Discharge Case Study

The hospital that I worked for while working as a case manager was not in network with Kaiser Permanente. It was also the time when the hospital started to hire hospitalists to manage patient care while they are a patient in the hospital. It actually worked out because it filled in the gap in patient care. The hospitalists were acting as the patient's primary care provider. Kaiser as with many other insurance have a case manager designated to ensure that the patient is meeting criteria not only for an inpatient hospital stay but for the level of care they are receiving as well such as ICU, Stepdown, or Med-Surg. I would have to give them an updated clinical information daily or every 3 days depending on the severity of illness. As a case manager, I was responsible for discharge planning and I preferred to transfer the patients to

S has quite a strong baseline of strengths. Firstly, Mrs. S is a very kind man, never lashing out during interviews, always receptive of health provider interventions even when he might not agree. In addition, he has completed his high school diploma. Mr. S is also good at maintaining and looking after his room at the booth, as evidenced by the recounts of the case manager’s room visit. In addition, Mr. S always attends his medical appointments, and IM injection appointments, and has good insight on their importance. The patient is also has insight to find help from the institute or ER if warning signs, or symptoms creep up. Mr. S is also responsible enough to call if he cannot make an appointment. In addition, he has good personal hygiene during his visits. Mr. S also has a number of deficits he has to combat. First of the deficits, include his ¬¬lack of social support; like previously mentioned about his parents, half-sister or half-brother. This can put Mr. S at risk for redevelopment of avolition and negative symptoms that have previously hindered his success, and will become deficits. Another deficit is his inability to manage his own finances and money, as he gets his welfare allowance every week from his case manager, and social worker, who also manages his finances. A third deficit might be his inability to get food. The final deficit, would be his situation with the Booth Center, as he might find himself to be homeless. Mr. S’ only resources are the case manager, the writer, social worker, and the FEPP

REQUEST, REASON, ISSUES, BOARD TYPE, AND DECISION: The applicant requests an upgrade of his uncharacterized discharge to honorable. The applicant states, in effect, he served for four years in the National Guard and deployed to Afghanistan in 2005 thru 2006. The applicant contends, he enlisted upon redeployment despite having Post-traumatic Stress Disorder (PTSD) symptoms and other medical problems. The applicant states, he requested counseling for his PTSD, instead he received a counseling statement informing him that he would receive an entry level status (ELS) separation with an uncharacterized discharge. The applicant further contends, he was diagnosed with PTSD and rated 40 percent disabled rating by the VA for PTSD. The applicant states, he had held a position as the communications sergeant with the McAllen Police Department after being discharged. The applicant contends, he is an upstanding member of the community has never been in trouble with the law, and this is evidence of his desire to serve. The applicant further contends, he served his country honorably as an infantry Soldier and an uncharacterized discharge for PTSD is wrong. The applicant states, an honorable discharge would do justice for the unfortunate administrative action taken against him in September 2006.

Objectives/Progress: As the Pt. has participated in the AMS program since 8/24/16 and he has been able to maintain abstinence from all illicit drugs for 6 months straight t. Pt.'s UDS has shown no evidence of drug use or lapse/relapse. Pt. is currently in the action stage of change as indicated by reminding himself of how much progress he has made and ability to change his behavior and achieve goals during the past quarter. He has currently obtained a full-time job as a shelving installer. Patient reports as scheduled to receive maintenance medication services as instructed by AMS Doctor and attends all mandatory one therapy session once a month. He continues to share his understanding of being powerless and unmanageable over his addiction. During the next quarter sessions, Counselor will support a realistic view of change through small steps.

Problem #5 Illicit opiate use Goal(s): To become drug free Status: Active Objectives/Progress: Pt. has not done well in achieving his goal of maintaining abstinence from all illicit substance use over the last quarter as evidenced by his positive UDS. Patient’s last urine screen results indicate that opiates have been used. Pt. reported that he was able to be clean from more than 30 days but he used drugs while walking through his neighborhood. Counselor expressed concern and disappointment about his recent relapse on heroin. During last month session, Pt. recognized the danger of the situation and how he will avoid the acquaintance that offered him drug. Pt. has failed to move to Phase 1 of the AMS of DE TX program due to his four positive UDS since entering the program on 7/6/16.Counselor will meet with Pt. to examine pt.'s motivation to stay clean, how to deal with triggers in order to achieve continued abstinence, to help him recover from his recent relapse and reenter the change process.

Problem # 5 Illicit opiate use Goal(s): to be free from illicit drugs. Status: Active Objectives/Progress: Pt. has struggled with continued use of illicit drugs (marijuana, opiates and amphetamines) and his last quarter UDS reflect a pattern of heavy substance use. Pt. was encouraged to work with the medical staff to achieve a stable dosing level. Pt. is regularly taking his medication as prescribed by AMS Doctor and he stated his current prescribed methadone 90 mg is working "well". During the last quarter, Pt. made progress on developing a therapeutic relationship with his new AMS counselor for the upcoming quarter. Also, Counselor focused therapy session on establishing rapport and building trust with him. Pt. is currently in the contemplation stage of change because he more open to receiving information about his negative habits and willing to use educational interventions which he agreed with this assessment. Pt. was reinforced for any statement that reflected acceptance of his chemical dependence and acknowledgment of the negative consequences that opiates has had on his life. During the upcoming quarter, Counselor will assist Pt. to discuss and weigh the pros and cons of continuing his addictive

PO showed up for his scheduled appointment on time with a positive attitude. PO indicated that he is doing well with treatment and work, attends community self-help meeting as recommended, and comply with all DOC and treatment requirements as he realizes how important to be a responsible person, and change his addictive behaviors. No struggles or urges/cravings for substance use was reported. Informed PO that his case will be discussed for completion in two weeks. New ISP for continuing care was developed.

Met with PO for an individual session to discuss treatment progress and concerns. PO was on time with a delightful attitude. PO has a positive response to treatment, and is in compliance with treatment expectations. Reported no alcohol or substance use, clean and sober date as 11-03-2015. Indicated that he "got a driver license", the first driver license in his life, and plans to buy a car and insurance next week. PO stated that he keeps himself busy as boredom is one of his major relapse triggers. New ISP was established in Dim. 5 to develop a balanced life style without substance use.

History of Present Illness: The patient has been seen in this clinic since 2016. She is diagnosed to have ADHD, Bipolar II disorder, Generalized Anxiety disorder, Alcohol and Cannabis use dependence. The patient has struggled with separation from an abusive ex-husband, who is currently

SSA received a phone call from Verna Goecke-PRPV inquiring if the Bond family was aware of Katlyn’s discharge from the facility. She stated that she had not heard from Mr. Bond regarding the discharge notice and according to Katlyn she had not discussed the discharge arrangements with her parents. SSA shared that two messages had been left on Karen Kohn’s cell phone. We discussed that in the event the family did not arrive to the meeting location this morning, PRPV was willing to transport Katlyn to the family home. Verna asked SSA to email the family’s home address in the even they needed to transport Katlyn to the home.

The client stated that due to his addiction, he would place himself in dangerous situations. The client has been able to identify previously unknown triggers that lead to relapse. For example, the client stated that he would drink large amounts of alcohol because it "wasn’t my drug of choice". The client soon relapsed on his drug of choice. The client stated, "I never thought about why I relapsed before". The client expressed the importance of aftercare to maintain long-term sobriety. The client attends weekly AA/NA and Big Book meetings in the PWC ADC. The client will continue to work on identifying and developing healthy coping skills, learning and building an awareness of triggers, understanding the importance of aftercare, and working on a relapse prevention

10:24-10:50 AM SC completed monitoring phone call with Pa on 12/24/2015. SC spoke with Tina Carroll Pa’s dtr and CG/DOC. Tina reported that Pa is getting worse and she is just doing the best she can. No falls, ER visit, hospitalization or medications were reported since last contact. Tina reported that Pa is satisfied with services and her agency and aides. Tina is requesting weekend PAS support. SC informed the Tina that SC will assess Pa’s needs that home visit in January, 2016 Tina agrees. Tina confirmed that Pa is receiving services as indicated in the ISP in the following type, scope, amount, frequency and duration: Pa receives Agency Model PAS 4 hours 5 days a week 10am - 2pm via Independent Home Care. PAS provide assistance with bathing,

said he plans to follow through with treatment recommendations and stop smoking marijuana, because he wants to earn take home privileges and he is going to be really busy at his work. Counselor explained the take home request form and the requirements to move to Phase 1 of the tx program. Pt. commented that he would like to attend the AMS clinic once a week by this summer. Pt. said he does not have a problem asking his supportive people and AMS staff to help him with identifying negative habits and behaviors that he may not always recognize. Also in this session, Pt. learned the stages of change and processed assignment “My Action Plan for Sobriety.” Pt. and writer discussed the ways in which sobriety and relapse are processes, and the ways in which relapse is a decision process. Pt. examined the different types of relapse warning signs he experienced, and he reviewed the components of a full recovery program, including those components that are challenging for him. Pt. processed the progression of his addiction and previous negative lifestyle and how his mother treated so bad when growing up. Pt. reported that he is in the action stage because he has decided to quit and he would like to continue a drug free life.

PO attended group on time and engaged well in the group activities. PO had a strong participation in the group discussions as well. PO completed the Mapping Recovery exercise. PO stated that his goal is living a substance free life, and shared the benefit of being clean and sober with pers. PO indicated “stay clean and sober is importance because I can think better and make better decisions”. PO appears to understand that staying clean and sober is the basic principle for recovery, and appears to be in the preparation

D: Met with client for an individual session and treatment plan review. Client presented a good attitude and outlook, response to treatment appears positive. Reported no use of alcohol or other substances. Reported taking medications for anxiety, stress, and chronic physical pains as prescribed. Reported taking Antabuse for alcohol use disorder as court ordered. Client indicated main area of concern is attending self-help meeting. Client demonstrated variable compliance with treatment expectations, such as treatment group attendance, UA result was negative for alcohol and other substances. Client showed improvement on relapse prevention and problem solving skills, and is working on establishing and maintaining meaningful, intimate interpersonal relationship.