Fundamentals of Case Management Practice: Skills for the Human Services 5th Edition Solution Manual

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Exercises for Chapter 1ExercisesThese exercises can also be filled out online at CengageBrain.com.Exercises I: Case ManagementInstructions:In each of the following situations, develop a tentative plan for the client. List thevarious services you believe each person needs initially. Include in your plan for each client bothformal and generic services, and where appropriate, use social supports and support groups.Suggest other services the person might use later once the case is stabilized. Think about howyou can involve others close to the person and how you will involve the client in planning.1.You are called by the daughter of an elderly woman who lives alone. The daughter livesin another city and is concerned because her mother does not drive and has seemedunhappy and listless on the phone. The daughter expresses concern that her mother seemslonely and is perhaps depressed. The daughter does not know her mother’s neighbors andcalls you instead at the Office of Aging. She has told her mother she is going to call youragency for help, and the mother had no objection to that.2.A man with an intellectual disability lives alone with his widowed mother. She has fallenand broken her hip and will be at the rehabilitation hospital for about 6 weeks. He cannotstay alone. He has a job at Goodwill Industries. County transportation takes him thereevery morning at 8:30A.M.and brings him home at 5:00P.M.3.A woman and her two children are waiting to receive their welfare check. They came toyour state from another to escape an abusive husband and father. The woman is frail and

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appears sick. They have no place to go and have not eaten in several days. The childrensmell as if they need a bath and are listless.4.A mother of two preteens has brought her son in for services. The woman is a widow.She confides that she has been having trouble controlling the boy, who is the oldest, andthat the girl is disgusted with her brother’s behavior and does not want to be involved inhelping him. Lately the boy has become involved with teens his age and older. They havebeen drinking and coming home when they feel like it. The mother allowed them tosmoke pot in the garage in hopes that she could keep the boy at home, but nowshe feelsthat backfired. The boy makes it clear that he thinks coming for help is ridiculous andsays the one thing he will not do is give up his friends.5.A man has been referred by his family physician for help. The man seems extremelyinebriated. His wife brings him in and says she is worried that he may go into deliriumtremens if he withdraws from alcohol too quickly. His family physician did not see himbut sent the couple straight to your office.6.A father brings in his 14-year-old daughter who is running the streets, refusing to listen,and failing in school. He is at his wits’ end, saying he must work and cannot be homewhen the girl returns from school. Her mother died 4 years ago, and the trouble startedwhen the daughter was about 12. The father feels that he and his daughter have a difficulttime communicating with one another.7.A police officer asks you to come to the home of an older man he has been concernedabout for several weeks now. The man is delighted to see you and tells you that he ishaving pains in his legs and is unable to walk. During your visit, he asks you to getthingsfor him that are nearby, but obviously it is too painful for him to get up. He says he does

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not go to the kitchen often to prepare meals, but the police officer has stopped by severaltimes with sandwiches, and Mrs.Jones from up the street, an old friend of the man’s latewife, has brought a casserole on occasion. He is adamant that he wants tostay in hishome as long as he can.8.A woman comes in complaining of depression. She says it started when her husband leftwith a younger woman and she has not been “right since.” She reports having difficultyfalling asleep and complains of no appetite. She says she has missed more than 3 weeksof work since he left last month. There are no children, but she tells you she hasneglected the dog and cannot remember if she fed him last night or not. She appearslistless and very sad, weeping off and on during the interview.9.A man in his 60s comes in on the recommendation of his doctor. He had a back injurysome years ago and was placed on codeine at the time. After the back injury, other thingswent wrong. The plant where he worked closed down and his mother died. He foundhimself feeling very alone and uncertain about finances. “It was then that I started todrink too,” he tells you. When you ask what he means by “too,” he says his doctorbelieves he has become addicted to codeine. “I don’t know,” he says. “I’ve gotten to thepoint that I can’t get through a day without a lot of help.”10.A single mother brings her 12-year-old son in because they are “not getting along.” Shereports that he does not listen and comes and goes as he pleases. His homework has fallenoff and his grades have slipped, but he is still doing well in math and likeshis mathteacher. The boy’s father was killed in a railroad accident 2 years ago. The mother tellsyou that the boy and his father enjoyed a close and warm relationship, and that she hasfelt her influence on him slipping away since the accident.

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11.A woman comes to your agency on a referral by the courts after she was arrested forselling various prescription medications on the street. She tells you she currently hassome amphetamines, Xanax, and a popular addictive pain medication in her bag. Thecourt is ordering her to show within the next week that she has enrolled in a program thatwill get her help with her own addiction to some of the medications she sells. “I haveregular customers,” she tells you. “And they are going to crap when I stop comingaround.” Asked where she gets her medications, she smiles mysteriously and says, “Thepolice are looking into that—you don’t need to.” She denies she is addicted to anything,but court records, including an evaluation by a psychologist, which she has brought withher, indicate that she is addicted to several different medications.12.A woman who was recently placed in the community after 3 years in a state mentalhospital is having trouble adjusting to the living arrangement made for her by thehospital. She is not going out and does not participate in any activities. She is friendlywhen you talk to her and seems glad to have your company, but she does not seem toknow how to take care of the details of everyday living. She has a roommate who is morecompetent and independent. The two get along well.13.A woman with two small children is referred to you because she recently lost herapartment. She has a meager income from a part-time job as a clerk in a conveniencestore and was unable to pay the rent and take care of other bills. She seems unaware thatshe might be eligible for financial assistance. She is not sure where her children’s fatheris at the moment. All her belongings are packed in five bulging garbage bags. She and herchildren seem malnourished and thin.

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14.A man comes in who was referred by his job for possible crack use. The man admits heuses crack, but rarely and certainly not to the extent that it would interfere with his work.He will be given 4 weeks off if he enrolls in a legitimate program for detoxification. Heseems reluctant and torn. Eventually, he agrees to work with you on a plan.15.An older woman comes to you for help after a particularly abusive incident with herhusband. She admits that she is becoming increasingly afraid of him. She has no friendsand no job, “because he wouldn’t let me out of the house—or out of his sight.” She has anumber of old bruises and lost two teeth in this last incident. She is asking for help andsays, “I don’t know. I really fear for my life. It’s just gotten out of hand and I don’t knowwhere it will end.”

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Exercises II: Decide on the Best Course of ActionInstructions:Sit with a small group of other students and decide how you will handle eachsituation. There are many areas both ethically and legally that are not clear, so the discussion youhave with your colleagues about these cases is much like a discussion you might have in a realagency. There are no “correct answers.”1.You are the casemanager for a man who has only recently had a first manic episode. Hehad submitted to treatment, responded well, and returned to work. However, he iscurrently experiencing another episode, and this one seems more severe. He is notsleeping or eating, issending cryptic messages on the Internet, and believes everything hereads there is directed at him. He believes the government is “monitoring” him, and thathe has an important job lined up with a record company in New York. You havedetermined that he isnot leaving his house, and that he is preoccupied with what ishappening on message boards and chat rooms on the Internet. You have checked in withhim several times by phone. Each time he assures you that he is fine and does not needhelp.What is the best course of action? Do you risk seeking an involuntary commitment,knowing that he seems just well enough to convince the emergency room physician he isnot in need of hospitalization? Will this alienate him and make it impossible for you towork with him? Do you wait for things to get worse? If so, is there a chance he may leavethe house and get into trouble? What might happen if you wait it out?2.A 72-year-old woman on your caseload has been in mental health services for a numberof years, ever since the year after she graduated from college. She has had severeepisodes of schizophrenia over the years with countless hospitalizations and prescriptions

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for numerous antipsychotics and antidepressants. All her life she has been a client ofsocial services and hotlines, reaching out frequently for any support she could get. Shehas always been very dependent on her case managers, calling them often for support.When support was withdrawn, as it often was when workers tried to get her to be moreindependent, the woman would deteriorate.Sometime after she turned 60, these severe, acute episodes diminished, and she has beenliving in comfortable subsidized living arrangements for senior citizens. As she hasgrown older she has developed breathing problems that will eventually take her life. In aneffort to be helpful and without your knowledge, her family doctor referred her to hospicefor support. In his view she was facing the end of her life. Hospice entered the picturewith considerable support, seeing her often, providing meals and companionship. Thislevel of attention met the woman’s needs for support and she became extremelydependent on the hospice workers. She seemed happier and began to participate more inthe group activities at the apartment building where she lived. This levelof support ismore than you could give and you have been relieved that she is doing so well with thehospice workers. However, hospice has decided to withdraw their services. Thewoman’sdeath does not appear to be imminent. In fact she appears to be improving slightly. Thewoman has called you, her case manager, in a complete panic at the prospect of losingthis support. She is not eating and is distraught.What are the ramifications here? What does continued hospice support mean for hospice,which relies on public and charitable funding? What are the consequences if the servicesare withdrawn for this woman and for you? Are there solutions to this problem? Are thereethical considerations here?

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Exercises for Chapter 2ExercisesThese exercises can also be filled out online at CengageBrain.com.Exercises I: EthicsInstructions:The hypothetical practice situations that follow are designed to stimulatethinking and discussion on the issue of confidentiality. Each situation is followed by amultiple-choice list of possible responses you might make. Choose the responses that youconsider the best. In some cases you might want to use more than one of theresponses listed.Others may choose a different answer. Discuss with your fellow students the differentpossibilities and what might present the best outcome for the client.1.Paula is a 17-year-old client in the daytime partial hospitalization program. Her motherphoned and requested to know Paula’s psychiatric diagnosis so that she could inform thefamily’s physician who is treating Paula for diabetes. You should:a.Advise themother of the diagnosis and the name of the psychiatrist who made thediagnosis.b.Call the family physician directly and advise him of the diagnosis.c.Ask Paula to sign a release of information form giving consent for the physician andthe mother to be advised of her diagnosis.d.Refuse to release the information at all.2.Kelly requests a copy of his current treatment plan. You should:a.Have Kelly put the request in writing and discuss the issue with the treatment team.b.Make a copy of the current treatment plan and give it to Kelly.

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c.Discuss the treatment plan with Kelly and then see that he has a copy.d.Refer Kelly to the attending psychiatric physician.3.A 13-year-old boy requests that his school counselor be sent a copy of his initialinterview and discharge summary. He signs a release of information form, documentinghis written consent for the information to be transmitted. You should:a.Forward the material to the school counselor.b.Give the information to the boy who can deliver it to the school counselor.c.Have the medical records department forward the information to the school counselor.d.Refuse to release the information until a parent cosigns the release of informationform.4.In the case above you woulda.Release the complete chartb.Release just the discharge summaryc.Release only those portions of the discharge summary that the school needs for theirwork with the boy and not release the initial intake summary as it containsinformation that is no longer relevant but taken out of context could be damaging tothe boy’sfamilyd.Meet with the parents to go over what you have decided to release as outlined in Cbefore anything is released to the school.5.Mary Smith is a depressed elderly woman who was admitted to Polyclinic Hospitaldue tosevere back pain. She was advised she might need surgery to correct the problem. Youare her case manager at the Office of Aging, and she calls to say she is consideringsuicide. The constant back pain has made her feel like “just giving up.” Maryis currentlyat home, awaiting a surgery date. You know Mary has a supply of pain pills, and she says

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she wants to take all the pills. You feel there isa substantial risk that Mary might followthrough on her threat. You should:a.Contact the Polyclinic orthopedic staff who are currently seeing Mary in theoutpatient clinic.b.Maintain frequent contact with Mary, but respect her wishes to keep her suicide plansconfidential.c.After discussing with Mary what you are about to do, contact crisis intervention.d.Advise the city police department of Mary’s suicide plans.6.Bill Jones is a client who has been in alcohol treatment programs at your facility.He iscurrently depressed about his pending divorce and present marital separation. He hassigned a release of information form for you to share information with his priest, who iscounseling Bill about his religious conflicts regarding the divorce.A man calls youclaiming to be Bill’s priest and requesting information on Bill’s current state of mind.You have never actually spoken with Bill’s priest, andyou think this might actually beBill’s wife’s attorney calling. You should:a.Give no information on the phone until you have verified the identity of the caller.b.Refer the caller to Bill, but send the information to the person at the address on therelease form Bill signed.c.Insist upon meeting with the priest in person.d.Share no information with the caller and contact Bille.Get the person’s number and call him back.7.Patty is completing a student internship for her associate’s degree in the therapeuticactivities program. She asks to review the medical records of the people who were just inher projects group. You are supervising Patty. You should:

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a.Advise Patty that the records are confidential and may not be inspected by students.b.Make certain that Patty is well trained in the policies and procedures relating toconfidential information, and only then allow her access to the medical records.c.Permit Patty free access to the records because she is like part of the staff.d.Obtain written consent from each client for Patty to review the records.8.Jerry was a client who improved and was discharged 2 years ago. You receive a call fromthe National Can Company. The caller explains that Jerry has applied for a job and thatthe company would like to hire him. Jerry told them he was in treatment 2 yearsago andwas discharged after showing considerable improvement. The company wishes toconfirm the fact that Jerry did indeed complete the program as he claims. You say to thecaller:a.“Idon’t know if Jerry was ever a client of our agency. If you send me a release-of-information form I can look into that and get back to you.”b.“Jerry was a patient here but I am not at liberty to say any more than that without arelease-of-information form.”c.“I can tell you that Jerry was a client here around 2012 and he successfully completedthe program with us. I will need a signed release-of-information form from Jerry toput in his file.”d.“I don’t know what you are talking about. Good-bye.”9.Clark is currently enrolled in treatment, and you are his case manager. He asks you if hemay read his medical record. You should:a.Ask Clark to put the request in writing, and assist Clark in completing the writtenrequest if he seems to have limited skills in reading and writing.b.Present Clark’s request to Clark’s treatment team.

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c.If the treatment team concludes that it will not harm Clark to review his record, allowClark to read it in the presence of a therapist (after deleting information from sourcesthat asked to remain anonymous).d.Decide with the treatment team who will assist Clark in reading and understanding hisrecord. Then follow through by allowing Clark to review his record with that person.

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Exercises II: Ethically, What Went Wrong?Instructions:The following hypothetical practice situations are designed to help you applywhat you have learned in this chapter. For each situation, decide what was done in thesituation that was unethical.1.Jennifer had a long day and was trying to get out of the office before 5:00P.M. She hadone more person to see. Dr. Adams had asked Jennifer to give Abdul, a young manrecently diagnosed with schizophrenia, a prescription for a new medication. Jennifer hadher coat on when she handed the prescription to Abdul in the waiting room. Abdul wantedto know what the medication was and why his prescription was being changed. “Willthere be any side effects?” he asked Jennifer. She replied hurriedly, “Oh, no. Dr. Adamssays just take this until he sees you next time.”2.Carl is uncomfortable around gay men. Bert, his client, is gay and has just broken up withhis lover. Bert, who is 42 years old, had been in a long-term relationship and is devastatedand in tears in Carl’s office. Because Bert has suffered from severe depression in the past,Carl attempts to have him evaluated by the therapist this afternoon. In the meantime, Bertis still weeping and now threatening to take his life. Carl is particularly uncomfortablewith this man’s tears and believes this is drama. Carlsays, “Oh, c’mon now. Let’s get agrip. You can’t sit in here all afternoon carrying on. Here, take some tissue and go out inthe waiting room until Dr. Paul can see you.”3.Elizabeth visited the home of an elderly man and got him to sign a release of informationform so she could process an application to the county nursing home. In the man’srecords were references to the fact that many years ago as a teenager he was convicted ofshooting a man in a bar fight, a crime for which he served 2years in prison. She knowsthe people at the home will be titillated over this little tidbit of information, especially her

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friend Rhoda, who does the intakes. Even though she knows this is not part of the home’sevaluation, that the client has led an exemplary life since that time, and that the nursinghome staff might take it out of context, she releases the information anyway, based on herclient’s signature on the release form. She and Rhoda have a good laugh about it the nextday.4.Jim is doing an intake with a man who claims he is depressed. He tells Jim that ever sincehis wife left he has had trouble concentrating and waking up in the morning. He talksabout how lonely it is at home, how much he misses his children, how he is tempted todrink in the evenings, and how little he has to look forward to. Jim nods. He understands.“Yes, my wife left last month too,” Jim tells the man. “I know just what you mean. I getto feeling like, well, like there isn’t as much meaning. I never knewthe kids were soimportant to me, but I guess they were. On Saturdays, I used to do things with my son andI still get him every other weekend, but it’s not quite the same thing, is it?” “No,” the manresponds, “I was thinking...” Jim interrupts the man to say, “Well, I do a lot of thinkingtoo. I think about what I could have done differently and if it was my fault. Don’t youthink these women would see that it’s hard, too hard I think, to raise kids alone?” Theconversation continues in this vein until the end of the interview.5.Carmen is supposed to see her small caseload of persistently mentally ill individuals atleast twice a week. Lately, with school and her mother’s death, she has not really seen herclients that often. She has checked in with them on the phone, but she alsohas used timewhen she was out seeing clients to do errands at the library and to empty her mother’shome. Now one of her clients is in court after committing a crime. The client and thelawyer agree that the client might be able to use his mental healthstatus as a reason forcommitting the crime, and they ask to introduce the case record as evidence in the courtproceedings. Fearing that it will be discovered how little supervision and attention she has

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given her client, and knowing that ultimately she could be blamed for the fact that herclient committed the crime while under her somewhat irresponsible care, Carmen invokesthe concept of privileged communication to avoid having to give the file to the court.6.Ted is in a clinic with his elderly client, Gretchen, for a routine blood workup, which theydo every other month. He notices Gretchen is bruised on the face and arms. For a whilehe makes small talk with her, and then he asks her about the bruises. She issomewhatevasive but indicates, “They weren’t the result of no fall!” Without explicitly blaming herdaughter and son-in-law, with whom she lives, Gretchen makes it quite clear that thebruises are not the result of an accident. After the blood test, during which neither thedoctor, who sees her briefly, nor the technician make any mention of the bruises, Tedtakes Gretchen home. He toys with the idea of reporting the bruises to protective servicesat the county Office of Aging but decides not to. He baseshis decision on the fact that thelaw does not specifically require him to do so, that it would be hard and take a lot of timeto have to place Gretchen in another living arrangement, and that the daughter seems likea very nice person whom Ted does not feel like stirring up over an uncomfortablesituation.7.Kitty has a whole list of things to do today and doubts she can get it all done. She hatesthe way there are always things left to do at the end of the day. It just seems that nomatter how hard she works, something new comes up that shecannot complete. One ofher clients, Isabel, has told her on the phone that she wants to sign a release ofinformation form for her lawyer. Kitty has the form ready for the time when Isabel will becoming in at the end of the week. Today a man calls and says he is Isabel’slawyer and heneeds just two dates to help him file a brief with the court on the Isabel’s behalf. Kittygives him the two dates and hurries to the next thing on her list.

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