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Introduction The mission and purpose of children and families area of specialization

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Introduction The mission and purpose of children and families area of specialization. This needs to be included in the introduction. “Although child welfare is designed to protect children from harm, ensure their wellbeing, help them to achieve permanency, and strengthen families (Child Welfare Information Gateway, 2012), child welfare systems cannot be expected to bear the sole responsibility for a child’s well-being.” Source is the NASW cultural standards 2003 Child welfare systems include a range of services (for example, family-based services, child protection, out-of-home placements, and adoption services), encompassing prevention, intervention, and treatment. Services are intended to protect children and their well-being, strengthen families, and provide permanency when children cannot safely remain with their families. Child welfare services should be strength based; family centered; trauma informed; and respectful of a family’s culture, values, customs, beliefs, and needs (Child Welfare League of America, 2005). What does the disruptive behavior? According to his teachers and the staff Jason displays disruptive behavior consisting of temper tantrums. Intervention strategy A category of disruptive behavior Tantrums are categorized by ….. Define. Kicking, screaming, throwing chair moving tables, hitting , ignore, defiant behavior attitude. The select two areas to focus on from the tantrums definition. Ex: Throwing things and screaming In this paper I will discuss the….tantrums in early childhood, focusing on how to reduce the frequency of the tantrums displayed by Jason. Minimizing him throwing things and screaming …… How am I going to intervene? What the literature say Based on the literature Theory that supports Jason’s tantrums Find research Support whatever you say with literature What practice model What stage of life he’s in: Preschool: 3-5 yrs. Your child is advancing from infancy toward and into the preschool years. During this time, his physical growth and motor development will slow, but you can expect to see some tremendous intellectual, social, and emotional changes. What does the literature say about Tantrums In early childhood? The reason that tantrums or storms of whatever kind are so common in the second to third year of life is because of the myriad changes that are occurring and the need for the child to understand and regulate the particularly strong and powerful feelings that are occurring as they experience boredom, frustration and disappointment. [Maria Robinson.Understanding Behaviour and Development in Early Childhood: A Guide to Theory and Practice] What role I’m performing My role was to facilitate Jason working with him to help minimize his tantrums and advocate on his behalf. Roles of a social worker Nasw standards of child… pg 19 He fits because he is a child needing improved…. Stay away from therapy in the human behavior section Using operant conditioning Missing application to Jason Identify two concepts of operant conditioning How Jason illustrates those concepts Engagement 3 skills and techniques What are they? Why was it used to engage Social Policy (still searching) Find a policy that is relevant to Jason Active social policy Strengthens and limitations Talk about elements appropriate to Jason Statistics Is the policy effective? No or partly due to…. Assessment What I did -Collected data, read through files -Observed Jason and took notes -Interviewed Jason to connect more with him At times he was nonverbal; used feelings chart etc How I interpreted Scale problem from 1-5 Ex: To get a better understanding of the problem with Jason and his behavior displayed during his tantrums I observed him for one week. Focusing on interactions with peers, teachers… Identify 2 strengths and limitations Ex: lack of communication What does the literature say about the lack of communication and its effects on the assessment? What does literature say about tantrums and 3 year olds? Because Jason has tantrums a possible injustice he can encounter is labeling. Jason is subject to a educational injustice due to his tantrums. Not allowing him to play can result in…. State what the issue is and give an example to support the issue. (Something that happened to support it) In this area you can draw from experiences you’ve noticed in the classroom with children that display behavior problems. Intervention Task centered practice Task-Centered Practice uses a four-step process to do this. • Define the problem • Establish goals • Work on goals • Review goals See attached ABAB design Evaluation Conclusion Systems theory External link describes human behavior in terms of complex systems. It is premised on the idea that an effective system is based on individual needs, rewards, expectations, and attributes of the people living in the system. According to this theory, families, couples, and organization members are directly involved in resolving a problem even if it is an individual issue. First submission 2a As per syllabus and announcements for this course, APA 7th edition formatting standards are required. Be sure to correct formatting errors in addition to presenting a proper title for the final paper. Per APA, the title is to summarize the main idea of the paper in a way that engages the reader. A proper introduction for an academic paper is required. Be sure to make this correction during your time of revision. The system level is individual; a male.... This is not adolescent. Is this correct? Focus on describing this individual’s situation, not on you and your role. That is to be discussed in a different part of this section. The; this display of behavior is not a factor of identity or possession Jason The It Rephrase per comment above Jason; refrain from using the term "client" or the phrase "my client" Punctuation error Addressing the question of specialization has nothing to do with you or an application of intervention. It has nothing to do with social workers practicing in the area of children and families. To address this question, you must research the mission and purpose of the children and families area of specialization. Then, you are to connect Jason's situation to that mission and purpose. This must be done using credible scholarly material. Kudos for getting started on writing the integrative paper, but there is much revision needed to satisfy the requirements for this section. First, there is a need to address each item of the guideline, identify a specific issue that will focus this paper, present a proper introduction, and restructure the organization of this section. Revision to present a logical flow of information is needed. The checklist is your outline for writing each section of the paper. It is to be followed accordingly. Second, this section requires additional integration of scholarly material. Be sure to research and include appropriate sources of information to support and give evidence to this section. On another note, your Unicheck percentage is above 10% and it needs to be below 10%. Every section of this paper is to be original and not copied from previous work. Be sure to address this with the revision. Lastly, as you're editing be sure to follow APA 7th edition standards which is required. 3A comments A heading and mini-introduction need to precede the engagement section. Refer to guideline/checklist. Additionally, APA 7th edition formatting is required. To save from red-lining more of the content in this section, I will end my review at this point. This section of the paper needs to be specifically focused on addressing the items of the guideline as related to an initial encounter with the person identified. It is necessary to just get to the point of the matter. What was the skill or technique used to build rapport and establish trust? Why was it used? What does the literature say about the importance of using it as related to developing rapport and establishing trust? How was the skill or technique used? That is all that is to be presented in this section. Anything else is not relevant. This section requires revision to focus specifically on addressing these questions. This section is to be written in first person and specifically focused on discussing engaging with the person of focus for this paper. In other words, this is not a general discussion. I look forward to reviewing the revised work. Additional scholarly material is required for this section. APA 7th edition formatting is required. 1 and 2a revisions A proper introduction is missing and is required. What is the purpose for this in-text citation? This part of the section should only present facts about Jason and his situation. Only state your role and involvement. This is not the section to discuss intervention. Avoid repeated what has already been stated. To address this question, you must research the mission and purpose of the children and families area of specialization. Present that information with references then connect the mission and purpose to Jason's situation. Never present a model as a guarantee in solving a problem. Besides, this section is not about solving a problem, it's about explaining behavior. I don't understand how this is relevant to explaining Jason's behavior. A number of claims have been made to this point and they are not supported by scholarship. Keep in mind that this is an academic research paper and requires the integration of scholarly material to support the information presented. Because you are not a therapist, an advanced social worker or a licensed clinician, this term is not to be used. You may refer to yourself as an advanced practice student or masters level student. Avoid the use of exaggerated language in this paper What does this mean? Significant revision is needed to this theory section. It is important that you recognize that the purpose of human behavior theory is not to intervene, treat, or solve an issue. The purpose of human behavior theory is only to explain behavior. Any reference to therapy is to be removed. This section is to include an adequate use of scholarly material throughout. Awaiting revised section 2b Mission and purpose of children and families area of specialization for social work Boehm, W. (1959). Objectives of the social work curriculum of the future. (Vol. I). New York: The council on social work education. Boehm, W. (1959). The social casework method in social work education. (Vol. X) New York: CSWE. Popple, P. (1985). Social work profession: A reconceptualization. Social service review, 59(4), 560-577. Popple, P. (1991). The introductory course in the undergraduate social work curriculum. Journal of sociology and social welfare, 18(1), 121-138. Preparing students for evidence?based child and family field social work: an experiential learning approach Evidence?based social care is the practice of a range of professionals in sound knowledge about the needs of children and families informed by: 1. the best available evidence; 2. the practice expertise of professionals; 3. the experiences and preferences of service users. (Atherton, 1999, p. 200) Framework for the Assessment of Children in Need and their Families (Department of Health et al., 2000) https://www.socialworkers.org/LinkClick.aspx?fileticket=_FIu_UDcEac%3d&portalid=0 Child welfare systems across the country serve some of the most vulnerable children, youths, and families. These systems are designed to support families and to protect children from harm through an array of prevention and intervention services; in particular, they are designed to support children who have been or are at risk of abuse or neglect NASW 2005) https://www.socialworkers.org/News/Facts/Types-of-Social-Work These standards can be regarded as a basic tool for social work practice in child welfare, which may include prevention, parenting programs, family support programs, family-based services, family foster care, kinship care, residential group homes, adoption, and independent living Although child welfare is designed to protect children from harm, ensure their well-being, help them to achieve permanency, and strengthen families (Child Welfare Information Gateway, 2012), child welfare systems cannot be expected to bear the sole responsibility for a child’s well-being Child welfare systems include a range of services (for example, family-based services, child protection, out-of-home placements, adoption services), encompassing prevention, intervention, and treatment. Services are intended to protect children and their well-being, strengthen families, and provide permanency when children cannot safely remain with their families. Child welfare services should be strength based; family centered; trauma informed; and respectful of a family’s culture, values, customs, beliefs, and needs (Child Welfare League of America, 2005). Definition from uta website Focuses on the characteristics, strengths, and service needs of children and their families. Addresses assessment and intervention skills to work effectively with a variety of child, parent(s), and family problems. Specific techniques considered include child therapy, play therapy, behavioral contracting, cognitive-behavioral interventions, and crisis intervention. Family centered practice? https://socialworklicensure.org/types-of-social-workers/child-family-school-social-workers/ SOCW-5395: INTEGRATIVE SEMINAR Integrative Paper Project Full Checklist Amber Graham Check the box if the item was included in the document being reviewed. PART 1: Assignment Standards ? *Briefly orient the reader about the overall subject/issue of focus for the paper. ? *Briefly state the motivation for choosing the subject/issue of focus for the paper. ? *Briefly state what the reader will review in the paper. 1: The Practice Situation (20 points, 2–3 pages) -2 pts ? Identify the system level (i.e. individual, family, small/large group, etc.). ? Identify and describe the subjects’ situation. ? Briefly discuss the reason intervention is being sought or is needed by the identified subject. ? Briefly discuss your role and involvement with the subject and/or situation. ? Discuss how the subjects’ situation fits into your chosen area of specialization. Partial credit PART 2: Assignment Standards ? *Briefly restate the system level and the identified subject. ? *Briefly identify the most relevant human behavior theory and the active social policy most relevant to the subject situation. 2A: Human Behavior Theory (20 points, 2–3 pages) -12 pts ? Identify and describe the most relevant human behavior theory that contributes to the subjects’ situation. You are to discuss the major theoretical assumptions and concepts that are applicable to the situation. ? Explain why the theory was chosen as most relevant and how the theory links to the practice situation. ? Reference evidence-based knowledge including strengths and limitations of current knowledge related to the selected theory and its application. ? Explain how the theory is relevant to the subjects’ problem situation. ? Apply the theory to the subjects’ situation using evidence and support from credible literary sources (i.e. books, peer-reviewed journal articles, research studies, government documents, reports, and data, etc.). 2B: Social Policy (30 points, 3–4 pages) -14 pts ? Identify and describe the active social policy most relevant to the practice situation. Agency related policy not accepted. Be sure to cite the laws and policies correctly. ? Identify which level the social policy was enacted (i.e. local, state, federal). ? Explain how the active social policy is relevant to the subjects’ problem situation. ? Use a policy analysis model to analyze the effectiveness of the social policy for the general subject group and then the identified subject specifically. This is not expected to be a full policy analysis; draw on a policy analysis model with which you are familiar and fully reference that model. ? Evaluate the strengths and limitations of the policy. Provide evidence-based knowledge about the policy and its effectiveness. ? Discuss the identified social policy and analysis of the social policy using properly referenced and cited credible sources (i.e. books, peer-reviewed journal articles, government documents, court decisions, etc.). ? Based on the analysis, explain what you will advocate in terms of policy review, application, formulation, or revision. PART 3: Assignment Standards ? *Briefly restate the subject situation. ? *Briefly identify the assessment, intervention, and evaluation strategy applied. 3A: Engagement (20 points, 2–3 pages) -15 pts ? Identify the specific social work engagement techniques and skills used with the subject. Partial credit ? Describe how the subject was engaged and why the selected techniques and skills were used. 3B: Assessment (30 points, 3–4 pages) -26 pts ? Describe the efforts made to collect, organize, and interpret information about the subject. Partial credit ? Identify the strengths and limitations associated with the subject. Discuss how the strengths and limitations influenced the assessment process. ? Discuss relevant aspects of diversity as related to the subject and the problem situation (i.e. age, class, color, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, etc.). How do aspects of diversity connect to the subjects’ problem situation? ? Discuss how issues of justice (i.e. social, economic, human rights, civil rights, etc.) may relate to the practice situation. 3C: Intervention (30 points, 3–4 pages) -30 pts ? Present a mutually developed and agreed upon intervention strategy with specific goals and objectives. ? Provide a rationale for the selection of the intervention strategy. ? Describe the intervention from beginning to end including termination. ? Discuss how did use of the intervention strategy help the subject prevent or resolve problems. ? Discuss how you negotiated, mediated, and advocated for the subject. ? Discuss at least 3 practice skills (micro/macro) used in your intervention with the subject. What was the rationale for using the selected practice skills? Present a critique of your work with the subject/system. Include the following: ? What did you do well regarding intervention? What didn’t you do well regarding intervention? ? What could have been done to improve outcomes with the subject? ? How was the intervention empowering? ? In what way the intervention was or might have been discriminatory or oppressive? ? Identify whether the intervention was developed from a theoretical practice model. If so, identify the practice theory. ? If the intervention was not developed from a theoretical practice model, discuss which practice theory could have been used to facilitate better outcomes. ? Analyze and provide evidence-based knowledge about the theory-based intervention (used or proposed) and its effectiveness. 3D: Evaluation (30 points, 3–4 pages) -24 pts ? Select and present one method used to evaluate change and improvement with the subject (i.e. single subject design, pretest/posttest, etc.). ? Provide a rationale for the evaluation method selected. Present strengths and limitations of the method and its relevance to the subject, practice situation as well as area of specialization. ? Describe the method and how you would facilitate using the method to collect data to assess change and improvement. PART 4: Assignment Standards ? *Provide a brief statement about the significance of professional social work practice as related to the subject or practice situation. 4: Conclusion (20 points, 2–3 pages) -20 pts Present a critical review of the practice situation and intervention as an external observer. Discuss the following: ? Identify and describe one or more potential ethical conflicts and/or values issues related to the practice situation. ? Reference and discuss relevance of the NASW Code of Ethics and other relevant professional literature. ? Discuss how the integrative paper assignment raised issues related to professional strengths and challenges. ? Formulate a plan for lifelong professional learning and continuing education. Discuss the plan by identifying at least one short-term goal and one long-term goal. Discuss the opportunities that will be sought and engaged to achieve each goal. FINAL REVIEW The final document… ? Is 20-25 double-spaced pages not including the cover and reference pages. Missed ? Is a 12-point font size and uses the Times New Roman font type for all text. ? Includes evidence and support from a variety of relevant scholarly sources. Significant missed opportunity in each section of the paper ? Is free of distracting errors related to grammar, sentence structure, and spelling as well as jargon, hyperbole, colloquial expression, and the anthropomorphism error. Multiple errors present ? Is structured according to APA 7th edition format and style guidelines. Multiple errors present NOTE: Items preceded by an asterisk (*) and having a blue font are not required but are expected to be addressed in its associated section. These items are intended to support the logical flow, comprehensive and formal delivery of the required material outlined in this checklist. 1 Advanced Social Work Practice Through Pamela’s Road to Recovery [Author Redacted] School of Social Work, University of Texas at Arlington SOCW-5395: Integrative Seminar Dr. Sherece Shavel [Date Redacted] Commented [SS1]: The author used a title that appropriately reflects the purpose of the paper. 2 Advanced Social Work Practice Through Pamela’s Road to Recovery In the United States, substance use disorders (SUD) have become one of the most detrimental societal issues that are increasingly on the rise and affect every race, gender, and socioeconomic status (Lipari & Van Horn, 2017; Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). In 2018 alone, it was estimated that over twenty million individuals, ages twelve and older, qualified for a SUD; of those, approximately eight million were for illicit drug use (Lipari & Van Horn, 2017; SAMHSA, 2019). That said, for an individual to be diagnosed with a SUD, certain criteria must be met that has been established by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the guiding authority for all clinical diagnoses. Multiple factors contribute to a diagnosis of a SUD, however, the essential characteristics are clusters of cognitive, behavioral, and physiological symptoms, that despite negative consequences and severe problems directly associated with substance use, the person is unable to stop (American Psychiatric Association [APA], 2013; SAMHSA, 2019). Along with the previously mentioned attributes, SUD also present in levels of severity that range from mild to severe, and each category is based on a host of different symptoms that have the propensity to change over time (APA, 2013). Moreover, there are multiple subcategories of SUD that were created because of different illicit drug use within the population. Commented [SS2]: The author uses scholarly material to orient the reader to the overall problem focus of the paper. The focal point of this paper is to demonstrate advanced practice competence in the context of one African American female challenged by stimulant use disorder, specifically crack Commented [SS3]: The author informed the reader of the system level using descriptive terms. cocaine. In this paper, I will share details of the individual’s situation to discuss the components Commented [SS4]: The author informed the reader about the specific substance of concern being presented. and stages of the helping process. I will present a human behavior theory and social policy most Commented [SS5]: The author narrowed down the focus of the paper and connected it to the overview presented in the two above paragraphs. relevant to the case, then discuss facilitation of engagement, assessment, intervention, and 3 evaluation. I also will describe a possible ethical dilemma with reference to the National Association of Social Workers (NASW) Code of Ethics, discuss my professional strengths and limitations, and provide a lifelong professional learning plan. For purpose of maintaining the Commented [SS6]: The author gave the reader a clear and succinct overview of what will be covered in the paper. confidentiality and privacy of persons and entities, subject names were replaced with a randomly chosen pseudonym and locations were generalized. The Practice Situation Pamela is a twenty-four-year-old African American female who resides with her mother and stepfather. She has three children, Junior, age six, Lilly, age four, and Sam, age three, and is currently thirty-two weeks pregnant with her fourth child. Pamela stated that she is in a relationship with the father of her unborn child, who is twenty years her senior. Pamela has two sisters, and three brothers and has a close relationship with all three of her brothers. However, Pamela expressed that she does not have a good relationship with either sister, as they have been estranged for over two years because of her use of substances. As obtained during intake processing, Pamela is a long-term substance abuser who started using drugs at the age of ten. Moreover, she is known to as a “chronic relapse” and has participated in treatment programming five different times, twice at New Beginnings. Pamela disclosed that she has been incarcerated multiple times since the age of seventeen and stated all were directly related to substance use. In addition, Pamela has had multiple cases with Child Protective Services (CPS) which resulted in the loss, and ultimately the termination of her rights of her three children. During intake, it was discovered that Pamela grew up in and out of foster care and was often placed with relatives as a result of her mother’s substance use disorder. Nevertheless, despite adverse circumstances, Pamela graduated high school in 2014 and has worked different jobs over the last several years; however, due to her drug use and multiple Commented [SS7]: The author has appropriately presented the pseudonym disclosure statement at the end of the introduction section, before introducing the practice situation. Commented [SS8]: The author humanizes the person of focus with a pseudonym that will be used to refer to this person of focus throughout the entire paper. This also reiterates that the system level is individual for this paper. Commented [SS9]: The author informed the reader on the source of the information. 4 incarcerations, she has been unable to maintain long-term employment. Lastly, five years ago Pamela stated that she was diagnosed with congestive heart failure, therefore, as a result of years of drug use and her medical condition, Pamela is considered to have a high-risk pregnancy (Anthony & Sliwa, 2016; Zapolski et al., 2016). Reason for Intervention, Role, and Involvement Presently, Pamela has been referred for substance abuse treatment at New Beginnings by her probation officer for failing a urine analysis. According to her probation officer, she is on Commented [SS10]: The author informed the reader of the reason for intervention. probation for burglary of a habitation, an offense that carries a two-year felony sentence. For the last four months, Pamela has been detained in a correctional facility while awaiting a bed to become available at the treatment program. She has had one prior incarceration for the current offense and had probation revoked for the same offense resulting in the referral to the New Beginnings treatment program. With respect to the DSM-5, Pamela meets the criteria for a diagnosis of a stimulant use disorder, specifically, cocaine because more than six symptoms are present; as such, this is Commented [SS11]: The author identified the specific issue that will focus the paper, the focus for intervention. qualifying criteria for inpatient substance use treatment (APA, 2013). Since Pamela is seeking help for a substance addiction in hopes of obtaining recovery, it is appropriate for her to receive services from the treatment program at New Beginnings. That said, my role and involvement is to help Pamela identify and address concerns caused by addiction with respect to social, physical, legal, employment, and family issues through counseling sessions, treatment plan assignments, and psychoeducational groups in an intensive inpatient setting (Faulkner & Faulkner, 2019). This will help Pamela work through the abovementioned problems, identify triggers, and teach her coping skills that will help her to achieve and maintain sobriety. Area of Specialization Commented [SS12]: The author informed the reader of the role and involvement to be taken to address the identified issue. 5 The purpose of mental health and substance abuse direct practice, which is my area of specialization, is to address the persistent and critical needs of those with mental health and substance use disorders by evaluating, diagnosing, and treating symptoms commonly associated with these disorders (NASW, 2012). Pamela is seeking help for a persistent cocaine addiction Commented [SS13]: The author informed the reader of the mission and purpose of the area of specialization. from which she hopes to achieve a state of recovery. Her situation, persistent cocaine addiction, is classified as a substance use disorder that is confirmed with an evaluation and diagnostic process and subsequently addressed using evidence-based techniques. Therefore, since the mission and purpose is to address the needs of those with substance use disorder, Pamela’s situation specifically aligns with the mental health and substance abuse specialization as it relates to evaluating, diagnosing, and treating symptoms associated with substance use disorder in the form of cocaine addiction. As a treatment center, New Beginnings specializes in providing addiction services to women with SUD. New Beginnings provides evidence-based interventions Commented [SS14]: The author informed the reader on how the practice situation fits the area of specialization. The author failed to use scholarly material to support the discussion. tailored to address issues commonly associated with addiction having an ultimate goal of the individual achieving sobriety. Part II: Human Behavior and Social Policy Pamela’s family system has been significantly impacted by generations of substance Commented [SS15]: The author informed reader by providing a mini introduction to Part 2 of the paper. abuse; consequently, this has contributed to her developing addictive behavior (English, 2000). Because of this, it is important to understand how her family relationships have influenced her behavior; to do this, I utilized the human behavior theoretical framework of systems theory. Commented [SS16]: The author informed the reader of the human behavior theory Next, without social policy, New Beginnings would cease to exist. As a non-profit substance use treatment center for women with children, the facility relies on public funding to provide resources and deliver services to our practice population. As such, the most relevant active social policy that will be discussed for Pamela’s situation is the Affordable Care Act. Commented [SS17]: The author informed the reader of the social policy 6 Human Behavior Theory Systems theory was created by Von Bertalanffy in the 1940s but has since been modified, once by Talcott Parsons in the 1950s and by Carel B. Germain in the 1990s (Friedman & Allen, 2014). Systems theory is a theoretical framework that provides an understanding of how systems interact with one another and the dynamics of those interactions (Friedman & Allen, 2014). The basic assumption of this theory is that a system is a set of elements that are interrelated and are contingent upon one another to create a functional whole (English, 2000; Kirst-Ashman, 2014). More importantly, the main goal of the system is to maintain homeostasis; so, when one part of the whole is off balance, the entire system suffers (English, 2000; Lander et al., 2013). Systems theory is comprised of several ideas, all of which pertain to Pamela; however, the ones that will be discussed here are the concepts of subsystems, relationships, feedback, boundaries, and homeostasis (Kirst-Ashman, 2014). To begin, a system is considered to be an organized whole, comprised of subsystems that include the family. The subsystems are connected and ultimately dependent upon one another for survival (English, 2000; Lai & Lin, 2017; Rothery, 2016). Within the subsystems, there are interpersonal relationships that affect how the system will think, feel, and behave in relation to the other subsystems (Kirst-Ashman, 2014). These behaviors are a byproduct of the feedback received from the subsystems as it relates to communication patterns and directly affects the behaviors of the system (Lander et al., 2013). Moreover, within these relationships, there are boundaries that serve as a protective barrier for the system that will also determine behaviors and interactions (Lander et al., 2013). Lastly, homeostasis is critical to discuss because it is the ultimate goal of the system (Hepworth et al., 2013). Homeostasis refers to maintaining balance and when a system is working as Commented [SS18]: The author transitioned to a focused discussion about the background as well as relevant assumptions, ideas, and concepts associated with the human behavior theory. 7 intended, balance is achieved; however, when a system struggles to adapt to the environment, disruption can occur causing the system to become dysfunctional (Friedman & Allen, 2014). As with any theory, there are strengths and limitations. From a strength’s perspective, systems theory provides an understanding of how people interact with subsystems and their environments (Lai & Lin, 2017). This helps to identify concerns and develop interventions based on those findings by looking at the whole picture (Friedman & Allen, 2014). For limitations, even though systems theory provides an understanding of how multiple systems interact, it is limited in that it gives minimal guidance about the specific outcomes of these interactions (Reid, 2002). Furthermore, systems theory provides little direction in the way of implementing specific interventions (Friedman & Allen, 2014). Nevertheless, this framework is relevant to Pamela’s situation because she comes from a family of substance use. Systems theory helps to explain how her family relationships, specifically, the relationship with her mother has fostered her addictive behavior (English, 2000). Commented [SS19]: The author explained why the theory was chosen as relevant and its link to the practice situation. Application to Situation New Beginnings utilizes a systems perspective because it is paramount to understanding how Pamela interacts within her subsystems. The most important subsystem in Pamela’s is her family; specifically, the relationship with her mother. As mentioned earlier, Pamela’s mother struggled with substance abuse, and Pamela disclosed during intake that she grew up in and out of foster care as a result. This may have contributed to Pamela's behavior considering that when any part of the system is off-balance, the other parts of the system struggle to function properly (Friedman & Allen, 2014). The constant separation from her mother may have created a lack of Commented [SS20]: The author uses the facts known about Pamela to make connections to the human behavior theory. Commented [SS21]: The author does not speak definitively but rather suggests the potential connection to and explanation using the chosen human behavior theory. stability and a disruption of balance within Pamela’s life which has affected her behavior (Hepworth et al., 2013). During intake, Pamela expressed that she started using substances at the Commented [SS22]: The author connects Pamela’s behavior to the ideas and assumptions of the human behavior theory. 8 age of ten and has repeatedly been involved in the criminal justice system. She also disclosed that as a result of addictive behaviors, she lost her children. That said, the presence of substance use within the family subsystem may have caused the system to be dysfunctional and affect the overall development of the subsystem (Saatcioglu et al., 2006). Since substance use has been a constant element in Pamela's life, it may have affected her Commented [SS23]: The author connects Pamela’s situation to the ideas and assumptions of the human behavior theory. emotionally fostering interpersonal conflicts because of the family subsystem feedback received during early life (Saatcioglu et al., 2006). Pamela expressed during intake that she struggles with anger and has a hard time forming healthy relationships. This experience may be a result of the feedback received by her mother. Feedback refers to the way that parts of the system communicate with one another and is ultimately how relationships are formed (Lander et al., 2013). Since the feedback that Pamela received at an early age from her mother was negative, it may have reinforced her conduct of negative behavior as well as how she forms relationships Commented [SS24]: The author connects Pamela’s behavior to the ideas and assumptions of the human behavior theory. (Lander et al., 2013). Additionally, the boundaries established in the subsystem seemed to have been skewed from the beginning. When substance use is present in the family subsystem, boundaries are permeable and provide no protective barriers which can lead to a loss of identity as well as other risk factors (Rothery, 2016). As can be seen by the abovementioned information provided about Pamela, the feedback and boundaries established at an early age may have prevented her from achieving a state of equilibrium; resulting in a lack of tendency toward maintaining a process of homeostasis (Hepworth et al., 2013). Hence, when substance use is present within a family subsystem, it acts as a stressor and becomes the systems organizing structure (English, 2000). Because of this, Pamela struggled to maintain homeostasis; subsequently, this may have caused years of Commented [SS25]: Another example of the author connecting Pamela’s situation to the human behavior theory. 9 dysfunction and chaos which may have become a contributing factor to ongoing addictive behavior (English, 2000). Social Policy Commented [SS26]: The author summarized the connections made in the previous paragraphs, connecting Pamela’s life to the human behavior theory. Essentially, giving a theoretical explanation to Pamela’s situation current situation. The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA), Public Law No. 111-148 is a federal policy that was enacted in 2010 as major health care reform (Lundgren & Krull, 2014). The ACA is an amendment to The Mental Health Commented [SS27]: The author descriptively and succinctly identified the chosen social policy. and Parity Act 2008 (MHAPA) which requires that SUD treatment be considered just as vital as other health care services; however, MHAPA offered little coverage for SUD treatment (Beronio et al., 2014). The primary goal of the ACA was to improve and expand health care coverage providing millions of people with SUD insurance (Humphreys & Frank, 2014; Sarata, 2011). As such, the ACA mandated coverage through several different financial resources (Humphreys & Frank, 2014; Sarata, 2011). One of the major sources of funding under the ACA was the expansion of Medicaid which extended coverage to over thirty million low-income individuals with an income threshold below 138 percent of the federal poverty line (FPL) (Maclean & Saloner, 2019). Other important provisions of the ACA that are important to mention include that it covers preexisting conditions, and it aims to provide greater access to treatment, removes barriers to treatment, integrates treatment with mainstream healthcare, and requires that treatment utilize evidence-based interventions (Abraham et al., 2017; Lundgren & Krull, 2014). Since implementation, the ACA has provided millions of Americans in expansion states with SUD the financial resources needed to access treatment (Humphreys & Frank, 2014). The ACA is relevant to Pamela’s situation, not only because she has a diagnosis of a stimulant use disorder, she is also unemployed and falls below the FPL. More importantly, she is Commented [SS28]: The author used scholarly material to inform the reader about the policy. 10 pregnant and has a preexisting condition (Humphreys & Frank, 2014). Hence, this policy is relevant to Pamela’s situation because under Medicaid expansion she would qualify for coverage that would provide her with the necessary financial resources needed to access evidence-based treatment. To date, Texas does not participate in the expansion. Since treatment is expensive, this is a major barrier that prevents individuals like Pamela from accessing services. Therefore, implementation of the Medicaid expansion is vital to reducing the noted barriers (Lundgren & Krull, 2014). Policy Analysis Commented [SS29]: The author stated how the active social policy is relevant to Pamela and used scholarly material to support the statement. To analyze the effectiveness of the ACA, this section will focus on Medicaid expansion and draw on the policy analysis model by McInnis-Dittrich (Ginsberg & Miller-Cribbs, 2005). This model consists of eight elements including a description of the policy, a description of the need the policy aims to address, the strengths and weaknesses of the policy, the overall logistics of the policy, a description of financial support, the changes that need to be made, an evaluation of the polices attention to social justice, as well as the personal perception by the advanced practice intern about the benefits of the policy (Ginsberg & Miller-Cribbs, 2005). Overall, the ACA was created to be a comprehensive health care reform with the intended goal of providing uninsured Americans with coverage that fell below certain income brackets through public and private funding (Humphreys & Frank, 2014; Lundgren & Krull, 2014). For ACA, one of the major strengths is the expansion of Medicaid which provides insurance to residents in the U.S. that fall below the FPL (Beronio et al., 2014). Since the expansion, it is estimated that nearly three million low-income individuals have gained insurance coverage that has funded substance use treatment in participating states (Abraham et al., 2019). Commented [SS30]: The author identified the social policy and gave a brief overview of the policy. Commented [SS31]: In this paragraph, the author failed to state why the policy analysis model was chosen, what should be the expected outcome when using the policy analysis model (i.e., what kind of information was the analysis model created to produce), and which parts (i.e., elements, components) of the model was used to analyze the chosen policy. This information is necessary to satisfy the criteria to “fully reference the model.” 11 Moreover, Medicaid covers SUD services in the same manner as other health care services so those with SUD are now able to receive quality treatment (McCabe & Wahler, 2016). Commented [SS32]: The author highlights a relevant factor to Pamela’s situation. On the other hand, several limitations are important to note. In 2012, the Supreme Court filed a ruling that allowed each state the choice to opt-out of the expansion, and as of 2017, only thirty-two states were participating (Maclean & Saloner, 2019). For those under the expansion, there are specific limitations under Medicaid plans that have treatment restrictions and financial requirements (Sarata, 2011). This includes limits on how many times a person can receive treatment and the number of days covered (Sarata, 2011). Lastly, in expansion states, there has been an influx in those seeking treatment, and the estimated 14,000 treatment centers in the U.S. now have limited space and waitlists can often be long (Abraham et al., 2019). Logistically speaking, the policy does address the needs and meets the intended goals for the target population in the states that accepted the expansion, however, for non-participating states, there is a gap in services and barriers to accessing treatment (Maclean & Saloner, 2019). In expansion states, funding for treatment increased by seventy-one percent as opposed to states that did not utilize the expansion (Maclean & Saloner, 2019). Individuals who received Medicaid under the expansion now have been able to reduce their out of pocket expenses and improve their financial wellbeing (Humphreys & Frank, 2014). More importantly, the states that have participated in the expansion have seen an overall reduction in debt (Maclean & Saloner, 2019). The ACA has also funded programs that integrate SUD services within systems of care that already exist; this has created services for those who do not qualify for institutionalized care through community-based services (McCabe & Wahler, 2016). One of the core values the social work profession embodies is that of social justice; this core value maintains that all people should have the same rights and access to the same services Commented [SS33]: The author gives a brief statement about effectiveness of the policy. 12 (NASW, 2012). The main goal of the ACA was to provide uninsured Americans with coverage and remove barriers to accessing treatment, however, there are still millions with a SUD diagnosis that do not qualify for services (Beronio et al., 2014). Therefore, the ACA falls short in providing social justice to all, especially, in non-expansion states. Commented [SS34]: The author gives a determination about the effectiveness of the policy. Advocacy for Policy Based on the analysis of the ACA, multiple changes need to be advocated. First and Commented [SS35]: In this paragraph, the author stated what will be advocated regarding the policy. foremost, since Texas does not participate in the expansion of Medicaid, it will be necessary to advocate at the state and federal level for implementation of the expansion (McCabe & Wahler, 2016). It is recommended that expansion be mandatory in all states which would help to alleviate the burden on those states as well as the vulnerable individuals without assistance (McCabe & Wahler, 2016). Next, since addiction is a chronic relapsing disease, it is unlikely that individuals will recover during their first time in treatment (NASW, 2012). Therefore, putting restrictions on how many times a person can go to treatment is harmful (Humphreys & Frank, 2014). It will be vital to advocate for amendments pertaining to the limitations under certain plans that place restrictions on the number of treatment episodes and days a person can receive services (Lundgren & Krull, 2014). Lastly, since there has been an influx in those seeking treatment, the providers who do accept Medicaid have found it difficult to provide services (Maclean & Saloner, 2019). As such, it will be necessary to advocate for more centers to be built that provide substance use treatment. Commented [SS36]: The author integrated scholarly material to support the advocacy discussion. Part III: The Helping Process The helping process consists of several vital stages including engagement, assessment, intervention, and evaluation. Since New Beginnings is a residential substance use treatment center, each phase is contingent upon the other (Hepworth et al., 2013). For Pamela, engagement Commented [SS37]: The author informed reader by providing a mini introduction to Part 3 of the paper. 13 is one of the most critical stages because this is where the therapeutic alliance begins and sets the tone for the rest of the helping relationship (Center for Substance Abuse Treatment [CSAT], 2006b). During assessment, I utilized a biopsychosocial questionnaire and the Addiction Severity Index to obtain, collect, and interpret information about Pamela to prepare for the intervention Commented [SS38]: The author identified the assessment tools used. phase (Faulkner & Faulkner, 2019). At New Beginnings, cognitive behavioral therapy (CBT) is Commented [SS39]: The author identified the intervention strategy. the primary modality utilized and is what I used to attempt to promote behavior change with Pamela. Lastly, throughout the course of the intervention, an ongoing evaluation was conducted to help me understand the effectiveness of the intervention and to determine if improvements were being made by using a single-subject research design (Smith et al., 2014). Commented [SS40]: The author identified the evaluation strategy. Engagement Engagement is about creating the connection between Pamela and myself, with the ultimate goal of providing a safe environment for her to disclose personal information (Staudt et al., 2012). Often, those with substance use disorders have endured painful and traumatic experiences that can be hard to talk about; therefore, Pamela may feel uncomfortable building trust which is an essential element to engagement (Kothari et al., 2010; Newman, 1997). Aside from this, building rapport will also help to minimize the level of threat perceived by Pamela Commented [SS41]: The author connected the importance of engagement to Pamela and her situation. (Hepworth et al., 2013). Therefore, being respectful, with a non-judgmental attitude and demonstrating empathy as well as authenticity will be critical attributes to possess throughout the duration of engagement (Faulkner & Faulkner, 2019). Other practice techniques that will be invaluable to utilize include active listening, open-ended questions, and focusing techniques like seeking concreteness as part of the exploration process (Karpetis, 2017). All these techniques and attributes will help me to build rapport with Pamela and create a therapeutic alliance (Hepworth et al., 2013). Commented [SS42]: The author gave a summary of skills and techniques used. 14 Implementation of Engagement Skills Initially, the first step was to greet Pamela and make an introduction with a warm and genuine attitude; consequently, this would set the tone for the rest of the process (CSAT, 2006b). Commented [SS43]: The author introduced an engagement skill/technique. Commented [SS44]: The author gave a scholarly supported reason why the engagement skill/technique was necessary. During the introduction, I introduced myself and made eye contact to establish focus with Pamela to make her feel welcomed and comfortable (Faulkner & Faulkner, 2019). Once I introduced myself, I encouraged Pamela to tell me a little about herself and her situation by asking open-ended questions to elicit more information (Newman, 1997). Utilizing open-ended Commented [SS45]: The author introduced an engagement skill/technique and why it was necessary. questions provides a certain sense of structure to the process and allowed Pamela the chance to expand on her thoughts and feelings (CSAT, 2006b). This technique also has the ability to enhance communication between Pamela and myself which will ultimately strengthen our relationship (Hepworth et al., 2013). As engagement progressed, I utilized active listening skills as Pamela continued to talk. Commented [SS46]: The author used scholarly material to justify reason for using the engagement skill/technique. Commented [SS47]: The author introduced an engagement skill/technique. By doing so, I was able to reflect back to her what she was saying so that she knew I was listening (CSAT, 2006b). Active listening is a useful tool to employ because, not only did it let Commented [SS48]: The author gave a scholarly supported reason why the engagement skill/technique was necessary. Pamela know that I was listening, she also felt heard (Hepworth et al., 2013). Weger et al. (2014) state that active listening conveys involvement in a non-verbal manner and utilizes reflection and paraphrasing techniques that let the individual know they have been heard. As a result, this encouraged Pamela to divulge more in-depth information. Active listening also builds trust and demonstrates empathy as it validates experiences (Weger et al., 2014). According to Karpetis Commented [SS49]: The author used scholarly material to justify reason for using the engagement skill/technique. (2017), empathy is an essential element of engagement because it accurately reflects and Commented [SS50]: The author introduced an engagement skill/technique. provides sensitivity to Pamela's feelings. I demonstrated empathy through the use of eye contact, Commented [SS51]: The author gave a scholarly supported reason why the engagement skill/technique was necessary. friendly tone of voice, and relaxed body language, all of which helped to create an environment 15 that would make Pamela feel safe and comfortable enough to discuss painful and personal information (Faulkner & Faulkner, 2019). Another important attribute that I aimed to demonstrate would be authenticity. Being authentic, especially when working with those with substance use disorders, is critical because it helped Pamela to see that I am genuinely sincere (Karpetis, 2017). I established authenticity by Commented [SS52]: The author gave a scholarly supported description on how the engagement skill/technique was used. Commented [SS53]: The author introduced an engagement skill/technique. Commented [SS54]: The author gave a scholarly supported reason why the engagement skill/technique was necessary. being open and honest about the process at New Beginnings, and I discussed with her what she could expect while being engaged in the intervention (CSAT, 2006b). At one point, Pamela expressed that she was ambivalent about participating. By acknowledging this, it helped to Commented [SS55]: The author gave a scholarly supported description on how the engagement skill/technique was used. Commented [SS56]: alleviate her fear and anticipation about what was to come (Newman, 1997). To gain a better understanding of why she felt this way, I implemented focusing techniques like seeking concreteness by asking her to be more specific about why she felt that way (Faulkner & Commented [SS57]: The author introduced an engagement skill/technique. Faulkner, 2019). This is a critical skill to use since individuals can often speak in generalizations; Commented [SS58]: The author gave a scholarly supported description on how the engagement skill/technique was used. therefore, using this method allowed me to clarify the meaning behind her ambivalence (Hepworth et al., 2013). Subsequently, I was able to elicit specific feelings and obtain an overall greater understanding of Pamela’s perceptions and concerns about the intervention (Faulkner & Faulkner, 2019). Once we discussed her fears and concerns, I acknowledged that change can be hard; however, expressed to her that I believed she was capable of change and could stay sober (Newman, 1997). Since engagement is an ongoing process, I would continue to build and strengthen my relationship with Pamela throughout the remainder of the helping relationship. By implementing the engagement skills described, the connection created between Pamela and I was established. Moreover, this connection produced important information that will be necessary for the remainder of the process and the next phase of assessment (Karpetis, 2017). Commented [SS59]: The author gave a scholarly supported reason why the engagement skill/technique was necessary. 16 Assessment New Beginnings uses several tools during assessment, with the most valuable being the biopsychosocial framework. The biopsychosocial framework is a holistic tool that examines a Commented [SS60]: The author identified the collection tool. person’s life in its entirety by looking at biological, psychological, and social dimensions that have been affected by substance use (Faulkner & Faulkner, 2019). The biopsychosocial framework identifies risk and protective factors that can pinpoint strengths and limitations as well as the needs and goals of the person; it can also determine which intervention strategies to implement (Faulkner & Faulkner, 2019). To obtain biopsychosocial information, it will be necessary to incorporate other tools to gather data about Pamela. New Beginnings utilizes the Addiction Severity Index (ASI) which covers seven domains Commented [SS61]: The author gave a scholarly supported description of the tool used to collect, organize and interpret information. Commented [SS62]: The author identified the collection tool. including substance use, family/social concerns, employment, medical, psychiatric, and legal issues (Samet et al., 2007). For Pamela, it will be vital to look at every domain because her Commented [SS63]: The author gave a scholarly supported description of the tool. experience with substance use has impacted every area of her life. In an effort to obtain and collect information about Pamela, I administered the ASI in a semi-structured fashion with the process taking about an hour (Ljungvall et al., 2020). During the interview, I asked specific questions about her level of distress for each of the aforementioned domains over the last thirty days (Samet et al., 2007). Once the interview was completed, I was given a score that Commented [SS64]: The author gave a scholarly supported statement about how information was collected. represented the level of severity Pamela was experiencing. Commented [SS65]: The author stated how information was interpreted. The ASI score is based on a scale ranging from zero to nine, with nine representing the highest severity and greatest level of need (Ljungvall et al., 2020). Based on the final score from Pamela's interview, she received a nine. This score indicated that the severity of her use of substances is considered life-threatening and intensive inpatient treatment is necessary (Samet et 17 al., 2007). By integrating both these tools during the assessment phase, I was able to obtain, Commented [SS66]: The author gave a scholarly supported explanation on how information was interpreted. collect, and interpret information that provided a greater understanding of Pamela's situation. Commented [SS67]: The author failed to discuss in the three paragraphs above how the information collected using the biopsychosocial tool was collected, organized, and interpreted. The author also failed to discuss how the information collected using the ASI tool was organized. Strengths, Limitations, and Resources New Beginnings utilizes a strengths perspective focusing on the person's strengths and resources. By doing so, this builds self-esteem and self-efficacy which increases competency, supports recovery skills, and fosters resiliency (Pulla, 2017). During the assessment, several strengths and resources were identified that will influence the assessment process. First, Pamela has a strong support system which is both a strength and a resource. Looking at her family Commented [SS68]: The author identified a strength. relationships can influence assessment because they can help provide an understanding of the initiation and pattern of Pamela’s substance use (CSAT, 2009). Moreover, her family was a motivating factor in her coming to the assessment and having a strong support system can also determine the overall success of the intervention (Gainsbury, 2016). That said, Pamela's family is also considered a resource because while she is participating in the treatment program, her Commented [SS69]: The author gave a scholarly supported reason for how the identified strength influences the assessment process. mother will provide transportation for her back and forth to the doctor for her medical condition of congestive heart failure. The next strength and resource that was identified is that Pamela has a spiritual foundation. Spirituality influences the assessment process because it plays a major role in a Commented [SS70]: The author failed to state how the strength is known and why this factor is identified as a strength. Commented [SS71]: The author identified a strength. person's life, specifically with regards to culture and identity (Hodge & Holtrop, 2002). Therefore, it is vital to understand and incorporate Pamela's spiritual beliefs during assessment because it is considered a strength and part of the recovery process (Hodge & Holtrop, 2002). Commented [SS72]: The author gave a scholarly supported reason why “spiritual foundation” is a strength. During assessment, Pamela expressed a desire to go back to church and recommit to her faith while at the facility. At New Beginnings, we provide individuals with the opportunity to go to church on Sundays and transport them to and from services. As such, this is a resource that is Commented [SS73]: The author identified how the strength is known and why this factor is identified as a strength. 18 provided by the facility and influenced the assessment process because in order for her to go church she has to have a permission pass to leave the facility. During the assessment, I was able to make those arrangements so that she could start utilizing this resource immediately. Commented [SS74]: The author stated how the identified strength influenced the assessment process. Several limitations were identified that could pose challenges during the assessment. First, Pamela is on probation as a result of substance use and was referred to New Beginnings by her probation officer. Because of this, she is an involuntary participant which can be problematic Commented [SS75]: The author identified a limitation during assessment as it may determine her willingness or lack thereof to participate (SAMHSA, 2014). As an involuntary participant, the assessment process was influenced because there were Commented [SS76]: The author gave a scholarly supported reason why “involuntary participant” is a limitation. certain issues that she did not want to talk about in fear that it would be reported to her probation officer. The next limitation is that Pamela is in a relationship with the father of her unborn child and with whom she has been using with for the last several years. Often, it can be hard for women to sever ties with their substance-using partners, and this can interfere with treatment Commented [SS77]: The author stated how the identified l imitation influenced the assessment process. The author failed to support this notion using a relevant and credible scholarly source. Commented [SS78]: The author identified a limitation. (CSAT, 2009). Since looking at intimate relationships is vital, this influenced the assessment Commented [SS79]: The author gave reason why “in a relationship with the father of her unborn child” is a limitation. because she was unwilling to discuss this relationship. This prevented me from obtaining the Commented [SS80]: The author gave a scholarly supported reason justification for why this factor is a limitation. information needed for this domain of the assessment process. Hence, these risk factors can influence the assessment process and negatively impact her success at New Beginnings because Commented [SS81]: The author stated how the limitation influenced the assessment process. The author failed to support this notion using a relevant and credible scholarly source. they have the potential to be a distraction and impede progress. Diversity Concerns Understanding diversity is a key element in substance use treatment, therefore, looking at Pamela's race, gender, class, and spiritual beliefs are vital to assessment (CSAT, 2009). Race, Gender, and Class. Pamela is a twenty-four-year-old African American female and is considered to be of a lower socioeconomic status. Looking at the diversity factors of race, gender, and class are important during assessment because African American women growing up Commented [SS82]: The author identified a combination of aspects of diversity. 19 in poverty are more likely to become addicted to drugs and face additional hardships than any other race (SAMHSA, 2014). This is relevant to the practice situation because understanding the disparities and barriers Pamela has experienced, with respect to the aforementioned diversity Commented [SS83]: The author gave a scholarly supported statement on how the aspect of diversity connects to Pamela’s situation. issues, will be critical to address during assessment to ensure that an effective intervention is provided based on these concerns (Gainsbury, 2016). Spirituality. Another important diversity factor that is relevant to look at during Commented [SS84]: The author gave a scholarly supported reason why the connection is relevant. Commented [SS85]: The author identified an aspect of diversity. assessment for Pamela and the practice situation is spirituality. As previously mentioned, Pamela believes in God and stated that she grew up Baptist. She communicated that growing up she would go to church all the time. However, as a result of substance use, it has been several years since she has been to church. Now that she is participating in the treatment program, she has expressed a desire to recommit to her spirituality. Spiritualty is an important diversity factor to consider because it can shape a person's worldview and guides beliefs, values, and perceptions (Hodge & Holtrop, 2002). Moreover, it can play a key role in the recovery process, therefore, understanding and incorporating this diversity factor during assessment for Pamela is vital because it is a strength and can impact progress of the intervention (CSAT, 2006b). Commented [SS86]: The author gave a scholarly supported statement on how the aspect of diversity connects to Pamela’s situation. Commented [SS87]: The author gave a scholarly supported reason why the connection is relevant. Social and Economic Justice Social and economic justice are key elements in providing services for vulnerable populations like Pamela as they embody values of fairness, equality, and advocate for access to resources (Obrien, 2009). As an African American woman growing up in poverty and with a SUD, Pamela has not always been treated fairly; as such, she has been unable to qualify for resources or receive evidence-based services in the past (SAMHSA, 2014). Consequently, growing up poor has contributed to a lack of opportunity, a lack of health care, and repeated involvement within the criminal justice system with respect to racial disparities (NASW, 2013). Commented [SS88]: The author gave a scholarly supported statement on how issues of justice relate to the practice situation. 20 Social and economic justice plays a vital role in the practice situation because Pamela deserves the same quality and extent of services despite her circumstances or the color of her skin. Human and Civil Rights. For human and civil rights, persons with SUD are subjected to Commented [SS89]: The author identified a specific type of justice issue related to the practice situation. stigma and experience discrimination on multiple levels; at its core, this is a violation of basic human rights and dignity (Wogen & Restrepo, 2020). Stigma comes in multiple forms and is a barrier that prevents individuals from seeking services. During the assessment, Pamela disclosed Commented [SS90]: The author gave a scholarly supported statement about the way justice is related to the practice situation. experiencing stigma and discrimination because of her race and SUD; consequently, this has prevented her from seeking addiction services in the past. Nevertheless, all the aforementioned have the potential to impact Pamela. There is still much stigma surrounding addiction as well as a major gap in services for those with SUD, especially, African American women from a lower socioeconomic status with a criminal history (NASW, 2013). Intervention Commented [SS91]: The author failed to integrate evidence-based knowledge to give an illustration (i.e., an example) of this type of justice issue as related to the practice situation. During this phase of the helping relationship, Pamela and I worked together to negotiate goals and objectives that were specific, measurable, attainable, relevant, time-specific, and Commented [SS92]: The author informs the reader on use of the SMART goals framework. congruent with problem areas identified during the assessment (CSAT, 2006a). Since substance use is her primary issue, it was important for her to work on this area first. To do this, we mutually agreed that she would begin working to identify maladaptive thoughts and behaviors related to addiction through the use of CBT techniques (Newman, 2016). Commented [SS93]: The author gave a scholarly supported focus to applying the intervention strategy. The first goal we negotiated was for Pamela to gain the skills and tools needed to maintain sobriety. To achieve this goal, Pamela was to use the CBT practice skill of completing homework assignments which consisted of her writing out her drug history, identifying triggers, and developing a relapse prevention plan that would be processed in group three times a week (Keegan & Holas, 2009). Next, she was to develop and work on new behaviors that were Commented [SS94]: The author presented a scholarly supported SMART goal. 21 consistent with a sober lifestyle by using the practice skill of behavioral rehearsal (Ruggiero et al., 2018). Pamela and I also negotiated and agreed that issues she did not feel comfortable talking about in group would be discussed in our weekly sessions. Lastly, she agreed to attend Alcoholics Anonymous (AA) meetings three times a week (Lee, 2015). Commented [SS95]: The author presented a scholarly supported SMART goal. The next goal that we negotiated focused on her family and interpersonal relationships. For this goal, Pamela was to build healthy relationships with her family members and other support systems. To do so, Pamela agreed to participate in living skills groups twice a week to learn healthy coping skills (Keegan & Holas, 2009). The next objective focused on her children Commented [SS96]: The author presented a scholarly supported SMART goal. and parenting skills. This goal was to be achieved by attending parenting classes twice a week. Commented [SS97]: The author presented a SMART goal. Lastly, because creating relationships with members in recovery is vital to staying sober, Pamela was to build a support system within the recovery community as evidenced by her obtaining at least four phone numbers from women in recovery at meetings (Jhanjee, 2014). Commented [SS98]: The author presented a scholarly supported SMART goal. Since Pamela’s projected stay at New Beginnings was approximately forty-five days, we agreed that all the goals and objectives were to be completed within this time frame. Moreover, Commented [SS99]: The author gave a target date/time for goal completion. the abovementioned goals, objectives, and intervention strategies are congruent with CBT and has proven to be one of the most effective interventions when working with persons who use substances (Newman, 2016). Furthermore, the rationale behind using CBT is that it is a timelimited intervention that will help Pamela to identify and modify irrational thoughts to elicit the desired behavior change with the goal of maintaining sobriety (Hebert et al., 2013; Jhanjee, 2014). Intervention Application Since the basic premise of CBT is behavior change, Pamela and I began working on identifying her negative thoughts and behaviors (Hebert et al., 2013). By using the practice skills Commented [SS100]: The author gave a scholarly supported rationale for selection of the intervention strategy. 22 of cognitive restructuring and behavioral rehearsal, she began to replace those negative thoughts with new thoughts and behaviors (Keegan & Holas, 2009). During the first week, Pamela identified internal and external triggers. She recognized her external triggers were money, substance using friends and family, and places; her internal trigger is anger (McHugh et al., Commented [SS101]: The author identified two practice skills used in the intervention with Pamela. The skills used are specifically associated with the intervention model. Commented [SS102]: The author gave a scholarly supported rationale for the using the selected practice skills. Commented [SS103]: The author began giving a descriptive overview of the intervention from beginning to termination. 2010). She expressed that she was her own personal trigger and identified harmful situations that would be problematic for her. After she identified these situations, alternative activities were presented that would help her to avoid these high-risk situations in the future (Newman, 2016). Some of these activities included going to an AA meeting, calling her sponsor, or hanging out with sober friends (McHugh et al., 2010). Pamela and I met for our weekly sessions and discussed her progress as well as homework assignments that she did not feel comfortable sharing in group. As we began to talk, she disclosed that she wanted to stay sober and raise her baby; however, became overwhelmed Commented [SS104]: The author identified another practice skill used in the intervention with Pamela. The skill used is specifically associated with the intervention model. However, the author failed to give a scholarly supported rationale for using the selected practice skill. with emotion and said she did not think that she could stay sober. As I actively listened, I reflected back to her what she said with empathy and asked her what made her think she could not stay sober (Hepworth et al., 2013). She replied, “I do not think I am worthy of sobriety”. Since this is a dysfunctional belief, we examined it further and came up with some alternative thoughts about sobriety; she agreed to practice replacing that negative belief with the belief that she was worthy of recovery (Newman, 2016). During our weekly sessions, since Pamela was on probation, I advocated on her behalf with her probation officer by giving weekly updates about the progress she was making. During our third weekly session, Pamela's probation officer informed her that she would have to come back to New Beginnings after she delivered her baby, and Pamela became upset. At this time, it was necessary for me to mediate between Pamela and her probation officer to diffuse the Commented [SS105]: The author stated how advocacy was performed for Pamela. 23 situation. During this mediation, we all agreed that would revisit this issue at a later date. Over the next three weeks, Pamela continued to attend her groups, work on her assignments, Commented [SS106]: The author stated that mediation was performed for Pamela. However, the author failed to state how mediation was performed for Pamela. participate in her weekly individual sessions, and make meetings. During each weekly session, Pamela and I continued to work on her cognitive distortions by utilizing cognitive restructuring practice skills and replacing her negative thoughts with more effective ways of thinking (Herbert et al., 2013; McHugh et al., 2010). As Pamela approached her due date, an agreement was made that she would return to the facility as soon as she was released from the hospital. Unfortunately, she did not comply with the rules implemented by New Beginnings, and she did not return until several days later. Upon return, she disclosed that she had used drugs. Because she was honest, the facility decided to let her stay but placed her on zero tolerance. This means that if she received any other sanctions, she would be immediately discharged unsuccessfully. At this time, she agreed to start her time over with a thirty-day restriction which included no phone calls for fourteen days, no weekend passes, and no family visits. After two days, Pamela decided to leave the facility against medical advice and was discharged unsuccessfully. Since Pamela was mandated to participate in the New Beginnings treatment program, her probation officer was notified immediately of her decision to leave. Intervention Critique Despite the outcome, Pamela did make significant progress during the intervention process. In my opinion, our individual weekly sessions appeared to be effective and therapeutic. At first, Pamela was reserved and unwilling to discuss certain issues. However, during our second session, the opportunity presented itself for me to use self-disclosure (Knight, 2012). By doing this, it allowed Pamela to feel comfortable and to be open sharing freely; as a result, she Commented [SS107]: The author informed the reader on the circumstances regarding termination and how termination was facilitated. 24 began to disclose painful experiences that she said she had never discussed with anyone (Knight, 2012). Talking about these experiences was empowering for her because the more she talked about them, the more freedom she felt (Faulkner & Faulkner, 2019). As a result of her disclosing these experiences during our sessions, she then felt empowered and comfortable enough to share with her peers. Moreover, on numerous occasions, Pamela expressed her trust in me and knew I Commented [SS108]: The author stated how the intervention was empowering for Pamela. cared; therefore, the utilization of practice skills was something I did well. I was also able to Commented [SS109]: The author stated what was done well and evidence to support that notion. teach Pamela some healthy coping skills that would be beneficial for her once she left New Beginnings. Some things I did not do well was with respect to the implementation of CBT techniques and maintaining boundaries. As an intern, I have only acquired the basic skills set for this intervention. Therefore, if I would have been more proficient in CBT, the overall outcome may have been more successful. For boundaries, I started with strong boundaries, however, throughout the process I did not maintain those boundaries. If I would have maintained better boundaries, this may have also improved the outcome (Faulkner & Faulkner, 2019). Lastly, the intervention may have been discriminatory and oppressive because Pamela was an involuntary Commented [SS110]: Here, the author stated what was not done well, the evidence to support that notion, and as well addressed what could have been done to improve outcomes with Pamela. The author failed to use adequate support from scholarly material for this discussion. participant. For this reason, outside forces were influencing her to engage in the intervention. This could have been oppressive because she was not there of her own free will; participation in the intervention was not voluntary. Nevertheless, Pamela did make some changes which suggests that the intervention may have been successful. Even though she left unsuccessfully, she did complete most of the goals listed on her treatment plan and worked on three of the abovementioned concerns. Theoretical Background Commented [SS111]: The author stated how the intervention was both discriminatory and oppressive but failed to support these claims with scholarly material. 25 The intervention strategy selected for Pamela, cognitive-behavioral therapy, is a theorybased intervention derived from cognitive behavior theory created by Aaron Beck in the sixties (Keegan & Holas, 2009). This evidence-based theoretical framework rests on the idea that Commented [SS112]: The author stated whether the intervention was developed from a theoretical practice model and re-identified the practice model. perceptions and thoughts influence emotions, behaviors, and reactions (Herbert et al., 2013). Thus, if an individual frequently experiences distress, their cognitions become distorted which can create unhealthy emotions and behaviors (Newman, 2016). For individuals like Pamela with a SUD, CBT aims to identify high-risk situations, dysfunctional beliefs, and automatic thoughts manifested by addiction; once these are identified, CBT helps to replace those with healthier ways of thinking to promote behavior change (Wells et al., 2013). This is done through the use of cognitive restructuring, behavior rehearsal, skill-building, homework assignments, and relapse prevention (Wells et al., 2013). Overall, significant empirical research indicates that CBT is one of the most effective modalities used to treat SUD because it focuses on changing behavior, preventing relapse, and helps the person maintain long-term sobriety (Jjanjee, 2014). At New Beginnings, we utilize CBT because it focuses on identifying negative cognitions and behaviors Commented [SS113]: The author used scholarly sources to discuss the advantages of using the theoretical practice model but failed to use evidence-based scholarly material to provide an analysis of the practice model. Commented [SS114]: The author gave a statement about the effectiveness of the theoretical practice model but failed to specifically identify and discuss the empirical evidence supporting the model’s effectiveness. that are commonly associated with SUD, and replaces those with more effective ways of thinking with the ultimate goal of promoting behavior change (Faulkner & Faulkner, 2019; Hebert et al., 2013). Evaluation To evaluate Pamela’s progress and the effectiveness of the intervention while at New Beginnings, I utilized a single subject research design (SSRD) evaluation method. SSRD is designed to help clinicians gauge the progress and effectiveness of interventions as they are being implemented with individuals like Pamela (Campbell, 1988). The essential feature of this evaluation method is to measure data repeatedly throughout the intervention to determine if there Commented [SS115]: The author identified one method used to evaluate change and improvement regarding Pamela. 26 is behavior change precipitated by the intervention (Mauldin, 2020). Since there are multiple Commented [SS116]: The author gave a scholarly supported rationale for selecting the evaluation method. types of SSRD, the specific model that was used to assess Pamela’s progress and the effectiveness of the intervention was the AB design. The AB design consists of a baseline phase and an intervention phase (Janosky, 2005). The desired behavior change is referred to as the dependent variable, also known as the baseline; Commented [SS117]: The author informed the reader on the specific design that was used to evaluate change. Commented [SS118]: The author used this paragraph to give a scholarly supported description about the selected evaluation method. the intervention phase is referred to as the independent variable and where the intervention takes place (Foster, 2010). The baseline phase consists of gathering information before the intervention and requires at least three data points to establish a point of reference (Backman et al., 1997). During this phase, the data collected provides an understanding of the problem and existing patterns of behavior that the intervention aims to alleviate (Byiers et al., 2014). Also, the baseline serves as a guide to understanding the effects of the intervention and the extent to which the intervention is needed (Campbell, 1988). Once the baseline is established, the intervention phase begins and is where the intervention is administered (Mauldin, 2020). During the intervention phase, progress is continuously monitored and compared to the baseline to determine if there is an improvement being made with respect to the intended behavior change (Nuehring & Pascone, 1986). That said, utilizing this evaluation method would provide me with feedback during Pamela's intervention to help determine if improvements were being made. Strengths, Limitations, and Rationale Commented [SS119]: The author gave a summary statement on the reason for selecting the evaluation method. There are multiple strengths and limitations associated with this evaluation model that are relevant to Pamela, the practice situation, and the specialization of mental health and substance use. The first strength of this model is that it is compatible with direct mental health and substance use practice because it easily integrates intervention with evaluation (Byiers et al., 2014; Nuehring & Pascoe, 1986). Consequently, this allowed me the opportunity to assess Commented [SS120]: The author gave a scholarly supported strength of the evaluation method followed by a statement about relevance. 27 Pamela's progress and the effectiveness of the intervention while she was at New Beginnings (Smith et al., 2014). Another strength of SSRD is that it is ideal for evidence-based practices and congruent with CBT (Mauldin, 2020). CBT is the primary intervention modality implemented at New Beginnings and was utilized with Pamela to elicit behavior change. Lastly, New Beginnings Commented [SS121]: The author gave a scholarly supported strength of the evaluation method followed by a statement about relevance. is a non-profit organization so financial resources are not always available to conduct in-depth evaluation research; as such, this evaluation method is relevant because it is cost-effective and fairly simple to utilize (Foster, 2010; Janosky, 2005). For limitations, the most relevant limitation important to mention is that the AB design is the weakest of all the SSRD designs because it lacks internal validity (Backman et al., 1997). Commented [SS122]: The author gave a scholarly supported strength of the evaluation method after giving a statement about relevance. Commented [SS123]: The author gave a scholarly supported limitation of the evaluation method. Although this model is effective in observing behavior change, it lacks the ability to determine if the behavior change was directly related to the intervention or if other factors contributed to the change (Foster, 2010). In Pamela’s case, the external factors that could contribute to her behavior Commented [SS124]: The author gave a scholarly supported limitation of the evaluation method. change would be that she is on probation and pregnant. Therefore, it could be hard to determine if the intervention is responsible for her behavior change or these external forces (Foster, 2010). Despite the drawback of this model, the rationale for using the AB design with Pamela while at Commented [SS125]: The author gave a scholarly supported limitation of the evaluation method after giving a statement about relevance. New Beginnings is that it is designed to assess the effectiveness of the intervention with individuals by providing objective data, is cost-effective, and compatible with direct practice as well as CBT (Backman et al., 1997; Mauldin, 2020). Application of SSRD To begin the evaluation process, the first step will be to establish a baseline for Pamela to identify target behaviors that the intervention was attempting to alleviate (Campbell, 1988). As previously mentioned, Pamela was incarcerated four months before arriving at New Beginnings, and once she arrived at the facility intervention immediately began. Therefore, to establish the Commented [SS126]: The author used the remaining portion of this section of the paper to give a scholarly supported detailed description on how the evaluation method was used to collect and assess change. 28 baseline it was be necessary to collect data using information obtained during screening, intake, and from review of previous case files (Engle & Schutt, 2016). I also asked Pamela if she was willing to provide information about the frequency, intensity, and extent of her own substance using activity (Engle & Schutt, 2016). By collecting data from her directly, I was able to gain a better understanding on the severity of her situation and to establish a baseline that would provide stability (Mauldin, 2020). Some of the questions that I asked Pamela were how much she used, how many times a week did she use, and the duration of her use. By incorporating all the information obtained through the abovementioned sources of data as well as self-reports by Pamela, I was able to establish a pattern of behavior and a stable baseline (Foster, 2010). Once the baseline was established, I created Pamela's treatment plan based on the information collected to target behaviors that the intervention would attempt to improve (Nuehring & Pascone, 1986). The goal for Pamela while at New Beginnings was to remain abstinent from all mind-and mood-altering substances. Since she was already sober upon arrival, the intervention focused on changing negative thoughts about substance use with the application of CBT techniques to prevent relapse (Willner-Reid et al., 2018). Over the course of six weeks, I introduced and implemented CBT techniques during individual sessions to elicit behavior change (Spaid, 2004). Each time Pamela thought about using substances, she was to replace that negative thought with a healthy thought and keep track of it (Nuehring & Pascone, 1986). Utilizing the AB design, I repeatedly compared her behavior before intervention with the changes that she was making throughout the intervention to assess the effectiveness of the strategy (Backman et al., 1997). Since New Beginnings is a residential facility, I had the advantage of working with Pamela almost daily and was able to observe her behavior changes periodically (Byiers et al., 29 2014). Moreover, during our weekly sessions, I utilized progress notes and bi-weekly treatment plan reviews that also allowed me to gauge her progress and assess changes in her thinking. Overall, Pamela made significant progress during the intervention process while at New Beginnings. When comparing the baseline phase and intervention phase, it was noticed that the improvements made were significant which indicated success during the intervention (Foster, 2010). Part IV: Conclusion Professional social work practice is built on ethical principles and a set of core values that serve as a guide to ethical decision making (NASW, 2017). As such, the profession is significant Commented [SS127]: The author informed the reader by providing a mini introduction to Part 4 of the paper that discussed the significance of professional social work practice as related to the practice situation. when working with substance using individuals like Pamela because the NASW Code of Ethics is utilized to help make ethical decisions and strives to empower and enhance the well-being of vulnerable persons among the substance using population (Lee, 2015; NASW, 2017). At New Beginnings, the facility is in a unique position to help women struggling with addiction through the lens of evidence-based informed approaches used to provide the most effective intervention support available (Proctor, 2017). Potential Ethical Dilemma Social workers can face potential ethical dilemmas in multiple practice situations (Reamer, 1983). As I assess Pamela’s case, there is the potential for an ethical issue to arise regarding self-determination with respect to working with an involuntary participant (Regehr & Antle, 1997). One ethical standard for social work practice, as per the NASW Code of Ethics, is to honor the individual's right to self-determination and provide guidance as they make their own choices (NASW, 2017; Saxon et al., 2006). That said, when working with involuntary participants, informed consent must be provided (Akbar, 2019). Regardless of the involuntary Commented [SS128]: The author identified an ethical standard associated with the identified ethical dilemma. 30 nature of Pamela's situation, she had the right to make her own decisions including the right to refuse services at any time (Regehr & Antle, 1997). Since Pamela was mandated to engage in services at New Beginnings, her right to selfdetermination was limited. Even so, she still had the right to make her own decisions but there were consequences if she chose not to comply (Regehr & Antle, 1997). This poses a potential ethical dilemma. Pamela’s well-being assigned as my primary responsibility involved actively working with her based on a court-appointed obligation resulting from a criminal offense. I had a legal obligation to report any non-compliance on the part of Pamela (Lee, 2015; NASW, 2017). That said, the potential ethical dilemma arose after Pamela left the facility to deliver her child but did not return till days later. Once she returned, she disclosed that she had used substances. The facility chose to let her stay and did not report the incident to her probation officer. This poses an Commented [SS129]: The author identified an ethical dilemma and described the ethical conflict as related to the practice situation. ethical dilemma for me because, although Pamela's well-being is the primary concern, the duty to report the incident was a legal obligation the treatment team at New Beginnings failed to comply with (Saxon et al., 2006). Professional Strengths and Challenges Throughout the integrative process, I have become aware of some of my professional strengths and limitations with respect to the different phases of the helping process. Overall, the strengths that I possessed, and the areas that I am most knowledgeable in were engagement, assessment, and intervention. For engagement, my understanding and application of the skills and techniques needed to effectively engage Pamela was something that I did well (Hepworth et al., 2013). Another strength that I possessed was during the assessment phase and utilizing the biopsychosocial framework (Faulkner & Faulkner, 2019). As a result, I was able to obtain, collect, and interpret a significant amount of information that helped to guide and influence the Commented [SS130]: The author further reiterated the extent of the identified dilemma using a scholarly source for support. 31 intervention. Next, I have a good understanding of the intervention process and all that it entails. For intervention, although I am limited in the skill of implementing certain modalities, I have a good understanding of how to formulate goals and objectives using the SMART goals framework (CSAT, 2006a). On the other hand, the challenges that I faced when working on this project were in the Commented [SS131]: Referencing scholarly sources, the author discussed how the integrative paper brought awareness to professional strengths. The author failed to use scholarly material to support the discussion. areas of human behavior in the social environment, social policy, and evaluation. I have come to realize that I have a lot to learn about human behavior and how to apply it to an individual in a direct practice setting. This was an area that I struggled in the most. As per the NASW Code of Ethics (2017), social workers must understand human behavior and the function it has on society. As such, this is an area that I need to focus on moving forward. For social policy, I knew coming into this course that this was an area I lacked knowledge in, however, I now understand the importance social policy plays in the helping process and how vital is it to be proficient in this area because social policy shapes everything we do (Proctor, 2017). Lastly, evaluation is another area that I need to dedicate more time to. Although I have a basic understanding of the different types of evaluation methods, I found it difficult to implement the evaluation design. Conducting evaluations and understanding the effectiveness of the interventions I am utilizing will be critical in helping me determine if what I am doing is working or not (Proctor, 2017). Professional Development Plan To ensure that I am of maximum service to all vulnerable populations, it will be necessary for me to formulate a lifelong professional plan and engage in continuing education. The NASW states that social workers are responsible for their professional development, and continuing education is vital to ensuring that quality services are provided ensuring receipt of the best possible care available (NASW, 2003). That said, as I prepare to graduate with a Master of Commented [SS132]: Referencing scholarly sources, the author discussed how the integrative paper brought awareness to professional challenges. The author discussed how the integrative paper brought awareness to professional strengths. 32 Social Work (MSW) degree, my first short-term goal is to study for the licensing exam. While studying for the test, I will devote extra time to the abovementioned challenges that I faced when working on this integrative project. Once I take and pass my test, I plan to work in a direct practice clinical setting working with individuals challenged by a SUD. Commented [SS133]: The author identified a short-term goal but failed to discuss the opportunities that will be sought and engaged to achieve the goal. My long-term goals for professional development and to increase competency is to gain as much information with respect to human behavior, social policy, intervention, and evaluation (NASW, 2003). I will do this by participating in conferences, symposiums, trainings, reading professional journal articles, and conducting research (Jivanjee et al., 2015). Also, I plan to become certified in evidence-based interventions that have been proven effective with a variety Commented [SS134]: The author identified a long-term goal and discussed the opportunities that will be sought and engaged to achieve the goal. of vulnerable populations including cognitive behavioral therapy, motivational interviewing, and eye movement desensitization and reprocessing (EMDR) (Faulkner & Faulkner, 2019). To achieve this, there are multiple online programs that provide these certifications and which I have already researched. Nevertheless, regardless of what setting I am in, being competent in all aspects of the helping process as well as being culturally competent will be vital to assisting the most vulnerable populations (Gainsbury, 2016; Jivanjee et al., 2015). Furthermore, I will strive to be an agent of change. It will be my lifelong goal to continue to grow and evolve so that I can be of maximum service to the most vulnerable and oppressed. Commented [SS135]: The author identified a long-term goal and discussed the opportunities that will be sought and engaged to achieve the goal. 33 References Abraham, A. J., Andrews, C. M., Grogan, C. M., D'Aunno, T., Humphreys, K. N., Pollack, H. A., & Friedmann, P. D. (2017). The Affordable Care Act transformation of substance use disorder treatment. American Journal of Public Health, 107(1), 31–32. https://ajph.aphapublications.org/doi/10.2105/AJPH.2016.303558 Abraham, A. J., Smith, B. T., Andrews, C. M., Bersamira, C. S., Grogan, C. M., Pollack, H. A., & Friedmann, P. D. (2019). Changes in state technical assistance priorities and block grant funds for addiction after ACA implementation. American Journal of Public Health, 109(6), 885–891. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2019.305052 Akbar, G. L. (2019). Thinking critically about self-de...