Problem identification
The case presented is about a 43-years-old Latina woman called Paula Cortez. Paula is from Colombia, but she currently lives in New York, United States. According to the case study, Paula left home when she was only 17 years old. Paula had left home because her parents were very abusive. After escaping from her family, Paula started living in the streets because she had nowhere to stay. Paula started using intravenous drugs such as heroin and cocaine. Intravenous drugs are directly administered into the venous circulation using an intravenous catheter or syringe. The intravenously are often more dangerous than these other substances because they are injected directly into the main bloodstream, resulting in an instant and long-term effect ( Mulemba et al. 2020). She followed her husband to the United States and even stopped using drugs when she realized she was pregnant. However, Paula's husband, David, continued to use drugs more frequently, resulting in their marriage failure. When Paula gave birth to their first son in 1987, she was diagnosed with HIV. Paula lost custody of her son when he was only eight years old due to her medical condition. After losing her son, Paula decided to transform, and she went back to school, where she obtained a degree in Bachelor of Arts.
Upon graduation, Paula got a full-time job with a clothing designer where she worked for some time before, and her health condition worsened, and she could no longer work. Besides her HIV status, Paula was diagnosed with bipolar disorder; she occasionally experienced rapid cycles of depression and mania when she failed to take her medication seriously. Additionally, Paula had been diagnosed with a T-cell count of less than 200 and brain infection. The low T-cell count was associated with HIV infection. She eventually became paralyzed on her right side due to her worsening health conditions. Alter being paralyzed, Paula was also diagnosed with Hepatitis C.
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Paula has been seen in the outpatient facility by one of the social workers. The worker considered her after she noticed that Paula was pregnant. Paula has reported being afraid of the father of her unborn child because he is a drug user and becomes demanding and controlling all the time. Paula's interdisciplinary team was worried about her health condition and her pregnancy status; they were concerned about the baby's health and health in general because Paula seemed to be incompliant with medication instructions given to her.
Interventions
When seeking an appropriate intervention plan, it is essential to consider the patient medical conditions and the best approach to best encounter the existing health conditions. In the case of Paula Cortez, it is necessary to assess her general health conditions and how they could be tackled systemically. When handling the issue of Paula Cortez, I would first concentrate on her physical safety because she might not be able to do anything under the threats from the drug user who impregnated her. To counter her condition, I would first take through application for protection from abuse by the father of her unborn baby or an order restricting the father from accessing Paula.
The second issue I would attend is Paula's inability to follow the medication instruction. I would convince Paula to regularly take her medicine by explaining the importance of taking medication as per the doctor's prescription. I would urge Paula to maintain her medication without any single miss because it would significantly affect the medication's effectiveness. I would further state to Paula the risk she exposes her unborn baby to by not taking her medication seriously.
The third issue I would address is how to help Paula create a working plan that she would use when the baby is born. I would give Paula technical assistance on preparing for the coming baby and how she would take good care of her despite her existing medical conditions. I would assist Paula in applying for the Supplemental Nutrition Assistance Program (SNAP) and Women Infants and Children (WIC) benefits. I believe that such programs can help Paula acquire food assistance that would help throughout her expectancy period and the time she will give birth to her child. With Paula's current financial status, WIC and SNAP can allow Paula to acquire some essential items for her unborn baby and secure a better apartment that would offer a better environment for raising her unborn baby. Paula's most important thing is to take care of herself by addressing her current health condition and taking care of her unborn baby. Her current health status does not interfere with the baby's growth and development in the womb. Besides that, it is essential to note that the unborn baby will need much attention to one born. The child will require special treatment, and therefore the mother must have a preliminary plan that would ensure that child is safe once he or she is born.
I would use the Goal Attainment Scale (GAS) to observe change and evaluate the intervention's effectiveness. According to Jennings et al. (2018), the Goal Attainment Scale refers to the individualized outcome measure that involves using standardized goal scaling and goal selection in calculating the level to which the patient's goal has been met. GAS is an essential tool in the healthcare setup as it enables healthcare providers to gauge the effectiveness of the medications used. In evaluating the intervention used, I would use a 5-point scale that ranges from the most unfavorable outcome to the most favorable outcome. The tool would enable me to identify the intervention's effectiveness. I would use GAS to track how Paula is progressing with treatment throughout the intervention process. The consistent evaluation of the process at different stages is vital as it will create room for improvement before the process is completed. I would quickly switch off to another intervention if the current one is not working instead of waiting until the process is complete. The intervention used must also be inclined towards achieving Paula's medication goals.
I could use the Psychiatric Rehabilitation Process model retrieved from the SAMHSA website as an alternative intervention. Hasson-Ohayon et al. (2020) define the Psychiatric Rehabilitation Process model as a mental illness recovery model. The Psychiatric Rehabilitation Process model is process-based rather than outcome-based. The model is centered on an individual's potential to recover from the existing mental health condition. It focuses on providing social exclusion, support, empowerment, and coping skills. The model can be beneficial in treating Paula, considering her present state. Paula requires financial support, coping skills, and social inclusion. Therefore, the alternative model can help in addressing Paula's critical situation. According to Torres (2017), the Psychiatric Rehabilitation Process model is strength-based and client-centered; it helps build self-determined goals, provide direct training skills, and maximize the client's independence. Paula would find a better room for expressing herself and providing more accurate and reliable information regarding her condition.
The interventions would help Paula maintain her physical and mental health and improve her social service assistance by developing and implementing her rehabilitation plans. The intervention outcomes would allow Paula to achieve basic survival techniques to guide her throughout her recovery period. The intervention would provide her with a quality life, enhance human service use, and obtain a better housing status. Paula is generally in a delicate condition and needs much attention ( Aubry et al., 2016). Paula's treatment program would run for three months and 15 months, depending on her response to the intervention and her treatment need. The earlier Paula can respond to treatment, the better. However, the treatment process should not be hurried and should go as per the patient's ability to respond to treatment.
Evaluation Plan
Single-system designs would be used for developing an appropriate evaluation plan for the intervention used. The design system is useful in evaluating controlled experiments and uncontrolled programs with a single subject or system, like in Paula's case. I would specifically apply the Single Subject Research Design (SSRD) for creating an appropriate evaluation plan. According to Kenyon et al. (2019), SSRD refers to a single-system design involving the study of a single system or subject by conducting repeated measurements of a single dependent variable or more. The system design is crucial during research due to its ability to validate practices and shows individual differences. The model can evaluate how a study is progressing and the individuals participating in the study. The frequency of behavior change and progress over time can be measured using the created graphs and charts. The measurement is done per session based on the time frame, whether yearly, monthly, weekly, or daily progression. In Paula's case, the charts would show the changes and performance progress, whether declining or improving.
The repetition of research study would equally be beneficial in the case of Paula Cortez. The replication is conducted under different subjects and situations to determine the basics of original study findings ( Uchihara et al., 2019). In Paula's first treatment case, it would be essential to focus on her intervention and provide a healthy and safe environment for the unborn baby. The second phase in the chart would assist in supporting the Psychiatric Rehabilitation Process Model. The second phase intervention's effectiveness would depend on Paula's behaviors and progress throughout the intervention process.
References
Aubry, T., Duhoux, A., Klodawsky, F., Ecker, J., & Hay, E. (2016). A longitudinal study of predictors of housing stability, housing quality, and mental health functioning among single homeless individuals staying in emergency shelters. American Journal of Community Psychology , 58 (1-2), 123-135.
Hasson-Ohayon, I., Roe, D., & Lysaker, P. H. (2020). Applying the concept of metacognition in the field of psychiatric rehabilitation: An introduction to the special issue. Psychiatric Rehabilitation Journal , 43 (4), 271.
Jennings, L. A., Ramirez, K. D., Hays, R. D., Wenger, N. S., & Reuben, D. B. (2018). Personalized goal attainment in dementia care: Measuring what persons with dementia and their caregivers want. Journal of the American Geriatrics Society , 66 (11), 2120-2127.
Kenyon, L. K., Chapman, A., Williams, B., & Miller, W. C. (2019). Use of single-subject research designs in seating and wheeled mobility research: a scoping review. Disability and Rehabilitation: Assistive Technology .
Mulemba, T., Bank, R., Sabantini, M., Chopi, V., Chirwa, G., Mumba, S., ... & Hockenberry, M. (2020). Improving peripheral intravenous catheter care for children with cancer receiving chemotherapy in Malawi. Journal of Pediatric Nursing , 56 , 13-17.
Torres, A. (2017). The Impact of Motivational Interviewing Training on Rehabilitation Counselors: Assessing Working Alliance and Client Engagement: A Randomized Controlled Trial (Doctoral dissertation, Florida Atlantic University).
Uchihara, T., Webb, S., & Yanagisawa, A. (2019). The effects of repetition on incidental vocabulary learning: A meta‐analysis of correlational studies. Language Learning , 69 (3), 559-599.
