Mental Health Services: A Case Study

D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for

D-Met with the patient to discuss her Aruba trips. This writer advised the patient that this writer is making contact with some staff members at the hospital, but was unable to speak to someone from the psychiatry department due to the hours as there is a 2 hour difference. The patient appeared to cheerful to learn that this writer is moving her host application forward. According to the patient, she apologized about her behavior yesterday and says, " Bobby was on me like why your counselor is not doing anything. My counselor did this and that.....it's frustrate me." This writer informed the patient that this clinic did not ignore her request whereas this writer was aware of it a month ago, but there was barriers to the patient dose as she

RT had a scheduled medication management appointment with Mary Pestrak at 4:30pm on 6/15/16, but RT called NP Mary and rescheduled. RT stated that she wouldn't be able to come to TSI for her appointment. However, writer met with RT and inquired about RT's well-being and RT stated " I am doing good". RT informed writer that on 6/14/16, she went to her PCP and did blood work and is scheduled to go back to her PCP on 6/21/16 to get the completed physical form hat was provided to RT by writer. RT's medication management appointment is rescheduled for 6/22/16, RT ensured writer that she will be there. Writer informed RT that she is awaiting to hear from Marguerite to get more information on a GED program. RT was appreciative of writer's assistance.

D-The patient requested an increase on her dose as she reports that she is experiencing chills. When asked as to what alternatives has done to address the chills rather than using illicit drugs. The patient reports she's been taking each day at time and used relaxation techniques; however, at times the "chills" can be unbearable to the point the patient does not want to relapse because she's been drug free for over a year, at which this writer provided positive feedback for the patient recovery process. Furthermore, this writer and the patient discussed the suspension of the patient take home bottles as the patient reports that the reason why the bottles were suspended was due to her medication; however, the patient reports she provided the clinic with an updated letter from her psychiatrist and notification that she is no longer prescribed with Hydroxyzone and wants to apply for all of her take homes. This writer addressed with the patient about program policy about medication/take home bottles. Furthermore, two of the patient's medication needs an updated RX script before the patient request can be reviewed. Also, a letter from her psychiatrist once again about the patient compliance with treatment and medication management. The patient reports she can get the updated script by next as this writer will assist obtaining an updated letter from her psychiatrist about the patient's overall treatment. This writer completed the dose change request form to increase the patient's dose by 5mgs.

D-The patient arrived on time to attend the Women's Group. This writer advised the patient that the group session was cancelled due to low attendance; however, the patient agreed to meet with this writer for a 1:1 to get credit for attendance, This writer informed the patient about what to expect pertaining to topics of what will be discussed and then asked the patient about her expectation of the group session. Furthermore, this writer addressed with the patient about last week session regarding to patient #2570 comment. When asked by this writer as to how often she sees patient #2570, the patient response was, " Well, I am not trying to get anyone in trouble, but she drinks occasionally.....probably would have one to drink during special

D-The patient reports she is stable on her current dose and haven't used any illicit drugs since her last encounter with this writer. The patient reports her due date regarding to the birth of her child is scheduled for 05/03/2016. Futhermore, the patient is excited that she got her engagement and looking towards to planning her wedding next year around Halloween. The patient's missed the take home bottle group due to not feeling well.

D-The patient arrived late to her counseling session. Reported stability on her current dose and denies the need for a dose increase when offered by this writer. This writer addressed with the patient about her attitude about learning about her results yesterday as she appeared to be in a hurry and nonchalant about the result. According to the patient, he was affected by the news and says, " I had left over cocaine and threw it away.....I am done with that stuff." The patient updated this writer on her plans to change her mental health provider from CHR to the Hope Center as the patient dislike her psychiatrist at CHR. Furthermore, the patient reports, her CHR case manager will assist the patient referral to Chrysalis to be assigned with a

D/A: There were no medical appointments for Mr. Brown this week. Mr. Brown attended dialysis twice this week on 01/03/17 and 01/7/17 at the Fresenius Medical Center and received treatment on 01/5/17 at the Kent General Hospital. On 12/31/16, Mr. Brown was admitted to the Kent General Hospital and was discharged on 01/07/17 at 7 pm, where he was diagnosed and treated for Pneumonia and Congestive Heart Failure. Consumer has a new addition medication “Prednisone,’’ that he will be taking once in the morning for three consecutive days. Consumer did not meet with his Psychiatrist Dr. Capiro this week because he was admitted at Kent General Hospital.

D-Met with the patient to address her request for a change of counselor. According to the patient, she expressed that her assigned counselor shows no empathy towards her personal issues when she attempts to discuss it with her assigned counselor. The patient then says, " With Cherron, every session is negative, nothing positive. No encouragement by him......I've through a lot. I broke up with the love my life 8 months as he left me for another woman....I was there for him when he was incarcerated for two years (the patient was emotional-in tears). I tried to talk to Cherron but he was not being understanding. I, know, I keep testing positive, but I am going through a lot, you know. I am the care taker of my parents. No social life." This writer reviewed the patient's case history as there has been numerous no shows and the patient is currently on a Step 3 for the no shows/ongoing illicit use. According to the patient, she continues to miss her session due to her feelings towards her counselor. When questioned as to why she did not mentioned this prior as to why it took 8 months. The patient says, " I did and was told that it will be entered in some green book.....I need a female counselor that can relate to me or even have empathy. I need guidance and Cherron is not helpful at all.....He tends to keep me in session for an hour whereas it was suppose to be a 1/2 hour session." Nevertheless, the patient is seeking to enrol in mental health services through Brownstone for treatment or IOL.

D-The patient arrived on time for her scheduled appointment. According to the patient, she wants to increase on her dose, but needs more time to think about it without feeling pressured. The patient reports that she hasn't used any cocaine or THC for the past four days, at which this writer commends the patient for her effort to not using any drugs. The patient appeared to be very emotional discussing her husband's death and struggle with coping with the loss. This writer and the patient discussed coping skills whereas the patient is coping by being a grandmother to her grandchildren. The patient then discussed briefly about how her husband's death affected the family to the point that her son, who lives in Kenturky attempted to suicide at least 4 times. The patient tends to stay in communication with her son to ensure of his safety and well-being. As for the patient's daughter, the patient was again emotional discussing her daughter using heroin and being influenced by her boyfriend. The patient reports about talking to her daughter about her lifestyle, but nothing has prevail. This writer discussed with the patient about continuing to be a supportive mother and reaching out to her daughter to abstain from illicit drugs. This writer learned that the patient lives with the daughter in the home.

The patient and the writer spoke earlier as the patient requested a later appointment. Upon meeting with the patient, this writer completed the patient's annual admission form and annual ROI- Emergency contact and medical providers. The writer and the patient discuss his tx plan goals; however, it was not completed for the patient signed as the patient shifted the conversation about his curiousity of having a surrogate mother in the event that his fiancee', who is 39 years old cannot have any children. The writer discuss his feeling about wanting to have children of his own even though he is a step father of 3. The patient view himself as the children step father regardless if he is not married to his fiancee'. The patient discusses a great deal about having an emptiness of not having a child of his own to call his own. The writer validated the patient's feeling greatly, but also address patience. The writer addresses with the patient about his compliance with treatment plan regardless that the patient did in fact

During the course of the session was spent on the patient detailing problematic issues with her grandson mother threats, instability to care for her daughter of whom she has in her care, and not being about to meet child's basic needs. This writer strongly advised the patient

Plan: The patient enjoys seeing this writer weekly as it is helpful for him to have someone to talk with as therapeutic. In essence, the patient will continue to meet with this writer weekly to address his recovery

D-According to the patient she hasn't used any illicit drugs for the past three days, at which this writer commends the patient. This writer discussed the patient 4 months of UDS result as she continues to test positive for heroin and cocaine and her reasoning for her use is due to her anxiety attack. The patient reports that her PCP conducted a referral for the patient to be seen at Brownstone Behavioral Health on 05/05/2016.The patient was advised about the concerns surrounding her footwear as the patient is not wearing proper footwear to help her with her walking. The patient reports that the program director of the clinic spoke with her again about the matter. In addition, the patient reports she is going to see her PCP on 04/5/2016 to

D-The patient arrived on time for her appointment. AWOL yesterday due to her intake process at the Hartford Behavioral Health, which started at 9:30am, but ended at 12pm. This writer had the patient called the clinic for confirmation that she did in fact conduct the intake and is currently scheduled for counseling session with Josh Cohen on 07/01/2016 at 1:30pm. The patient is upset about not being able to get dose increase, even though it was approved to increase her dose by 5mgs due to her recent AWOL status. This writer advised the patient that she can received the dose increase within 3 days, but cannot receive no further AWOLs. This writer provided positive feedback to the patient about conducting her intake and asked about she felt