Family Assessment

  The chief tramp in ancillary a client is conducting a thoroughgoinggoing tribute. The clinical gregarious compositioner must prove multiple perspectives in enjoin to disclose a accomplished reason of the office. From this reason, the gregarious compositioner is powerful to acknowledge the client’s strengths and disclose cogent strategies for diversify. For this Discussion, reconsideration the “Cortez Family” occurrence narrative. Post your description of how micro-, mezzo-, or macro-levels of experience aid gregarious compositioners in assessing families. Assess Paula Cortez’s office using all three of these smooths of experience, and fulfill two strengths and/or solutions in each of these smooths. Describe the rate in strength-based solutions.  The Cortez Origin   Paula is a 43-year-old HIV-absolute Latina woman originally from Colombia. She is bilingual, abundant in twain Spanish and English. Paula lives fantastical in an berth in Queens, NY. She is divorced and has one son, Miguel, who is 20 years old. Paula maintains a huskred succeeding a while her son and her ex-husband, David (46). Paula rising Miguel until he was 8 years old, at which order she was difficult to quit conservatorship due to her medical proviso. Paula is seriously gregariously unmixed as she has poor adjunction succeeding a while her origin in Colombia and bankruptcys a equal netcomposition of any husk in her vicinity. Paula identifies as Catholic, but she does not regard belief to be a big disunite of her thrifter. Paula came from a moderately courteous-to-do origin. She ments suffering natural and tender affront at the agencys of twain her parents, who are living and inhabit in Colombia succeeding a while Paula’s two siblings. Paula accomplishedd elevated ground in Colombia, but ran loose when she was 17 years old owing she could no craveer admit the affront at abode. Paula became an intravenous garbage user (IVDU), disuniteicularly of cocaine and heroin. David, who was originally from New York City, was one of Paula’s “garbage buddies.” The two eloped, and Paula followed David to the United States. Paula continued to use garbages in the United States for different years; notwithstanding, she stopped when she got prolific succeeding a while Miguel. David continued to use garbages, which led to the scarcity of their wedding. Once she stopped using garbages, Paula repeateded the Fashion Institute of Technology (FIT) in New York City. Upon completing her BA, Paula compositioned for a dress contriver, but realized her gentleman vehemence was depicting. She has a assembly of further than 100 drawings and depictings, multifarious of which mark the uninterruptedness of her identical and tender tour. Paula held a full-order job for a enumerate of years anteriorly her vigor prevented her from inaugurated. She is now waste and assent-tos Supplemental Security Insurance (SSI) and Medicaid. Paula was diagnosed succeeding a while bipolar conjecture. She experiences accelerated cycles of derangement and debasement when not unexceptionably medicated, and she besides has a leaning inproducer paranoia. Paula has a narrative of not allowing succeeding a while her psychiatric medication composition owing she does not love the way it performs her feel. She frequently-again-and-again misrepeat it succeeding a whileout effective her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for at smallest five years. Paula accepts her bipolar idiosyncrasy, but demonstrates poor instinct into the huskred among her symptoms and her medication. Paula was diagnosed HIV absolute in 1987. Paula adventitious AIDS different years succeeding when she was diagnosed succeeding a while a serious brain contamination and a T-cell number close than 200. Paula’s brain contamination left her accomplishedly superannuated on the suiteffectual producer. She past office of her suiteffectual arm and agency, as courteous as the power to tramp. Succeeding a crave cling in an sharp thrift hospital in New York City, Paula was communicated to a trained nursing address (SNF) where she artifice she would die. It is at this order that Paula gave up conservatorship of her son. However, Paula’s proviso improved partially. Succeeding entity in the SNF for further than a year, Paula regained the power to tramp, although she does so succeeding a while a serious rest-still. She besides regained some office in her suiteffectual arm. Her suiteffectual agency (her dominant agency) sweepings semisuperannuated and rest-still. Aggravate the uninterruptedness of different years, Paula taught herself to depict succeeding a while her left agency and was powerful to retaliate to her loved art. In 1996, when elevatedly erratic antiretroviral therapy (HAART) became profitable, Paula began composition. She responded courteous to HAART and her HIV/AIDS was courteous inferior. In observation to her HIV/AIDS indisposition, Paula is diagnosed succeeding a while hepatitis C (Hep C). While this proviso was inferior, it has reached a sharp-end where Paula’s teachman is recommending she arise composition. Paula besides has indicative circulatory problems, which producer her serious abstinence in her inferior extremities. She uses prescribed opiate abstinence medication to guide her symptoms. Paula’s circulatory problems accept besides led to continuous ulcers on her feet that conciliate not reconcile. Composition for her floor ulcers demands repeated marks to a annoy thrift clinic. Paula’s abstinence paired succeeding a while the floor ulcers perform it reserved for her to ambulate and liberty her abode. As succeeding a while her psychiatric medication, Paula has a leaning not to allow succeeding a while her medical composition. She frequently-again-and-again disregards instructions from her teachmans and resorts to holistic compositions love treating her ulcers succeeding a while chamomile tea. Inaugurated succeeding a while Paula can be very frustrating owing she is frequently-again-and-again doing very courteous medically and psychiatrically. Then, out of the blue-colored, she stops her composition and deteriorates at-once. I met Paula as a gregarious compositioner industrious at an outpatient general thrift clinic located in an sharp thrift hospital in New York City. The clinic offices as an interdisciplinary influence and follows a uninterruptedness of thrift design. As a remainder, clinic patients are followed by their physician and gregarious compositioner on an outpatient foundation and on an inpatient foundation when admitted to the hospital. Thus, gregarious compositioners interact not hardly succeeding a while teachmans from the clinic, but besides succeeding a while teachmans from all services throughout the hospital. Succeeding inaugurated succeeding a while Paula for closely six months, she designated to edify me that she was prolific. Her tidings was foul owing she did not accept a boyfriend and never spoke of dating. Paula explained that she met a man at a finferior ammunition, they spoke different orders, he marked her at her berth, and they had sex. Paula artifice he   was a “rest up guy,” but of-late totalthing had diversifyd. Paula began to conjecture that he was using garbages owing he had inaugurated to   become guideling and demanding. He showed up at her berth at all orders of the mystification demanding to be let in.   He designated her sternly, and when she did not pluck up the phone, he left her balance and impending messages.   Paula was terrible for her security.  Given Paula’s involved medical feature and her psychiatric idiosyncrasy, her teachman, psychiatrist, and I were disturbed environing Paula maintaining the pregnancy. We not hardly feared for Paula’s and the baby’s vigor, but besides for how Paula would discuss caring for a baby. Paula besides struggled succeeding a while what she should do environing her pregnancy. She seriously regarded having an pigmy. However, her Catholic roots paired succeeding a while examination an ultrasound of the baby reindifficult her crave to go through succeeding a while the pregnancy. The principal rendezvous of composition at-once became negotiation succeeding a while Paula’s huskred succeeding a while the baby’s father. During compacts succeeding a while her psychiatrist and me, Paula reputed sensibility terrible for her security. The father’s relentclose phone calls and voicemails rattled Paula. She became wandering, slept poorly, and her paranoia increased indicatively. During a disuniteicular compact, Paula reputed that she had inaugurated smoking to strive succeeding a while the pressure she was sensibility. She besides established that she had stopped her psychiatric medication and was not regularly portico her HAART. When we proved the dangers of Paula’s actions, twain to herself and the baby, she implied that she knew what she was doing was hurtful but she did not thrift. Succeeding completing a suicide tribute, I was incontrovertible that Paula was decompensating at-once and at endanger of harming herself and/or her baby. I consulted succeeding a while her psychiatrist, and Paula was involuntarily admitted to the psychiatric item of the hospital. Paula was noticeablely hasty at me for the way. She blamed me for “locking her up” and not ancillary her. Paula remained on the item for 2 weeks. During this cling she reinaugurated her medications and was stabilized. I trained to mark Paula on the item, but the chief two orders I showed up she refused to see me. Eventually, Paula did accord to see me. She was stationary hasty, but she was powerful to see that I had acted succeeding a while her best profit in impetus, and we were powerful to retrieve our huskred. As Paula easy for free, she spoke further environing the father and the pressure that had driven her to the way in the chief establish. Paula accordd that resisting her fears she had to do bigwig environing the office. I accelerationed Paula disclose a security contrivance, educated her environing filing for a styptic enjoin, and referred her to the AIDS Law Project, a not-for-profit construction that accelerations individuals succeeding a while HIV agencyle lawful issues. Succeeding a while my patronage and that of her advocate, Paula filed a police ment and successfully got the styptic enjoin. Once the enjoin was served, the phone calls and marks stopped, and Paula regained a sentiment of guide aggravate her thrifter. From a medical perspective, Paula’s pregnancy was regarded “elevated endanger” due to her entangled medical office. Throughout her pregnancy, Paula remained on HAART, abstinence, and psychiatric medication, and composition for her Hep C was postponed. During the pregnancy the ulcers on Paula’s feet worsened and she discloseed a serious scourge contamination, ostemeylitis, in two of her toes. Outproducer composition the contamination was noticeablely exposed to twain Paula and her baby. Paula was admitted to a medical item in the hospital where she inaugurated a 2-week uninterruptedness of intravenous (IV) antibiotics. Unfortunately, the antibiotics did not composition, and Paula had to accept portions of two of her toes amputated succeeding a while poor anesthesia due to the pregnancy, extending her hospital cling to almost a month. The proviso of Paula’s feet heightened my regret and the composition team’s regrets environing Paula’s power to thrift for her baby. There were multiple factors to regard. In the present order, Paula was hardly powerful to tramp and was consequently unpowerful to do totalthing to plan for the baby’s air (e.g., gather preparation, seize parenting dispose, etc.). In the balance order, we scarcityed to address how Paula was going to thrift for the baby day-to-day, and we scarcityed to purpose environing how she would thrift for the baby at abode loving her natural periodations (i.e., poor power to ambulate and poor use of her suiteffectual agency) and her vulgar medical resting. In observation, we had to regard what she would do succeeding a while the baby if she required another hospitalization. In the crave order, we scarcityed to purpose environing permanency contrivancening for the baby or for what would occur to the baby if Paula died. While Paula acknowledged the concern of all of these issues, her misgiving smooth was fur inferior than mine and that of her composition team. Possibly she did not see the undiminished asceticismt as we did, or possibly she was in protest. She frequently-again-and-again told me, “I perceive, I perceive. I’m impartial going to do it. I rising my son and I am going to seize thrift of this baby too.” We indeed did not accept an rejoinder for her poor tender vindication, we impartial scarcityed to converge her where she was and actuate on. One of the things that thunderstruck me most environing Paula was that she had a noticecogent power to joke mass environing her. Nurses, teachmans, gregarious compositioners: we all wanted to acceleration her equal when she trained to shove us loose.  The Cortez Family  David Cortez: father, 46  Paula Cortez: woman, 43  Miguel Cortez: son, 20   While Paula was in the hospital item, we were powerful to converse environing the baby’s thrift and permanency contrivancening. Through these discussions, Paula’s gregarious detachment became further and further palpable. Paula had not told her parents in Colombia that she was having a baby. She feared their refusal and she established, “I can’t rest to incline my woman’s negativity.” Miguel and David were informed of the pregnancy, but they each had their own lives. David was remarried succeeding a while posterity, and Miguel was inaugurated and in ground full-time. The fancy of burdening him succeeding a while her scarcitys was bigwig Paula would not regard. There was no one else in Paula’s thrifter. Therefore, we were difficult to observe at options outproducer of Paula’s poor gregarious network. Succeeding a month in the hospital, Paula went abode succeeding a while a surgical boot, instructions to period port influence on her floor, and a schedule of referrals from me. Paula and I accordd to stop in total other day by telephone. My artifice was to instructor how she was sensibility, as courteous as her journey succeeding a while the referrals I had loving her. I besides wanted to cater her succeeding a while patronage and fearlessness that she was not getting from anywhere else. On multifarious occasions, I hung up the phone frustrated succeeding a while Paula owing of her dilatoriness and bankruptcy of follow-through. But notwithstanding she accomplishedd what she scarcityed to   for the baby’s air. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women,   Infants, and Children, and was besides powerful to assure a pocket and other baby essentials.  Paula delivered a vigory baby maid. The baby was born HIV denying and current the alienate HAART composition succeeding lineage. The baby gone-by a week in the neonatal intensive thrift item, as she had to detox from the proceeds of the abstinence medication Paula took throughout her pregnancy. Loving Paula’s low proceeds, vigor, and Medicaid resting, Paula was powerful to devote for and assent-to 24/7 in-abode branch thrift abettance through New York’s open abettance program. Depending on Paula’s vigor and her scarcity for acceleration, this provision can be qualified as deemed alienate. Miguel did seize a disunite in caring for his half sister, but his abettance was poor. Ultimately, Paula accomplishedd the alienate permanency contrivancening papercomposition succeeding a while the abettance of the construction The Origin Center. She designated Miguel the baby’s conservator should bigwig occur to her.