PS450 Unit 5 Special Needs Case Management Paper Example

Trauma, Hepatitis C and Two Children: A PS450 Unit 5 Special Needs Case Management Paper

[Student Name]

Purdue University Global

PS450: Case Management in Clinical Settings

Unit 5 Special Needs Case Management Paper

[Instructor Name]

[Date]

The client, her history and the program are composite; the protocols, guidelines and manual cited are real.

Beyond the Standard Plan

By her second month with us, Brandi's plan was working on paper. Her service plan addresses recovery, reunification with her two children, housing and work. As her case manager, I learned during those two months that several needs were not yet reflected in it.

The first was trauma. In her fourth individual session, Brandi told her counselor that her former partner, the father of her daughter, had beaten her repeatedly over four years and once choked her until she lost consciousness. She left him two years ago. She has nightmares, startles when men raise their voices and avoids the street where they lived. Her counselor's assessment found posttraumatic stress disorder. She also told us that he had recently been released from jail.

The second was hepatitis C, which she acquired while injecting drugs and had been diagnosed with before entering the program. She had been referred to a liver clinic but missed two appointments because she believed treatment meant a year of injections that made people sick, as it once did, and because she feared being judged at the clinic.

What the Protocol Says

The federal treatment improvement protocol on comprehensive case management for substance abuse treatment devotes a chapter to clients with special needs (Center for Substance Abuse Treatment, 1998). It identifies groups whose needs require adaptations, including people with co-occurring mental disorders, people with HIV or other serious medical conditions, women, especially those with children, people involved with the criminal justice system and people who are homeless. Brandi belongs to four of those groups. The protocol stresses that special needs are not add-ons; they shape every part of case management, from assessment to the setting in which services are offered.

Brandi does not have a substance use problem plus some special needs; her trauma, her illness and her children are part of the same recovery.

Adapting for Trauma

SAMHSA's guidance on a trauma-informed approach asks programs to build services on six principles, which in plain terms are: keep people physically and emotionally safe, be open and predictable, use peers, share power, let clients choose, and pay attention to culture, history and gender (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). It also asks staff to understand how common trauma is, to notice its signs in the people they serve, to change routines in response, and to avoid practices that wound people again.

Several changes to Brandi's case management followed. Safety came first. With Brandi, I contacted the court about her former partner's release, helped her apply for a protective order and changed her group schedule so that she did not walk alone after dark. Choice and control mattered too. Brandi had been assigned a male counselor at intake; we offered her a female counselor, and she accepted. Our program meets clients in a building where a man in the waiting room had once made her leave in a panic; I began meeting her in a smaller office near the back entrance.

Treatment was also adapted. Her counselor began Seeking Safety, a present-focused therapy for people with both PTSD and substance use problems that teaches coping skills without requiring detailed discussion of trauma memories (Najavits, 2002). The approach fits early recovery, when reliving trauma might threaten sobriety.

Coordinating Medical Care

Hepatitis C treatment has changed dramatically. Current oral antiviral medications cure most people in eight to twelve weeks with few side effects. CDC guidance calls for a hepatitis C test for every adult and repeat testing for people with ongoing injection risk (Schillie et al., 2020), and people in recovery are now routinely offered treatment rather than being asked to wait for long periods of sobriety.

Brandi's fear was based on outdated information and on shame. Case management addressed both. I asked the liver clinic's nurse to call Brandi and explain the current treatment, which took ten minutes. I booked her appointment on the same day as her drug screen in the same building to reduce trips. I went with her to the first visit, at her request, and waited in the lobby. She started treatment in May and took her medication daily, keeping the bottle beside her buprenorphine as a reminder. Her twelve-week result showed no detectable virus.

When the Needs Collided

The needs did not always fit together neatly. In June, the hearing on Brandi's protective order was set for the same morning as her family treatment court review. Missing either could have cost her: the protective order protected her safety, and a missed court review could delay unsupervised visits. I called the treatment court coordinator, explained the conflict without sharing the details of her trauma, and the judge moved her review to the afternoon. I then went with Brandi to the protective order hearing, where her former partner appeared. She shook through the hearing but answered every question, and the order was granted.

A second collision came from her treatment for PTSD itself. In the weeks after the hearing, her nightmares worsened and she had a positive drug screen for methamphetamine, her first in two months. Under a less flexible approach, the positive screen might have been treated only as a violation. Her counselor, the court team and I treated it as a signal that her trauma symptoms were outrunning her coping skills. The court imposed a modest sanction, an extra screen each week, while her counselor increased sessions and I arranged a peer mentor with a similar history.

Women with Children

The protocol's attention to women with children applies directly. Brandi's parenting obligations shape everything: her visits with her children, her daughter's school events and her son's own treatment. Services built for single adults would ignore these. Her plan schedules group around supervised visits, the program provides childcare during evening sessions when her children visit, and I coordinate with the child welfare caseworker so that progress in trauma treatment counts toward reunification rather than being hidden.

Conclusion

Brandi's case shows why special needs cannot be treated as an appendix to a standard plan. The federal protocol identifies the groups she belongs to, trauma-informed principles changed where and how services are offered, Seeking Safety fit her early recovery, and coordinated medical care cured her hepatitis C. Each adaptation removed a barrier that would otherwise have stood between her and her children.

References

Center for Substance Abuse Treatment. (1998). Comprehensive case management for substance abuse treatment (Treatment Improvement Protocol [TIP] Series No. 27). Substance Abuse and Mental Health Services Administration.

Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Press.

Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A. B. (2020). CDC recommendations for hepatitis C screening among adults: United States, 2020. MMWR Recommendations and Reports, 69(2), 1-17. https://doi.org/10.15585/mmwr.rr6902a1

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884).