Chcece003 | Care | Early Assessment Answers

Case Study – Harry

Harry was looking forward to moving in to his new group home. He had always lived with his parents, but like his older brother, Harry wanted to move out. That’s what people in their 20’s did, right? Harry has an intellectual disability and suffers from depression.

There was another reason Harry wanted to move in with other people – Harry had never really had any friends. He liked to be around other people, but he didn’t really know how to talk with them. “I will learn how to get friends by seeing how other people interact, and having staff show me how to do it” Harry thought. “And I’m sure I will even have fun playing Uno and other games with the people I live with”.

Harry’s other problem with making friends was that he didn’t like going to the shops. It was too noisy, there were too many people, and it was too chaotic. Harry felt really stressed when he went to the shops. He wanted to go to the shops (“that’s where they have the good coffee!!!” thought Harry), but it was really hard for him.

When Harry moved in to his new home, things were, well, not what he was expecting.

It seemed like the staff were running around and too busy to spend time with him, let alone show him how to make friends. And it seemed like the people he lived with were just as shy as he was – They were very nice to be around, but they were not so good at starting off talking with Harry. When the staff helped get the talk under way, they got on pretty well. But without the staff to help them, they just kind of sat around not talking.

Harry’s mum asked about this. The staff said they really wanted to spend more time with the residents, but they were really busy. And besides, each of the residents had their 1:1 community access with staff.

One day, Harry thought about complaining. He had always been taught to call 000 when things weren’t going right.

They didn’t like it when Harry called 000. ”Maybe I will try and call again tomorrow, maybe they will be nicer then…”

After 3 months staff described Harry to the house manager as:

• Not engaging well in the house – Not talking to his housemates without staff making him.
• Resisting community access by not going to the cinema and the coffee shops at the local shops.
• Having harassed his parents, needing them to give him constant engagement.
• Making nuisance phone calls to 000.

One day, on the way home from an outing, the staff member working with Harry had to stop at the shops to get milk – The other staff had called while they were out.

The staff member was really confused – I know Harry doesn’t want to go in to the shops, but I know I shouldn’t leave him in the car. He decided Harry should come into the shops. “It is one of his goals after all, may as well start now” he thought.

When they arrived, Harry said “no no no no no no no”. He was tense, he could feel his face getting red, and he didn’t want to stand up. The staff talked to him about holding his hand, and that they really needed to get the milk for dinner tonight. “That is pretty important” Harry thought to himself. And the staff member made a deal that they would use some of the milk for an extra coffee when they got home. “Deal” thought Harry!

Harry tried really hard. And things went pretty well, until a man bumped into Harry’s back,

Harry fell to the ground. He started to scream, an ear-piercing scream. He kicked over the chips stand. This went on for about 5 minutes. After that Harry was able to be helped up, back to the car, and home.

The staff member had thought Harry would be OK. Harry had come into the store with him. They had made a deal. And going to the shops was a goal for Harry. But now he didn’t know how he could make things better for Harry about going to the shops.

Why did Harry react this way? What is the chain around this?

Complete ALL of the following tasks:

• What is Harry’s developmental progress while they’ve been at your service?
• What indicators of attachment disorder or trauma does Harry display?
• What interventions have you employed or could employ to ensure Harry’s trauma is not exacerbated?
• Describe how you would provide positive support in response to a behaviour of concern.
• Have there been any critical incidents in working with Harry? How did/would you respond to the incidents? What documentation is required?
• Describe how you would use a person-centred approach in response to a behaviour Harry has displayed. How would you review and monitor this response in the long term?
• How would meet Harry’s daily needs while he is in care? How do you support him to maintain a safe and clean environment and maintain his possessions appropriately?
• Outline how you would provide Harry with opportunities for education, including life skills, attend school or undertake employment opportunities.
• How would you manage the ongoing health care needs of Harry?
• What are the emotional, social and physical support needs of Harry?
• What resettlement needs can you identify for Harry? How would you go about supporting him?
• What would be an appropriate level of contact with Harry once they are out of care?
• What communication strategies would you need to consider when working with Harry?
• How would you identify and then work with any particular areas of diversity, culture or background when working with Harry?
• Identify at least one area of legal and ethical compliance in regard to caring for Harry or in your work in general. Describe how you would address this area and any follow up actions that may be required.

Case study Geoff

Geoff has Autistic Spectrum Disorder (ASD) and experiences 'hyper-sensitivity' to noise. He has a moderate intellectual disability. Geoff uses a visual communication system to tell others what he wants. He can become highly excitable and / or anxious.

Geoff gets distressed whenever he hears sudden or loud noises (car horns, sirens, shouting), and when he gets confused, dis-orientated or unsafe he may demonstrate challenging behaviour.

Geoff lives in a group home with 4 other adult males. He has lived there for less than a year. He finds it difficult to cope with anxiety and where the behaviours of others are unpredictable for him. Sometimes when this happens he bites his wrist.

Geoff also has a profile that indicates history of physical abuse and neglect. He becomes distressed whenever "pressured" to perform or self-manage in stressful situations. At such times, he may appear anxious, aggressive and become either highly "controlling" or "refuse to engage".

Most commonly he will run away from the situation in an aggressive manner. In such situations / settings this means he may:

• strike a carer or other person in the community, or
• run away knocking others as he passes or
• cause property damage

He has significant communication difficulties (i.e. has difficulty understanding language and expresses himself using some manual signs and a picture communication system) and uses challenging behaviour if pressed to comply with directions when he doesn't understand.

Geoff also has trouble with changes to his routines and schedule, especially when this happens without adequate / effective explanation. Geoff appears to enjoy making choices when available. He enjoys his morning and work time schedules but has difficulty after work. His afternoon activities presently include unpacking and re packing his work bag, a leisure activity that Geoff can choose from a selection of about 5 options, meal preparation, and some "free time". Dinner is usually at 7.00 pm.

One afternoon, several of the other clients that Geoff lives with were involved in an incident where they were yelling and shouting. Geoff walked into the group home (returning from his day program) and found the others shouting. The carer came up to Geoff and said to him "because everyone is upset and we have had to calm everyone down, dinner would not be until 7:30pm.

As soon as Geoff heard this, he dropped his bag, started to jump up and down biting his wrist. When the other residents saw Geoff doing this, they started yelling at him to stop. This made Geoff even more upset, and he ran past the staff member, pushing them against the wall out of the way, and went out into the back yard, refusing to come inside.

Later on (about an hour later) staff were able to get Geoff to come back inside and give him some dinner. As a result of the incident, Geoff was tired and irritable for the rest of the night, and got he refused to come inside.

Complete ALL of the following tasks:

• What is Geoff’s developmental progress while they’ve been at your service?
• What indicators of attachment disorder or trauma does Geoff display?
• What interventions have you employed or could employ to ensure Geoff’s trauma is not exacerbated?
• Describe how you would provide positive support in response to a behaviour of concern.
• Have there been any critical incidents in working with Geoff? How did/would you respond to the incidents? What documentation is required?
• Describe how you would use a person-centred approach in response to a behaviour Harry has displayed. How would you review and monitor this response in the long term?
• How would meet Geoff’s daily needs while he is in care? How do you support him to maintain a safe and clean environment and maintain his possessions appropriately?
• Outline how you would provide Geoff with opportunities for education, including life skills, attend school or undertake employment opportunities.
• How would you manage the ongoing health care needs of Geoff?
• What are the emotional, social and physical support needs of Geoff?
• What resettlement needs can you identify for Geoff? How would you go about supporting him?
• What would be an appropriate level of contact with Geoff once they are out of care?
• What communication strategies would you need to consider when working with Geoff?
• How would you identify and then work with any particular areas of diversity, culture or background when working with Geoff?
• Identify at least one area of legal and ethical compliance in regard to caring for Geoff or in your work in general. Describe how you would address this area and any follow up actions that may be required.

Task

This case study is to be completed on an actual client you currently work with. You will need to provide an outline of the person (with de-identified details) and provide answers and information to the following points.

Your work must be signed and authorised by your workplace supervisor. They will need to complete the Workplace Log Book to certify that the work is an actual example and that they have observed you in the workplace undertaking all of the strategies and points you have provided.

Complete ALL of the following tasks:

• Provide an outline of the client, their history, background and your current role in working with them.
• What is their developmental progress while they’ve been at your service?
• What indicators of attachment disorder or trauma do they display?
• What interventions have you employed or could employ to ensure their trauma is not exacerbated?
• Describe how you would provide positive support in response to a behaviour of concern.
• Have there been any critical incidents in working with this person? How did/would you respond to the incidents? What documentation is required?
• Describe how you would use a person-centred approach in response to a behaviour they have displayed. How would you review and monitor this response in the long term?
• How would meet their daily needs while they are in care? How do you support them to maintain a safe and clean environment and maintain their possessions appropriately?
• Outline how you would provide the person with opportunities for education, including life skills, attend school or undertake employment opportunities.
• How would you manage the ongoing health care needs of this person?
• What are the emotional, social and physical support needs of this person?
• What resettlement needs can you identify for this person? How would you go about supporting them?
• What would be an appropriate level of contact with this person once they are out of care?
• What communication strategies would you need to consider when working with your client?
• How would you identify and then work with any particular areas of diversity, culture or background when working with this person?
• Identify at least one area of legal and ethical compliance in regard to caring for your client or in your work in general. Describe how you would address this area and any follow up actions that may be required.

Reflective Journal

You will need to complete at least 8 journal entries as part of your work role. Please discuss any issues or reflections with your supervisor if you need follow up support or advice. The journal entries need to cover a range of issues, encounters or situations across your work duties. They need to include at least one of the following areas:

• How you’ve applied a trauma informed care perspective with a client
• How you’ve used your knowledge of developmental issues to support a client
• How you’ve worked with a client to manage their ongoing placement in residential care
• How you’ve managed conflict using a positive and supportive approach

Answer:

Introduction

The study has discussed early childhood studies based on trauma care. Trauma is a mental disorder that happens after witnessing any mental shock like the death of the closest ones, accidents or physical assault. This study has evaluated two case study regarding the effectiveness of trauma care along with developing a case study on personal experience and reflection of journal entries. Proper mental assistance, medication, meditation, counselling and polite behaviour can provide an effective outcome.

Analysis

Case study-Harry

• Developmental progress of Harry: Harry had a pre-dominated fear of going to the shops. He preferred to be alone than to be in the noisy areas. He thought he would be stressed if he goes to shops. However, Harry agreed to go to the shops with the staff with the condition of getting extra milk in his coffee. Moreover, it was also observed that he requires a polite treatment for his mental health development. Slow progress has been witnessed in Harry’s mental health during his stay in the care service he agreed to go to the shop at the end what he disliked the most previously due to its crowd and noise. The adaptation of coping up in the noisy area can be identified as the developmental progress of Harry.
• Indicators of attachment disorder in Harry’s display: Harry’s inability to adjust with the crowd and the noisy areas can be identified as his trauma. He disliked going the public places that are crowded. Moreover, he never wanted to make friends as he felt uneasy to adjust different kinds of people which are very uncommon for the people of his ages. Thus, his detachment from the greater part of society can be stated to be his attachment disorder.
• Intervention: Harry's detachment from society and his inability in adjusting with the different kinds of people can be identified as a traumatic experience or attachment disorder. Quality care, medication and proper counselling ensure that Harry’s trauma is not exacerbated.
• Positive support in response to behaviour or concern: Harry had a very unusual behaviour while meeting with new people and going to any crowded place. For example- he was unwilling to go to the shop with the staff to buy milk. Moreover, he fell down in the ground and screamed loudly when a man bumped into his back. This proves his physical and mental instability. The positive support and counselling can be provided to him by behaving with him politely and listening to all his words patiently.
• Critical incidents in working with Harry, its responses and the required documents: A critical incident happened when the staffs were trying to bring him out from the car to go to the shop to buy milk. Harry screamed "no no no no” and was stopping the other staffs to him out from the car to go to the local shop. He was found stressed and his face was getting red. Apart from this, Harry’s nuisance call to the “000” number also created harassment to the staffs.

In the first instance, a polite behaviour with holding his hands and offering him more milk in his coffee pacified the situation. The second situation was also handled with a sympathetic behaviour by convincing him to use the number only in the emergency. The required documents are- Harry's his behavioural observation report.

• A person-centred approach can be applied to Harry for his mental health development: A one to one conversation must be arranged between Harry and the mental health professional. A polite behaviour must be displayed to Harry during the conversation. This conversation can be helpful to address the barriers and the reasons that are stopping Harry act socially. A careful listening of all these barriers can be helpful to make a strategy to sort out all the behavioural issues that Harry has displayed.

All his words must be written in detail and along with the behavioural issues. Furthermore, all these reports must be reviewed and monitored comparing his present behaviour and healthcare incidents.

• Maintaining Harry’s need and support: Harry’s daily needs can be satisfied by providing him quality care and employing a healthcare staff for him all the time. A proper and timely meal, medication and mental health support are also effective measures to satisfy his mental health.

He can be supported by providing him a culturally and socially safe and unbiased healthcare environment. The care staffs must provide him with quality care and unbiased treatment.

• Providing opportunities to Harry regarding education, life skills and employment: Harry must be convinced the usefulness of perusing education and the importance of developing a professional career. A can be given small handcrafts like drawing some landscapes or animals or the nature around him. Moreover, he can be given rubric cube to adjust all the colours. This can be helpful for his skill development. Additionally, he can be given moral storybook that can develop his reading habit to grow his interest in school. Moreover, both family care and medical care are required for him to develop his cognitive ability so that he can move his life with his career.
• Managing healthcare needs of Harry: the healthcare needs of Harry can be satisfied with the effective application of quality care from the healthcare staffs. Additionally, he must be given a proper and healthy meal and a sound sleep. For the mental health needs- he must be provoked to be engaged in various extracurricular activities. Hence, a routine counselling session must be arranged for him to satisfy his healthcare needs.
• Emotional, social and physical support for Harry: A polite and friendly behaviour with Harry can provide him with positive emotional support. Harry must be convinced regarding the effectiveness of making and talking with different kinds of people. Moreover, he requires proper counselling and must be provided proper diet and meal regularly with sufficient water along with sufficient physical exercises and a regular counselling.
• Resettlement needs for Harry: Harry needs a settlement that supports his social, cultural and mental biases. Additionally, the companions of the new settlement must be caring and friendly for Harry for the mental health development of Harry. He can be provided mental support and friendly gesture must be shown to him. Additionally, he must be assured social, cultural and linguistic respect in the new settlement.
• The appropriate level of contact: When they are out of care the appropriate level of contact with Harry can be arranged with the effective implementation of the Intensive Outpatient Program (IOP). This is an interventional protocol used to contact the patient when they are out of care.
• Communication strategy for Harry: Both verbal and nonverbal communication must be developed with Harry for the betterment of healthcare communication when working with him.
• Identification of diversity, culture and program while working with Harry: diversified cultural background can be identified from the patient’s behaviour. The faiths, beliefs and biases can be located from the behaviour of Harry. He can be provided with an ambience that supports his culture, religion and linguistic faiths and beliefs. A community assessment can also be done to communicate with Harry properly.
• One area of legal and ethical compliance: As per the Australian Charter of Healthcare rights (2008), the care and cultural competency must prevail in the healthcare organisation for Harry. The legal and ethical compliance of this right states that patients from diversified background must be provided with equal quality care and cultural respect in the healthcare organisations. Any avoidance of securing care rights of Harry can be highly punishable for the healthcare staffs and legal actions may be supposed on the inability to, perform the duty of care (Goertz et al., 2013).

Case study- Geoff

• Geoff’s developmental progress: Geoff had an excessive behavioural disorder. Moreover, most of his daily tasks are full of abnormalities. He feels uncomfortable in noisy areas and change of routines in daily tasks. Thus, his developmental progress can be started by behaving with him politely with quality care.
• Indicators of attachment disorder in Geoff: The indicators of attachment disorder in Geoff are- his situational distress dusting any noise, his difficulty in coming up with the anxiety against any unpredictable behaviour, his habit of biting his wrist whenever he feels uncomfortable and his vulgar outburst in any kind schedule mismanagement.
• Interventions to employ Geoff’s trauma is not exacerbated: Geoff requires unbiased quality care and support to ensure his trauma is not exacerbated. Additionally, he requires counselling to understand his existing behavioural disorder in order to ensure his trauma is not exacerbated.
• Positive support in response to the behavioural concern of Geoff: An Unbiased quality care must be provided to him. Additionally, his socio-cultural and religious faith must be respected in the care organisation in order to provide him with positive support in response to his vulgar behaviour. Moreover, a sympathetic, polite and friendly behaviour must be shown to him for additional support.
• Critical incidents, its response and its required documentation: Once, while everyone residing with Geoff were upset and the care staff tried to pacify them which delayed the usual dinner time of 7 pm. Geoff went furious over the fact and started showing unusual behaviours bitting his own wrist and went to the backyard and stayed there for a long time without having dinner for a long time.

It was responded with politeness. Geoff was convinced several times with politeness to go inside and have dinner. He was convinced at last by the caregiver to go for dinner after talking to him, with politeness and friendly attitude.

The required documents for this situation are noting down his behavioural symptoms, identifying his responses after specific incidents and his healthcare barriers.

• A person-centred approach in response to Geoff's behaviour: a person centre approach is essentially required for the trauma care of Geoff. The person-centred behaviour requires a man to man counselling session where Geoff can open up all his distressful factors, negligence and unsatisfied desires. The record of the conversation of Geoff must be compared with his present behavioural outbreak. The comparison can be useful for the behavioural monitoring process and healthcare analysis for Geoff.
• Geoff's daily need while in care and providing a clean and safe environment: The mental and trauma care development of Geoff requires effective healthcare environment. A calm and culturally safe environment must be provided to Geoff. A sociocultural and linguistic safety is essentially required for Geoff to maintain his quality care rights in the organisation.
• Geoff's opportunities for education, life skills, school attendance and employment opportunities: Geoff first requires a proper counselling in order to make him suitable to go for school and education or peruse any career.. a morning school with mental healthcare facility is most suitable for him as he behaves normally. The daily activities of Geoff must be monitored to locate his extracurricular efficiency. He can be motivated to take adopt a career as per his interest or hobby.
• Healthcare needs of Geoff: By providing quality care, proper diet, timely medication, proper physical activities and a regular counselling session, the healthcare needs of Geoff can be satisfied.
• Emotional, social and physical support for Geoff: A polite and friendly behaviour can provide him, emotional support. A regular counselling session to convince him to adjust with the social crowd can be social support for him. A regular physical exercise and meditation can provide him with physical support.
• Resettlement needs for Geoff: A socially, culturally and linguistic safe environment is the essential requirement for the resettlement needs of Geoff. He can be supported by allowing him in a residential trauma care home where the caregivers can assure an unbiased treatment along with a socially, cultural and linguistic safety to Geoff.
• The level of contact with Geoff while he is out of care: Geoff generally prefers eye contact to connect people around him. However, Intensive Outpatient Program (IOP) contact can be useful for him while he is out of care.
• Communication strategies with Geoff: Geoff generally prefers eye contact communication. Thus, the nonverbal communication strategy should be applicable to him.
• Identification of diversity, culture and background of Geoff: The diversity and cultural background of Geoff can be assumed with his behavioural outcome. His way of using a language and his religious faith are the background and cultural determinants of Geoff.
• Legal and ethical compliance of trauma care: The right to equal healthcare under the Australian Charter of Healthcare rights (2008) is the legal and ethical compliance for Geoff.

Task

• Clients’ history, background and my current role: The name of the client is Jerome Taylor is a twenty-seven years old man from Sydney. He has a vulgar attitude. My role was to provide quality care, medication and care advice for him.
• Developmental progress: Jerome has become a little polite as his overreaction has decreased a little during his stay at the residential care organisation. It can be identified as his developmental progress.
• Attachment disorder of Jerome: Jerome does cannot adjust himself within a crowd or noisy area. He feels uncomfortable and expresses his vulgarity over trivial issues that can be identified as his attachment disorder or trauma.
• Interventions to ensure Jerome were not trauma exacerbated; Jerome was not trauma exacerbated because not abnormality can be identified when he is far from the crowd and surrounded by his close ones. Thus, his trauma cannot be identified as exacerbated. Additionally, he has been given quality care, proper medication and proper mental support to assure his trauma was not exacerbated.
• Positive support in response to behavioural concern: A quality care, mental assistance and culturally safe environment are provided to him in order to provide him with positive support.
• Critical incidence, response and documentation: A critical incidence happened while serving him lunch at a time when he was not interested to have that. He went furious and physically assaults the healthcare staff. However, he was pacified with a mild and polite behaviour by convincing him the necessity to have lunch at that time. The required documents are his previous healthcare records and his reaction after certain actions.
• Person-centred care review and monitoring: A person-centred care is required for Jerome for his trauma care. This includes a daily one to one counselling session where he can express all his mental health barriers and issues and his reactions over certain actions. This can be reviewed and monitored after comparing it with his reaction against certain actions and his reaction during the counselling session.
• Meeting daily need and support with the safe environment: The daily need of Jerome can be satisfied by providing him timely food, proper care, motivating him for physical exercises and giving him time for care.

He can be supported with a socially and culturally safe environment and quality care. Moreover, he should be given mental assistance through polite behaviour, friendly interaction and cultural and religious support.

• Support with the opportunities of education, skill and employment opportunities: He must be motivated to pursue his hobbies like painting, playing games or making handicrafts. Moreover, a proper caregiver must be employed to provide him with the opportunity to continue his education that can support his career development.
• Managing ongoing healthcare needs: The ongoing healthcare needs can be satisfied by providing him with a proper meal, water, medicine, assisting him in his daily activities and employing quality care for him.
• Emotional, social and physical support for Jerome: A polite behaviour and quality motivation can be used for emotional support. Providing a socially and culturally safe environment for Jerome can assist his social support. EMDR, BBT and cognitive behavioural test along with exercising sports and swimming can provide him with physical support.
• Resettlement needs and support: The resettlement needs can that can be identified for Jerome is to provide him with a more culturally safe environment. He can be provided with an opportunity to resettle in a care home that his socially and culturally more supportive of him.
• Appropriate level of contact during out of care: Intensive Outpatient Program (IOP) contact can be useful for Jerome while he is out of care.
• Communication strategies: Jerome did not have any communication problem. Thus, both verbal and nonverbal communication strategies can be used for him.
• A particular area of diversity, culture and background: The particular areas of diversity, culture and background can be identified from the accent, attire and religious faith (Baker & Giles, 2013). Jerome is Catholic Christian by faith that can be identified from his routine of going local church regularly to participate in the prayer.
• Legal and ethical compliance: The right to unbiased care under the Australian Charter of Healthcare rights (2008) is the legal and ethical compliance for Jerome.

Reflective Journal

Conclusion

The study has evaluated several care processes and care techniques of trauma care based on case studies. The case study of Harry has different trauma issue while Geoff has different. The personal experience case study of Jerome also reflected critical parts of trauma care. The journal entries have reflected on several situations and observations on personal reflection. Proper care and medication can provide a good health outcome.

References

Baker, A. C., & Giles, A. R. (2013). Cultural safety: A framework for interactions between Aboriginal patients and Canadian family medicine practitioners. International Journal of Indigenous Health, 9(1), 15-22.

Goertz, C. M., Long, C. R., Honduras, M. A., Petri, R., Delgado, R., Lawrence, D. J., ... & Meeker, W. C. (2013). Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study. Spine, 38(8), 627-634.