Running head: PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT

Psychosocial Rehabilitation Clinical Assignment Dermot Connolly Stenberg College PSYN 212-6 M. Jordan Aug 2013

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Psychosocial Rehabilitation Clinical Assignment The universality and effectiveness of the psychosocial rehabilitation model has being well documented and demonstrated through its application across a wide range of psychiatric

disciplines. Of particular interest is its application in the correctional sector as it has successfully served to rehabilitee into the community many incarcerated clients throughout the years. The purpose of this discussion is to demonstrate the effectiveness of that rehabilitation model using a case study example of a client serving an eight year sentence for aggravated assault and breach of the peace. The client in question is a thirty four year old aboriginal male who is eligible for parole in September 2013 (Correctional Services Canada 2012) who will hereafter be referred to as either client or by his initials KB. An initial holistic assessment of the client will be carried out demonstrating the clients physiological, cultural, spiritual, psycho-social and mental well being. This will be followed by a more focused assessment demonstrating the clients current condition in the form of a mental status exam. In addition, the psychosocial rehabilitation needs of the client will be assessed against the resources available from two communities in the lower mainland. First an analysis of each community is presented before identifying five community agencies within each community that meets the diverse needs of the client presented in this report. Case Study Holistic Assessment

Physiological :

KB had carpel tunnel release surgery on his right hand in 2010. He was referred for further assessment of his left hand, but did not attend the appointment. In 2011, he complained of pain in his left wrist and a numbness that kept him awake at night. He was referred to

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT physiotherapist who provided him with stretching exercises. (Correctional Services Canada 2012). This condition may prevent the client from engaging is certain activities or employment that involves the repetitive use of his right hand such as clerical activities, loading, lifting or twisting. The client has no other history of documented medical conditions. (Correctional Services Canada 2012).

Cultural:

KB is aboriginal and values his culture. He originates from a reserve in Saskatchewan and speaks native Cree. Prior to his incarceration, he identified with many of the customs associated with Native culture such as hunting and trapping. KB has received a ten year ban from holding any weapons, ammunition or explosives from a previous conviction which will inhibit his ability to pursue some of these interests once he is released. (Correctional Services Canada 2012). He enjoys participating in other native activities such as pow wow dancing and aboriginal artwork. (Correctional Services Canada 2012).

Spiritual:

KB claims to be quiet spiritual, attending ceremonies with the elders within the aboriginal chapel located in the prison. (Correctional Services Canada 2012). KB may do well being placed in a facility that is respectful to the needs of the aboriginal community.

Psycho-Social:

Within the prison, KB has a good relationship with his peers, clinical staff and correctional officers. He has responded well to positive reinforcement where he has walked away

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT from provocation where has being observed at managing his emotions appropriately. (Correctional Services Canada 2012). Client also remains in contact with some of his family members in Saskatchewan but reports that many of his former friends are now involved in gang lifestyles and substance use and as a result does not associate with them any longer. (Correctional Services Canada 2012). KB has never lived on his own before and has not yet applied any of the skills obtained from his occupational therapy interventions into real life situations. KB has shown that he is independent with cooking but would benefit from assistance with budgeting and grocery shopping. It is likely that he will also require assistance with managing his finances. (Correctional Services Canada 2012).

Mental Health:

KB has not being diagnosed with a mental condition and as such has not being prescribed any psychotropic medications. He denies distortions of thoughts although he does admit that he is still prone to some suspiciousness of others when decisions are vague or delayed being communicated to him. (Correctional Services Canada 2012). He occasionally experiences ongoing headaches associated with the long term consequences of major head trauma inflicted as a child. He is focused and self reports no overt mental health concerns outside of anxiety relating to his impending release into the community. (Correctional Services Canada 2012). As a result, it is expected that the client would benefit from programs that will improve the clients cognitive functioning use as the use of a memory book to help him keep track of his scheduled appointments and activities. (Correctional Services Canada 2012). Such activities will help keep the client focused and reduce anxiety.

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Mental Status Exam

Attitude, Appearance, and General Behavior KB is a 6ft 4 age appropriate 34 year old aboriginal male with brown eyes and long brown hair. He has several tattoos on both his forearms and on the back of his hands. He is dressed in correctional issued blue jeans and t shirt. During our conversation, he appears relaxed with his hands by his sides at all times and engages readily in conversation. He is clean shaved and well groomed with clean fingernails. His eye contact is appropriate with normal psychomotor activity. Mood, Feelings and Affect KBs mood is calm throughout the interview although he states he is feeling anxious about his impending release as he is unsure how he will cope with independent living. Client reports he gets along with other inmates on his range while admitting that there are others he no longer speaks to. His emotional response was appropriate throughout with a flat affect. Perceptual Disturbances Client describes having sensations in his ears similar to buzzing noises and voices. He however denies any visual or auditory hallucinations. Client has a history of such complaints which are considered organic in nature as a historical consequence of a head injury suffered as a child.

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Thought Process KBs thought were organized and appropriate to conversation. He spoke only when spoken to but thoughts displayed productivity of thought and goal directed thinking towards his impending release. In 2010, KBs completed the neurobehavioral cognitive status examination to assess his level of cognitive functioning. KB scored in the moderate to severe range for impairment for attention (Correctional Services Canada 2012), although he remained engaged with writer throughout the interview. Cognitive Functions KB does not have diagnoses of a mental illness although he does report being inflicted with a head injury at the age of twelve as a result of being kicked by a horse. In 2011 KB consented to participate in the Rivermead Behavioral Memory Test which assessed the components of his prospective and retrospective memory. KB obtained a general memory index (GMI) of 67 which falls in the significant impaired range. (Correctional Services Canada 2012). On verbal and prospective memory tasks, KB scored higher on delayed recall suggesting that he would benefit from increased processing time. KB score demonstrated the greatest difficulty in new learning, indicating a significant impairment. (Correctional Services Canada 2012). Concentration and Attention Client is alert and oriented to time date and place. He has a history of picking at the skin around his nails when he is anxious (Correctional Services Canada 2012), which was evident throughout interview. He also stated that he uses a stress ball as an alternative but continues to engage in this behavior.

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Judgment KB displays traces of poor judgment. He understands the importance of displaying appropriate behavior while out on parole and the consequences for failing to do so. Yet he jokes about previous reported statements where he indicated his desire to scalp his parole officer. Insightful KB is insightful into the reasons behind why he is in prison displaying voiced concerns and regret over the circumstances that led to his incarceration. He is aware of his detailed rehabilitation plan and the steps he must take to prevent him from being re-incarcerated. Observed Rehabilitation Needs 1. Cognitive Functioning / Intellectual Capacity Objectives: To improve clients cognitive functioning such as goal directed behavior, problem solving, concentration and memory skills. The clients need to identify and cope with cognitive functioning deficits is also recognized. (Correctional Services Canada 2012).

Planned Interventions: The use of memory aids such as a memory book to remind the client of scheduled meetings and activities. (Correctional Services Canada 2012). 2. Thought Process and Emotions Management Objectives: To decrease rigid negative attitudes and beliefs or pro criminal thinking. To improve ability to implement relevant cognitive restrictive strategies such as problem solving, perception checking and clarification. (Correctional Services Canada 2012).

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Planned Interventions: Individual cognitive skills. 1:1 counseling with a focus on listening to others and preparing what you want others to hear. (Correctional Services Canada 2012). 3. Substance Abuse Objectives: To access the degree to which the client has a maladaptive pattern of substance abuse linked to relapse and / or reoffending. To reduce the use and reliance on alcohol and / or other drugs. (Correctional Services Canada 2012).

Planned Interventions: The placement of the client into a residential drug and alcohol treatment facility as a condition of his release. (Correctional Services Canada 2012). 4. Living Skills Objectives: To improve living skills to support more independent functioning within institutional / community environments. (Correctional Services Canada 2012). Planned Interventions: To date there has being limited opportunity for the client to practice independent living skills. Client has participated in an independent living scales assessment, completed a meal management group and participated in training related to money management. Client is encouraged to continue practicing these skills within the community and is encouraged to attend other banking and budgeting workshops once released. (Correctional Services Canada 2012). 5. Education Objectives: To enhance meaningful involvement in educational activities aimed at increasing self-efficacy and potential for successful community integration. (Correctional Services Canada 2012).

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Planned Interventions: Client is currently working on his ABE 2 level school work and is encouraged to continue to further his education once released. (Correctional Services Canada 2012). Summary of Acquired Communities The two communities chosen as being suitable locations for the transition and

rehabilitation of my client are Langley and Vancouver. Langley was chosen due to its pedestrian friendly downtown core coupled with its extensive translink bus routes and cycle lanes. (City of Langley 2013). Access to grocery stores, independent stores, farmers markets and the Willowbrook shopping mall is easily accessible on foot or via translink. My client will benefit from these services as he attempts to practice his living and money management skills. Langley is a growing economy with large industrial and service industry employing many local residents which will enable my client to engage in active employment. In addition Service Canada has an office based in Langley which offers employment services to those looking for work. Langley is a small tight knit community with its own school district offering continued secondary education which would identify with my clients accessed education needs. In addition, third level adult education classes are also available through Kwantlen University. Langley central location in the lower mainland coupled with its relaxed lifestyle and access to over 300 acres of parks will benifit my client as he attempts to manage his thoughts and emotions. (City of Langley 2013). Langleys other list of amenities include its own airport and hospital together with a network of local doctors and specialists. (City of Langley 2013). The city of Vancouver was chosen due to its proximity to the downtown core and the extensive list of services and amenities that accompany that location. Vancouver has an

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ethnically diverse population accepting of all minority groups including Aboriginals. (Living in Canada n.d.).Compared to other Canadian cities, Vancouver has a more relaxed feel to it in addition to an established aboriginal population (Living in Canada n.d.), both of which will benefit my client as he attempts to acclimatize into his new community and address his emotions. Vancouver is also British Columbias commercial hub and is Canadas largest industrial centers with a diverse economy. (Living in Canada n.d.). Coupled with an extensive local transportation system that includes buses, ferries, bike access and skytrain service, my client will have ample opportunity to engage in employment opportunities. Vancouver also has the largest range of support services for my client should he every need them, ranging from counselling, medical, addictions and housing. (Living in Canada n.d.). In addition to the network of secondary education facilities in Vancouver, the city also has two major universities, the British Columbia Institute of Technology and several community colleges (Living in Canada n.d.) all of which allows my client to further his education if he chooses to do so. With so many activities and is proximity to the coast, Vancouver is an ideal location for my client to be released into the community. The only concern that remains is the high crime rates associated with the city which may decompensate my client. Community Agencies Tables 1 and 2 below provides a summary of the five community agencies identified to meet the observed rehabilitation needs of the client in both the Langley and Vancouver areas.

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Table 1: Community Agencies Langley Observed Rehabilitation Need Cognitive Functioning / Intellectual Capacity Community Agency Community Therapists Services Provided Provide a range of assessment and treatment services for clients experiencing physical, cognitive, developmental and psychological disabilities. Counseling services for; Anger Management Relationships Self Esteem Family Divorce Abuse Holistic drug treatment centre for individuals with dependency addictions A chef training program A Hospitality server training program A building service worker training program Offers secondary school options for adults and teenagers looking to continue and complete their secondary education Location 200 15387 - 104th Avenue Surrey, BC V3R 1N5

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Reference

(Community Therapists 2013).

Thought Process and Emotions Management

Inner Solutions Counseling Services

Inner Solutions Counselling Services Langley, British Colum bia Canada V2Y 3B5

(Inner Solutions Counselling 2013).

Substance Abuse

LDR Holistic Wellness Centre The Salvation Army

Living Skills

5724 Glover Road, Langley British Columbia Canada, V3A 4H8 5787 Langley Bypass, Langley, BC V3A 0A9

(LDR Holistic Wellness Centre n.d.). (The Salvation Army 2009).

Education

Langley Education Centre

20216 Fraser Highway, Langley BC.

(Langley Education Centre n.d.).

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Table 2: Community Agencies Vancouver Observed Rehabilitation Need Cognitive Functioning / Intellectual Capacity Community Agency Community Therapists Services Provided Provide a range of assessment and treatment services for clients experiencing physical, cognitive, developmental and psychological disabilities. Counseling services for; Anger Management Relationships Self Esteem Family Divorce Abuse Individual, couple and family addiction counselling services Assesses the needs of the client and recommends appropriate treatment options. Skills development programs Educational programs Legal Services Recreational and social activities Skills development programs Educational programs Legal Services Recreational and social activities Location

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Reference

#203 5740 Cambie street Vancouver, BC V5Z 3A6.

(Community Therapists 2013).

Thought Process and Emotions Management

Inner Solutions Counseling Services

Inner Solutions Counselling Services 1178 Hamilton Street Vancouver, British Col umbia Canada V6B 2S2 Vancouver Coastal Health Corporate Office 11th Floor, 601 West Broadway Vancouver, BC V5Z 4C2

(Inner Solutions Counselling 2013).

Substance Abuse

Vancouver Coastal Health

(Vancouver Coastal Health 2013).

Living Skills

Belkin House. The Salvation Army

555 Homer St Vancouver, BC V6B 1K8

(Belkin House n.d.).

Education

Belkin House. The Salvation Army

555 Homer St Vancouver, BC V6B 1K8

(Belkin House n.d.).

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT Writers Observations

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KB has made extensive improvement against his rehabilitation plan since his incarceration which is a testimony to the work of both the client and his treatment team. This report has helped the writer identify with the role of the psychiatric nurse in meeting the rehabilitation and treatment needs of the client. In particular the holistic approach to rehabilitation was evident through the engagement of a multifunctional team in the identification and treatment of the clients needs. Positive reinforcement was evident throughout which empowered the client to actively engage with his treatment team and resulted in his successful release from his correctional facility. Throughout the research for this report, the writer was exposed and overwhelmed with the extensive amount of community support programs available to all clients seeking assistance. While the views of the writer have not being altered, they have being enlightened into the importance of the community psychiatric nurse. Not only is the psychiatric nurse responsible to advocate for their client, but they are also an important cog in the wheel of a larger team of support services that include the clients psychologist, parole officer, social worker, occupational therapist and of course the client themselves. The writer found the experience of completing this assignment both educational and humbling.

PSYCHOSOCIAL REHABILITATION CLINICAL ASSIGNMENT References

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Belkin House (n.d.). Retrieved from: http://www.belkinhouse.ca/

City of Langley (2013). Retrieved from: http://www.city.langley.bc.ca/

Community Therapists (2013). Retrieved from: http://www.communitytherapists.com/

Correctional Services Canada (2012). RTC initial treatment plan summary. Retrieved from: Internal internet communications Regional Treatment Centre Canada. Inner Solutions Counselling (2013). Inner solutions counselling services. Retrieved from: http://www.iscounselling.ca/ Langley Education Centre (n.d.). Retrieved from: http://www.sd35.bc.ca/schools/lec/default.aspx Living in Canada (n.d.). Living in Vancouver British Columbia. Retrieved from: http://www.livingin-canada.com/living-in-vancouver.html LDR Holistic Wellness Centre (n.d.). Retrieved from: http://www.holisticdrugrehab.org/ The Salvation Army (2009). Langleys gateway of hope shelter officially opens its doors. Retrieved from: http://www.salvationarmy.ca/2009/11/26/langley%E2%80%99sgateway-of-hope-shelter-officially-opens-its-doors/ Vancouver Coastal Health (2013). Adult addiction counselling Vancouver downtown community health centre. Retrieved from: http://www.vch.ca/403/7676/?program_id=10926