Reference no: EM133721312

Case Study

Tammy is a 45 year old white, female-identified client who has been admitted to the Violence Against Women (VAW) shelter you work at in Toronto after being referred by the Assaulted Women's Helpline. Tammy has her children with her upon admission, Thomas, aged 10, and Elizabeth, aged 13, along with the family dog, Spot. Tammy, Thomas, and Elizabeth present as adequately dressed for the weather and well-groomed. In intake, Tammy explains that she is fleeing her control the household finances including Tammy's personal money, and hit her.

Tammy states the abuse has been going on since Thomas was born and has progressively worsened. Tammy shows you text messages from John that are threatening, stating if she does not return to the home and if she tells anyone, he will harm her extended family. Tammy states she is fearful of this. Tammy expresses that she isn't sure if she should stay but is anxious if she goes back that John will escalate and harm her children or Spot. Thomas and Elizabeth appear withdrawn but become irritable when you engage, asking for their ages and what school they are enrolled at. You provide the family with a tour of the shelter and offer a snack. You suggest to Tammy a meeting for you and her to discuss case management services at the shelter. You and Tammy decide to meet the next evening when she returns from her job at the bank and picking the children up from school.

The next day, you notice Tammy, Thomas, and Elizabeth came back early to the shelter. When you answer the door, Tammy appears frantic, pushing her children into the door and running in requesting the door be shut and locked immediately. Tammy directs Thomas and Elizabeth to go into their room with Spot. You ask Tammy if she is okay. Tammy stated she is frightened after an encounter with John. You escort Tammy to your office to speak. Tammy explains that she saw John circling around her work. Tammy left through a back door at her work and noticed a note attached to her car windshield from John stating to "watch her back." Tammy is adamant she cannot return to work. She explains that the incident made her fear worse and she is scared for her and her children's lives.

Tammy shares with you, that she has experienced nightmares, unwanted thoughts during the day about the abuse, feelings of hopelessness, and that she hasn't seen her friends or family in awhile. Tammy shares that she likes to listen to music and take Spot for walks when she feels like this. Tammy stated that both Thomas and Elizabeth used to exceed in school and participate in after school sports. However, Tammy reports both have become irritable and frustrated with her. Tammy stated she caught Elizabeth drinking and smoking marijuana, and is scared Elizabeth is falling into the "wrong crowd." Tammy shared that Thomas has been name-calling her, often repeating what John would say to her. Tammy feels like her whole world has fallen apart. When asked what Tammy would like to work on, Tammy isn't sure but does express she'd like to find a safe place to stay with her children and dog. Tammy asks you what her goals should be.

Reflection Questions

These are questions to consider when building a case management plan for Tammy. Not all these questions have to be answered in our discussions, but rather serve to help you brainstorm.

Assessment

• What are the presenting concerns in this study? Hint: think issue, length of time the issue has been present, and problems the issue has caused.
• What information is missing? What questions would you ask to obtain this information? How would you obtain this information? Hint: think about aspects such as physical health, activities of daily living, finances.
• What goals does Tammy present to you, both directly and indirectly?
• What would impede Tammy's goals? What strengths does Tammy have and what are her protective factors? Hint: think coping skills and relationships.

Planning

• What immediate needs are present? How can these be addressed before progressing to Tammy's goals? Hint: think safety in-home and in-community.
• What resources are present in the community that could help address Tammy's goals?

Linking

After mapping what resources are available, what resources would you select? What barriers could exist in accessing these resources?

Monitoring

• How would you monitor Tammy's progress on their goals? Hint: think of numeric and conversational measures.
• How would you adjust Tammy's case plan when connected with resources? Hint: think length of time between visits, different services offered, etc.
• What steps would you take if Tammy expressed conflict with a service provider you referred her to?

Ethics

• How would you respond when Tammy asks you what her goals should be? Hint: think self-determination, autonomy.
• Would you support Thomas and Elizabeth while supporting Tammy? How would you navigate the relationship between you, Tammy, and her children?
• Tammy may express wanting to return to John. How would you react? How would you plan this with Tammy? Hint: think personal values and beliefs. mandated reporting regarding children.
• When would you decide for Tammy to be discharged? What ethical considerations need to be considered when discussing discharge?
• What other ethical issues could arise when working with Tammy?
• What different ethical considerations would be made if Tammy's demographics changed? Think: race, culture, gender, etc.
• How would you apply an ecological model to address macro level issues that impact Tammy and those in similar situations? Hint: think system challenges, what resources exist or do not exist, funding for services, etc.