Scenario 1: Report
The client under discussion is a 37-year-old White man who is a homeless person, and he does not have any job. The main activity of this person is begging. The client regularly consumes a fifth of liquor a day, and he also smokes opiate hashish with a history of several years of taking the drug. The man’s clothes are untidy, he looks older than his age, and he maintains eye contact when speaking. The purpose of this report is to present the decision regarding the course of action in the situation when this client comes to the agency being sober and eligible for admission into the proposed program.
The client’s score for the Alcohol Use Disorders Identification Test (AUDIT) is 30. This score indicates an extremely high health risk for a person. It is possible to assume that the client is alcohol dependent (Babor, De La Fuente, Saunders, & Grant, 2011). Referring to the CAGE questionnaire, the score is 3. This result is high and indicates that the client has a problem with consuming alcohol. The score related to the Drug Abuse Screening Test (DAST) is 10, and it is rather high. Thus, it is possible to speak about the presence of a drug-related problem (Yudko, Lozhkina, & Fouts, 2007). Focusing on possible physical dysfunction in the client, it is possible to notice tremors in his hands that are symptoms of alcohol withdrawal. One can assume that the client is in the withdrawal stage because of the observed complications. This rhythmic shaking can be characterized as mild. During communication, the client does not express any suicidal intent, and there are no signs of organic brain dysfunction except for physiological tremors.
According to the SOAR model for initial assessment, the first three steps or actions include providing support, asking questions, and offering assistance. The first important action is ensuring the communication with the client is open and friendly. The second step is asking the client about the history of his alcohol and drug consumption, continuing assessment using additional screening tools, applying the withdrawal assessment tool, and discussing the client’s health and social status. The third recommended action is offering assistance (Perkinson, 2017). The client should receive consultation and advice regarding his drinking behavior and substance use. The man should be informed about options for changing his behavior in the context of the agency’s program.
The client is eligible for admission into the agency’s program because he is sober and drug-free when coming here, he is over 21 years old, he has problems with alcohol and drug consumption, and he needs the program of recovery. The referral process should include the following steps: the determination of treatment modalities to propose, receiving the client’s consent to participate in offered programs, the completion of the referral forms including the information about the client, and exchanging data with other agencies. The client has started the withdrawal process, and it is possible to propose further assessment, a brief free intervention, and referring to clinical stabilization services. While communicating with other agencies, possible legal and ethical issues include the secure exchange of confidential data and accurate assessment results. Data should be protected by passwords and shared using secure channels, such as intranet services and corporate-protected emails.
Scenario 2: Report
The client requiring assistance is a homeless male person in his middle thirties, who is possibly alcohol dependent and drug-addicted. The man does not have a permanent home place or a job, and he actively uses the support provided by social workers in his community. It is important to note that he gets money with the help of street begging. Assessing the client’s physical appearance, it is important to note that his clothing is dirty. It seems that his weight is lower than the norm for his age, there are dark circles under his eyes, he looks exhausted, and he lacks reactions to many external stimuli. In this report, the decision regarding possible treatment options for this client is presented in the context of the fact that he is intoxicated when coming to the agency, but eligible for admission into the offered program.
According to the Alcohol Use Disorders Identification Test (AUDIT), the client’s result is 30. This score is extremely high, and it points at a high risk of damaging the person’s health with the focus on a high level of alcohol dependence (Babor et al., 2011). The score related to the CAGE questionnaire is 3, and it accentuates a clinical situation regarding the client’s alcohol consumption. The result of the Drug Abuse Screening Test (DAST) is 10, which indicates the possibility of the substance use disorder currently observed in the client (Yudko et al., 2007). When coming to the agency, the client is intoxicated, and this aspect influences physical dysfunction. The level of intoxication can be discussed as moderate, and the following signs and symptoms are observed: the client cannot stand still, his speech is slurred, and the eyes are red.
The first action to take while conducting the initial assessment is engaging the client in communication despite the fact that he is intoxicated. It is possible to conduct the breath alcohol test at this stage. The next step is asking the client about the last alcohol consumption, associated motivation, frequency, and quantity of drinking. At this stage, it is necessary to conduct additional alcohol consumption and drug-use tests if the client is able to answer questions. The determining symptoms and signs should be assessed according to the DSM-V classification. The assessment determining the need for detoxification is required at this stage (Harris, Louis-Jacques, & Knight, 2014). The next step is the provision of advice regarding detoxification and further care in the context of the agency’s program, as well as the assessment regarding associated psychological and health problems.
The client can be discussed as eligible for admission into the agency’s program. The reason is that the person is an adult who regularly consumes alcohol and substances. Immediate treatment and referral to other agencies are necessary in his case. Thus, the client needs assistance and a structured healing program with access to a drug-free environment. The client is intoxicated, and he needs to be detoxed in order to continue participation in counseling sessions. The client should be referred to an acute treatment center for detox and a specialized shelter. The process includes the following steps: the choice of services to refer to, signing the consent form, and filling referral forms to be provided to other agencies. The communication with other involved agencies should be based on the principles of protecting the client’s privacy, confidentiality, and dignity to avoid ethical and legal issues.
Scenario 3: Report
This report is aimed at presenting the decision on the further treatment for a 37-year-old White male person. The client is homeless, and he usually lives in shelters for homeless people in his community. Although he has no occupation, the client takes a fifth of liquor per day, and he has also been a regular smoker of opiate hashish for several years. Referring to the physical presentation, one should note that the client is dressed in dirty clothes, there is a body odor, and he is rather agitated. In this report, it is important to provide the course of action for this client coming to the agency while being intoxicated and not eligible for admission into the program.
The client’s test result related to the Alcohol Use Disorders Identification Test (AUDIT) is 30, and it is associated with the high-risk consumption of alcohol that is typically supported by a person’s dependence. The further assessment of harm caused to health and dependence is required (Babor et al., 2011). The CAGE test result is 3, which accentuates the presence of a clinical situation to pay attention to because the client has problems with drinking. The score received according to the Drug Abuse Screening Test (DAST) is 10, and this result is typical of persons who currently suffer from a substance use disorder or had it in the past (Yudko et al., 2007). The client is highly intoxicated, and it is possible to observe such signs of physical dysfunction as drowsiness, reported nausea, an intense headache, and confusion. The client’s eyes are watery and red, he cannot focus on a person or an object, and he also reports double vision. The person cannot stand still, he needs someone’s support. The man’s speech is quick, but he stops in the middle of sentences.
The first initial assessment action to recommend while working with the client is the focus on learning about the client’s history of consuming alcohol and substances. It is important to learn what amount of substance and alcohol has led to the current intoxication and what the frequency of using drugs is. Furthermore, additional screening assessments are required, as well as the test on the need for detoxification in this particular case. Such aspects as daily drinking, morning drinking, all-day drinking, and high-volume drinking patterns need to be taken into account. Additional assessment of the mental health status and psychotic symptoms is required (Berger, Hernandez-Meier, Hyatt, & Brondino, 2017; Perkinson, 2017). The next step is the provision of recommendations on changing the drinking behavior if the client demonstrates readiness for that step.
The referral to another agency is the only possible option for this client as he is not eligible for admission into this agency’s program. The client is intoxicated, and the level of intoxication is extremely high to accept him to the program. Intensive counseling services can be provided in acute treatment centers and clinical stabilization programs after the successful withdrawal. The referral process is based on contacting the selected acute treatment center for providing the detox program and intensive counseling services. It is important to determine the period of the client’s participation in each of these programs and receive the client’s consent. The next step is the preparation of referral protocols to include medical and psychosocial history, as well as the results of assessments. While communicating with the representatives of other agencies and providing them with the client’s data, it is important to guarantee following integrity, confidentiality, and privacy norms and principles to address ethical and legal issues.
References
Babor, T. F., De La Fuente, J. R., Saunders, J., & Grant, M. (2011). The Alcohol Use Disorders Identification Test: Guidelines for use in primary care (2nd ed.). Geneva, Switzerland: World Health Organization.
Berger, L., Hernandez-Meier, J., Hyatt, J., & Brondino, M. (2017). Referral to treatment for hospitalized medical patients with an alcohol use disorder: A proof-of-concept brief intervention study. Social Work in Health Care, 56(5), 321-334.
Harris, S. K., Louis-Jacques, J., & Knight, J. R. (2014). Screening and brief intervention for alcohol and other abuse. Adolescent Medicine: State of the Art Reviews, 25(1), 126-156.
Perkinson, R. R. (2017). Chemical dependency counseling: A practical guide (5th ed.). Thousand Oaks, CA: SAGE Publications.
Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of Substance Abuse Treatment, 32(2), 189-198.