CHCDIS010 Provide Person-Centred Services To People With Disability With Complex Needs Assessment:CaseStudy

Case Study One - Simone

Simone is a 28 year old woman who has a mild intellectual disability as well as depression (which was diagnosed 8 months ago). Simone lives at home in a bungalow at the back of her mother’s house. She works 3 days a week in a factory with other supported workers, packaging goods. Simone has been morbidly overweight for most of her adult life. She has problems with shortness of breath, recurring constipation, heartburn and high blood pressure. Simone assists her mother in making dinner a couple of nights a week, but has a tendency to snack on unhealthy food when not at work. Her mother usually does the shopping on a Sunday afternoon when Simone is resting, so she has little input into what is purchased. She doesn’t like fresh fruit and will only eat a small range of vegetables reluctantly. Beth and Simone argue quite a lot about her diet.

Simone attends a ‘Lighthouse’ program based at her local community house on Thursdays with her friend Cheryl where they have art and craft activities. She has not been interested in getting involved in physical activities before, and in today’s meeting, staff are hoping to assist her in developing a plan to address some of her most important health goals. Simone is on medication which could also be affecting her motivation, as she often finds she is tired in the afternoons and needs to rest.

Simone would love to have a themed party for her birthday in 6 months and wear a special dress. She would like to lose about 10 kilograms. You are coordinating the individualized planning session today, which includes Simone, her mother Beth and her friend Cheryl. There is also a dietician from the local community health initiative, Deann, as well as a psychologist Nerida, from the same service.

Question 1a

Identify and priorities Simone’s health requirements, taking into account her disability and complex needs.

Question 1b

How are these health problems presenting themselves in Simone’s case?

Question 2

What are your responsibilities in this situation, as a coordinator?

Question 3a

Why is it important to involve health professionals in creating an individual plan for Simone and facilitating the achievement of her goals?

Question 3b

What information can you gather from both the dietician and the psychologist?

Question 3c

How can you use this information in preparing an individual plan with Simone?

Question 4a

When developing an individual plan with Simone, what are some possible implications for Simone’s mother who provides majority of ongoing primary care at home?

Question 4b

How might Simone’s health impact her relationship with her friend Cheryl?

Question 5

• Due to funding restrictions you are unable to fund a gym membership for Simone.
• What alternative suggestions can you provide Simone for consideration for her goals and individual plan?

Question 6

List five activities or supports that you could negotiate with Simone for her individual plan.

Question 7

• Complete the individual plan document for Simone.
• You will need the Individualized Plan document to complete this part. It can be found in the LMS.
• Complete the Individualized Plan based on the case study. All sections must be completed.

Question 8

How can you ensure that the people working with Simone to achieve her goals are suitable and qualified?

Question 9a

What strategies can you and your organization use to gain feedback regarding Simone’s progress?

Question 9b

Who can you obtain this feedback from?

Question 10

If Simone is having difficulty achieving her goals who can you seek support from?

Question 11

After a review of Simone’s progress what changes might be made to her individual plan?

Case Study Two - Cathy

Watch the following videos “My Life, My Choice, My Plan” about person-centred planning:
https://www.youtube.com/watch?v=Xzco2nT3pOc (8 minutes, 26 seconds) Cathy is a young woman who has Downs’s Syndrome. She is having a PATH planning meeting with a range of support staff, to assist her in developing ideas about how best to attain her dreams and goals.

Question 12a

What challenges does Cathy face in being able reach the dreams that she is mentioning in her PATH meeting?

Question 12b

What did the facilitators suggest as more realistic and possible goals that aligned with her original goals?

Question 13a

What are Cathy’s goals that can be put into her individual plan?

Question 13b

List these goals in order or time frame to be able to be achieved.

Question 14

If Cathy was living in your local area which services could you access to help Cathy achieve her goals?

Question 15

What are the best practice person-centred strategies that the facilitators used to help identify Cathy’s goals and strategies to achieve them?

Question 16

Complete the individual plan document for Cathy.

You will need the Individualized Plan document to complete this part. It can be found in the LMS.
Complete the Individualized Plan based on the case study. All sections must be completed

Case Study Three - Danny

Danny is a 45 year old Aboriginal man, who has an ABI (acquired brain injury) after a car accident when he was 19. He has been on a disability support pension for a number of years, and lives in a special accommodation housing complex in Carlton.

His speech is affected as well as his walking gait, and he uses a motorized wheelchair to move about. He gets frustrated that people find it difficult to understand him, and will often get his support worker to communicate for him when they are out in public. He has difficulty swallowing so he mainly has a soft food diet. He has ongoing problems with alcohol use and has been smoking marijuana for about 12 years.

Danny’s HACC support worker is Troy. Troy has developed a good working relationship with Danny over several months, and assists during the week with personal care, shopping and occasional trips to the footy. Danny would like to reconnect with his family, who live in Shepparton, and who he hasn’t seen for a number of years. He also has a 12 year old son Dylan who lives in Canberra, who he hasn’t had contact with for about 3 years, since he breached an AVO (Apprehended Violence Order) that his ex-partner took out. Danny misses his son and talks about him a great deal. Since the AVO breach, Danny has completed an anger management course, and sees a psychologist fortnightly. He needs assistance with his substance issues and has said he wants to “quit smoking and turn my life around”. Danny feels disconnected from his Aboriginal heritage – his grandmother was a survivor of the Stolen Generation, having been taken away from her family when she was a little girl - and he has had only brief contact with his mother and sisters over the past several years.

After recent discussions with Danny and Troy, you are coordinating the individualized planning session today, to identify some of Danny’s main goals and to facilitate the process of providing person-centred support services to Danny. In attendance will be: Danny, Troy, yourself, Danny’s friend Marcus, Marsha (dietitian), Rob (his psychologist) and Murray from the local Aboriginal Cultural Centre.

Question 17a

What are Danny’s current priorities?

Question 17b

Based on your discussions with Danny and considering all his complex needs, which issue would you work on addressing first and why?

Question 18

What information can you gather by liaising with Danny’s dietitian, psychologist and a representative from the Aboriginal Cultural Centre?

Question 19

• Complete the individual plan document for Danny.
• You will need the Individualized Plan document to complete this part. It can be found in the LMS.
• Complete the Individualized Plan based on the case study. All sections must be completed.

Question 20

After three sessions Danny comes to you saying he doesn’t feel he is making progress with his psychologist and would like some help finding a new one. What steps would you take to follow up this request?

Question 21a

How often would you schedule reviews of Danny’s plan? Why?

Question 21b

Who will you have involved in reviews of Danny’s plan?

Question 21c

What feedback would you hope to gain from the health professionals and community services involved in supporting Danny?

Question 21d

What feedback would you be asking for from Danny?