Discussion 1: Looking Through Different Lenses
Discussion 1: Looking Through Different Lenses
As a social worker, you bring your own lensthat is, your own set of assumptions, biases, beliefs, and interpretationsinto your interactions with clients and the human services professionals with whom you collaborate. Human services organizations have their own cultures that influence their organizational lenses. An organizational lens reflects key assumptions about the individuals to whom the organization provides services. These assumptions influence the organizations policies and procedures which, in turn, impact service delivery. For example, an organization that focuses on understanding the perspectives of the clients it serves may allow clients to provide feedback about their client experience through membership on advisory boards or boards of directors. The clients may have the power to make recommendations and decisions about the organizations policies and procedures.
Understanding cultural lensesyour personal lens, as well as those of the organizations and other individuals with whom you work and interactwill enable you to better serve your clients.
Focus on the Paula Cortez case study for this Discussion. In this case study, four professionals present their perspectives on the Paula Cortez case. These workers could view Paulas case through a variety of cultural lenses, including socioeconomic, gender, ethnicity, and mental health. For this Discussion, you take the role of the social worker on the case and interpret Paulas case using two of these lenses.
By Day 3
Post how you, as a social worker, might interpret the needs of Paula Cortez, the client, through the two cultural lenses you selected. Then, explain how, in general, you would incorporate multiple perspectives of a variety of stakeholders and/or human services professionals as you treat clients.
Required Readings
Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Los Angeles: Sage Publications
Reprinted by permission of Sage Publications via the Copyright Clearance Center.
Chapter 15, Culture and Leadership (pp. 383421)
Chun-Chung Chow, J., & Austin, M. J. (2008). The culturally responsive social service agency: The application of an evolving definition to a case study. Administration in Social Work, 32(4), 3964.
Cortez Family: A Meeting of an 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 Paulas 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 medsno 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 Paulas psychiatrist for close to 10 years, I have followed her progress in and out of the hospital for quite a whileand I know her very well. She is often non-compliant with her medications, randomly stopping them after she reports she doesnt 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 medicationand 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 43in addition to her HIV and Hepatitis status and her bipolar diagnosismust 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 hes a bad man and he wont 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 doesnt 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 infantlet 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 cant have a healthy baby. If she keeps up with her HAART medications and comes to her prenatal visits, theres no reason this baby cant 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 dont see that we would have to recommend termination.
Social Worker
Dialogue 2
Paula has overcome many obstacles in her life, but a babyat her age and with her medical profileis very different. Paula has made many bad decisions in her life, and the…
