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Case Study Summary
Corporal Colby King is a veteran of an Afghanistan campaign that took place for eight months in 2012. He was honorably discharged six months ago and is having trouble readjusting to his new life. His mother and his girlfriend brought him to the ED after a threat of ending his own life. Cpl. King suffers from a psychological trauma associated with the loss of friends and comrades during the Afghanistan campaign of 2012. He is hesitant to open up to anyone and spends time in the company of his marine friends. Three months ago, Cpl. King suffered a back injury from a motorcycle accident, which leaves him in a condition of constant pain. Additional symptoms include aggressive mood swings, a lack of interest in continuing relationships, and general apathy towards anyone besides his few marine friends.
Engaging Cpl. King
Merrill (2013) states that the clinician strategy for patients such as Cpl. King, who demonstrate clear signs of suicidal and self-harming behavior, should be based on three principles:
- Friendliness. The clinician is expected to demonstrate a supportive, caring, concerned, and compassionate attitude towards the patient.
- Frankness. The clinician must be direct and candid when talking to the patient about the risks of their behavior. Must not be afraid to ask difficult questions.
- Firmness. The clinician must hold a confident tone and apply pressure when necessary, in order to facilitate a therapeutic process.
These behaviors, combined together, will help create a healthy relationship between the patient and the healthcare provider, based on respect, mutual trust, and relational honesty. Establishing rapport with Cpl. King is essential, as he shows signs of aversion towards psychologists. It is recommended to present oneself as a social worker, as the word “psychologist” is a loaded term that often has a negative connotation.
The interviewing strategy will implement a normalization process, which would enable extracting important information out of the patient (Rubin, Weiss, & Coll, 2012). The primary sources of information would include interviews of the patient, his family, his marine friends, as well as medical logs and reports of the primary healthcare providers. Some of the critical information to be accessed must include the following (Merrill, 2013):
- Suicidal ideation – determining what triggers suicidal thoughts in a patient.
- Suicidal planning – determining what plans the patient had about his own suicide.
- Means – what means of suicide are immediately accessible to the patient.
- Protective factors – means of suicide prevention.
- Past experiences – the patient’s history of suicide attempts.
- Future expectations – determining the patient’s expectations towards life, the possibility of suicide, and perceived reactions to it.
Psychometric Assessment Tools
The primary assessment tool for social workers and clinicians dealing with suicide is the Suicide Affect Behavior Cognition Scale (SABCS). It is a six-item scale that assesses the patient based on suicidal affect, behaviors, and cognition (Scott, Whitworth, & Herzog, 2016). It was constructed using the classic test theory and item response theory as primary psychometric frameworks. It has shown good results and a greater measure of internal reliability.
Risk Factors and Protective Factors
Some of the risk factors that Cpl. King is exposed to include alcohol, trauma, social displacement, and relationship status. His current standing with his girlfriend is unstable, as the woman wishes to terminate the relationship. Due to a physical injury 3 months ago, the patient experiences pain, which further worsens his mood and self-perception. Alcohol use increases the chances of self-harm and unpredictable behavior Scott et al., 2016).
Cpl. King’s protective factors include strong relationships with his fellow marines, who could be a powerful force in his future recovery. Relationships with his mother and girlfriend could also be used as protective measures against suicide. Finally, Cpl. King’s sense of honor integrity as a former marine can be utilized to prevent suicide.
Based on the information provided in the case study, Cpl. King’s levels of risk for suicide are rated as moderate-high. He has threatened suicide on at least one occasion, as various means of committing it, and is not forthcoming to treatment. In addition, the reliance on pain medications and alcohol makes his situation even more unstable. The patient is not rated higher due to several powerful anchors, such as his friends and family.
The preliminary safety plan for Cpl. King would involve a six-step procedure, which would involve the patient, his friends, and his family. The steps for this plan are as follows (Merrill, 2013):
- Learning and recognizing the warning signs. In Cpl. King’s case, some of them include a desire to drink alcohol and general tiredness from family, socialization, and life.
- Determining internal coping strategies. The social worker will need to conduct a series of conversations with the patient in order to determine ways of distracting oneself from suicidal thoughts through means other than alcohol consumption.
- Engaging in social contacts. As it was stated, Cpl. King places great value on the company and the opinions of his former comrades. Engaging them in transmitting a positive message to the patient can potentially lead to recovery.
- Involving family. The patient’s mother and girlfriend should be providing assistance to Cpl. King’s recovery. The patient did not present any direct hostile intent towards them, meaning that they are in relative safety.
- Involving healthcare agencies and social services. Having the patient visited by a nurse or a social worker would ensure progress and stable monitoring of the situation.
- Reducing the risk of violent suicide. Removing drugs, weapons, and alcohol from the patient would improve his chances of survival.
Merrill, G. (2013). Assessing client dangerousness to self and others: Stratified risk management approaches. Web.
Rubin, A., Weiss, E. L., & Coll, J. E. (2012). Handbook of military social work. New York, NY: John Wiley & Sons.
Scott, D. L., Whitworth, J., & Herzog, J. (2016). Social work with military populations. New York, NY: Pearson.