Task group for intervention.

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As a clinical social worker, it is important to understand group typology in order to choose the appropriate group method for a specific population or problem. Each type of group has its own approach and purpose. Two of the more frequently used types of groups are task groups and intervention groups.

For this Assignment, review the “Cortez Multimedia” case study, and identify a target behavior or issue that needs to be ameliorated, decreased, or increased. In a 2- to 4-page report, complete the following:

Choose either a treatment group or task group as your intervention for Paula Cortez.

Identify the model of treatment group (i.e., support, education, teams, or treatment conferences).

Using the typologies described in the Toseland & Rivas (2017) piece, describe the characteristics of your group. For instance, if you choose a treatment group that is a support group, what would be the purpose, leadership, focus, bond, composition, and communication?

Include the advantages and disadvantages of using this type of group as an intervention.

Reference: Please Use the Following

Toseland, R. W., & Rivas, R. F. (2017). An introduction to group work practice (8th ed.). Boston, MA: Pearson.

  • Chapter 11, “Task Groups: Foundation Methods” (pp. 336-363)
  • Chapter 12, “Task Groups: Specialized Methods” (pp. 364–395
  • Himalhoch, S., Medoff, D. R., & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis. AIDS Patient Care and STDs, 21(10), 732–739.
  • Lasky, G. B., & Riva, M. T. (2006). Confidentiality and privileged communication in group psychotherapy. International Journal of Group Psychotherapy, 56(4), 455–47

Toseland, R. W., & Rivas, R. F. (2017). An introduction to group work practice (8th ed.). Boston, MA: Pearson.

  • Chapter 1, “Introduction” (pp. 1–42)
  • Chapter 2, “Historical and Theoretical Developments” (pp. 45–66)

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Paula Interdisciplinary Team Paula has just been involuntarily hospitalized and placed on the psychiatric unit, for a minimum of 72 hours, for observation. Paula was deemed a suicidal risk after an assessment was completed by the social worker. The social worker observed that Paula appeared to be rapidly decompensating, potentially placing herself and her pregnancy at risk. Paula just recently announced to the social worker that she is pregnant. She has been unsure whether she wanted to continue the pregnancy or terminate. Paula also told the social worker she is fearful of the father of the baby, and she is convinced he will try to hurt her. He has started to harass, stalk, and threaten her at all hours of the day. Paula began to exhibit increased paranoia and reported she started smoking again to calm her nerves. She also stated she stopped taking her psychiatric medications and has been skipping some of her HIV medications. The following is an interdisciplinary team meeting being held in a conference room at the hospital. Several members of Paula’s team (HIV doctor, psychiatrist, social worker, and OB nurse) have gathered to discuss the precipitating factors to this hospitalization. The intent is to craft a plan of action to address Paula's noncompliance with her medications, increased paranoia, and the pregnancy. physician Dialogue 1 Paula is a complicated patient, and she presents with a complicated situation. She is HIV positive, has Hepatitis C, and multiple foot ulcers that can be debilitating at times. Paula has always been inconsistent with her HIV meds—no matter how often I explain the need for consistent compliance in order to maintain her health. Paula has exhibited a lack of insight into her medical conditions and the need to follow instructions. Frankly, I was astonished and frustrated when she stopped her wound care treatments and started to use chamomile tea on her foot ulcers. Even though we have educated her to the negative consequences of stopping her meds, and trying alternative medications instead, she continues to do so. Psychiatrist Dialogue 1 As Paula’s psychiatrist for close to 10 years, I have followed her progress in and out of the hospital for quite a while—and I know her very well. She is often non-compliant with her medications, randomly stopping them after she reports she doesn’t like the way they make her feel. She has been hospitalized to stabilize her medications several times over the last 10 years, although she has managed to stay out of the psychiatric unit for the last three. Recently, she had seemed to appreciate the benefits of taking her medications and her compliance has much improved. She had been seeing her social worker regularly, and her overall mental health and physical health were improving. This has changed recently, after several stressful life events. We learned that Paula was pregnant by a man she met briefly at a local flower shop. She also reports he has been harassing her with threatening phone calls and unwarranted visits to her home. Paula disclosed to the social worker that she was neither eating nor taking her medication—and she had not gotten out of bed for days. Her decompensation was rapid and extremely worrisome and, therefore, called for a 72-hour hold. OB Nurse Dialogue 1 I have not known the patient long, but it does appear that she is trying her best to deal with a very difficult situation. Pregnancies are stressful times for even the healthiest of women. For Paula to learn she is pregnant at 43—in addition to her HIV and Hepatitis status and her bipolar diagnosis—must be so overwhelming. Adding to this, she has come to her two appointments alone and stated she has no one to bring along with her. When I inquired about the father of the child, she said he’s a bad man and he won’t leave her alone. She seemed truly frightened of him and appears convinced he will hurt her. Social Worker Dialogue 1 When Paula came to me and told me she was pregnant, I was indeed shocked by this announcement. She had never mentioned dating anyone, and with her multiple medical and psychiatric issues, I never thought this would be an issue we would address. Paula and I have developed a strong working relationship over the last two years, and she has shared many private emotions and thoughts. This relationship has been tested, though, since I suggested she be admitted to the hospital. Paula was furious with me, accusing me of locking her up and not helping her. It will take time to repair our working relationship. Once I rebuild that rapport, we will need to work together to find a way to address all of her concerns. We will need a plan that will address her medical needs, her psychiatric needs, and the needs of her unborn child. Physician Dialogue 2 As far as her pregnancy, if Paula doesn’t take her HAART medications religiously, she risks having a baby who is HIV positive. I am concerned about how she is going to care for a baby with her multiple medical issues. On the practical side, I wonder how she will physically care for this child. She has a semi-paralyzed right hand and walks with a limp. Additionally, when her foot ulcers flare up, she can barely put pressure on her feet. Newborns take a lot of time and energy, and I am not sure she has the capacity to handle the needs of an infant—let alone a toddler. I have not made any formal recommendations to Paula regarding whether to continue the pregnancy, but I have told Paula that, if she does decide to have the child, she must take her HAART medications every day. I explained that this is vital to her health and the health of her unborn child. Psychiatrist Dialogue 2 When her social worker, who I am in regular contact with, informed me that Paula announced she was pregnant, I was obviously concerned. Knowing Paula as well as I do, I felt I could be honest with her and give her my opinion about the situation. I told her that she should abort. Based on her medical history, including her physical and mental health disabilities, I did not believe she had the capacity to care for this unborn child. She has absolutely no support at all, outside of the treatment team, and would have no familial assistance to take care of this child. My recommendation for abortion was only solidified when we had to involuntarily hospitalize her. I fear that Paula cannot take care of herself, and she cannot be trusted to take her medications. If she does decide to continue with the pregnancy, my recommendation would be that she stay on the psychiatric unit for her entire pregnancy. That way, we will know that she is taking her medications and that the fetus is safe. OB Nurse Dialogue 2 Paula is most definitely a high-risk pregnancy, but that does not mean she can’t have a healthy baby. If she keeps up with her HAART medications and comes to her prenatal visits, there’s no reason this baby can’t be born healthy and HIV negative. My larger concern is with the pain medications she takes for her foot ulcers. There is a slight chance the baby will be born addicted to them. We would have to plan for a stay in the NICU if that occurs. While Paula clearly started to decompensate and exhibited some very risky behaviors recently, I think we should try and understand the stress she has been under. While it is not my place to tell the patient what she should do about a pregnancy, I don’t see that we would have to recommend termination. Social Worker Dialogue 2 Paula has overcome many obstacles in her life, but a baby—at her age and with her medical profile—is very different. Paula has made many bad decisions in her life, and the decision to keep this baby may or may not be the best for both her and the child. That being said, if her decision is to continue the pregnancy, we need to find a way to face the mountain of obstacles. She has little to no social support, and there will be many difficulties she will face caring for the baby alone. Paula also has limited financial resources and will need to apply for WIC and Medicaid. There are the numerous supplies that we will need to obtain, such as a crib, clothing, diapers, and formula. She has historically been unreliable about following up with referrals, so she is going to need a lot of encouragement and support. Honestly, I may not believe this pregnancy is a good idea, although I would never tell her that—that’s not up to me or anyone else. We all, ultimately, need to accept her decision and move on. Our goal now is to help Paula make it safely through this pregnancy and work on a plan to help her care for this baby once it is born. I don’t agree that she should be kept on the psychiatric unit for the next seven or eight months. Allowing Paula to play an active role in preparing for the baby is an important task, and she will need to be out in the community and in her home taking care of things. We have to show that we believe in her and her willingness to manage this situation to the best of her ability. We need to affirm her strengths and support her weaknesses. Paula is a 43-year-old HIV-positive Latina woman originally from Colombia. She is bilingual, fluent in both Spanish and English. Paula lives alone in an apartment in Queens, NY. She is divorced and has one son, Miguel, who is 20 years old. Paula maintains a relationship with her son and her ex-husband, David (46). Paula raised Miguel until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula is severely socially isolated as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood. Paula identifies as Catholic, but she does not consider religion to be a big part of her life. Paula came from a moderately well-to-do family. She reports suffering physical and emotional abuse at the hands of both her parents, who are alive and reside in Colombia with Paula’s two siblings. Paula completed high school in Colombia, but ran away when she was 17 years old because she could no longer tolerate the abuse at home. Paula became an intravenous drug user (IVDU), particularly of cocaine and heroin. David, who was originally from New York City, was one of Paula’s “drug buddies.” The two eloped, and Paula followed David to the United States. Paula continued to use drugs in the United States for several years; however, she stopped when she got pregnant with Miguel. David continued to use drugs, which led to the failure of their marriage. Once she stopped using drugs, Paula attended the Fashion Institute of Technology (FIT) in New York City. Upon completing her BA, Paula worked for a clothing designer, but realized her true passion was painting. She has a collection of more than 100 drawings and paintings, many of which track the course of her personal and emotional journey. Paula held a full-time job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Insurance (SSI) and Medicaid. Paula was diagnosed with bipolar disorder. She experiences rapid cycles of mania and depression when not properly medicated, and she also has a tendency toward paranoia. Paula has a history of not complying with her psychiatric medication treatment because she does not like the way it makes her feel. She often discontinues it without telling her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for at least five years. Paula accepts her bipolar diagnosis, but demonstrates limited insight into the relationship between her symptoms and her medication. Paula was diagnosed HIV positive in 1987. Paula acquired AIDS several years later when she was diagnosed with a severe brain infection and a Tcell count less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function of her right arm and hand, as well as the ability to walk. After a long stay in an acute care hospital in New York City, Paula was transferred to a skilled nursing facility (SNF) where she thought she would die. It is at this time that Paula gave up custody of her son. However, Paula’s condition improved gradually. After being in the SNF for more than a year, Paula regained the ability to walk, although she does so with a severe limp. She also regained some function in her right arm. Her right hand (her dominant hand) remains semiparalyzed and limp. Over the course of several years, Paula taught herself to paint with her left hand and was able to return to her beloved art. In 1996, when highly active antiretroviral therapy (HAART) became available, Paula began treatment. She responded well to HAART and her HIV/AIDS was well controlled. In addition to her HIV/AIDS disease, Paula is diagnosed with hepatitis C (Hep C). While this condition was controlled, it has reached a point where Paula’s doctor is recommending she begin treatment. Paula also has significant circulatory problems, which cause her severe pain in her lower extremities. She uses prescribed narcotic pain medication to control her symptoms. Paula’s circulatory problems have also led to chronic ulcers on her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to ambulate and leave her home. As with her psychiatric medication, Paula has a tendency not to comply with her medical treatment. She often disregards instructions from her doctors and resorts to holistic treatments like treating her ulcers with chamomile tea. Working with Paula can be very frustrating because she is often doing very well medically and psychiatrically. Then, out of the blue, she stops her treatment and deteriorates quickly. I met Paula as a social worker employed at an outpatient comprehensive care clinic located in an acute care hospital in New York City. The clinic functions as an interdisciplinary operation and follows a continuity of care model. As a result, clinic patients are followed by their physician and social worker on an outpatient basis and on an inpatient basis when admitted to the hospital. Thus, social workers interact not only with doctors from the clinic, but also with doctors from all services throughout the hospital. 23 SESSIONS: CASE HISTORIES • THE CORTEZ FAMILY After working with Paula for almost six months, she called to inform me that she was pregnant. Her news was shocking because she did not have a boyfriend and never spoke of dating. Paula explained that she met a man at a flower shop, they spoke several times, he visited her at her apartment, and they had sex. Paula thought he was a “stand up guy,” but recently everything had changed. Paula began to suspect that he was using drugs because he had started to become controlling and demanding. He showed up at her apartment at all times of the night demanding to be let in. He called her relentlessly, and when she did not pick up the phone, he left her mean and threatening messages. Paula was fearful for her safety. Given Paula’s complex medical profile and her psychiatric diagnosis, her doctor, psychiatrist, and I were concerned about Paula maintaining the pregnancy. We not only feared for Paula’s and the baby’s health, but also for how Paula would manage caring for a baby. Paula also struggled with what she should do about her pregnancy. She seriously considered having an abortion. However, her Catholic roots paired with seeing an ultrasound of the baby reinforced her desire to go through with the pregnancy. The primary focus of treatment quickly became dealing with Paula’s relationship with the baby’s father. During sessions with her psychiatrist and me, Paula reported feeling fearful for her safety. The father’s relentless phone calls and voicemails rattled Paula. She became scared, slept poorly, and her paranoia increased significantly. During a particular session, Paula reported that she had started smoking to cope with the stress she was feeling. She also stated that she had stopped her psychiatric medication and was not always taking her HAART. When we explored the dangers of Paula’s actions, both to herself and the baby, she indicated that she knew what she was doing was harmful but she did not care. After completing a suicide assessment, I was convinced that Paula was decompensating quickly and at risk of harming herself and/or her baby. I consulted with her psychiatrist, and Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula was extremely angry at me for the admission. She blamed me for “locking her up” and not helping her. Paula remained on the unit for 2 weeks. During this stay she restarted her medications and was stabilized. I tried to visit Paula on the unit, but the first two times I showed up she refused to see me. Eventually, Paula did agree to see me. She was still angry, but she was able to see that I had acted with her best interest in mind, and we were able to repair our relationship. As Paula prepared for discharge, she spoke more about the father and the stress that had driven her to the admission in the first place. Paula agreed that despite her fears she had to do something about the situation. I helped Paula develop a safety plan, educated her about filing for a restraining order, and referred her to the AIDS Law Project, a not-for-profit organization that helps individuals with HIV handle legal issues. With my support and that of her lawyer, Paula filed a police report and successfully got the restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a sense of control over her life. From a medical perspective, Paula’s pregnancy was considered “high risk” due to her complicated medical situation. Throughout her pregnancy, Paula remained on HAART, pain, and psychiatric medication, and treatment for her Hep C was postponed. During the pregnancy the ulcers on Paula’s feet worsened and she developed a severe bone infection, ostemeylitis, in two of her toes. Without treatment the infection was extremely dangerous to both Paula and her baby. Paula was admitted to a medical unit in the hospital where she started a 2-week course of intravenous (IV) antibiotics. Unfortunately, the antibiotics did not work, and Paula had to have portions of two of her toes amputated with limited anesthesia due to the pregnancy, extending her hospital stay to nearly a month. The condition of Paula’s feet heightened my concern and the treatment team’s concerns about Paula’s ability to care for her baby. There were multiple factors to consider. In the immediate term, Paula was barely able to walk and was therefore unable to do anything to prepare for the baby’s arrival (e.g., gather supplies, take parenting class, etc.). In the medium term, we needed to address how Paula was going to care for the baby day-to-day, and we needed to think about how she would care for the baby at home given her physical limitations (i.e., limited ability to ambulate and limited use of her right hand) and her current medical status. In addition, we had to consider what she would do with the baby if she required another hospitalization. In the long term, we needed to think about permanency planning for the baby or for what would happen to the baby if Paula died. While Paula recognized the importance of all of these issues, her anxiety level was much lower than mine and that of her treatment team. Perhaps she did not see the whole picture as we did, or perhaps she was in denial. She repeatedly told me, “I know, I know. I’m just going to do it. I raised my son and I am going to take care of this baby too.” We really did not have an answer for her limited emotional response, we just needed to meet her where she was and move on. One of the things that amazed me most about Paula was that she had a great ability to rally people around her. Nurses, doctors, social workers: we all wanted to help her even when she tried to push us away. The Cortez Family David Cortez: father, 46 Paula Cortez: mother, 43 Miguel Cortez: son, 20 24 SESSIONS: CASE HISTORIES • THE CORTEZ FAMILY While Paula was in the hospital unit, we were able to talk about the baby’s care and permanency planning. Through these discussions, Paula’s social isolation became more and more evident. Paula had not told her parents in Colombia that she was having a baby. She feared their disapproval and she stated, “I can’t stand to hear my mother’s negativity.” Miguel and David were aware of the pregnancy, but they each had their own lives. David was remarried with children, and Miguel was working and in school full-time. The idea of burdening him with her needs was something Paula would not consider. There was no one else in Paula’s life. Therefore, we were forced to look at options outside of Paula’s limited social network. After a month in the hospital, Paula went home with a surgical boot, instructions to limit bearing weight on her foot, and a list of referrals from me. Paula and I agreed to check in every other day by telephone. My intention was to monitor how she was feeling, as well as her progress with the referrals I had given her. I also wanted to provide her with support and encouragement that she was not getting from anywhere else. On many occasions, I hung up the phone frustrated with Paula because of her procrastination and lack of follow-through. But ultimately she completed what she needed to for the baby’s arrival. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children, and was also able to secure a crib and other baby essentials. Paula delivered a healthy baby girl. The baby was born HIV negative and received the appropriate HAART treatment after birth. The baby spent a week in the neonatal intensive care unit, as she had to detox from the effects of the pain medication Paula took throughout her pregnancy. Given Paula’s low income, health, and Medicaid status, Paula was able to apply for and receive 24/7 in-home child care assistance through New York’s public assistance program. Depending on Paula’s health and her need for help, this arrangement can be modified as deemed appropriate. Miguel did take a part in caring for his half-sister, but his assistance was limited. Ultimately, Paula completed the appropriate permanency planning paperwork with the assistance of the organization The Family Center. She named Miguel the baby’s guardian should something happen to her.
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