Reference no: EM133367052

Case Study 1

Teresa is a 32-year-old woman in your practice who frequently misses her appointments and at other times shows up without an appointment, often in crisis. She currently uses alcohol and tobacco, and has started to use street drugs.

As you have developed a therapeutic relationship with Teresa, you learn that she grew up in a household with a violent father who frequently assaulted her mother, her siblings, and herself. Although now estranged from her father, the impact of his violence presents itself on a daily basis as Teresa struggles to cope with the trauma she experienced.

Teresa left school early, has few marketable skills, and has never been able to hold a job for more than three months. Teresa receives $606 per month from Ontario Works and has no money left for food or other essentials at the end of the month. She is currently in a relationship with a man whom you suspect may be violent

Questions

1. What are the next steps with Teresa?

2. How do we go about providing trauma-informed care?

3. Is a crisis intervention required?

4. What other interventions could we take to improve Teresa's health in this situation that includes addressing health inequities and structural drivers of the conditions of daily life, such as the inequitable distribution of power, money, and resources?

Case Study 2

Joseph is a 55-year-old First Nations man on Ontario Disability Support Program due to a physical back injury in the factory he worked in. Despite his injury, he still receives work health benefits and is able to perform some amount of activities of daily living. Due to his chronic back pain, his doctor has prescribed Oxycodone which he uses occasionally (prn), as prescribed. However, he also uses marijuana daily because it makes him feel more in control. He is recently divorced, lives alone, and is finding it hard to cope with this loss. Joseph presents at the clinic reporting increasing pain. During your conversation, you discover that he is gradually increasing the amount of marijuana he is using to combat his pain and feelings of isolation.

Questions:

1. What are the next steps with Joseph?

2. How would we conduct a motivational interview?

3. What do we suggest talking about with Joseph at his next appointment?

4. What strategies could we provide that would support a recovery-oriented approach?

5. What strategies could we provide that assist with harm reduction?

Case Study 3

Thomas, a 16-year-old high school student, visits you during class in distress. He tells you that he's being bullied at school because the kids think he is gay. Thomas tells you he thinks he might be transexual, but that he is scared to tell anyone, and voices suicide ideation. He is not supported at home: his mother and father, both professionals work long hours and his older sister picks on him. Thomas's best friend since the age of 10 recently told him he didn't want to hang out with him anymore because he was "weird." A few months ago another friend who was picked on more than Thomas went missing. Rumour in the school indicates that he ended his life.

Questions:

1. What are your next steps with Thomas?

2. Do we have any immediate concerns in terms of Thomas's safety?

3. Is a crisis intervention required?

4. What kinds of community-based support strategies would you recommend?

5. Do you approach Thomas's family? If so, how?

6. What role in terms of mental health advocacy and promotion?

7. How does organizational culture influence the current provision of mental health care for students; how might that culture impact any changes you propose?

8. What kinds of strategies can we develop?

9. Who might be on an inter and intra-professional team?

10. What kinds of stakeholders are available to assist with policy or program development?

Case Study 4

Gladys, an 84-year-old widow, is close to being discharged from outpatient services after breaking her hip from a fall. She uses alcohol, and tells you that she has been drinking more heavily since her husband passed away more than a year ago to help her cope with grief. She won't tell you how often or how much she drinks, but admits that she's lost over 25 pounds in the past year.

Questions

1. How do we establish a therapeutic relationship with Gladys?

2. What support can we provide for Gladys?

3. What are some key risk considerations?

4. When would we consider a harm reduction approach?

5. What are the suicide considerations in this scenario?

6. What are interventions that would tackle the immediate risks in daily live, such as housing situation or ambulation?

7. What are the key medication considerations, especially give her age and alcohol use?

8. What other considerations may you have to maintain her safety?

9. How would you use a harm reduction approach with Gladys?

10. What accommodations at home may she need?