S Word Count 2166

Transcription

1 Student name Susann Treston Student number Course code Assignment Number 2 Topic Case study Word Count 2166 Lecturer Davina Rowe Due date 3 June 2011

2 Table of Contents Introduction... 3 Case Discussion... 3 Theoretical Framework and Interventions... 4 Discussion... 7 Proposed Intervention... 7 Conclusion... 8 References... 9 Appendix A Susann Treston Page 2 of 11

3 Introduction The following case study introduces two Indigenous males that have come into contact with Corrective Services as a consequence of their actions in the community. Both are at differing transitional life stages and have had contrasting life experiences and opportunities. The process of change has been positive for Joe and not so successful for Jim. This case study will examine the theoretical frameworks and evidence based influences towards possible interventions for Jim. Inferences towards the strengthening factors of positive supportive relationships, employment, health and education can be deduced by comparison of the two men s life pathways and the different outcomes. Case Discussion Joe is a 40 year old involuntary Aboriginal participant currently serving a Probation Order, involving 12 months of supervision in the community; this is his third correctional episode. The current and previous offences involved driving a vehicle whilst over the general limit of 0.05 blood alcohol content. The Probation Order has an additional condition; to attend an 11 week Under the Limit drink driving prevention and rehabilitation program. Joe is employed, achieved a Grade 12 education, and has a supportive co-habiting relationship his partner of 13 years and her 14 year old daughter. Joe s father died from alcohol related diabetes and he and his brother were raised by his mother and all have a close supportive relationship. Joe feels a great sense of shame and remorse for his actions, feels like he has let the family down and has stated that it will never happen again, it was a big wake up call. Consequently he has drastically reduced his alcohol consumption and is further supported by his mother, brother and partner in his endeavours. Joe Takes pride in his car, enjoys working and participating in family based activities. Jim is a 33 year old involuntary Aboriginal participant currently serving a Probation Order, involving 12 months of supervision in the community; this is his sixth correctional episode. His current offences involved the possession of drugs and utensils and public nuisance. The Probation Order has an additional condition; must submit to medical, psychiatric or psychological treatment. In 2002, Jim was diagnosed as having schizophrenia and began medication, he was placed on an Involuntary Treatment Order which expired in 2007 and currently is no longer taking medication. Jim commenced drinking and using cannabis at the age of 16 and started misusing inhalants approximately 2 years ago. He achieved a Grade 9 level of education and is currently on a disability support pension. Jim resides with his mother and two of his five siblings whilst his father periodically resides at the same residence. Jim reports that his family relationships are positive and supportive although he has had nil intimate partner relationships. Susann Treston Page 3 of 11

4 He was first arrested at 13 years of age in 1991 for break and enters offences. In 1993 his offences escalated to violence, drug offences, and numerous more break, enter and stealing offences where he was placed on various juvenile supervision orders before being sentenced to juvenile detention for a period of 14 weeks. Jim s adult criminal history commenced when he was seventeen years old and has a myriad of entries recorded. Jim appears to have a history of offences committed whilst under the influence of alcohol and/or cannabis. Additionally the current offences appear to represent a significant escalation in the severity of Jim s offending behaviour given the sexual threats he has posed upon members of the public. Jim has on occasion attempted to justify his behaviour and shows no remorse for his actions. Whilst he does communicate adequately with staff, at times there are communication barriers, possibly due to his mental health condition or cultural barriers. Jims stated interests are fishing, his general days activities involve watching TV, walking around and associating with friends. Previous engagement with Mental Health and ATODs has ceased upon the completion of previous Probation Orders and the associated legal requirement for contact and therefore interventions have lost continuity. Furthermore, there has been a succession of case managers, inhibiting the development of a trusting therapeutic relationship. At this stage Jim is resistant and engagement with his case manger involves minimal levels of communication, either responding to questions with Yes No, I m good or no verbal response. Additionally, Jim s personal hygiene and appearance have deteriorated. Theoretical Framework and Interventions Eco systematic theory provides a framework for the assessment process. Interactions occurring between individuals, their families, communities and systems suggest interdependence critical to understanding individual identity and role. The individual can only be understood in reference to the circumstances of their lives and in cultural and historical context, therefore the person and the environment exist in a relationship of mutual influence (ACT Prison Project Office (ACTPPO) 2002). Problems emerge where there is a negative fit between coping skills and environmental demands, illuminating a lack of personal, interpersonal and political power to influence the environment. Change efforts are directed towards understanding environmental impacts, increasing skills and influence to cope with the environment, reducing stressors and increasing available supports. Collaborative interventions on behalf of the individual are focused on rehabilitative efforts to enhance adaptive exchanges (Young & Smith, 2000, cited ACTPPO 2002, p.5). Raif and Shore (1993) state the assessment process also collects baseline data against which client change is measured, assisting framework development towards guiding future needs and services decisions (Moore et al 2009, p. 113). Susann Treston Page 4 of 11

5 Organisational context influences assessments in terms of process and emphasis; policy, procedure and administrative process results in formal assessments becoming risk management rather than client driven assessment tools. Ongoing assessment should include feedback from the client, family and supports and practitioner reflection on practice (Moore et al 2009). Disadvantage faced by Indigenous Australians is well documented; in all judicial jurisdictions Indigenous people are over represented (ABS 2006, ABS 2010).The Human Rights and Equal Opportunity Commission attributes overrepresentation to historically derived disadvantage and ongoing systemic discrimination. Experiences of separation through the criminal justice system, combined with dysfunctional behaviours such as family violence and substance misuse contribute to Indigenous inequality and marginalisation (Thomas 2010). Social and emotional wellbeing (SEWB) is a holistic concept; where conventional models identify the problem within an individual, the SEWB framework looks to broader social processes to locate dysfunction. Indigenous concepts of mental ill health take into account physical, mental, emotional, and spiritual and cultural states of being. Experiences of trauma include situational, cumulative and intergenerational trauma which over time impacts on individual and community coping mechanisms. Subjective distress relating to Indigenousspecific issues includes loss of identity, acculturation stress and spiritual sickness (Thomas 2010, Green and Baldry 2008). Issues can be exacerbated in criminal justice settings and require specialist responses and interventions, additionally co-morbidity of mental health problems and substance use increases the complexity of providing service responses (Thomas 2010) Many individuals with schizophrenia lack formal and informal social connections, involvement, and commitments. Deficits may result from specific cognitive and affective factors, unstimulating social environments; a downward spiral may also be created as poor social skills and impoverished social environs contribute to one another (Carey et al, 2001) Social systems and ecological theory both place value on culture and diversity in the lives of clients. The theories are empowerment based; reducing barriers assists a client to have power and control over their lives (Teater 2010). Behavioural theory suggests that anti social behaviour develops by association with anti social peers, exposure to anti social role models and reinforcement and rewarding of anti social behaviour. Alternatively, pro social behaviour may be developed by reciprocal prosocial association, exposure and reward (Trotter 2006). Susann Treston Page 5 of 11

6 Social skills influence ability to engage in change-related efforts, such as initiating social substance free activities, or negotiating health-provider networks, or establishing a therapist relationship. Social impairment relevant to substance use treatment includes difficulty resisting social pressure, establishing new relationships with non-user friends and developing sufficient social support to abstain or reduce use (Carey et al, 2001). Cognitive theory recognises that thoughts and feelings influence the learning process. The practice model encourages changing anti social thinking and behaviours (Trotter 2006). Bellack and DiClemente (1999) have identified three areas of difficulty which inhibit the change process for dually diagnosed clients; cognitive impairment, social impairment, and obstacles to motivation (cited Carey et al, 2001). Understanding why participants with schizophrenia abuse substances is important: 45% to 60% used alcohol and cannabis for its euphoric, antidepressant, relaxing and anxiety relieving effects. Additionally substance usage can be the focus of social activities and subject to peer pressure (Litteral and Litteral, 1999). Critical theory is based on a premise that social problems are socially constructed and related to structural factors such as class and role expectations, inequality, poverty, poor housing, unemployment and inadequate social security systems. Oppression is sustained by dominant discourse of economic rationalisation and corporatisation. Practice involves constructing the client situation in terms of need rather than risk (Trotter 2006). Anti Oppressive practice focuses on combating societal institutionalised discrimination (Payne 2005). Racism and discrimination impact on mental health are experienced at systemic and interpersonal levels. An individual s experience of racism and discrimination can provoke anger, hostility, erosion of self worth and damage to self identity; racism and discrimination have significantly impacted Indigenous mental health and wellbeing (Thomas 2010). Attending to clients strengths rather than deficits facilitates learning and progress, therefore using a Strengths based approach focuses on achievements and is based on the assertion that even a problem saturated person has inner resources that can help them develop (Saleeby 2001, quoted Trotter 2006, p. 61). The Strengths approach develops client resilience, the capacity to thrive despite stress and poor environment by accessing client s individual resources and support within family or wider networks and utilises optimism towards developing client goals and solutions (Trotter 2006, Van Wormer and Boes, 1998). Susann Treston Page 6 of 11

7 Discussion A stable pattern of antisocial behaviour, early-onset substance abuse, and persistent and versatile offending are characteristic of psychopathy, driven by partially heritable personality traits, strengthened or weakened during childhood and adolescence by parenting and other environmental factors. Investigations of offenders with schizophrenia have consistently found that the presence of substance abuse increases the risk for violent offending (Tengstrom et al. 2004, Thompson and Stewart 2007). Substance abuse/dependence hinders mental health treatment. Dually diagnosed outpatients have poor medication compliance, report more severe psychiatric symptoms, are minimally involved in structured treatment programs and likely would benefit from interventions that enhance motivation (Tengstrom et al 2004). Culturally safe services ensure client s cultural, social and human values are respected. Cultural validation improves reliability of assessments uses culturally validated assessment tools and processes and takes place in a culturally safe context. Western notions of mental illness can lead to misdiagnosis, under diagnosis and over-diagnosis where Indigenous people are assessed outside their cultural context (Green and Baldry 2008). For example, some problems are not captured within a biomedical approach to some cultural behaviours may be confused with symptoms of mental illness (Thomas 2010). Proposed Intervention Individuals need to be provided with long-term care, preferably in specialized community treatment programs, with the possibility of court-ordered attendance if necessary (Tengstrom et al 2004). Interventions focus on halting current substance abuse and preventing further abuse and require a combination of non- pharmacologic and pharmacologic approaches. The recommendations include psycho social interventions: family involvement, cognitive behavioural approaches, relapse prevention, contingency contracting and self help programs. (Littrell and Litterall, 1999, Prins and Draper 2009).An intervention for dually diagnosed individuals with low readiness-to-change, and/or low level of engagement in treatment for substance abuse is designed to increase problem recognition and enhance motivation to change maladaptive patterns of substance use, and to facilitate engagement in substance abuse treatment. To achieve these goals, constructs from the Tran theoretical Model of Change, uses principles of motivational and harm reduction interventions tailored to the target population (Carey et al, 2001). At the individual level, the importance of kinship and family to Indigenous culture and healing should be recognised; strengthening social supports can reduce contact with the justice system. Diversion and support programs should work with and support family and their community to in turn support the person at risk (Thomas 2010). Susann Treston Page 7 of 11

8 Conclusion Clinical research determining treatments which are most effective for people with dual disorders identified elements common to successful programs. These are assertive engagement, close monitoring techniques, integration of staged mental health and substance abuse treatments, long term perspective and optimism (Drake 1993, cited NSW Health Department 2000). The Burdekin Report further states a need for service integration, including a primary care worker (regardless of agency) with emphasis upon a holistic approach, all agencies working as a team and therefore co-ordinating all treatment (NSW Health Department 2000). Consequently, further actions would include following through with the court ordered psychological assessment, the co-ordination a case management team meeting with family members, Mental Health, ATODS, the police and the local Indigenous Health Service to discuss the deterioration of Joes mental condition as demonstrated by the escalation of offending behaviour, increased substance usage, lack of engagement and personal appearance and hygiene. Additionally the inclusion of other agencies and programs such as PHAMs (Personal Helpers and Mentors) should be investigated. Susann Treston Page 8 of 11

9 References ACT Prison Project Office 2002, From exclusion to inclusion, viewed 26 May 2011, Australian Association of Social Workers 2002, Practice standards for social workers, viewed 7 March 2011, Australian Association of Social Workers 2010, Code of ethics, Canberra, viewed 5 April 2011, Australian Bureau of Statistics 2006, Population Distribution, Aboriginal and Torres Strait Islander Australians, viewed 29 May 2010, Australian Bureau of Statistics 2010, Corrective Services, viewed 29 May 2010, cument&tabname=notes&prodno=4512.0&issue=dec%202010&num=&view Carey B, Purnine D, Maisto S and Carey, M 2001, Enhancing readiness-to-change substance abuse in persons with schizophrenia : a four-session motivation-based intervention, Behavior Modification, vol. 25, no. 3, pp (Sage Journals online). Green, S and Baldry, E 2008, Building indigenous Australian social work, Australian Social Work, vol. 61, no. 4, pp , viewed 15 May 2011, (online Ebscohost). Littrell K and Litterall, S 1999, Schizophrenia and Comorbid Substance Abuse, Journal of the American Psychiatric Nurses Association, vol. 5. no 2, pp , (Sage Journals online). Moore, E, Randall, C and Barton, H 2009, Practice functions in E. Moore (ed), Casemanagement for community practice, Oxford University Press, South Melbourne. NSW Health Department 2000, The management of people with a co-existing mental health and substance use disorder - discussion paper, viewed 2 June 2011, data/page/1267/discussion_paper_comorbidity.pdf Payne, M 2005, Modern social work theory, Palgrave MacMillian, New York. Prins, S and Draper L, 2009, Improving outcomes for people with mental illnesses under community corrections supervision, Council of State Governments Justice Centre, New York, viewed 23 May 2011, Teater, B 2010, Applying social work theories and methods, Open University press, Berkshire. Tengstrom A, Hodgins S, Grann M and Kullgren, G 2004, Schizophrenia and criminal offending the role of psychopathy and substance use disorders, Criminal Justice And Behaviour, vol. 31, no. 4, pp (Sage Journals online). Thomas, J 2010, Diversion and support of offenders with a mental illness, Justice Health, Victorian Government Department of Justice and the National Justice Chief Executive Officers Group, Melbourne, viewed 31 May 2011, a/aic/njceo/diversion_support.pdf Thompson, C and Stewart A, 2007, Risk of re-offending: probation and parole version screening tool administration manual, Griffith University, Brisbane. Trotter, C 2006, Working with involuntary clients: a guide to practice, Allen & Unwin, Crows Nest. Van Wormer, K and Boes, M 1998, Social work corrections and the strengths perspective, paper presented at the National Social Work Conference, June, viewed 23 May 2011, Susann Treston Page 9 of 11

10 Appendix A AASW Relevant Practice Standards Standard 1.1 The social worker has the necessary knowledge, skills and resources to bring to the client situation. Standard 1.2 The client is made aware of the nature and extent of the social work service being offered and this information is recorded. Standard 1.3 The client is involved, as far as possible, in developing a service plan with the social worker and in its implementation, the strengths and capacities of the client being acknowledged and respected. Standard 1.4 The social work assessment and the intervention taken is appropriate to the client s situation, in keeping with ethical and legislative requirements and directed towards appropriate outcomes reached in agreement with the client wherever possible. Standard 1.5 The social worker is aware of the relationship between the client and their social environment and takes appropriate action. Standard 1.6 Records are kept and maintained in accordance with ethical principles and the relevant legislation regarding record keeping, privacy and freedom of information provisions relevant to the jurisdiction in which the social work service is being offered. Standard 1.7 Reports accurately and objectively reflect client circumstances, in keeping with ethical principles and legislative provisions. Standard 1.8 Within the multi disciplinary team, the social worker maintains social work principles, values and practice whilst acknowledging the practice base of other disciplines. Standard 1.9 The social worker recognises the need for supervision and, when necessary, obtains advice. Standard 1.10 When necessary, the social worker recognises the need for, and arranges a referral to, a relevant service provider and/or for termination of the social work service; and, where service is interrupted for some reason, puts in place appropriate interim service or other arrangements. Standard 1.11 The social worker advises the client of their right to query the service provided and the avenues and procedures to follow if the client wishes to do so. Standard 1.12 The social worker seeks feedback from the client in the evaluation of service provision and uses this to improve future practice.. Standard 2.3 The social work manager encourages non-discriminatory policies and practices and advocates for resources to meet client rights and needs. Standard 2.5 The social work manager promotes effective teamwork and communication. Standard 2.6 The social work manager takes responsibility for delivering an efficient and accountable service. Standard 2.11 The social work manager ensures a commitment to continuous quality assurance and improvement and practice research. Standard 2.12 The social work manager ensures that policies and procedures are documented and are accessible. Standard 3.1 The social worker demonstrates knowledge and understanding of organisational systems and processes and of wider societal systems Standard 3.2 The social worker has made an analysis of organisational systems and processes and the extent to which these are responsive to the needs of the client. Standard 3.3 The social worker works with the client and the organisation(s) so that the client receives the most appropriate and effective service from the organisation. Susann Treston Page 10 of 11

11 Standard 3.5 The social worker is able to identify when change is needed and ways in which appropriate change might be achieved as well as actively contributeto the change process.. Standard 3.9 The social worker is aware of, and assists clients to make appropriate use of, internal organisational review, complaint and appeal processes, as well as external administrative and other appeal processes when relevant. Standard 3.10 The social worker identifies the need for change in wider societal systems and raises this appropriately for consideration and possible action. Standard 4.1 As part of their practice, the social worker identifies the policy context in which they work and determines whether it is consistent with social work values and principles. Standard 4.2 The social worker identifies aspects of policy, relating to their practice context, which are inappropriate, inconsistent or inadequate and is able to explain why this is so.. Standard 4.5 Appropriate action is initiated by the social worker for the development, implementation and/or change of policy in their practice context. Standard 4.6 The social worker has taken relevant and reasonable steps to have appropriate policy developed, accepted and implemented. Standard 4.8 The social worker contributes to increasing public awareness of client needs and social justice issues generally and in specific circumstances when they arise. Standard 4.9 The social worker is able to identify circumstances in which policy requirements or directions in their practice context raise social work ethical issues and is able to deal with this appropriately. Standard 5.1 The social worker conducts all aspects of research consistent with the five basic values of social work practice: human dignity and worth, social justice, service to humanity, integrity, and competence. Standard 5.4 The social worker s practice is informed by the evidence based research in the area of practice. Standard 5.5 The social worker shares the outcomes of research with colleagues so that the research product is available to other practitioners. Standard 6.1 The social worker is engaged in a process of continuing professional education which assists the development of their skills and knowledge in their chosen field of practice and their understanding of the issues facing the wider community. Standard 6.2 The social worker includes supervision as an important part of their continuing professional education. Standard 6.3 The social worker uses ongoing reflection on practice in order to enhance the development of their skills, knowledge and understanding Standard 6.4 The social worker views their own development as an ethical practitioner as essential. Standard 6.5 The social worker conducts or participates in research that informs their practice and contributes to the understanding of issues facing individuals and communities. Standard 6.6 The social worker incorporates research, knowledge and understanding of the changing needs of their community into their social work practice. (Australian Association of Social Workers 2003) Susann Treston Page 11 of 11