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Model Treatment or Service Plan
Using the attached template, fill in each section making sure that there is sufficient information to demonstrate the objectives are measurable, related to the identified problem or community service plan objective, and that there are included target dates. The plan must have an introduction defining the client or the community population and a summary that identifies the differences and similarities between an individual client treatment plan and a community action or service plan.
Use the Riverbend City case studies, or another client or population you are familiar with, to develop the treatment plan or organizational service plan. In the Riverbend cases, you can work with an individual or family plan (micro level) or an organizational plan for the servicing organization (macro level) interventions.
The treatment or service plan must include the following components:
- Identified issue, situation, or problem.
- Objectives to be achieved (2–3).
- Measurable goals for each objective (1–2).
- Target completion dates.
- Indicators of successful completion.
Define the similarities and differences between an individual treatment plan and a community, organization, or group service plan.
Resources
- Model Treatment or Service Plan Scoring Guide.
- Riverbend City: Focus on Diversity Case Studies.
- Treatment Plan Template.
- APA Style and Format.
ASI Treatment Plan Template
(ASI/DENS Format)
Client/Organization Name:
Counselor Name:
Date
Problem Statement
Goals
D/C Criteria
Objectives
What will the client say or do? Under what circumstances? How often will he/she say or do this?
Interventions
What will the counselor/staff do to assist client? Under what circumstances?
Service Codes
Target Date
Resolution Date
Participation in Treatment Planning Process
Participation by Others in the Treatment Planning Process
Note: All participants may not have participated in every area.
|
Client Signature/Date |
|
Counselor Signature/Date |
Service Codes
I=Individual
G=Group
F=Family
C=Couples
P=Psychoeducational
H=Homework
R=Reading
M=Media
V=Videotape
A=Audiotape
R=Referral
Treatment Planning M.A.T.R.S.:
Utilizing the Addiction Severity Index (ASI) to Make Required Data Collection Useful
INTRODUCTION: WELCOME TO RIVERBEND CITY
Expository Text: Lu is a young Hmong child who has been exposed to chemicals after a freight train derailment in Riverbend City. His family sends Jason, his 17-year-old cousin, to the hospital to represent them, but Jason’s youth and the hospital’s policies get in the way. When one of the nurses calls child protective services to report the welts she discovered on Lu’s back, the situation becomes more complicated. The welts were caused by “cao gio” or coining, a folk therapy practiced by many Southeast Asian cultures. While sensitivity to different cultures is important, so too is protection of children from injury—intentional or not.
Instructional Text: As you watch this case unfold, consider how different theoretical models could be employed and what issues are being illustrated by this case. Consider also the different systems — micro, mezzo, and macro — and what research topics within these systems are suggested by this case.
Characters in this Mission:
Chandra Capshaw – Hospital Social Worker
Christina Chang – ER Receptionist
Jessica Jameson – RN–RCMC
Carl Lauderback – RN–Nurse Supervisor, RCMC
Stewart Mason – EMT
Patricia Olsen – RN–L&D Nurse, RCMC
Christine Sassman – RN–Pediatric Intensive Care Specialist, RCMC
Katy Stanfield – RN–Emergency Department RCMC
Bo Vang – Lu’s Aunt
Jason Vang – Lu’s Cousin
Kaying Vang – Lu’s Mother
SCENE 1: RIVERBEND CITY MEDICAL CENTER, EMERGENCY ROOM
Expository Text: Having received notification that MedAir rescue is enroute with children injured by exposure to hazardous chemicals that were released during a train derailment near their school, the Riverbend City Medical Center Emergency Department is ready to take action. The situation is complicated when the ER staff discover that the child does not speak English.
Instructional Prompt: Click on all highlighted characters to hear their concerns about their patient.
Dialogue 01: Stewart gives Carl the report on his patient, Lu Vang, an elementary school child who was exposed to the chemical cloud.
STEWART:
Carl … over here!
CARL:
What have you got for us, Stewart?
STEWART:
Approximately 8- or 9-year-old boy exposed to chemicals released by the train derailment. Some chemical burns on his skin and apparent respiratory involvement. It’s hard to tell for sure because he is hysterical and speaks virtually no English.
JESSICA:
Did someone contact his parents?
STEWART:
I’m not sure. The school nurse is coming in behind us with more kids … less injured. She should have that information.
CARL:
Do you know what language he speaks?
STEWART:
I am pretty sure the nurse said he’s Hmong.
CARL:
Okay … Jessica, go with Stewart and put the boy in an ER bed, then page Christina Chang to whatever room you’re in. Start your assessment and the intake paperwork … can you handle that?
JESSICA:
You bet. Let’s go, Stewart.
Dialogue 02: Carl follows up with Jessica on Lu’s status.
CARL:
Okay, Jessica, how is he doing?
JESSICA:
Carl … this child has been abused!
CARL:
What? How do you know this?
JESSICA:
He’s covered in bruises. I’ve never seen anything like it. It’s like he’s been beaten with a stick or a rubber hose or something.
CARL:
Did he explain to Christina how he got them?
JESSICA:
Oh my gosh… I am so sorry. I forgot to page her. I started my assessment of this poor boy and when I saw his back, I totally forgot that you’d said to page her.
CARL:
Okay, I’ll take a look at him, but I want you to go get Christina. We need to be able to communicate with the boy and find out what’s going on.
Dialogue 03: Jessica tells her colleague Katy Stanfield about Lu’s bruises.
KATY:
How’s your patient doing?
JESSICA:
My kid has respiratory issues, but I think he’s going to be fine. He’s got rales, but I think he may have had a cold or upper respiratory infection. He’s got bigger problems than that, though.
KATY:
What do you mean?
JESSICA:
Someone is beating him … bad.
KATY:
What? Are you sure? I didn’t think he spoke any English?
JESSICA:
He doesn’t but when I was examining him, I discovered that he’s covered in bruises. There’s no way they are accidental, either.
KATY:
Have you called Child Protective Services?
JESSICA:
No … Carl didn’t say to. Should I?
KATY:
Yes, if you have a reasonable suspicion of abuse, you are required to report it?
SCENE 2: RIVERBEND CITY MEDICAL CENTER, PEDIATRIC INTENSIVE CARE UNIT
Expository Text: Having received an urgent call from his mother, Jason Vang has come to RCMC and is now trying to get information about his young cousin’s status.
Instructional Prompt: Click on Jason to hear more about the situation.
Dialogue 04: Jason approaches a nurse and asks for help.
JASON:
Excuse me… they told me down in the lobby that Lu Vang was brought here?
PATRICIA:
Who did you say you are?
JASON:
I… I didn’t say yet. I’m his cousin. He and his family haven’t been in the U.S. very long. My parents sponsored his family, so I’m kind of like his older brother.
PATRICIA:
I’m sorry, we can’t give information to people outside of the immediate family. That’s kind of like a violation of patient privacy.
JASON:
His mother and my parents are on their way here can’t you just tell me if he’s even in this hospital?
PATRICIA:
Yes, I am allowed to give you that information. Lu Vang has been admitted to this unit.
JASON:
Is he okay? I hear a lot of crying around here but I don’t hear anyone speaking Hmong. Is he awake? Is he even alive?
CHRISTINE:
Pat, do you need some help here?
PATRICIA:
I think I’m okay, Chris. This young man was looking for his cousin, who was one of the children brought in earlier. Now that he knows his cousin is here, I was suggesting that he go down to the lobby to wait for the boy’s mother and… I guess the patient’s parents are coming also.
JASON (to Christine):
Excuse me ma’am, but my family asked me to come here and help Lu until they can get here. I don’t think I am very much help waiting down in the lobby. Why can’t I see my cousin?
CHRISTINE:
Let’s back up a little. What’s your name and what’s your cousin’s name?
JASON:
Jason Vang. My cousin is Lu Vang.
[Commotion is heard… Stephanie Peavey has just been told that her son died. Exclamations of shock and grief.]
CHRISTINE:
I’m sorry… I don’t mean to be rude but I’ve got other patients I need to help. You’re just going to have to wait until your parents and Lu’s parents get here.
SCENE 3: RIVERBEND CITY MEDICAL CENTER, EMERGENCY ROOM WAITING AREA
Expository Text: In the emergency department waiting room, members of Lu Vang’s family have arrived and are trying to get information about his condition. The family wants Jason Vang, Lu’s 17-year-old cousin to represent them, but the hospital workers consider him a minor and want to deal with an adult. Chandra Capshaw, the hospital social worker, tries to facilitate the discussion.
Instructional Prompt: Click highlighted characters to hear their concerns.
Dialogue 05: Frustrated that he cannot assume the role his family wants him to assume, Jason’s temper flares.
JASON:
I’m sorry, Mom, they wouldn’t let me do anything here. They told me that Lu is here but they won’t tell me anything else. And I think that some other kid died from this stuff. It’s really bad!
BO:
I don’t want to tell Kaying that! She scared enough already.
CHANDRA:
Hello. Are you the Vang family?
JASON:
Can’t you tell? We’re the only short, slanty-eyed people in the room aren’t we?
BO:
Jason! Don’t be rude! I’m sorry, yes we are the Vangs.
CHANDRA:
You are Lu’s aunt, right?
BO:
Yes.
CHANDRA:
All right. I can take you up to your nephew, but first we need to talk about some concerns we have about Lu’s physical condition. Would you explain to Lu’s mother … this is his mother, correct? Could you explain that we are bringing in an interpreter?
JASON:
She doesn’t need an interpreter! That’s what we’re here for.
CHANDRA:
I understand that you want to help, but we have found that it’s actually better to have a trained medical interpreter who can explain terminology and such with fewer misunderstandings.
JASON:
What? Because we’re too stupid to explain things to our own family?
CHANDRA:
No, that is not what I meant at all. I can see you’re very upset which is perfectly understandable, but let’s focus on Lu and his family.
JASON:
I am his family. That’s what you stupid people don’t understand!
Dialogue 06: Carl attempts to defuse the deteriorating situation.
CARL:
Hey Chandra, how you doing?
CHANDRA:
Hey Carl, I’m fine. This is the family of one of the children who came in earlier from the Washington Allston school.
CARL:
The Vang boy, yes. He was my patient when he was here in the ER. I think there may have been some misunderstandings about his condition.
CHANDRA:
What do you mean?
CARL:
One of our nurses mistook the marks on Lu’s back for signs of abuse and called CPS. By the time I found out, the boy had already been moved up to the PICU.
CHANDRA:
I am totally confused.
CHRISTINA:
The marks were probably from coining. It’s a folk treatment that lots of Hmong people use.
CHANDRA:
Can you ask the family?
CHRISTINA:
Sure
Dialogue 07: Christina tries to explain the misunderstanding about the marks on Lu’s back to his family.
CHRISTINA:
Mrs. Vang, My name is Christina Chang. I’ve been asked to help interpret for Lu’s mother.
BO (to Kaying in Hmong):
They want to have this woman talk to you about Lu. She is Hmong and can interpret.
KAYING: (to Bo in Hmong):
Why should we do that? Can’t Jason talk for us?
BO (to Christina):
Lu’s mother wants Jason to interpret for us.
CHANDRA:
We prefer to not use minors for interpreting.
CHRISTINA (In Hmong):
There is a problem. The nurses saw marks on Lu’s back and they reported them to Child Protective Services. You need to explain what caused the marks and that no one is hurting Lu.
Dialogue 08: Chandra tries to calm Jason, who has been further angered by what he perceives as a grave accusation.
JASON:
Are you telling us that you think Lu has been abused? That his parents hurt him? Is that what you people think?
CHANDRA:
It isn’t a question of what we think, Jason. We’re trying to determine what happened. I think we can all agree that we all want what’s best for Lu.
BO:
Jason, you have to calm down. You’re frightening Kaying and making things worse. (To Christina) You’re Hmong?
CHRISTINA:
Yes, my name is Christina Chang. I work as an admin here, but I am also trained in medical interpreting. I can help get this figured out.
JASON:
We don’t need your help. Just get my cousin and we’ll take care of him ourselves.
CHANDRA:
Jason, we do need Christina’s help. Child Protective Services has been called in and we need to determine what exactly happened before we can even think about releasing Lu.
JASON (Raising voice):
You need to just get my cousin and let us get out of here. We never asked you people for help … you don’t have any right to keep him against our will.
Dialogue 09: Jessica is called back to explain why Child Protective Services has been called.
JESSICA (Apprehensively):
What’s up?
CARL:
We’re trying to understand what you saw during your assessment of the Vang boy. This is his mother.
KAYING (In Hmong … crying):
Why can’t I see Lu? Why did the police take Jason away? I don’t understand what’s happening and why you won’t let my family help me.
CHRISTINA (In Hmong):
It’s going to be alright. I will help you and when we tell them why Lu had the marks on his back, I am sure we can get Jason and his mother back to help you. It is going to be alright.
(In English) Carl … Mrs. Vang is very frightened. Can you ask her what you need to ask so she knows what’s going on?
CHANDRA:
Let me start. You’re ready to interpret for her?
CHRISTINA:
Yes.
CHANDRA:
Mrs. Vang … when the nurse examined Lu, she saw red marks on his back. Can you tell me how those marks got there?
CHRISTINA (In Hmong):
Mrs. Vang … when the nurse examined Lu, she saw red marks on his back. Can you tell me how those marks got there?
KAYANG (In Hmong):
Lu had a cold (mob khaub thuas) … congestion (txhaws ntswg). So, I gave him Hmong remedies. I boiled some Hmong herbs for him to drink, I rubbed him with tiger balm and used a coin to get rid of the bad wind. That was two days ago.
CHRISTINA:
Lu had a cold and congestion. So, she gave him Hmong remedies. She made a tea with some Hmong herbs for him to drink, and then she put tiger balm on him and rubbing his back with a coin to get rid of the bad wind. That was two days ago.
JESSICA:
Bad wind? What is that? Do you expect us to believe those terrible welts were made just by rubbing his back with a coin?
CARL:
Jessica … let’s listen to Mrs. Vang.
CHANDRA:
Carl, I have to admit, I am confused. The boy had bruises on his back?
CARL:
If you haven’t ever seen coining before, it can be shocking.
CHRISTINA (In Hmong):
Chandra said, “I am confused. The boy had bruises on his back? Mr. Lauderback … he is a nurse here … said “If you have not seen coining before, it can shock you”.
KAYING (In Hmong):
Really? This is so strange. Everyone I know knows what this is.
CHRISTINA (In English):
She said this is strange. All Hmong people know what coining is.
CARL:
It is a very common practice in the Hmong community. Chandra, I examined the boy myself. He does have marks from the coining, but they’re not bruises. In my opinion, there is no sign of abuse. Can we talk to CPS and get them to back off? This boy was injured by his exposure to the chemicals and we need to focus on that … and help his family make the best decisions about his care.
CHANDRA:
I’ll go talk to them. Christina—can you explain to Mrs. Vang what we’re doing and then bring her up to the PICU? I’ll meet you both up there.
CARL:
Jessica—go up to the PICU and tell them—in person—that the Vangs will be heading up to see Lu.
JESSICA:
Sure. Whatever you say.
MISSION SUMMARY
Congratulations on completing the Vang Family Case Study. You will have an opportunity to talk about this case with your classmates in a discussion question in the course, and you may choose to use this case to generate a topic for your annotated bibliography. As you consider the case, ask yourself the following questions. What skills and resources could you offer as a generalist social worker if you were responding to this situation? What are some of the key concerns you’d want to address? What social issue does this case highlight at the micro, mezzo, or macro levels?
RIVERBEND CITY: SHELDON GREENBERG CASE STUDY
INTRODUCTION: WELCOME TO RIVERBEND CITY
Expository Text: Sheldon Greenberg, a retired postal worker, was exposed to airborne chemicals after a train derailment and hazardous materials spill. When he was taken to the Riverbend City Medical Center Emergency Department, health care providers quickly determined that his bone cancer, which was thought to be in remission, has metastasized to his lungs and liver. While the medical staff address his physical needs, his family must work with the medical social worker to arrange his discharge and aftercare.
Instructional Text: As you watch this case unfold, consider how different theoretical models could be employed and what issues are being illustrated by this case. Consider also the different systems — micro, mezzo, and macro — and what research topics within these systems are suggested by this case.
Characters in this Mission:
Chandra Capshaw – Hospital Social Worker
Jon Conklin – Hospital Social Worker
Bruce Greenberg – Riverbend City Public Schools Superintendent
Sheldon Greenberg – Riverbend City Resident
Shirley Greenberg – Riverbend City Resident
Sheila Meeks – RN–Day Shift Triage Nurse, RCMC
Justine Nelson – RN–Hospice Nurse
April Nguyen – Case Manager, RSS
Rita Woods – RN–Hospice Nurse, RCMC
Edmond Yee – MD–ER Medical Director RCMC
SCENE 1: RIVERBEND CITY MEDICAL CENTER, EMERGENCY ROOM
Expository Text: Sheldon Greenberg, an elderly resident of the Rondo neighborhood in Riverbend City is exposed to the chemical cloud that resulted from the train derailment. He is taken via ambulance to the emergency room, accompanied by his son, Bruce. Once in the hospital, it is determined that the bone cancer that he and his family thought was in remission has returned and metastasized to his lungs and liver.
Instructional Prompt: Click on the highlighted characters to learn more about Sheldon Greenberg’s case.
Dialogue 01: Nurse Sheila Meeks tends to Sheldon Greenberg, who has been intubated.
SHEILA:
Hi. I’m Sheila. Are you Mr. Greenberg’s son?
BRUCE (anxious and frantic):
Yes, I’m Bruce Greenberg. I came as soon as I heard. How is he doing?
SHEILA:
Well, he was intubated in the ambulance, and he’s breathing much better now.
BRUCE:
Oh, thank goodness! Dad lives near the elementary school and was out taking his morning walk, and wow! Who would have thought there’d be a train derailment and a chemical cloud?
SHEILA:
I know. It’s crazy. I actually remember your father. He was in here last week with your mother when she broke her finger. He was very proud to show me a picture of his great-granddaughter.
BRUCE:
That’s my dad. Making friends wherever he goes.
SHEILA:
I am concerned about your father’s lungs. His breathing doesn’t seem normal. Does your father have any medical conditions?
BRUCE:
Yes, he has multiple myeloma. Bone cancer, stage 2. He’s had it for a year and it’s been under control. But he’s been having some breathing pain lately, so I was going to take him to his oncologist later this week. You don’t think he needs a CAT scan, do you?
SHEILA:
He might. I’m going to ask Dr. Yee to take a look at him just as soon as he’s available.
BRUCE:
Thank you, Sheila! Dad? Daddy, it’s me, Bruce. I’m here. Everything is going to be okay.
Dialogue 02: Dr. Yee breaks the news to Sheldon Greenberg’s wife and son.
EDMOND:
Hello, Mrs. Greenberg, Mr. Greenberg. I’m Dr. Yee.
SHEILA:
And I’m Sheila, Mrs. Greenberg. Do you remember me?
SHIRLEY:
Of course, dear. You taped up my finger.
BRUCE:
How is my father, doctor?
EDMOND:
Well, first of all, his breathing from the chemical exposure has stabilized. As you know, we conducted a CAT scan to find out why Mr. Greenberg was breathing irregularly. (pause) Unfortunately, I’m sorry to say that Mr. Greenberg’s cancer has spread. We found large tumors in his right lung and liver.
BRUCE (quietly):
Oh no.
SHIRLEY:
Doctor, that can’t be. Sheldon has bone cancer, but our oncologist said that Sheldon could live for up to 10 years.
EDMOND:
We’ll definitely bring your oncologist in for a full examination. In the meantime, we’ll do everything we can to make Mr. Greenberg comfortable.
BRUCE:
Doctor, how bad is it?
EDMOND:
Like I said, we do need to have your father’s oncologist come in for a complete evaluation. However, based on the CAT scan, I’m sorry to say that this looks very serious. I think your father is in the end stages of cancer.
SHIRLEY (crying, frantic):
No! That can’t be true! He was fine this morning. There must be a mistake.
SHEILA:
I’m so sorry, Mrs. Greenberg.
Dialogue 03: Sheldon Greenberg learns that his cancer has spread.
BRUCE:
Hello, Dad. How are you feeling?
SHELDON:
Oh, I’ve had better days! I’m breathing at least.
EDMOND:
Mr. Greenberg, I’m Dr. Yee. I need to talk to you about the results of your CAT scan.
SHELDON:
Yes, Doctor?
EDMOND:
Mr. Greenberg, I’m very sorry to tell that your cancer has spread. We’ve found large tumors in your right lung and your liver.
SHELDON (long pause):
Wow. I wasn’t expecting to hear that. How much longer do I have?
EDMOND:
I don’t know, Mr. Greenberg. We’re going to bring your oncologist in for a full examination.
SHELDON:
But it doesn’t look good, huh?
EDMOND:
No, sir. It doesn’t look good. It looks like end stage cancer.
SHIRLEY (sobbing):
Oh, Sheldon!
SHELDON:
Shirley, don’t cry, sweetheart. We’ve had a good life together. I even got to live to see my great-granddaughter.
SHEILA:
I’m so sorry, Mr. Greenberg. We’re going to do everything we can for you.
SCENE 2: RIVERBEND CITY MEDICAL CENTER, HOSPICE WARD
Expository Text: Sheldon Greenberg is moved up to the hospice floor of the hospital. His situation deteriorates quickly. He is in a good deal of pain.
Instructional Prompt: Click on the highlighted characters to learn more about Sheldon’s case.
Dialogue 04: Hospice Nurse Supervisor Rita Woods talks to Justine Nelson about the Greenberg family.
RITA:
So, Justine, how are things going with the Greenbergs?
JUSTINE:
Oh, Rita, just awful! Mrs. Greenberg won’t even speak to me now. She’s so angry at me about the morphine. I don’t know what to do.
RITA:
Well, you were in the right about the morphine. The patient’s wishes have to come before the family’s. This isn’t the last time you’re going to have a conflict like this one.
JUSTINE:
I know… but I feel terrible. And she’s not communicating with me, which is a real problem. Her son talks to me, but I need to be able to speak with her as well.
RITA:
How do you think she’s responding to her husband’s illness?
JUSTINE:
Not well at all. She sits by his bed all day and sobs. Her son tries to get her to eat, and she doesn’t. It’s like she’s shutting herself down. I guess I understand. I mean, can you imagine being married to someone for 60 years and then knowing he’s about to die?
RITA:
It sounds like we could use a little help here. I’m going to call in Chandra Capshaw, one of the hospital social workers. She has experience with these kinds of situations. We need to open the lines of communication between you and Mrs. Greenberg, and help her get the support she needs during this time. And we also need to help the family make a decision about whether Mr. Greenberg is going to stay here or spend his last days at home.
SCENE 3: RIVERBEND CITY MEDICAL CENTER, MEETING ROOM
Expository Text: The Greenbergs meet with Chandra Capshaw, a hospital social worker.
Instructional Prompt: Click any highlighted character or object to continue.
Dialogue 05: Chandra helps build an open line of communication between Shirley Greenberg and Justine Nelson.
CHANDRA:
Mrs. Greenberg, I understand you haven’t been willing to talk with Justine and the other hospice nurses. Can you tell me what’s going on?
SHIRLEY:
I don’t want to talk about it.
BRUCE:
Mom, please. (sighs) My mother is very upset that my father’s morphine drip was increased against her wishes.
SHIRLEY:
I know that’s not what Sheldon wants! He wants to be able to talk with us, even if that means he’s in pain. He wants to be able to say goodbye to our granddaughters and our great-granddaughter.
CHANDRA:
Justine?
JUSTINE:
Mrs. Greenberg, I am so sorry. I know you didn’t want me to increase your husband’s morphine drip. But we have to follow hospital policy. Mr. Greenberg asked for more pain relief, and because he’s of sound mind, we had to follow his wishes.
CHANDRA:
That is hospital policy, Mrs. Greenberg. I know Justine didn’t want to go against your wishes, but she didn’t have a choice. I also know that she wants to help you and your family get through this difficult time.
BRUCE:
Mom, you saw how much pain Dad was in. Maybe this is for the best.
SHIRLEY:
I… I don’t know…
CHANDRA:
Mrs. Greenberg, do you think you could be more communicative with Justine and the other hospice nurses? The nurses need to be able to ask you questions in order to give your husband the best care they can.
JUSTINE:
I really do want to help, Mrs. Greenberg.
BRUCE:
Mom? Please? Can you agree to be more cooperative?
SHIRLEY (quietly):
I will try.
Dialogue 06: Shirley Greenberg opens up about her grief.
SHIRLEY:
I feel like this happened so suddenly. I know he had cancer, but he was doing so well, and the doctors said that people with multiple myeloma can live with it for years.
CHANDRA:
I know what a shock this is, Mrs. Greenberg. I understand you’ve been married for 60 years?
SHIRLEY:
Yes. We started dating when I was sixteen. I can’t even imagine living my life without Sheldon there. He’s been around so long he’s like a part of my body.
JUSTINE:
I can only imagine, Mrs. Greenberg.
SHIRLEY:
Sheldon does so many things for me. He pays the bills, he fixes things. He does all the driving when we leave town. I don’t like to drive on freeways. How am I going to cope without Sheldon?
BRUCE:
Mom, Terri and I and the girls will always be there for you. You’ll never be alone.
CHANDRA:
Bruce, how are you coping?
BRUCE:
I’m doing the best I can. One step at a time. (sighs) My youngest daughter just got engaged, and we’re all really sad he’s not going to be there for the wedding. I’m an only child, so my dad and I have always been close. He’s the kind of dad who never missed one of my ballgames.
CHANDRA:
We have support groups at the hospital for families of terminally ill patients. Would the two of you like more information about them?
BRUCE:
That sounds like a good idea.
Dialogue 07: The family discusses options for Sheldon’s care.
BRUCE:
I know we have to discuss where Dad is going to spend the end of his life. The doctors think he’s going to be with us for another few months. I know he doesn’t want to die in the hospital.
JUSTINE:
You mentioned you were thinking about another hospice.
BRUCE:
Yes. Our rabbi was talking to us about a Jewish hospice that’s very close to my home. I’ve heard good things about it. But I’m not sure that’s what my dad wants either.
SHIRLEY:
I want to bring Sheldon home. I know that’s what he wants too. But I don’t know how I’d be able to take care of him by myself.
CHANDRA:
You wouldn’t have to care for him alone, Mrs. Greenberg. If your husband goes home, he’ll have home hospice workers assigned.
BRUCE:
I’d like to bring him home too. But how do we arrange for that kind of care?
CHANDRA:
I can help you with that. Many terminal patients choose to die in their homes, and I can make this as easy for you as possible. First, why don’t you talk to Mr. Greenberg and see what he wants? How communicative is he right now?
JUSTINE:
He’s doing a little better. We might be able to lower the morphine dose.
CHANDRA:
Let’s communicate with him as much as we can. If he wants to go home, we’ll do everything we can to arrange that.
SCENE 4: RIVERBEND CITY MEDICAL CENTER, MEETING ROOM
Expository Text: The next day finds members of the Greenberg’s care team working with a non-profit senior services organization—Riverbend Senior Services—to identify sources of assistance if the family does, in fact, take Sheldon home for in-home hospice care.
Instructional Prompt: Click on all highlighted characters to hear their thoughts about the situation.
Dialogue 08: April asks some questions about the Greenbergs and their needs.
APRIL:
It’s good to see you both again. How have you been?
JON:
Busy, but good. Yourself? It seems like RSS is always in the news. You’ve been expanding your outreach, haven’t you?
APRIL:
We sure have. Of course, that means we’re all busier than ever, but it’s good knowing that we’re making a difference.
JON:
Well, I am hoping that you can help here. Let me give you the digest version of the Greenberg’s situation. Sheldon presented with respiratory issues after exposure to the chemical spill the other day. On examination, though, it was determined that his bone cancer, which had been thought to be in remission, had metastasized to multiple locations. His wife, Shirley, is having a very difficult time accepting this and has been in conflict with the nursing staff over his treatment — particularly in terms of pain management. The family would like to take Sheldon home and receive in-home hospice care — preferably aligned to their Jewish faith.
RITA:
Normally, that’s exactly what we’d be encouraging the family to do. But the wife’s inability to accept that her husband is dying concerns us. I just wonder — will she be able to care for him? She would definitely need in-home help, but can hospice provide enough help to ensure that Sheldon receives appropriate palliative care throughout the process of dying?
APRIL:
These are good questions and I can help with some of them. We’re going to want to tap more than one source of help. Let’s start at the beginning, though. Here, I’m going to take notes on the whiteboard while we talk.
JON:
Sure … let me grab my laptop from my office, too. I’ll be right back.
MISSION SUMMARY
Congratulations on completing the Sheldon Greenberg Case Study. You will have an opportunity to talk about this case with your classmates in a discussion question in the course, and you may choose to use this case to generate a topic for your annotated bibliography. As you consider the case, ask yourself the following questions: What skills and resources could you offer as a generalist social worker if you were responding to this situation? What are some of the key concerns you’d want to address? What social issue does this case highlight at the micro, mezzo, or macro levels?
RIVERBEND CITY: TAD GREEN
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AW CASE STUDY
INTRODUCTION: WELCOME TO RIVERBEND CITY
Expository Text: Recent graduates of Beck University, Tad and Becca Greenlaw live in rural Dodd County and have recently had their first child. Tad and Becca have been struggling to maintain the small family dairy farm they inherited while also repaying student loans and dealing with the demands of parenthood. When a horrific farm accident results in the amputation of Tad’s right hand, the couple face physical, emotional and financial challenges greater than they ever imagined.
Instructional Text: As you watch this case unfold, consider how different theoretical models could be employed and what issues are being illustrated by this case. Consider also the different systems — micro, mezzo, and macro — and what research topics within these systems are suggested by this case.
Characters in this Mission:
Lydia Candelario – Financial Counselor
Jon Conklin – Hospital Social Worker
Natalie Gilbert – MD–Dodd County Regional Hospital
Becca Greenlaw – Farmer
Tad Greenlaw – Farmer
Bobbie King – RN–Nurse Manager, Dodd County Regional Hospital
Curtis Payne – Physical Therapist
SCENE 1: DODD COUNTY REGIONAL HOSPITAL, EMERGENCY ROOM
Expository Text: In emergencies, medical treatment must be provided, regardless of a person’s insurance status. What many people do not realize is that a patient may be billed later for those emergency services. When Tad Greenlaw arrived at the emergency room with a mangled hand, the financial ramifications of his accident were the furthest thing from his mind, but that quickly changed.
Instructional Prompt: Click on all highlighted characters to hear their perspective on the situation unfolding in the ER.
Dialogue 01: Becca Greenlaw seeks help for her badly injured husband, Tad.
BECCA:
Help … I need some help! My husband … his hand … he’s hurt his hand… that stupid combine, he was fixing it again and I don’t know what happened, I don’t know… it’s totally crushed his hand…
NATALIE:
Okay, Maam… I’m a doctor. Let me take a look. What’s this…frozen peas?
BECCA:
I made him put it in ice…whatever I had that was frozen. Was that wrong?
BOBBIE:
No, that was good. We’re going to need to take a look. What’s your name, Sir?
TAD:
Tad Greenlaw. Oh man… it hurts so bad. So bad… I’ve never done anything this bad to myself before. This hurts worse than anything I’ve ever felt.
NATALIE:
I’m not surprised, Mr. Greenlaw… you’ve got some serious damage here.
BECCA:
Is he going to lose his hand?
NATALIE:
Not if I can help it, but we’re going to need to get him to a specialist. We don’t have the skills or facility to properly treat this. I want to get him to RCMC as fast as possible. Bobbie, page Max for me and get Donna to contact Med Air — we need to get him stabilized and on his way — STAT.
TAD:
Med Air..? Wait a minute… a helicopter? We can’t afford a helicopter ride. Becca — you drive me there, okay?
NATALIE:
Mr. Greenlaw, air evac is the best choice. The sooner we can get you seen by orthopedic specialists at RCMC, the better your chances are to keep function in that hand. Med Air will have trained personnel who can help you.
Dialogue 02: Bobbie tries to calm the Greenlaws.
BOBBIE:
Mrs. Greenlaw … why don’t you come with me so that we can start the paperwork before the ambulance gets here.
NATALIE:
Tad, do you have any allergies to medication? I want to give you something for the pain while we stabilize your injuries.
TAD:
No.. no allergies. But look … I don’t have insurance. We kept planning to get it now that we have the baby, but we haven’t gotten any yet. I can’t afford helicopters and specialists. We’re barely making due as it is.
NATALIE:
Let’s worry about all that later. The important thing is to get you treated.
TAD:
Not if it puts us in the poorhouse. Does the hospital write it off if I don’t have insurance?
BOBBIE:
That’s more for the business office to deal with. Right now, we just need to get you on your way to someone who can help you.
BECCA:
Tad, stop arguing with them. They’re just trying to do the best for you.
TAD:
Becca — this kind of treatment isn’t free. Think about how much having Emma cost — this is going to be 10 times as much.
BOBBIE:
Mr. Greenlaw… you need to try to calm down. We can sort all this out later, but right now, your medical needs are the most important thing.
TAD:
Not if the damned hospital ends up taking my farm, they aren’t. You don’t understand. All you care about is what you’re lookin’ at, but there’s more to it.
SCENE 2: RIVERBEND CITY MEDICAL CENTER, PHYSICAL THERAPY DEPARTMENT
Expository Text: Farmer Tad Greenlaw suffered a devastating injury and subsequently lost his right hand. With the wound healed, he is now receiving physical therapy and will soon be discharged. His physical injuries are in many ways the least of his problems. Anger, fear, depression and worry that his medical bills will result in the lost of his farm are all causing pressures for Tad and his wife Becca.
Instructional Prompt: Click on all highlighted characters to learn about their concerns and issues.
Dialogue 03: Tad erupts in anger at the end of a difficult physical therapy session.
TAD:
Son of a GUN!!!
[sound of something clattering to floor followed by sound of other stuff being thrown across room.]
CURTIS:
All rightie, then … is that your way of saying you’ve had enough for today?
TAD:
Yeah, I’m done. I’m sure you think it’s really hilarious watching me screw up again and again and again. Big yuck-it-up-time, right?
BECCA:
Come on, babe … don’t talk that way. Curtis just wants you to get better.
TAD:
Becca, why don’t you shut your face? If you don’t know what you’re talking about, just zip it, okay?
CURTIS:
Look, man … I know this is frustrating and I know it hurts like the dickens. That’s no reason to be nasty. Not to Becca and not to me.
BECCA:
He’s just frustrated, Curtis, it’s okay.
CURTIS:
No … it isn’t okay. Tad, I’ll let the orderly know you’re ready to go back to your room. Becca — you aren’t a punching bag. Don’t forget that.
BECCA:
Tad … he’s right, you know. It’s like you’re always angry.
TAD:
I am always angry. I’m scared half to death about how I’m supposed to provide for you and Emma. I’ve got a hand that’s not there that always hurts, and I have a wife who’s supposed to be my shoulder to lean on who can’t stand for me to be anywhere near her.
BECCA:
How can you say that? That’s totally not true.
TAD:
Just leave me alone. Go over to your folks’ house and tend to Emma, and leave me alone, okay?
SCENE 3: RIVERBEND CITY MEDICAL CENTER, MEETING ROOM
Expository Text: Jon Conklin, one of the hospital social workers, meets with Tad and Becca to help them begin planning Tad’s discharge. Knowing that the financial burden of Tad’s medical care is a primary concern, he has arranged for a financial counselor to join the Green law’s care team.
Instructional Prompt: Click on all highlighted people to learn more about this case.
Dialogue 04: Jon begins facilitating a discussion with Tad, Becca, and Lydia Candelario, a financial counselor.
JON:
Tad … Becca … how are you both doing today?
TAD:
Better than a one-armed wallpaper hanger… oh, wait … maybe ’bout the same.
JON:
Normally, I’d laugh, but I’ll be honest — I’m not sure if that’s humor or anger. Various people on the staff say you’re angry a lot of the time.
TAD:
I suppose. It’s not something I have a whole lot of control over.
JON:
no, but it’s something we can help with. You’re going to be discharged fairly soon. I’m told that barring suprises, it will be sometime in the next couple weeks. We need to talk about what your needs are going to be and what resources are out there to provide support.
BECCA:
We feel like we’re caught between a rock and a hard place — we don’t have insurance, but we’re not really poor. We’re kind of land poor, but obviously we don’t want to give up the farm.
TAD:
Becca, don’t beg.
JON:
Tad, that didn’t really sound like begging to me. It sounded like she was being honest. Can I be honest with you? It seems like you have some serious anger issues that could really cause problems for you and your family. Becca is your main helper and support right now, but I’ve been seeing you pushing her away. That’s too bad, because while she’s your support; she needs support and encouragement, too, and she’s sure not getting it from you right now. I am worried about what you two are going to do when you’re back home and you’re in each other’s faces 24/7.
LYDIA:
I’d like to address the financial issue. My name is Lydia Candelario and I am with Patient Financial Services in the hospital. What I do is help people who are either underinsured or uninsured in finding help to reimburse the hospital for their care. That might mean determining if you’re eligible for state-funded programs such as the StateCare plan or various free-care programs.
TAD:
Free-care programs. Sounds like charity or welfare to me
L
YDIA:
Yes, it probably does and I can tell that’s something that is hard for you to accept. The bottom line is that we will work with you to find a solution that you can live with. You’re not the first farmer to be injured and you won’t be the last. Quite frankly, the hospital isn’t in the business of running a dairy farm. There are a lot of options and resources that we can explore before we need to start talking about selling the farm.
TAD:
I’m not about to start taking handouts. Get that straight.
JON:
No one is talking about handouts. I think the first thing to talk about is counseling. I really think you need some help in processing what’s happened and how you’re going to deal with it.
[cell phone rings]
BECCA:
Oh, that’s my mom… can I take this please? She’s got the baby.
JON:
Sure. Tad — Lydia, would either of you like some coffee or a coke or something while we wait?
MISSION SUMMARY
Congratulations on completing the Tad Greenlaw Case Study. You will have an opportunity to talk about this case with your classmates in a discussion question in the course, and you may choose to use this case to generate a topic for your annotated bibliography. As you consider the case, ask yourself the following questions: What skills and resources could you offer as a generalist social worker if you were responding to this situation? What are some of the key concerns you’d want to address? What social issue does this case highlight at the micro, mezzo, or macro levels?
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