Gomez Family IDT

Presentation
Julie Johnson
Florida State University College of Social Work
SOW 5603-0003
Professor Brenda Legaspi
October 20, 2022
 Angela Gomez Demographics
• Angela Gomez
• 39 years old
• Puerto Rican
• Bilingual (Spanish and English)
• Lives alone
• Son Eduardo (19 years old)
• Isolated- no local support
• Family in Puerto Rico (parents and 2
siblings)
• Catholic- not actively practicing
• High school graduate
• SSI and Medicaid due to health problems
 Angela Gomez Family History and Childhood
• Victim of physical and emotional abuse
during childhood
• Upper-middle class parents
• Ran away at 16 to NYC
• Started using heroin with boyfriend Jose
• Used IV drugs
• Stopped when she got pregnant
• Marriage ended because of Jose’s use
• Attended Fashion Institute of Technology
• Paints and draws about her emotional
journey through life
 History
• Diagnosed with Bipolar at 26 years-old
• Rapid cycling of mania and depression
when she’s not on medication
• Paranoid tendencies
• Not compliant with medication
• Does not tell psychiatrist when she stops
medication
• Multiple psychiatric hospitalizations but
none in the last year
• Gave up custody of Eduardo to her sister in
Puerto Rico due to mental health issues
• Untreated Hepatitis C for 3 years
 Angela Gomez Current Issues
• Pregnant by man she met online but he
does not know about the baby
• He may be using drugs
• Harasses her for money and threatens her
• Afraid for her safety
• Refused abortion due to Catholic history
• Guilty due to Eduardo- wants to do better
• High risk due to age, physical health, and
mental health
• Worried about Hepatitis C treatment
impact on baby
• May not be capable of caring for baby
Impact of Social Determinants
5 Domains of Social Determinants:
1. Economic Stability
• Poverty negatively impacts well-being
• Steady income usually means better health
• People with disabilities, injuries, and chronic conditions
struggle to maintain jobs (Social, n.d.)
• Job security through employment programs, career
counseling, and quality childcare (Social, n.d.)
• Reduce poverty through relevant policies on food,
housing, education, and health care (Social, n.d.)
How Does this Domain Apply to Angela?
• She has Medicaid and steady income from disability, but
she lives in poverty
• Angela could benefit from childcare for baby
• Career counseling to determine if she could find
employment that she could handle especially since she
is socially isolated

Social Determinants of Health. (n.d.). U.S. Department of Health and Human Services.
https://health.gov/healthypeople/priority-areas/social-determinants-health
Impact of Social Determinants
5 Domains of Social Determinants:
2. Education Access and Quality
• Graduating from high school and college increases
access to better jobs (Social, n.d.)
• Stress from poverty negatively impacts child brain
development (Social, n.d.)
• Better jobs decrease health problems such as heart
disease and depression (Social, n.d.)
How Does this Domain Apply to Angela?
• Her child could benefit from early education
intervention services to offset the effects of poverty
(Social, n.d.)
• Dropout prevention could keep Angela’s child on
track to graduate when she is older
• Angela could further her education to explore new
career options if she is able

Social Determinants of Health. (n.d.). U.S. Department of Health and Human Services.
https://health.gov/healthypeople/priority-areas/social-determinants-health
Impact of Social Determinants
• 5 Domains of Social Determinants:
3. Health Care Access and Quality
• Increase access to healthcare services to treat chronic
conditions (Social, n.d.)
• Access to healthcare promotes better health through
screenings and regular visits (Social, n.d.)
• Healthcare should be accessible even to people with no
transportation (Social, n.d.)
How Does this Domain Apply to Angela?
• Her child could benefit from regular contact with a
pediatrician for well visits and routine services (Social,
n.d.)
• Angela should obtain a primary care physician, so she has
access to preventive screenings and regular healthcare
services
• Angela should find physicians in her area since she will be
more likely to stay in contact

Social Determinants of Health. (n.d.). U.S. Department of Health and Human Services.
https://health.gov/healthypeople/priority-areas/social-determinants-health
Impact of Social Determinants
5 Domains of Social Determinants:
4. Neighborhood and Built Environment
• Neighborhoods with high rates of crime contribute to
higher health risks (Social, n.d.)
• Environmental hazards such as pollution are
detrimental to people’s health (Social, n.d.)
• Access to bike and walk in communities has a positive
impact on health (Social, n.d.)
How Does this Domain Apply to Angela?
• Living in a high crime area could have an impact on
what kind of activities Angela feels comfortable doing
with her child
• Residing in an unsafe neighborhood puts daily stress on
residents which affects people physically, so Angela
could be affected negatively if that is her living situation
Social Determinants of Health. (n.d.). U.S. Department of
Health and Human Services.
https://health.gov/healthypeople/priority-areas/social-
determinants-health
Impact of Social Determinants
5 Domains of Social Determinants:
5. Social and Community Context
• Positive relationships counteract negative effects of
living in stressful conditions (Social, n.d.)
• Social networks combat depression and anxiety (Social,
n.d.)
• Community connections improve people’s health and
well-being (Social, n.d.)
How Does this Domain Apply to Angela?
• She is completely isolated from her family who live in
Puerto Rico
• Angela does not work so she does not have social
contact with adults on a regular basis
• She is not involved in community activities, so she has
no connection
Social Determinants of Health. (n.d.). U.S. Department of
Health and Human Services.
https://health.gov/healthypeople/priority-areas/social-
determinants-health
Roles and Responsibilities of • Attending Physician- coordinates
IDT Members medical care while in the hospital
• OB/GYN- monitor Angela’s
pregnancy while she is admitted
• RN- provide direct medical care
while Angela is in the hospital
• Pharmacist- observe Angela’s
reactions to her new medications
• Hepatologist- monitor Angela’s
Hepatitis C while she is admitted
• Dietician- ensure a healthy diet
while admitted
• Social Worker-coordinate discharge
services and resources
Value and Goals of the IDT
Value:
•Dignity within a patient-centered approach
•Honesty to promote transparency (Mitchell, et.al., 2012)
•Trust to assist with effective communication (Mitchell,
et.al., 2012)
Goals:
•Coordinate care for hospital stay
•Address barriers to care
•Appropriate referrals based on individual needs
•Integration of resources and ideas across specialty areas
(Behm and Gray, n.d.)

Behm, J., Gray, N. (n.d.). Interdisciplinary Rehabilitation Team.

Jones and Bartlett
Learningchrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/h
ttps://samples.jbpub.com/9781449634476/80593_ch05_5806.pdf
Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C.,
Rohrbach, V., Von Kohorn, I. (2012). Core Principles & Values of
Effective Team-Based Health Care. Institute of Medicine of the
Academies. October 2012.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://w
ww.careinnovations.org/wp-content/uploads/Team-Based-Care-
Principles-Values_KPTA.pdf
 Challenges for Healthcare IDTs
• Understanding each professional’s skills and responsibilities
(Ambrose-Miller and Ashcraft, n.d.)
• Coordinating goals when team members come from different
specialties (Zajac, 2021)
• Respectful problem-solving when conflicts arise (Zajac, et. al.,
2021)
• Promoting teamwork (Zajac, et. al., 2021)

These challenges should be addressed because they could interfere

with providing high-quality, seamless care for Angela and hinder the
team’s ability to remain focused on Angela’s needs.

Ambrose-Miller, W. and Ashcroft, A. (2016). Challenges Faced by Social Workers are Members of
Interpersonal Collaborative Health Care Teams. National Association of Social Workers.
file:///C:/Users/jkjohnson/Downloads/Amrose-Miller%20and%20Ashcroft%202016_Challenges%20faced
%20by%20SWers%20as%20members%20of%20interprofessional%20collaborative%20HC%20(1).pdf
Zajac, S., Woods, A., Tannenbaum, S., Salas, E.,Holladay, C. (2021). Overcoming Challenges to
Teamwork in Healthcare: A Team Effectiveness Framework and Evidence-Based Guidance. Front.
Commun., 17 March 2021. https://doi.org/10.3389/fcomm.2021.606445
 Addressing Challenges for IDTs
•We do not need to understand the intricacies of each
person’s job, but respect their knowledge and contribution to
the case
•Listen openly to ideas based on each member’s skills
(Mitchell, et.al., 2012)
•Create an environment that allows team members to express
concerns and make suggestions to resolve issues (Mitchell,
et.al., 2012)

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C., Rohrbach, V., Von Kohorn, I. (2012).
Core Principles & Values of Effective Team-Based Health Care. Institute of Medicine of the Academies.
October 2012. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.careinnovations.org/
wp-content/uploads/Team-Based-Care-Principles-Values_KPTA.pdf
Angela Gomez Strengths
According to the Strengths-Based Approach
which focuses on client strengths and
talents, Angela has the following strengths
to help her be successful in treatment:
• Resilient
• Creative
• Independent
• Self-aware
• Determined
• Saleebey, D. (1996). The strengths perspective in social
work practice: Extensions and cautions. Social Work, 41(3),
296–305. https://psycnet.apa.org/record/1996-03967-006
 Two Interventions for Angela Gomez
• Angela will be referred to the Community Health
Network which includes Stuphin Health Center and
CHN Jamaica in Queens
• Spanish-speaking staff including LCSW for mental
health counseling, Midwife, Nutritionist, Physicians
for general care, Pediatrics, Dental Care, Pharmacy
• Medical Mobile Van has primary care services for
people who do not have transportation
• Job counseling
• Referrals to social services
• Referrals to medical specialist
• Addiction counseling
• Care coordination
• Food pantry

Community Healthcare Network. (n.d.).

https://www.chnnyc.org/frequently-asked-questions/#
 Two Interventions for Angela Gomez
• Angela will be referred to the Queens Healthy
Start Center through Public Health Solutions
• Accept all pregnant mothers
• Conduct screenings to determine which in-
home services are most beneficial
• Offer parenting skills classes
• Child development awareness
• Safe sleep practices
• Breastfeeding and nutrition information

Public Health Solutions. (n.d.). Queens Healthy

Start Network.
https://www.healthsolutions.org/community-
work/family-support/home-visiting-programs/
healthy-start/
 Assessments for Angela Gomez
• Angela would be given the Bech-Rafaelsen
Mania Rating Scale to assess for bipolar
symptoms (Johnson, et. al, 2018)
• Angela would also be given the Young
Mania Ratings Scale to assess for bipolar
symptoms (Johnson, et. al, 2018)
• Angela would be given the Trauma
Symptom Checklist-40 assessment to
determine the effect of childhood trauma
on her current functioning (Treatment,
2000)

Johnson, S., Miller, C., Eislner, L. (2018). Chapter 9: Bipolar

Disorder. Pages 173–192. April 2018.
https://academic.oup.com/book/1201/chapter/140046109
Treatment Improvement Protocol (TIP) Series (2000.). Chapter
2: Screening and Assessing Adults For Childhood Abuse and
Neglect. Center for Substance Abuse Treatment.Rockville (MD):
Substance Abuse and Mental Health Services Administration.
2000. https://www.ncbi.nlm.nih.gov/books/NBK64895/
Analysis of
Interventions
• Health Center Programs have served 30
million people who are underserved or
living in poverty (Health, n.d.)
• Health Center Programs reduce
healthcare costs by 24% which is
important for people who are living in
poverty (Health, n.d.)
• These programs allow coordinated,
comprehensive patient care that
integrates medical, dental, behavioral
health, and family medicine for better
patient outcomes (Health, n.d.)
Health Center Programs: Impact and Growth
(n.d.). https://bphc.hrsa.gov/about-health-
centers/health-center-program-impact-growth
Analysis of
Interventions
• Healthy Start programs are used to combat
infant mortality in disadvantaged families
like Angela
• Provide parental empowerment which
Angela needs since she feels guilty about
not raising her son
• 90% of clients are Hispanic, Native
American, or African American because of
higher risk of low birth weight
• Angela is a high-risk pregnancy and Healthy
Start provides comprehensive prenatal
services including nutrition and education
for better outcomes
Healthy Start Beginnings. (n.d.).
https://www.nationalhealthystart.org/healthy
-start-initiative/#:~:text=As%20the%20federal
%20government's%20signature,track
%20record%20of%20saving%20lives.
Analysis of
Assessments
•Angela should be screened for trauma symptoms
that could be present based on her history of
childhood abuse (Treatment, 2000)
•She also needs screened for current trauma
symptoms because parents who have been
abused are more likely to repeat the cycle
(Treatment, 2000)
•The Trauma-40 Scale shows reliability and validity
in assessing symptoms from trauma (Treatment,
2000)
•Angela needs the Young Mania Rater Scale since it
is reliable in assessing severity of bipolar
symptoms which is important because she is
pregnant and has not been taking medication
(Johnson, et. al., 2018)
•The Bech-Rafaelsen Mania Scale would be
administered because of its strong validity and
psychometric properties to determine episodes of
mania (Johnson, et. al., 2018)
Johnson, S., Miller, C., Eislner, L. (2018). Chapter 9: Bipolar Disorder. Pages
173–192. April 2018.
https://academic.oup.com/book/1201/chapter/140046109
Treatment Improvement Protocol (TIP) Series (2000.). Chapter 2: Screening
and Assessing Adults For Childhood Abuse and Neglect. Center for
Substance Abuse Treatment.Rockville (MD): Substance Abuse and Mental
Health Services Administration. 2000.
 Final Recommendations
• Assessments for trauma and bipolar
symptom manifestation to determine current
needs
• Referral to Queens Healthy Start Center for
parenting classes, education, and prenatal
nutrition
• Referral to the Community Health Network
for comprehensive medical, dental, social
services, and behavioral health services
which are available in Spanish if needed
• Discharge planning services will include help
with paperwork related to referrals, making
follow up appointments, and development of
a crisis plan
References
Ambrose-Miller, W. and Ashcroft, A. (2016). Challenges Faced by Social Workers are Members of
Interpersonal Collaborative Health Care Teams. National Association of Social Workers.
file:///C:/Users/jkjohnson/Downloads/Amrose-Miller%20and%20Ashcroft%202016_Challenges%20f
aced%20by%20SWers%20as%20members%20of%20interprofessional%20collaborative%20HC%20(1
).pdf
Behm, J., Gray, N. (n.d.). Interdisciplinary Rehabilitation Team. Jones and Bartlett Learning. chrome-
extension://efaidnbmnnnibpcajpcglclefindmkaj/https://samples.jbpub.com/
9781449634476/80593_ch05_5806.pdf
Community Healthcare Network. (n.d.). https://psycnet.apa.org/record/1996-03967-006
Healthy Start Beginnings. (n.d.). National Healthy Start Association.
https://www.nationalhealthystart.org/healthy-start-initiative/#:~:text=As%20the%20federal
%20government's%20signature,track%20record%20of%20saving%20lives.
References
Johnson, S., Miller, C., Eislner, L. (2018). Chapter 9: Bipolar Disorder. Pages 173–192. April 2018.
https://academic.oup.com/book/1201/chapter/140046109
Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C., Rohrbach, V., Von Kohorn, I.
(2012). Core Principles & Values of Effective Team-Based Health Care. Institute of Medicine of the
Academies. October 2012.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.careinnovations.org/wp-
content/uploads/Team-Based-Care-Principles-Values_KPTA.pdf
Public Health Solutions. (n.d.). Queens Healthy Start Network.
https://www.healthsolutions.org/community-work/family-support/home-visiting-programs/
healthy-start/
Saleebey, D. (1996). The strengths perspective in social work practice: Extensions and cautions.
Social Work, 41(3), 296–305. https://psycnet.apa.org/record/1996-03967-006
References
Social Determinants of Health. (n.d.). U.S. Department of Health and Human Services.
https://health.gov/healthypeople/priority-areas/social-determinants-health
Treatment Improvement Protocol (TIP) Series (2000.). Chapter 2: Screening and Assessing Adults For
Childhood Abuse and Neglect. Center for Substance Abuse Treatment.Rockville (MD): Substance
Abuse and Mental Health Services Administration. 2000.
https://www.ncbi.nlm.nih.gov/books/NBK64895/
Zajac, S., Woods, A., Tannenbaum, S., Salas, E., Holladay, C. (2021). Overcoming Challenges to
Teamwork in Healthcare: A Team Effectiveness Framework and Evidence-Based Guidance. Front.
Commun., 17 March 2021. https://doi.org/10.3389/fcomm.2021.606445