Discussion 1: Family Assessment

  The aboriginal footfall in allowance a applicant is administering a absolute assessment. The analytic amusing artisan charge analyze assorted perspectives in adjustment to advance a complete compassionate of the situation. From this understanding, the amusing artisan is able to admit the client’s strengths and advance able strategies for change. For this Discussion, analysis the “Cortez Family” case history. By Day 3 Post your description of how micro-, mezzo-, or macro-levels of convenance aid amusing workers in assessing families. Assess Paula Cortez’s bearings application all three of these levels of practice, and analyze two strengths and/or solutions in anniversary of these levels. Describe the amount in strength-based solutions.   Required Readings Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Amusing assignment convenance with individuals and families: Evidence-informed assessments and interventions. Hoboken, NJ: John Wiley & Sons, Inc. Chapter 9, “Assessment of Families” (pp. 237–264) Plummer, S.-B., Makris, S., & Brocksen, S. (Eds.). (2013). Sessions case histories. Baltimore, MD: Laureate International Universities Publishing. “The Cortez Family” (pp. 23–25) Smokowski, P. R., Rose, R., & Bacallao, M. L. (2008). Acculturation and Latino ancestors processes: How cultural involvement, biculturalism, and acculturation gaps access ancestors dynamics. Ancestors Relations, 57(3), 295–308. Olson, D. H. (2000). Circumplex Archetypal of Marital and Ancestors Systems. Journal of Ancestors Therapy, 22(2), 144–167.   The Cortez Ancestors  Paula is a 43-year-old HIV-positive Latina woman originally from Colombia. She is bilingual, chatty in both Spanish and English. Paula lives abandoned in an accommodation in Queens, NY. She is afar and has one son, Miguel, who is 20 years old. Paula maintains a accord with her son and her ex-husband, David (46). Paula aloft Miguel until he was 8 years old, at which time she was affected to abandon aegis due to her medical condition. Paula is acutely socially abandoned as she has bound acquaintance with her ancestors in Colombia and lacks a associate adjustment of any affectionate in her neighborhood. Paula identifies as Catholic, but she does not accede adoration to be a big allotment of her life. Paula came from a moderately flush family. She letters adversity concrete and affecting corruption at the easily of both her parents, who are animate and abide in Colombia with Paula’s two siblings. Paula completed aerial academy in Colombia, but ran abroad back she was 17 years old because she could no best abide the corruption at home. Paula became an intravenous biologic user (IVDU), decidedly of cocaine and heroin. David, who was originally from New York City, was one of Paula’s “drug buddies.” The two eloped, and Paula followed David to the United States. Paula connected to use drugs in the United States for several years; however, she chock-full back she got abundant with Miguel. David connected to use drugs, which led to the aborticide of their marriage. Once she chock-full application drugs, Paula abounding the Fashion Institute of Technology (FIT) in New York City. Upon commutual her BA, Paula formed for a accouterment designer, but accomplished her accurate affection was painting. She has a accumulating of added than 100 assets and paintings, abounding of which clue the advance of her claimed and affecting journey. Paula captivated a full-time job for a cardinal of years afore her bloom prevented her from working. She is now unemployed and receives Supplemental Security Insurance (SSI) and Medicaid. Paula was diagnosed with bipolar disorder. She adventures accelerated cycles of aberration and abasement back not appropriately medicated, and she additionally has a addiction against paranoia. Paula has a history of not acknowledging with her psychiatric medication analysis because she does not like the way it makes her feel. She generally discontinues it afterwards cogent her psychiatrist. Paula has had assorted psychiatric hospitalizations but has remained out of the hospital for at atomic bristles years. Paula accepts her bipolar diagnosis, but demonstrates bound acumen into the accord amid her affection and her medication. Paula was diagnosed HIV absolute in 1987. Paula acquired AIDS several years afterwards back she was diagnosed with a astringent academician infection and a T-cell calculation beneath than 200. Paula’s academician infection larboard her absolutely bedridden on the adapted side. She absent action of her adapted arm and hand, as able-bodied as the adeptness to walk. Afterwards a continued break in an astute affliction hospital in New York City, Paula was transferred to a accomplished nursing adeptness (SNF) area she anticipation she would die. It is at this time that Paula gave up aegis of her son. However, Paula’s action bigger gradually. Afterwards actuality in the SNF for added than a year, Paula regained the adeptness to walk, although she does so with a astringent limp. She additionally regained some action in her adapted arm. Her adapted duke (her ascendant hand) charcoal semiparalyzed and limp. Over the advance of several years, Paula accomplished herself to acrylic with her larboard duke and was able to acknowledgment to her admired art. In 1996, back awful alive antiretroviral analysis (HAART) became available, Paula began treatment. She responded able-bodied to HAART and her HIV/AIDS was able-bodied controlled. In accession to her HIV/AIDS disease, Paula is diagnosed with hepatitis C (Hep C). While this action was controlled, it has accomplished a point area Paula’s doctor is advising she activate treatment. Paula additionally has cogent circulatory problems, which account her astringent affliction in her lower extremities. She uses assigned analgesic affliction medication to ascendancy her symptoms. Paula’s circulatory problems accept additionally led to abiding ulcers on her all-overs that will not heal. Analysis for her bottom ulcers demands common visits to a anguish affliction clinic. Paula’s affliction commutual with the bottom ulcers accomplish it difficult for her to ambulate and leave her home. As with her psychiatric medication, Paula has a addiction not to accede with her medical treatment. She generally disregards instructions from her doctors and resorts to holistic treatments like alleviative her ulcers with chamomile tea. Alive with Paula can be actual arresting because she is generally accomplishing actual able-bodied medically and psychiatrically. Then, out of the blue, she stops her analysis and deteriorates quickly. I met Paula as a amusing artisan active at an outpatient absolute affliction dispensary amid in an astute affliction hospital in New York City. The dispensary functions as an interdisciplinary operation and follows a chain of affliction model. As a result, dispensary patients are followed by their physician and amusing artisan on an outpatient base and on an inpatient base back accepted to the hospital. Thus, amusing workers collaborate not alone with doctors from the clinic, but additionally with doctors from all casework throughout the hospital. 23 SESSIONS: CASE HISTORIES • THE CORTEZ FAMILY Afterwards alive with Paula for about six months, she alleged to acquaint me that she was pregnant. Her account was abominable because she did not accept a admirer and never batten of dating. Paula explained that she met a man at a annual shop, they batten several times, he visited her at her apartment, and they had sex. Paula anticipation he   was a “stand up guy,” but afresh aggregate had changed. Paula began to doubtable that he was application drugs because he had started to   become authoritative and demanding. He showed up at her accommodation at all times of the night ambitious to be let in.   He alleged her relentlessly, and back she did not aces up the phone, he larboard her beggarly and aggressive messages.   Paula was aflutter for her safety.  Given Paula’s circuitous medical contour and her psychiatric diagnosis, her doctor, psychiatrist, and I were anxious about Paula advancement the pregnancy. We not alone feared for Paula’s and the baby’s health, but additionally for how Paula would administer caring for a baby. Paula additionally struggled with what she should do about her pregnancy. She actively advised accepting an abortion. However, her Catholic roots commutual with seeing an ultrasound of the babyish able her admiration to go through with the pregnancy. The primary focus of analysis bound became ambidextrous with Paula’s accord with the baby’s father. During sessions with her analyst and me, Paula appear activity aflutter for her safety. The father’s adamant buzz calls and voicemails ashamed Paula. She became scared, slept poorly, and her paranoia added significantly. During a accurate session, Paula appear that she had started smoker to cope with the accent she was feeling. She additionally declared that she had chock-full her psychiatric medication and was not consistently demography her HAART. Back we explored the dangers of Paula’s actions, both to herself and the baby, she adumbrated that she knew what she was accomplishing was adverse but she did not care. Afterwards commutual a suicide assessment, I was assertive that Paula was decompensating bound and at accident of harming herself and/or her baby. I consulted with her psychiatrist, and Paula was involuntarily accepted to the psychiatric assemblage of the hospital. Paula was acutely affronted at me for the admission. She abhorrent me for “locking her up” and not allowance her. Paula remained on the assemblage for 2 weeks. During this break she restarted her medications and was stabilized. I approved to appointment Paula on the unit, but the aboriginal two times I showed up she banned to see me. Eventually, Paula did accede to see me. She was still angry, but she was able to see that I had acted with her best absorption in mind, and we were able to adjustment our relationship. As Paula able for discharge, she batten added about the ancestor and the accent that had apprenticed her to the acceptance in the aboriginal place. Paula agreed that admitting her fears she had to do article about the situation. I helped Paula advance a assurance plan, accomplished her about filing for a abstinent order, and referred her to the AIDS Law Project, a not-for-profit alignment that helps individuals with HIV handle acknowledged issues. With my abutment and that of her lawyer, Paula filed a badge abode and auspiciously got the abstinent order. Once the adjustment was served, the buzz calls and visits stopped, and Paula regained a faculty of ascendancy over her life. From a medical perspective, Paula’s abundance was advised “high risk” due to her complicated medical situation. Throughout her pregnancy, Paula remained on HAART, pain, and psychiatric medication, and analysis for her Hep C was postponed. During the abundance the ulcers on Paula’s all-overs worsened and she developed a astringent cartilage infection, ostemeylitis, in two of her toes. Afterwards analysis the infection was acutely alarming to both Paula and her baby. Paula was accepted to a medical assemblage in the hospital area she started a 2-week advance of intravenous (IV) antibiotics. Unfortunately, the antibiotics did not work, and Paula had to accept portions of two of her toes amputated with bound anesthesia due to the pregnancy, extending her hospital break to about a month. The action of Paula’s all-overs acute my affair and the analysis team’s apropos about Paula’s adeptness to affliction for her baby. There were assorted factors to consider. In the actual term, Paula was almost able to airing and was accordingly clumsy to do annihilation to adapt for the baby’s accession (e.g., accumulate supplies, booty parenting class, etc.). In the average term, we bare to abode how Paula was activity to affliction for the babyish day-to-day, and we bare to anticipate about how she would affliction for the babyish at home accustomed her concrete limitations (i.e., bound adeptness to ambulate and bound use of her adapted hand) and her accepted medical status. In addition, we had to accede what she would do with the babyish if she adapted addition hospitalization. In the continued term, we bare to anticipate about permanency planning for the babyish or for what would appear to the babyish if Paula died. While Paula accustomed the accent of all of these issues, her all-overs akin was abundant lower than abundance and that of her analysis team. Conceivably she did not see the accomplished account as we did, or conceivably she was in denial. She again told me, “I know, I know. I’m aloof activity to do it. I aloft my son and I am activity to booty affliction of this babyish too.” We absolutely did not accept an acknowledgment for her bound affecting response, we aloof bare to accommodated her area she was and move on. One of the things that afraid me best about Paula was that she had a abundant adeptness to assemblage bodies about her. Nurses, doctors, amusing workers: we all capital to advice her alike back she approved to advance us away. The Cortez Ancestors David Cortez: father, 46 Paula Cortez: mother, 43 Miguel Cortez: son, 20  24     SESSIONS: CASE HISTORIES • THE CORTEZ FAMILY While Paula was in the hospital unit, we were able to allocution about the baby’s affliction and permanency planning. Through these discussions, Paula’s amusing abreast became added and added evident. Paula had not told her parents in Colombia that she was accepting a baby. She feared their disapproval and she stated, “I can’t angle to apprehend my mother’s negativity.” Miguel and David were acquainted of the pregnancy, but they anniversary had their own lives. David was remarried with children, and Miguel was alive and in academy full-time. The abstraction of burdening him with her needs was article Paula would not consider. There was no one abroad in Paula’s life. Therefore, we were affected to attending at options alfresco of Paula’s bound amusing network. Afterwards a ages in the hospital, Paula went home with a surgical boot, instructions to absolute address weight on her foot, and a account of referrals from me. Paula and I agreed to analysis in every alternative day by telephone. My ambition was to adviser how she was feeling, as able-bodied as her advance with the referrals I had accustomed her. I additionally capital to accommodate her with abutment and advance that she was not accepting from anywhere else. On abounding occasions, I afraid up the buzz balked with Paula because of her dabbling and abridgement of follow-through. But ultimately she completed what she bare to   for the baby’s arrival. Paula auspiciously activated for WIC, the federal Supplemental Nutrition Affairs for Women,   Infants, and Children, and was additionally able to defended a bassinet and alternative babyish essentials.  Paula delivered a advantageous babyish girl. The babyish was built-in HIV abrogating and accustomed the adapted HAART analysis afterwards birth. The babyish spent a anniversary in the neonatal accelerated affliction unit, as she had to detox from the furnishings of the affliction medication Paula took throughout her pregnancy. Accustomed Paula’s low income, health, and Medicaid status, Paula was able to administer for and accept 24/7 in-home adolescent affliction abetment through New York’s accessible abetment program. Depending on Paula’s bloom and her charge for help, this adjustment can be adapted as accounted appropriate. Miguel did booty a allotment in caring for his bisected sister, but his abetment was limited. Ultimately, Paula completed the adapted permanency planning paperwork with the abetment of the alignment The Ancestors Center. She called Miguel the baby’s guardian should article appear to her.  

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