Post an explanation of how multiple systems within the social environment interact to impact individuals across the life span. Use Lester’s case as an example. Then explain how you as a social worker might apply a systems perspective to your work with Lester. Finally, explain how you might apply a systems perspective to social work practice in general.
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© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social
work case studies: Foundation year. Laureate International Universities Publishing.
Lester
Lester is a 59-year-old divorced African American male with two adult children. Four
months ago, he was a driver in a multiple vehicle crash while visiting his daughter in
another city and was injured in the accident, although he was not at fault. Prior to the
accident he was an electrician and lived on his own in a single-family home. He was an
active member in his church and a worship leader. He has a supportive brother and
sister-in-law who also live nearby. Both of his children have left the family home, and his
son is married and lives in a nearby large metropolitan area.
When he was admitted to the hospital, Lester’s CT showed some intracerebral
hemorrhaging, and the follow-up scans showed a decrease in bleeding but some
midline shift. He seemed to have only limited cognition of his hospitalization. When his
children came to visit, he smiled and verbalized in short words but could not
communicate in sentences; he winced and moaned to indicate when he was in pain. He
had problems with balance and could not stand independently nor walk without
assistance. Past medical history includes type 2 diabetes; elevated blood pressure; a
long history of smoking, with some emphysema; and a 30-day in-house treatment for
alcoholism 6 years ago.
One month ago, he was discharged from the hospital to a rehabilitation facility, and at
his last medical review it was estimated he will need an additional 2 months’ minimum
treatment and follow-up therapies in the facility.
As the social worker at the rehab center, I conducted a biopsychosocial assessment
after his admission to rehabilitation.
Biopsychosocial Assessment
At the time of the assessment, Lester was impulsive and was screened for self-harm,
which was deemed low risk. He did not have insight into the extent of his injury or
changes resulting from the accident but was frustrated and cried when he could not
manipulate his hands. Lester’s children jointly hold power of attorney (POA),but had not
expressed any interest to date in his status or care. His brother is his shared decision
making (SDM) proxy, but his sister-in-law seemed to be the most actively involved in
planning for his follow-up care. His son and daughter called but had not visited, but his
sister-in-law had visited him almost daily; praying with him at the bedside; and
managing his household financials, mail, and house security during this period. His
brother kept asking when Lester would be back to “normal” and able to manage on his
own and was eager to take him out of the rehabilitation center.
Lester seemed depressed, showed some flat affect, did not exhibit competency or show
interest in decision making, and needed ongoing help from his POA and SDM. His
medical prognosis for full recovery remains limited, with his Glasgow Coma Scale at
less than 9, which means his injury is categorized as catastrophic.
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© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social
work case studies: Foundation year. Laureate International Universities Publishing.
Lester currently has limited mobility and is continent, but he is not yet able to self-feed
and cannot self-care for cleanliness; he currently needs assistance washing, shaving,
cleaning his teeth, and dressing. He continues with daily occupational therapy (OT) and
physical therapy (PT) sessions.
He will also need legal assistance to apply for his professional association pension and
benefits and possible long-term disability. He will also need help identifying services for
OT and PT after discharge.
He will need assistance from family members as the determination is made whether he
can return to his residence with support or seek housing in a long-term care facility. He
will need long-term community care on discharge to help with basic chores of dressing
and feeding and self-care if he is not in a residential care setting.
A family conference is indicated to review Lester’s current status and short-term goals
and to make plans for discharge.