After reading Other Conditions That May be a Focus of Clinical Attention in the DSM-5, State your opinion on the value of the Z and T codes and how they compare to the biopsychosocial model used by social workers.

The DSM-V is the standard reference for diagnosing mental disorders. However, the mental disorders noted in the DSM-V are not comprehensive and do not cover all the symptoms a patient might present with. There are cases where a patient might have issues related to mental health, but they do not meet the diagnostic criteria to be diagnosed with a particular disorder. In such cases, the patient is assigned a Z or T code to describe the symptoms the patient presents with when no specific disorder is mentioned in the DSM-V, but they still need treatment (American Psychiatric Association, 2013). There are numerous conditions a person might present with when seeking mental health services, and some might not be due to a particular underlying condition like depression. Therefore, there was a need to ensure those patients were not sent home without treatment being offered. Creating the Z and T codes provides mental health workers with information that the patient does not meet the criteria for being diagnosed with a particular disorder as per the DSM-V, but they still need mental health treatment. These codes ensure that we do not send at-risk patients home without treatment merely because they do not meet the diagnostic criteria. The patient’s symptoms might be temporary and, if not properly managed, might lead to the development of a full-blown disorder.

The biopsychosocial model used by social workers indicates that the health and well-being of an individual depend on biological, psychological, and social factors (Bolton & Gillett, 2019). These factors make up the biopsychosocial model and are equally vital for the health and well-being of all humans. The biopsychosocial model is popular among social workers because it offers a mind-body connection that should be considered when dealing with clients. We should understand that while a patient can present with specific symptoms, it does not necessarily mean we have to diagnose them with a particular diagnosis. There are instances where the patient might have a problem in an area of their life they have not addressed, leading to their symptoms. When proposing treatment or diagnosing a patient, we have to consider the impact of their biological, psychosocial, and social factors on their presenting symptoms. These three factors determine a person’s mental health, and we must consider them to understand their distress and the best treatment action.

The Z and T codes compare to the biopsychosocial model through the understanding that there are symptoms a person might present with that are not related to a particular disorder. The patient will still need assistance to manage their presenting symptoms, and to help them we have to consider other factors. The codes have mentioned what might be the issue the patient presents, and we can use that to determine how to handle the case. The biopsychosocial model encourages social workers to look into the three factors of biology, psychology, and social to determine where there is distress and figure out how to help the patient overcome their distress. The codes present issues that should be examined and are of clinical focus. However, since the symptoms do not meet a particular DSM-V diagnosis, we should not assume that the patient is okay. We should dig deeper to understand how we can help them overcome their symptoms and lead healthy lives. The same is the goal of the biopsychosocial model. The focus is on identifying where the problem might be in the patient’s life and developing treatment targeting those particular areas. Therefore, the codes and the biopsychosocial model push for the treatment of a person regardless of if they meet the diagnostic criteria. What matters the most are the presenting symptoms.

Part 5

Cross-cutting symptom measures

The cross-cutting symptom measure assists in identifying additional areas that may guide treatment. When analyzing a patient, we might find we are stuck on a way forward regarding their treatment. However, we can employ the cross-cutting symptom measures to identify additional areas of inquiry that had been overlooked and significantly impacted the patient’s treatment and prognosis. Performing a comprehensive mental status assessment will aid in drawing attention to vital symptoms across diagnoses. These symptoms could be the key to offering effective treatment. There have been cases where a patient presents with symptoms similar to those of two disorders, making treatment difficult because it is unclear what condition they should be treated for. Also, a patient can fail to fit into the set of the predetermined diagnostic characteristics for a disorder. In such cases, we need to perform a cross-cutting symptom measure to establish the vital symptoms to initiate treatment.

When an individual presents with symptoms that meet the diagnostic criteria for more than one disorder, it becomes difficult to determine their underlying disorder. Diagnostic comorbidity seems to be the norm rather than the exception. Therefore, we should have a way of uncovering the vital symptoms so we can imitate treatment. A clinician is stuck wondering if the patient has multiple mental disorders or if they have one disorder being given numerous diagnoses. These questions can make it challenging to treat a patient because we cannot determine the best course of action. The cross-cutting symptom measure provides a brief questionnaire that is easy for a patient to fill and clear-cut. The questionnaire can be administered at the start and as treatment progresses to monitor effectiveness. Considering it is a short questionnaire, its administration is simple and can be completed at multiple intervals depending on the stability of the patient’s symptoms.