Blind Taper Case Summary

3. The patient had informed this writer initially of his goals of wanting to return back to the Hartford Dispensary due to the length of time he has been with the clinic and his positive rapport with his prior counselor at the other facility. The patient was compliant with his individual sessions with this writer and provided cancellation if unable to attend the session in the meantime while he awaits on the process of completion with his intake at Hartford Dispensary.

D-The patient arrived on time for her session. Reports stable on her dose. This writer discussed about tapering off on her methadone, at which the patient is willing to consider doing, but needs more time. She then says, " I might consider doing it next month, but not right now......I was doing it before, but it stopped....just want to take my time." The patient then discussed about having to go to SSA to obtain the payment for the funeral cost. The patient is upset about the small amount she is about to receive. This writer discussed the grieving process of her loss of her husband and also, her mother in law. The patient appeared to be annoyed with her son for not participating in his grandmother funeral arrangement and also, not showing

D-Met with the patient to address a fax from DCF request of the patient records. The patient immediately said, " Don't send this shit. I cannot stand that worker.....I was in court the other day and I am tired of this and this worker always in my business." The writer explained to the patient that should he continue to refuse to sign an ROI, it may hurt his reunification with his son as the patient detailed to this writer about how DCF got involved in his life ( According to the patient, he was intoxicated when visiting his son and a case was called against him and the child's mother). The patient made it clear to the writer that he has no desires to signed an ROI for DCF and for the clinic to ignore DCF request.

D-This writer met with the patient upon her request to complete the dose change request form to lower her dose as the patient experience she wants to start tapering off methadone as the patient haven't used any illicit drugs for several months. This writer completed the dose change request form with the patient pressence and also, assessed the patient that she has not experience any withdrawals since prior increase based on her order history. The patient denies any cravings and withdrawals. Furthermore, while completing the request, this writer learned that the patient is prescribed with Albuterol inhaler and strongly urges the patient to bring in the RX script tomorrow. The patient complained that no one has ever told her of this and this

Supervisor Comments: This writer met with Cherron to address services due by counselor and reminded the Cherron about submitting his services by staff by day every week on Friday, of which Cherron have been doing. Cherron is still behind on his treatment; however, he was able to update this writer about the status of where he is with getting current with his work. Based on the services due provided from Cherron, Cherron is in need of 5 patient signatures and few was already submitted to the Clinical Director, but pending. This writer offered to help Cherron if he is in need to obtained the patient signature.

SC contacted Jonathan about his progress on controlling his diabetes. Jonatahan noted he just come back from his PCP. He informed SC that he level was high. He noted the PCP said his weight is has increase which is why is diabetes is high. The doctor recommend a low – carb diet and exercise. Jonathan noted he will work on his diet and exercise more. Jonathan noted his eating habits changed once he stop going to day hab. SC asked Jonathan about his behavior at his previous day and would he like behavior support. Jonathan noted he don’t want behavior support and he has not had the behavior since he left day hab. SC asked if be around his peers since he left the day Hab. He noted yes

The patient was not pleased with the new and again, he was emotional. This writer provided a explanation as to why this is occurring due to this writer current position. However, in the event, should the patient needs an assistance he can request to see this

D-According to the patient, she is excited to be admitted to the take home bottle group today. The patient thanks this writer in a joyful manner. During the course of the session, this writer commends the patient as she's been compliant with treatment, mental health services, and maintaining a negative UDS result. In addition, this writer and the patient completed the first take home application. This writer advised the patient that this writer will be monitoring her mental health services every quarter to ensure the patient is maintaining compliance with her mental health treatment.

Indicate the expected outcome for D.Z. that is associated with each of the medications he is receiving.

D-The patient reports she is stable on her current dose and haven't experienced any withdrawals and/or cravings. The patient further mentioned that work is going okay, but still exploring other job opportunities. This writer provided positive feedback towards the patient's recovery process. In addition, the patient reports she has to do a pneumonia test as it was suggested by her PCP today. This writer requested for the patient to detailed if she's experiencing any symptoms and would like to consult with the clinic medical doctor. Based on the patient, she reports she was experiencing some backaches, but now, feels okay. During the remainder of the session, the patient discussed her plans for the Easter holiday and also shared with this writer that today is her son birthday.

The patient reports DCF was called against her by an anomoymous caller, who reports that the patient had drugs in the car in the present of her child. The patient was emotional and blames her boyfriend mother, who the patient reports has an vendetta against her. When asked by this writer for more details and the patient reponse was, " I do not know. She's mad that her son is not talking to her......His family does not treat him good." The patient signed a ROI in the event that DCF was to call. The patient does not want her UDS results to be revealed only her pressence in treatment and dose history.

In this meeting, a formal plan will be put together with others who have experience from the different disciplines being recommended in the treatment plan. There are three goals for this presentation. First, is determining a provisional diagnosis since they are usually required for billing purposes and can be changed after the client has been observed. Second, a level of case management will need to be assigned if your agency uses different levels. The final goal is to determine the type of service the client will receive. (Summers, 2012) Once the treatment plan has been finalized, it is time to review it with Mr.

D-The patient arrived on time for her appointment and this writer apologized for meeting with the patient late as this writer was meeting with another patient prior, which interefere with this patient appointment time. The patient was clearly understanding and waited patiently. Reports stable on her dose. Denies cravings/withdrawals. However, the patient is still actively using and reported, it has nothing to do with withdrawals or cravings. The patient is unable to provide a proper reason for her use, besides shrugging her shoulder as she says, " i do not know why." Patient last used was yesterday, cocaine- $40 worth. The patient then reported, she only uses cocaine less then once a month. This writer addressed alternatives.

Since the decision was to start the transition from Station 10+00.00, and the calculated length of taper is 1000 feet, the end of the taper would be at Station 20+00.00 that means 549.47 feet after the first curve. The cross-section along the taper will have some differences.

A. Minor Point 1: Many patients can’t decide for themselves and it is not fair for family members to decide for them.