Introduction
In the last few years, considerable attention has been given to determine the increased risk of suicide in veteran populations. It has led to the development of new support options, which could be helpful in responding to veterans in distress. The military patient’s history is important for recognizing risk factors such as suicide and helps healthcare professionals to adopt the right treatment plan (Kelly, Barksdale, & Gitelson, 2011). The assessment report covers a case study of a veteran and determines the effectiveness of a comprehensive biopsychosocial-spiritual model for his assessment.
Background of the Study
In the United States, young veterans aged 18-22 are most at risk to commit suicide, and around 18-20 American veterans commit suicide per day (Olenick, Flowers, & Diaz, 2015). Therefore, it is the duty of health care professionals to address veterans’ emotional concerns as well as their physical safety concerns. It has been revealed in medical records of veterans that they mostly encounter behavioral or mental health disorders or are usually diagnosed with at least one disorder such as Substance Use Disorders (SUDs) and Post Traumatic Stress Disorders (PTSD) (Rubin, Weiss, & Coll, 2013). The Bio-Psycho-Social (BPS) framework is a widely-used approach that is based on the importance of a systematic view of the individual’s behavior and actions along with the integration of biological, psychological, and sociocultural factors with human functioning and development.
Case Study
The case study focuses on a veteran of the Iraq War, named Mike (pseudo name) with Traumatic Brain Injury (TBI), depressive symptoms, Post-traumatic Stress Disorder (PTSD), and alcohol dependence. He is a person whom I have met during my summer internship program at XYZ hospital. He is a 24-year-old single American man, who has served two tours of duty in Iraq. During this period, he experienced multiple combat fire-fights and witnessed many deaths and losses. Moreover, he was also seriously injured twice with many severe wounds and infections. He also suffered from severe headaches, confusion, vertigo, and loss of hearing.
Relevant Theory
The application of the Bio-Psycho-Social-Spiritual approach requires theoretical underpinning based on the case scenario. In this case, it is crucial to select a theory that places more importance on phenomenon studies rather than the method used to study it. Therefore, it would allow an in-depth understanding of the case and applying the approach that could assist the patient to overcome his concerns and problems. The theory relevant to the case of Mike is Constructive Grounded Theory (Finnegan, 2016). The reason for selecting this theory is that it is crucial for the therapist to form a mutual understanding and relationship by conducting multiple sessions to establish trust and get more information that could help in developing a meaningful treatment plan for the patient.
Identification of Client’s Strengths
Mike has robust social support from his family and friends that encouraged him to continue his normal life again. He has reported no significant medical or psychological difficulties before military services. Moreover, he has a positive family history with no previous record of depression and alcohol use disorder. He has a strong personality but the events during his time in Iraq affected him.
Cultural Issues
Mike is a Latin American and lives with his family as he joined the US Army after graduation. In clinical practices, it is important to acknowledge differences when dealing with a diverse population. There are different cultural factors including language, religious beliefs and practices, values, and understanding of medical treatment that would be considered in the selected case (Pullen, 2014). Different tools that can be used for communicating with clients from diverse populations include multimedia tools, language-based materials, and bilingual practitioners, etc. These tools can help in increasing awareness and understanding of the patient regarding the approach adopted by the therapist or counselor.
Goals and Objectives
The patient has a list of problems that need to be addressed by following a proper treatment plan that includes three goals and nine objectives that have been set by keeping in mind the problems and concerns of the patient.
Goal 1: To develop skills to change his drinking habit necessary to maintain a sober lifestyle
Objectives:
- To develop a program of recovery by keeping a record of the situation as he tried to stop drinking but was not able to resist it.
- To record events when he used chemicals for overcoming uncomfortable feelings related to his past.
- To follow up with a proper diet plan to maintain healthy body weight.
Goal 2: To develop the ability to control his anger and keep calm in different situations
Objectives:
- To share his positive feelings with others and keep a record of the events when he was unable to express his thoughts.
- To develop the ability to ask others for his needs and wants.
- To keep a record of the time when he was unable to sleep comfortably.
Goal 3: boost his self-confidence and learn assertive skills to maintain a healthy relationship with his family and friends
Objectives:
- To observe Mike when sharing his thoughts and feelings by practicing assertive skills in a group.
- To plan an activity to determine whether Mike improves his self-esteem or not.
- To keep a log of assertiveness and share it with the counselor on a daily basis.
Bio-Psycho-Social-Spiritual Assessments
As Mike faced several psychological and medical problems, the assessment was carried out by following the bio-psycho-social-spiritual approach. Mike is living a complicated life and having multiple layers of health concerns. Therefore, it is challenging for me to plan effectively to serve him and address his various issues. Detailed evaluation and assessment have been found effective to provide the best treatment possible. The selected framework for Mike’s case is the biopsychosocial and spiritual assessment that includes all aspects of a complete assessment. It consists of four categories, i.e., biological, psychological, social, and spiritual, and it is referred to as “Bio-Psycho-Social-Spiritual Assessment” (Hunt, 2014). The step-by-step process of evaluation helps in questioning the client and reducing the chances of confusing and disorganized information.
The step-by-step assessment process of biopsychological spiritual assessment was adapted to identify the crucial issues and fundamental needs to start working on his case. The assessment is considered as an ongoing process and consists of many different strategies and approaches. It was noted that initially, Mike was not comfortable. Therefore, it was necessary first to make the client comfortable and let him share his thoughts without any fear (Scott, Whitworth, & Herzog, 2016). The constructive grounded theory requires the practitioner to design research in a way that makes Mike feels comfortable, and it would be much easier for the therapist or counselor to retrieve correct information from him as incomplete or wrong information results in perceiving improper outlook of his condition and state of recovery. Therefore, while conducting the first interview with Mike, I listened to him carefully and let him feel comfortable to share his thoughts with me. In the beginning, he was rigid and seemed unfriendly to express his feelings. It took almost two days to let him become expressive and share his feelings and views that assisted in achieving the second goal.
Use of Technological Advances
Visualization and conceptualization of mental images are supported by Constructive Grounded Theory to improve patient care (Nagel, 2011), which could be used in the case of Mike. The subsequent interviews involved the use of technological advances that have been adopted by clinical practices to improve patient outcomes. Different multimedia videos were suggested to Mike and occasionally shown him to learn about the experiences and successful recovery of other veterans. Moreover, Mike’s computerized health record was created and updated after each interview and assessment that assisted in addressing his health concerns in a systematic approach and reporting his progress regularly.
Step-wise Assessment
Biological Aspects
The biological phase of the assessment is very important as the functional capacity of individuals might be impacted by many biological concerns (Ainspan, Bryan, & Penk, 2016). In this phase of assessment, I asked Mike about his past and present medical illnesses and injuries. It also involved asking questions about his disabilities, substance abuse, and drinking, eating, and sleeping habits. Mostly, biological problems are addressed before discovering more complex psychological, emotional, and spiritual issues. The constructive grounded theory requires the collection of concurrent data, comparison, and analysis of information by linking at all levels. During the interview, Mike told me that he has problems sleeping as he could hardly sleep at night and does not feel like eating. It reflects his state of depression and stress as troubled sleep and irregular eating patterns are related to psychological issues.
Psychological Aspects
The psychological aspects of assessment are also critical. It is reported that veterans are more at risk for psychological disorders due to their exposure to traumatic events including disasters, physical and sexual assaults, and military combat. It could have long-lasting adverse effects on them such as anger, sleeping disturbance, nightmares, hyperactivity, and drug/alcohol abuse (Olenick et al., 2015).
In this phase of the assessment, Mike was assessed for any homicidal or suicidal ideations. I tried to get a clear understanding of his psychiatric hospitalization or suicidal attempts. He told me that many times, he wanted to take his life and get rid of the traumatic thoughts and losses. Mike also told me that he often becomes aggressive and violent due to the feeling of helplessness and inability to ask others for his needs and wants. The communication gap was due to his lack of self-confidence and self-esteem. He also shows symptoms of constant mood changes and memory problems. He was showing all signs of post-traumatic stress disorder (PTSD) and Traumatic brain injury (TBI). This phase includes all processes related to reasoning and thinking based on the constructive grounded theory and complete assessment of the client’s defense mechanisms. Therefore, I have to retrieve as much information as possible related to Mike’s psychiatric history and current status as possible.
Social Aspects
Many different features of a client’s story are included in the social aspects of the assessment. It includes a relationship with his friends and family, educational background, employment history, and legal issues. The social background of a person could impact his life in many different ways (Olenick et al., 2015). Mike has a supportive family, and it is the main reason that he wants to get back to normal life. Social support is very helpful especially in treating patients with psychological problems. Healthy relationships and a friendly environment lead to a healthy mind and lifestyle. Relationships can help in identifying other issues that would be required to be addressed (Ainspan et al., 2016).
Spiritual Aspects
The assessment’s spiritual phase could reveal a great deal about the client’s present and past life (Ainspan et al., 2016). I spent a lot of time asking numerous open-ended questions with Mike. It helped me to understand his spiritual/ religious beliefs and gathering history. The spiritual aspects also help in understanding the behavioral aspects, spiritual state, and inner spiritual beliefs of a person belonging to a different culture to understand his behavior and life choices. As Mike was somewhere in the middle with his spiritual belief, he did not have a strong religious belief that might be the reason he was not content with his life.
Conclusion
In conclusion, Mike needs the support of his family and friends along with counseling for dealing with his mental stress and depression. Several therapies such as family/group therapy, prolonged exposure therapy, psychotherapy, medication such as anti-depressants, and social support are also required to treat his symptoms of PTSD and TBI. Moreover, spiritual beliefs offer support by bringing hope and positivity in Mike’s life and helping him to feel purposeful in life. Thus, the bio-psycho-social-spiritual framework for assessment could be said to be the best model to understand the specific problems of a veteran.
References
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