Case management
Case management plays a highly important role in care delivery as it aims to assist in the achievement of the most appropriate patient results. The responsibilities of a case manager include “assessment, intervention, coordination and monitoring of services, advocacy, outreach, and referral” (Campinha-Bacote & Munoz, 2001, p. 48). At the same time within the framework of changing demographics and patient diversity, case management is necessary to be culturally responsible and relevant. According to the Canadian Standards of Practice, cultural awareness should underlie competent care delivery with the expression of sensitivity, appreciation, and respect for clients’ cultural peculiarities, such as traditions, values, and beliefs (National Case Management Network, 2009). In addition, the provision of culturally competent services presupposes the collection of relevant data related to cultural distinctions to replace biases and the cooperation with the representatives of other cultures and those who have knowledge connected with this subject.
Approach
In the case of Zahra and her parents, it is obvious that care delivery should be provided with respect to the family’s cultural and religious norms. Although Mohammed and Nina are very concerned about their daughter’s medical state, their attitude to her health issues is determined by traditions that presuppose hiding problems associated with substance abuse and sexual assault in order to avoid shame and stigmatization. Moreover, it is not clear whether they want Zahra to be healthy and satisfied with her life or they only put particular attention to her presence during family meetings, culturally prescribed behavior, and success that can be demonstrated to relatives and business partners.
It is obvious that case management aims to provide appropriate support to ensure successful treatment and positive patient outcomes. At the same time, for successful intervention, a patient’s agreement and willingness to participate in it in order to recover is essential (Module 4). As a young, intelligent, verbally competent, and attractive person, Zahra has more chances for successful treatment regardless of its objectives (Module 4). However, taking into consideration that substance abuse should be regarded as a combination of biological, psychological, and social factors rather than a moral weakness, a complex approach is required (Module 2). Although Zahra has particular problems with alcohol consumption, her substance abuse derives from the trauma connected with sexual assault that impacts her trust, self-esteem, functioning, and mood as well. At the same time, the absence of support from her parents may complicate the situation – thus, their participation in the process of treatment is essential regardless of cultural peculiarities that may create barriers.
Once Zahra’s parents return to the room, it is essential to ask them for a private conversation. In general, for culturally competent care delivery, self-assessment is necessary for a case manager in order to be aware of their culture and potential biases related to other values and beliefs to remove them. In other words, it is important to understand that all people are different, however, their cultural peculiarities should be respected. Zahra’s parents should be explained that their daughter’s substance abuse and mental issues are connected with the trauma received as a result of sexual assault. It is beneficial to demonstrate the knowledge of the aspects of the family’s culture and express the understanding of their culture-determined concerns in order to gain their trust. When Mohammed and Nina speak expressing their culturally informed attitude in relation to the necessity of treatment, a case manager should become an active listener to elaborate on the best strategies for a compromise, especially in the case of their rejection.
At the same time, it is necessary to explain to them that Zahra’s state will deteriorate not only without competent help but without her parents’ support as well. In this case, all information will be provided in a culturally sensitive manner for the family’s choice. All in all, parents should realize that their traditions, values, and beliefs are not neglected, however, for their daughter’s well-being, their involvement in treatment is necessary. As an alternative, it may be proposed to keep in contact with partners in order to avoid business ramifications and the family’s stigmatization, however, parents and siblings should provide all their support, understanding, and care to Zahra to make her feel valued.
Service Recommendations
Although Zahra has substance abuse-related issues, they derive from the trauma – thus, treatment should aim to minimize its negative consequences on the young woman’s mental health. According to a commonly accepted myth of psychotherapy, all interventions should provide equivalent outcomes (Norcross, 1995). However, the results of treatment should be relevant to every patient’s unique situation, and in the case of Zahra, the minimization of the trauma’s impact is a top priority, as it will lead to the solution of substance abuse-related problems.
In this case, support that may be recommended to Zahra is therapies. Although there are group and individual sessions, taking into consideration the patient’s cultural background, individual sessions are preferable. The first option is psychodynamic psychotherapy which focus on a victim’s mixed emotions and their expression (Cowan et al., 2020). Zahra has difficult memories determined by multiple hidden emotions that lead to sleep problems, substance abuse, and other mental health issues. During the work with a therapist, she will have an opportunity to perceive the nature of her feelings and release them.
Another type of therapy that may be recommended is trauma-focused cognitive behavioral therapy. It will allow the patient to reconstruct the event and detect negative thoughts associated with it that negatively affect her life. Subsequently, Zahra will be provided with efficient techniques for relaxation to replace traumatic experiences with a positive response (Cowan et al., 2020). While therapies’ methods differ, both of them may be regarded as beneficial for Zahra as along with the family’s support, they will help her minimize the impact of the trauma and its consequences.
At the end of the session, it is important to have a small talk with Zahra and her parents all together in order to assess their understanding of treatment and its potential outcomes. All details of how support may be received should be provided as well. All in all, the session may be closed in the following way:
Case Manager: Zahra, it is obvious that your substance abuse and emotional issues derive from the trauma and we are here to help you. You should know that you are not guilty and you are valued. Take your time to think about treatment and its significance and next time when we meet give an answer whether you agree to accept it or not. Mohammed and Nina, I respect your traditions, culture, and religion, and I know that the family’s reputation is highly important to you. At the same time, your daughter’s emotional state and related issues, including substance abuse, will exacerbate without appropriate treatment and your support. No matter what she will decide, I hope that you will trust her words and treat her with all love and care she deserves. I am glad that we understand each other and I would like to see you next time.
References
Campinha-Bacote, J., & Munoz, C. (2001). A guiding framework for delivering culturally competent services in case management. The Case Manager, 12(2), 48-52.
Cowan, A., Ashai, A., & Gentile, J. P. (2020). Psychotherapy with survivors of sexual abuse and assault. Innovations in clinical Neuroscience, 17(1-3), 22-26.
Module 2. Best practices in treatment.
Module 4. Treatment effectiveness and outcomes.
National Case Management Network. (2009). Canadian standards of practice for case management. Web.
Norcross, J. C. (1995). Dispelling the Dodo bird verdict and the exclusivity myth in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 32(3), 500–504. Web.