8e4aa878bac6a2720e237a1fe21b233b.pdf

1

Theory Into Practice: Four Social Work Case Studies

In this course, you select one of the following four case studies and use it throughout
the entire course. By doing this, you will have the opportunity to see how different
theories guide your view of a client and that client’s presenting problem. Each time you
return to the same case, you use a different theory, and your perspective of the problem
changes—which then changes how you ask assessment questions and how you
intervene.

These case studies are based on the video- and web-based case studies you encounter
in the MSW program.

Table of Contents

Tiffani Bradley ………………………………………………………………………………………………….. 2

Paula Cortez ……………………………………………………………………………………………………. 9

Jake Levey …………………………………………………………………………………………………….. 10

Helen Petrakis ………………………………………………………………………………………………… 13

2

Tiffani Bradley

Identifying Data: Tiffani Bradley is a 16-year-old Caucasian female. She was raised in

a Christian family in Philadelphia, PA. She is of German descent. Tiffani’s family
consists of her father, Robert, 38 years old; her mother, Shondra, 33 years old, and
her sister, Diana, 13 years old. Tiffani currently resides in a group home, Teens First,
a brand new, court-mandated teen counseling program for adolescent victims of
sexual exploitation and human trafficking. Tiffani has been provided room and board
in the residential treatment facility for the past 3 months. Tiffani describes herself as
heterosexual.

Presenting Problem: Tiffani has a history of running away. She has been arrested on

three occasions for prostitution in the last 2 years. Tiffani has recently been court
ed to reside in a group home with counseling. She has a continued desire to be
reunited with her pimp, Donald. After 3 months at Teens First, Tiffani said that she
had a strong desire to see her sister and her mother. She had not seen either of
them in over 2 years and missed them very much. Tiffani is confused about the path
to follow. She is not sure if she wants to return to her family and sibling or go back to
Donald.

Family Dynamics: Tiffani indicates that her family worked well together until 8 years

ago. She reports that around the age of 8, she remembered being awakened by
music and laughter in the early hours of the morning. When she went downstairs to
investigate, she saw her parents and her Uncle Nate passing a pipe back and forth
between them. She remembered asking them what they were doing and her mother
saying, “adult things” and putting her back in bed. Tiffani remembers this happening
on several occasions. Tiffani also recalls significant changes in the home’s
appearance. The home, which was never fancy, was always neat and tidy. During
this time, however, dust would gather around the house, dishes would pile up in the
sink, dirt would remain on the floor, and clothes would go for long periods of time
without being washed. Tiffani began cleaning her own clothes and making meals for
herself and her sister. Often there was not enough food to feed everyone, and Tiffani
and her sister would go to bed hungry. Tiffani believed she was responsible for
helping her mom so that her mom did not get so overwhelmed. She thought that if
she took care of the home and her sister, maybe that would help mom return to the
person she was before.

Sometimes Tiffani and her sister would come downstairs in the morning to find empty
beer cans and liquor bottles on the kitchen table along with a crack pipe. Her parents
would be in the bedroom, and Tiffani and her sister would leave the house and go to
school by themselves. The music and noise downstairs continued for the next 6
years, which escalated to screams and shouting and sounds of people fighting.
Tiffani remembers her mom one morning yelling at her dad to “get up and go to
work.” Tiffani and Diana saw their dad come out of the bedroom and slap their mom
so hard she was knocked down. Dad then went back into the bedroom. Tiffani

3

remembers thinking that her mom was not doing what she was supposed to do in the
house, which is what probably angered her dad.

Shondra and Robert have been separated for a little over a year and have started
dating other people. Diana currently resides with her mother and Anthony, 31 years
old, who is her mother’s new boyfriend.

Educational History: Tiffani attends school at the group home, taking general
education classes for her general education development (GED) credential. Diana
attends Town Middle School and is in the 8th grade.

Employment History: Tiffani reports that her father was employed as a welding

apprentice and was waiting for the opportunity to join the union. Eight years ago, he
was laid off due to financial constraints at the company. He would pick up odd jobs
for the next 8 years but never had steady work after that. Her mother works as a
home health aide. Her work is part-time, and she has been unable to secure full-time
work.

Social History: Over the past 2 years, Tiffani has had limited contact with her family

members and has not been attending school. Tiffani did contact her sister Diana a
few times over the 2-year period and stated that she missed her very much. Tiffani
views Donald as her “husband” (although they were never married) and her only
friend. Previously, Donald sold Tiffani to a pimp, “John T.” Tiffani reports that she was
very upset Donald did this and that she wants to be reunited with him, missing him
very much. Tiffani indicates that she knows she can be a better “wife” to him. She
has tried to make contact with him by sending messages through other people, as
John T. did not allow her access to a phone. It appears that over the last 2 years,
Tiffani has had neither outside support nor interactions with anyone beyond Donald,
John T., and some other young women who were prostituting.

Mental Health History: On many occasions Tiffani recalls that when her mother was

not around, Uncle Nate would ask her to sit on his lap. Her father would sometimes
ask her to show them the dance that she had learned at school. When she danced,
her father and Nate would laugh and offer her pocket change. Sometimes, their
friend Jimmy joined them. One night, Tiffani was awakened by her uncle Nate and his
friend Jimmy. Her parents were apparently out, and they were the only adults in the
home. They asked her if she wanted to come downstairs and show them the new
dances she learned at school. Once downstairs Nate and Jimmy put some music on
and started to dance. They asked Tiffani to start dancing with them, which she did.
While they were dancing, Jimmy spilled some beer on her. Nate said she had to go to
the bathroom to clean up. Nate, Jimmy, and Tiffani all went to the bathroom. Nate
asked Tiffani to take her clothes off and get in the bath. Tiffani hesitated to do this,
but Nate insisted it was OK since he and Jimmy were family. Tiffani eventually
relented and began to wash up. Nate would tell her that she missed a spot and would
scrub the area with his hands. Incidents like this continued to occur with increasing
levels of molestation each time.

4

The last time it happened, when Tiffani was 14, she pretended to be willing to dance

for them, but when she got downstairs, she ran out the front door of the house. Tiffani
vividly remembers the fear she felt the nights Nate and Jimmy touched her, and she
was convinced they would have raped her if she stayed in the house.

About halfway down the block, a car stopped. The man introduced himself as Donald,

and he indicated that he would take care of her and keep her safe when these things
happened. He then offered to be her boyfriend and took Tiffani to his apartment.
Donald insisted Tiffani drink beer. When Tiffani was drunk, Donald began kissing her,
and they had sex. Tiffani was also afraid that if she did not have sex, Donald would
not let her stay— she had nowhere else to go. For the next 3 days, Donald brought
her food and beer and had sex with her several more times. Donald told Tiffani that
she was not allowed to do anything without his permission. This included watching
TV, going to the bathroom, taking a shower, and eating and drinking. A few weeks
later, Donald bought Tiffani a dress, explaining to her that she was going to “find a
date” and get men to pay her to have sex. When Tiffani said she did not want to do
that, Donald hit her several times. Donald explained that if she didn’t do it, he would
get her sister Diana and make her do it instead. Out of fear for her sister, Tiffani
relented and did what Donald told her to do. She thought at this point her only
purpose in life was to be a sex object, listen, and obey—and then she would be able
to keep the relationships and love she so desired.

Legal History: Tiffani has been arrested three times for prostitution. Right before the

most recent charge, a new state policy was enacted to protect youth 16 years and
younger from prosecution and jail time for prostitution. The Safe Harbor for Exploited
Children Act allows the state to define Tiffani as a sexually exploited youth, and
therefore the state will not imprison her for prostitution. She was mandated to
services at the Teens First agency, unlike her prior arrests when she had been sent
to detention.

Alcohol and Drug Use History: Tiffani’s parents were social drinkers until about 8

years ago. At that time Uncle Nate introduced them to crack cocaine. Tiffani reports
using alcohol when Donald wanted her to since she wanted to please him, and she
thought this was the way she would be a good “wife.” She denies any other drug use.

Medical History: During intake, it was noted that Tiffani had multiple bruises and burn

marks on her legs and arms. She reported that Donald had slapped her when he felt
she did not behave and that John T. burned her with cigarettes. She had realized that
she did some things that would make them mad, and she tried her hardest to keep
them pleased even though she did not want to be with John T. Tiffani has been
treated for several sexually transmitted infections (STIs) at local clinics and is
currently on an antibiotic for a kidney infection. Although she was given condoms by
Donald and John T. for her “dates,” there were several “Johns” who refused to use
them.

5

Strengths: Tiffani is resilient in learning how to survive the negative relationships she
has been involved with. She has as sense of protection for her sister and will sacrifice
herself to keep her sister safe.

Robert Bradley: father, 38 years old
Shondra Bradley: mother, 33 years old
Nate Bradley: uncle, 36 years old
Tiffani Bradley: daughter, 16 years old
Diana Bradley: daughter, 13 years old
Donald: Tiffani’s self-described husband and her former pimp
Anthony: Shondra’s live-in partner, 31 years old
John T.: Tiffani’s most recent pimp

6

Paula Cortez

Identifying Data: Paula Cortez is a 43-year-old Catholic Hispanic female residing in New
York City, NY. Paula was born in Colombia. When she was 17 years old, Paula left
Colombia and moved to New York where she met David, who later became her
husband. Paula and David have one son, Miguel, 20 years old. They divorced after 5
years of marriage. Paula has a five-year-old daughter, Maria, from a different
relationship.

Presenting Problem: Paula has multiple medical issues, and there is concern about

whether she will be able to continue to care for her youngest child, Maria. Paula has
been overwhelmed, especially since she again stopped taking her medication. Paula is
also concerned about the wellness of Maria.

Family Dynamics: Paula comes from a moderately well-to-do family. Paula reports

suffering physical and emotional abuse at the hands of both her parents, eventually
fleeing to New York to get away from the abuse. Paula comes from an authoritarian
family where her role was to be “seen and not heard.” Paula states that she did not feel
valued by any of her family members and reports never receiving the attention she
needed. As a teenager, she realized she felt “not good enough” in her family system,
which led to her leaving for New York and looking for “someone to love me.” Her
parents still reside in Colombia with Paula’s two siblings.

Paula met David when she sought to purchase drugs. They married when Paula was 18
years old. The couple divorced after 5 years of marriage. Paula raised Miguel, mostly by
herself, until he was 8 years old, at which time she was forced to relinquish custody due
to her medical condition. Paula maintains a relationship with her son, Miguel, and her
ex-husband, David. Miguel takes part in caring for his half-sister, Maria.

Paula does believe her job as a mother is to take care of Maria but is finding that more
and more challenging with her physical illnesses.

Employment History: Paula worked for a clothing designer, but she realized that her true

passion was painting. She has a collection of more than 100 drawings and paintings,
many of which track the course of her personal and emotional journey. Paula held a full-
time job for a number of years before her health prevented her from working. She is
now unemployed and receives Supplemental Security Disability Insurance (SSD) and
Medicaid. Miguel does his best to help his mom but only works part time at a local
supermarket delivering groceries.

Paula currently uses federal and state services. Paula successfully applied for WIC, the

federal Supplemental Nutrition Program for Women, Infants, and Children. Given
Paula’s low income, health, and Medicaid status, Paula is able to receive in-home
childcare assistance through New York’s public assistance program.

7

Social History: Paula is bilingual, fluent in both Spanish and English. Although Paula
identifies as Catholic, she does not consider religion to be a big part of her life. Paula
lives with her daughter in an apartment in Queens, NY. Paula is socially isolated as she
has limited contact with her family in Colombia and lacks a peer network of any kind in
her neighborhood.

Five (5) years ago Paula met a man (Jesus) at a flower shop. They spoke several times.
He would visit her at her apartment to have sex. Since they had an active sex life, Paula
thought he was a “stand-up guy” and really liked him. She believed he would take care
of her. Soon everything changed. Paula began to suspect that he was using drugs,
because he had started to become controlling and demanding. He showed up at her
apartment at all times of the night demanding to be let in. He called her relentlessly, and
when she did not pick up the phone, he left her mean and threatening messages. Paula
was fearful for her safety and thought her past behavior with drugs and sex brought on
bad relationships with men and that she did not deserve better. After a couple of
months, Paula realized she was pregnant. Jesus stated he did not want anything to do
with the “kid” and stopped coming over, but he continued to contact and threaten Paula
by phone. Paula has no contact with Jesus at this point in time due to a restraining
.

Mental Health History: Paula was diagnosed with bipolar dis . She experiences

periods of mania lasting for a couple of weeks then goes into a depressive state for
months when not properly medicated. Paula has a tendency toward paranoia. Paula
has a history of not complying with her psychiatric medication treatment because she
does not like the way it makes her feel. She often discontinues it without telling her
psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of
the hospital for the past 5 years. Paula accepts her bipolar diagnosis but demonstrates
limited insight into the relationship between her symptoms and her medication.

Paula reports that when she was pregnant, she was fearful for her safety due to the
baby’s father’s anger about the pregnancy. Jesus’ relentless phone calls and voicemails
rattled Paula. She believed she had nowhere to turn. At that time, she became scared,
slept poorly, and her paranoia increased significantly. After completing a suicide
assessment 5 years ago, it was noted that Paula was decompensating quickly and was
at risk of harming herself and/or her baby. Paula was involuntarily admitted to the
psychiatric unit of the hospital. Paula remained on the unit for 2 weeks.

Educational History: Paula completed high school in Colombia. Paula had hoped to

attend the Fashion Institute of Technology (FIT) in New York City, but getting divorced,
then raising Miguel on her own interfered with her plans. Miguel attends college full time
in New York City.

Medical History: Paula was diagnosed as HIV positive 15 years ago. Paula acquired

AIDS three years later when she was diagnosed with a severe brain infection and a T-
cell count of less than 200. Paula’s brain infection left her completely paralyzed on the
right side. She lost function in her right arm and hand as well as the ability to walk. After

8

a long stay in an acute care hospital in New York City, Paula was transferred to a skilled
nursing facility (SNF) where she thought she would die. After being in the skilled nursing
facility for more than a year, Paula regained the ability to walk, although she does so
with a severe limp. She also regained some function in her right arm. Her right hand
(her dominant hand) remains semi-paralyzed and limp. Over the course of several
years, Paula taught herself to paint with her left hand and was able to return to her
beloved art.

Paula began treatment for her HIV/AIDS with highly active antiretroviral therapy
(HAART). Since she ran away from the family home, married and divorced a drug user,
then was in an abusive relationship, Paula thought she deserved what she got in life.
She responded well to HAART and her HIV/AIDS was well controlled. In addition to her
HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep C). While this condition
was controlled, it has reached a point where Paula’s doctor is recommending she begin
a new treatment. Paula also has significant circulatory problems, which cause her
severe pain in her lower extremities. She uses prescribed narcotic pain medication to
control her symptoms. Paula’s circulatory problems have also led to chronic ulcers on
her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a
wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to
ambulate and leave her home. Paula has a tendency not to comply with her medical
treatment. She often disregards instructions from her doctors and resorts to holistic
treatments like treating her ulcers with chamomile tea. When she stops her treatment,
she deteriorates quickly.

Maria was born HIV negative and received the appropriate HAART treatment after birth.
She spent a week in the neonatal intensive care unit as she had to detox from the
effects of the pain medication Paula took throughout her pregnancy.

Legal History: Previously, Paula used the AIDS Law Project, a not-for-profit organization

that helps individuals with HIV address legal issues, such as those related to the child’s
father . At that time, Paula filed a police report in response to Jesus’ escalating threats
and successfully got a restraining . Once the was served, the phone calls
and visits stopped, and Paula regained a temporary sense of control over her life.

Paula completed the appropriate permanency planning paperwork with the assistance
of the organization The Family Center. She named Miguel as her daughter’s guardian
should something happen to her.

Alcohol and Drug Use History: Paula became an intravenous drug user (IVDU), using

cocaine and heroin, at age 17. David was one of Paula’s “drug buddies” and suppliers.
Paula continued to use drugs in the United States for several years; however, she
stopped when she got pregnant with Miguel. David continued to use drugs, which led to
the failure of their marriage.

Strengths: Paula has shown her resilience over the years. She has artistic skills and has

found a way to utilize them. Paula has the foresight to seek social services to help her

9

and her children survive. Paula has no legal involvement. She has the ability to bounce
back from her many physical and health challenges to continue to care for her child and
maintain her household.

David Cortez: father, 46 years old
Paula Cortez: mother, 43 years old
Miguel Cortez: son, 20 years old
Jesus (unknown): Maria’s father, 44 years old
Maria Cortez: daughter, 5 years old

10

Jake Levy

Identifying Data: Jake Levy is a 31-year-old, married, Jewish Caucasian male. Jake’s

wife, Sheri, is 28 years old. They have two sons, Myles (10) and Levi (8). The family
resides in a two-bedroom condominium in a middle-class neighborhood in Rockville,
MD. They have been married for 10 years.

Presenting Problem: Jake, an Iraq War veteran, came to the Veterans Affairs Health

Care Center (VA) for services because his wife has threatened to leave him if he
does not get help. She is particularly concerned about his drinking and lack of
involvement in their sons’ lives. She told him his drinking has gotten out of control
and is making him mean and distant. Jake reports that he and his wife have been
fighting a lot and that he drinks to take the edge off and to help him sleep. Jake
expresses fear of losing his job and his family if he does not get help. Jake identifies
as the primary provider for his family and believes that this is his responsibility as a
husband and father. Jake realizes he may be putting that in jeopardy because of his
drinking. He says he has never seen Sheri so angry before, and he saw she was at
her limit with him and his behaviors.

Family Dynamics: Jake was born in Alabama to a Caucasian, Eurocentric family

system. He reports his time growing up to have been within a “normal” family system.
However, he states that he was never emotionally close to either parent and viewed
himself as fairly independent from a young age. His dad had previously been in the
military and was raised with the understanding that his duty is to support his country.
His family displayed traditional roles, with his dad supporting the family after he was
discharged from military service. Jake was raised to believe that real men do not
show weakness and must be the head of the household.

Jake’s parents are deceased, and he has a sister who lives outside London. He and
his sister are not very close but do talk twice a year. Sheri is an only child, and
although her mother lives in the area, she offers little support. Her mother never
approved of Sheri marrying Jake and thinks Sheri needs to deal with their problems
on her own. Jake reports that he has not been engaged with his sons at all since his
return from Iraq, and he keeps to himself when he is at home.

Employment History: Jake is employed as a human resources assistant for the

military. Jake works in an office with civilians and military personnel and mostly gets
along with people in the office. Jake is having difficulty getting up in the morning to go
to work, which increases the stress between Sheri and himself. Shari is a special
education teacher in a local elementary school. Jake thinks it is his responsibility to
provide for his family and is having stress over what is happening to him at home and
work. He thinks he is failing as a provider.

Social History: Jake and Sheri identify as Jewish and attend a local synagogue on

major holidays. Jake tends to keep to himself and says he sometimes feels
pressured to be more communicative and social. Jake believes he is socially inept

11

and not able to develop friendships. The couple has some friends, since Shari gets
involved with the parents in their sons’ school. However, because of Jake’s recent
behaviors, they have become socially isolated. He is very worried that Sheri will leave
him due to the isolation.

Mental Health History: Jake reports that since his return to civilian life 10 months ago,

he has difficulty sleeping, frequent heart palpitations, and moodiness. Jake had seen
Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-traumatic stress
dis (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms of anxiety
and depression and suggested that he also begin counseling. Jake says that he does
not really understand what PTSD is but thought it meant that a person who had it was
“going crazy,” which at times he thought was happening to him. He expresses
concern that he will never feel “normal” again and says that when he drinks alcohol,
his symptoms and the intensity of his emotions ease. Jake describes that he
sometimes thinks he is back in Iraq, which makes him feel uneasy and watchful. He
hates the experience and tries to numb it. He has difficulty sleeping and is irritable, so
he isolates himself and soothes this with drinking. He talks about always feeling
“ready to go.” He says he is exhausted from being always alert and looking for
potential problems around him. Every sound seems to startle him. He shares that he
often thinks about what happened “over there” but tries to push it out of his mind.
Nighttime is the worst, as he has terrible recurring nightmares of one particular event.
He says he wakes up shaking and sweating most nights. He adds that drinking is the
one thing that seems to give him a little relief.

Educational History: Sheri has a bachelor’s degree in special education from a local

college. Jake has a high school diploma but wanted to attend college upon his return
from the military.

Military History: Jake is an Iraqi War veteran. He enlisted in the Marines at 21 years

old when he and Shari got married due to Sheri being pregnant. The family was
stationed in several states prior to Jake being deployed to Iraq. Jake left the service
10 months ago. Sheri and Jake had used military housing since his marriage, making
it easier to support the family. On military bases, there was a lot of social support and
both Jake and Sheri took full advantage of the social systems available to them
during that time.

Medical History: Jake is physically fit, but an injury he sustained in combat sometimes

limits his ability to use his left hand. Jake reports sometimes feeling inadequate
because of the reduction in the use of his hand and tries to push through because he
worries how the injury will impact his responsibilities as a provider, husband, and
father. Jake considers himself resilient enough to overcome this disadvantage and
“be able to do the things I need to do.” Sheri is in good physical condition and has
recently found out that she is pregnant with their third child.

Legal History: Jake and Sheri deny having criminal histories.

12

Alcohol and Drug Use History: As teenagers, Jake and Sheri used marijuana and
drank. Both deny current use of marijuana but report they still drink. Sheri drinks
socially and has one or two drinks over the weekend. Jake reports that he has four to
five drinks in the evenings during the week and eight to ten drinks on Saturdays and
Sundays. Jake spends his evenings on the couch drinking beer and watching TV or
playing video games. Shari reports that Jake drinks more than he realizes, doubling
what Jake has reported.

Strengths: Jake is cognizant of his limitations and has worked on overcoming his

physical challenges. Jake is resilient. Jake did not have any disciplinary actions taken
against him in the military. He is dedicated to his wife and family.

Jake Levy: father, 31 years old
Sheri Levy: mother, 28 years old
Myles Levy: son, 10 years old
Levi Levy: son, 8 years old

13

Helen Petrakis

Identifying Data: Helen Petrakis is a 52-year-old, Caucasian female of Greek descent

living in a four-bedroom house in Tarpon Springs, FL. Her family consists of her
husband, John (60), son, Alec (27), daughter, Dmitra (23), and daughter Althima (18).
John and Helen have been married for 30 years. They married in the Greek Orthodox
Church and attend services weekly.

Presenting Problem: Helen reports feeling overwhelmed and “blue.” She was referred

by a close friend who thought Helen would benefit from having a person who would
listen. Although she is uncomfortable talking about her life with a stranger, Helen
says that she decided to come for therapy because she worries about burdening
friends with her troubles. John has been expressing his displeasure with meals at
home, as Helen has been cooking less often and brings home takeout. Helen thinks
she is inadequate as a wife. She states …