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This is a non-profit making organization that aims at providing rehabilitation to individuals facing different problems in their lives. It was started in 1959 by a catholic priest to help troubled boys in the Texas after noticing the dangerous affects that substance abuse had on them. Fees in this organization are assessed basing on a persons income and ability to pay, where Medicaid and insurance are accepted. It main goal during inception was to provide treatment services to victims of substance abuse regardless to race, sex, religion, color, or ethnic background. It is a private, not for profit, community and faith based organization that is based in San Antonio, Texas. The movement's mission is to motivate clients and families to begin and recovery using services of prevention and treatment that are designed to assist them resolve the problems of substance abuse. The movement believes in the Uniqueness and dignity of each individual, the rights of everyone to develop his or her maximum potential, the importance of the family in view of it being the basic unit of society, education as a basic medium for the growth and development of individuals, and a positive approach to treating the problems facing humans. It is licensed under the Texas Commission on Alcohol and Drug Abuse to provide residential, outpatient treatment, detoxification services to the community. It has received accreditation by the Joint Commission on accreditation of health organizations in the provision of quality services in the area of substance abuse and treatment. The staff is made up of one Executive Director, one medical director, and seven directors together with other junior staff members. It has six boards of Directors that oversee the running of the organization (Patrician, n.d).
The organization provides residential short term treatment and also residential long term treatment to its clients. It provides a number of services to its clients. These includes: Inpatient treatment and adult detoxification services. It provides up to date inpatient treatment and individualized detoxification services to women aged between 18 and 65 years. These include parenting classes, specialized medical services, and gender specific classes that are done beyond the usual scope of services; it gives inpatient treatment and individualized detoxification to women and also to their infants of 0-3 months. It provides basic instructions regarding pre-natal and infant/child care to pregnant and postpartum women. It also provides outpatient services to adults. This is aimed at achieving individual goals through the provision of services that are comprehensive, client centered, research based, and family focused chemical abuse or dependency (Patrician, n.d).
The movement also offers Youth Intervention program with their slogan that says Youth Empowered to Succeed. This targets youths between 6-17 years old who are prone to substance abuse. They use strategies designed to address behavior patterns that lead most youths to drug use so that it can give them information and drug abuse alternatives that can greatly help them and their families to come up and maintain a lifestyle that is drug free. In addition to these, the movement offers outpatient treatment services to adolescents in order to give them an opportunity to gain insights into their problem of substance abuse and also to interrupt the disruptive behavior patterns that are associated with the illness. The services include screening, assessment, planning and treatment, group counseling, individual counseling, family counseling, classes on drug and alcohol education, case management, relapse prevention services and lastly it provides aftercare services to its clients. There is also the HIV/AIDS Program that provides comprehensive services of intervention to those diagnosed as HIV+ substance abusers, those at risk of contracting HIV and their family members and other important persons. It gives such individuals the protection from possible re-infection or from infecting partners or family members. These interventions include HIV pre and post testing, counseling and treatment, referrals and connection to specialized care, case management, outreach through social networks, community level forums and skill building, and also social events (Patrician, n.d).
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Brief Strategic Family Therapy is also a program provided by this movement. It is a very effective, problem oriented and practical approach to substance abuse risk factors elimination. It is effective in reducing behavior problems in children and adolescents their strengthening them and their families. This program avails families with tools that can help in reducing individual and family risk factors via focused interventions that improve the rampant problematic family relations and strategies for skill building that give strength to families. This program fosters parental leadership, involvement of parents in their children's affairs giving them mutual support through effective communication, problem solving, rules that are clear and the consequences of breaking them and family responsibility for problems that are shared. It has various community initiatives that that serve as a catalyst for resource and partnership coordination with the aim of promoting self sufficiency economically, strengthens families, and enhancing the quality of life (Patrician, n.d).
The organization sources most of its funds from government grants, from corporate institutions and well wishers. The organization gets contributions from people through the Friends of the Patrician movement entity that is exclusively organized to support the future and current functions of the movement and also to reduce and prevent abuse of substance among the adult and adolescent population. This support is through charitable, scientific and educational programs. The Friends of the Patrician Movement's purpose is to support the current and future functions of the Movement and to prevent and reduce substance abuse mostly among the adolescent and the adult population in Texas and its surroundings. Most of the funds come form government grants that are aimed at helping institutions like this one to improve their services to the people. Grants also come from the Criminal Justice Council and the National Institute of Mental Health and of course some little amount usually comes form the petty payments that some of the patients pay and also from Medicaid and medical insurance (Patrician, n.d).
The provision of human services is very involving, encompassing many issues in the process. These mostly revolve around case management. Case management in social work is simply the method of availing services in which professional social worker asses collaboratively the needs of a client and the client's family if appropriate, and makes arrangements, coordinates, closely monitors, evaluates and recommends a number of measures to be used in meeting the special needs of the client. There arte many models used in case management, these include the brokerage/generalist model, that seeks to know the needs of the client and help in accessing resources, the assertive community treatment, where case managers go a step further in helping the clients overcome their problem, the strength based perspective model that helps people transit from institutionalized care to an independent living, and finally the clinical or rehabilitation model where therapy and case management are addressed jointly. But in general terms, case management is just a way of tailoring assistance together with early intervention to susceptible clients or those with circumstances that are exceptional. Case management involves various steps in its implementations, these are: assessment, planning, implementation, monitoring and ongoing review, and case closure (Bellow and Mink, 1996).
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This is used by the manager to get a clear picture of his client's or patient's needs. At the Patrician Movement, practitioners make sure that prior to any assessment, there is a relationship of trust that is developed between them and the clients. This involves creation of rapport and trust, clarifying roles and responsibilities and facilitation of discussion. At the movement it is believed that a trusting relationship is very important to the success of case management. Ample time is dedicated to developing this relationship with the client defining the boundaries of the relationship. This is also left to the client's discretion where by he or she can agree to it or disagree. The movement also knows that the commitment and motivation to achieve change must solely come from the client something that is not always easy and that is why it is advisable that the client manages the process with assistance from a social worker. Part of the assessment is dedicated to the analyzing of the client's current capability to effect any change and the factors that may limit this process and necessary steps taken (Bellow and Mink, 1996).
This is a model that seeks to identify the needs of a particular client and find ways of helping the client gain access to resources. This is usually very brief and therefore does not need active advocacy. It works well for those clients who are economically endowed, and therefore is not used by the Patrician movement because the movement mostly deals with the disadvantaged members of the society. This is where the understanding of the community, its culture and practices, comes in handy. The Patrician movement was solely started after an understanding of the issues affecting the society especially the youth in Texas with substance abuse. Collaboration with members in the community and other institutions like churches and schools has for a long time ensured the effectiveness of the organization's programs. This was made better by the establishment of referrals and partnerships that has ensured quality case management by the Movement's staff members. Trainings and presentations made to the community increase awareness, a measure that sees more clients come out to seek help. The staff members of the organization respond by providing them with information that helps them gain access to quality services not just to the organization but anywhere they will see appropriate (Bellow and Mink, 1996).
This comes after a successful assessment of a client's circumstance and involves four stages which are: Goal formulation where goals to which the client and his manager must be committed are set. These should be negotiated, specific and achievable; Setting priorities, the organization stipulates that priorities among the goals must be set so that critical needs can be addressed first and problem tackling is done in an organized sequence that makes sure that the manager and the client are not overwhelmed by the problems; picking the methods for goal achievement, these can be called strategies techniques, or interventions. Actions that are taken to effect the required changes; and finally identification of time and procedure for progress evaluation, this can lead to more assessment and plan, goal and strategy review. These processes are important in providing a clear basis for the required action bring about a successful action plan. There are cases where some clients may opt to resist the planning process. The movement tackles this through empathy, encouragement, or enlisting support from the clients close friends and counselors (Bellow and Mink, 1996).
After successfully deciding on an action plan, the manager and the client now embark on making it a reality. The case managers at Patrician movement then set about connecting their patients to the necessary resources. This is also where the patient's capacity to negotiate the system and be self reliant is developed. The movement usually faces difficulties in the motivation of patients especially those who come in when the problem has overwhelmed them, such individuals usually need more attention and specialized treatment. As already mentioned, empathy, encouragement and assistance from those who are close to the patient helps a lot in such situations, this has been proved to work at the organization, whereby many patients who had lost hope, or families that had given up trying to help their members, have been helped to go back to the normal lifestyle (Bellow and Mink, 1996).
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This is the overseeing and monitoring the coordinated system of treatment of a client to ensure that all the services provided work in unison towards the desired goals (Bellow and Mink, 1996).
Monitoring the client's progress is very important as it helps to gauge the effectiveness of the action plan. And that is why the Patrician movement provides short and long residential services to the patients so that their recovery process can be closely monitored. It measures the effectiveness of the process of management against the set goals and programs so that a review of the client, service, and referral satisfaction can be done and necessary steps made to improve on them in future. Monitoring also has enabled the Patrician movement to have a regular review of the management plan to see whether goals have been achieved, whether there were barriers on the way and steps taken to avoid them in future or take a different action plan. All records showing a client's progress over time should be safely kept, updated, and reviewed periodically (Wilson, 2003).
The Patrician movement also collaborates with community agencies; this allows for the building of partnerships that connects clients to more resources that help them get appropriate services. This also enables the community members to get awareness on the problems that they face, giving those in need of assistance to get professional services. The Patrician movement participates in many initiatives in bringing awareness to the people such as school based presentations that supports results from interviews and literature review that communities use to become aware of the risks that they face in their daily life and therefore make initiatives to avoid them. It is involved with civic and groups that are church related in providing information to the community regarding welfare procedures, social security benefits, family planning and substance abuse (Wilson, 2003).
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This is the final step in case management that involves disengagement between the client and the case manager. In this stage client independence is encouraged, his or her achievements reviewed, and the whole action plan reviewed in preparation for the final disengagement. This involves physical and emotional separation once it is established that the patient has achieved self efficacy (Wilson, 2003).
Because this is a non profit making organization that receives most of its funding from the public, well wishers and government grants, its functions are therefore closely monitored. Clinical decision making and policy depend heavily on the outcome data that show the impact of case management and substance abuse treatment interventions in regards to the services used and the money spent. These there calls for establishment of bench marks right from the beginning of a program that will be used to measure management process, for instance keeping records of how frequent a client shows up to get treatment. At the Patrician Movement measuring system outcomes is considered very important especially in the use services like hospitalization and residential treatment. This also measures the cost savings and the quality of care given. For instance continuous care to a patient who is at risk for relapse after having been detoxified and before being entered into outpatient treatment is a very appropriate measure of the system. The organization has a computerized information system of management that analyzes the system outcomes. Other methods of evaluation include reviewing the client records which helps in evaluation of the way service planning and referrals adhere to the required protocol and the expectations of procedure, carrying out surveys and interviews on medical practitioners and the victim's family members to see how effective the intervention is, and many others. Evaluating a client's response is not that easy, there those who measure an individual's response basing on sobriety others see that this should be done basing on a number of factors including a reduction in substance use, reduction in criminal cases, and improved family functioning. Staff supervision or consultation also provides an opportunity for self evaluation where by members have the chance to receive feed back from their fellow staff members. Program outcome evaluation also makes sure that objectives and goals remain realistic and gives room for the staff to pinpoint possible changes inside the program (Halley, Kopp and Austin, 1998).
Another effective way that has been used by the movement to gauge its effectiveness has been through client satisfaction. Knowing how the client value the services they get are very vital to evaluate the activities. Client satisfaction also facilitates treatment retention, where by the patients gain confidence in the organization. It also helps to determine whether the client and medical practitioner share a common view about the services provided. The movement also caries out aftercare services to its clients. This is the stage that follows immediately after discharge, where the client requirements are not that intense as when he or she first sought treatment. It includes minimal interaction between a counselor and the patient, where the only function of the counselor remains that of monitoring and evaluation of the effectiveness of the plan. This can be in form of periodic aftercare outpatient services, relapse or recovery groups and many others. The organization also takes this time to address areas that are related to environmental issues that includes vocational rehabilitation, employment seeking, and looking for safe housing for the victims. This is a sure way of gauging the Movement's performance. All the information that is gathered by the organization through its evaluation procedures is used for future directions and decision that will help in the improvement of services offered. The evaluation also allows the staff to single out the changes that the institution's programs may need making sure that its goals and objectives of helping the society remain in line with their mission (Halley, Kopp and Austin, 1998).
The organization is currently facing difficulties especially in the area of funding new initiatives due to the volatility in the political, social and economic environment. The recent introduction of managed Medicaid has made it difficult to carry out new programs and even implementing the existing ones. The reimbursement criteria has been altered, the government grants have been redirected to other areas, leaving the organization to fend for itself (Bellow and Mink, 1996).
As it has been established, the Patrician movement is a non-profit making organization that was started with the sole aim of helping the youth affected with substance abuse in the State of Texas in the US. With time the scope of its practice increased and the organization increased its services to include adult detoxification and inpatient treatment services, specialized treatment for adult women, and adult inpatient treatment services for postpartum and pregnant women together with their infants, adult outpatient treatment services, HIV /AIDS early intervention programs, and brief strategic family therapy. It provides residential short term and long term rehabilitation services to its patients. The organization gets most of its funds from grants from the government; corporate institutions as well as contributions from well wishers through the Friends of the Patrician Movement, an online initiative that encourages people to contribute towards helping those who can't afford get better and improved Medicare services. It has also been established that the delivery of human services involves case management which is a method of service provision where professional social workers collaboratively assess the client's needs and the needs of the family members if the situation calls for it. The worker also coordinates, monitors, assesses and evaluates the required needs of the patient's condition. Case management has various stages that it goes through, this include assessment, brokerage, planning, implementation, coordination, monitoring and case closure.
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Just like any other service providing organization, the patrician movement caries out evaluation to gauge the effectiveness of its services. The accountability of its staff is very important to start with. This is ensured through efforts of quality assurance and periodic evaluation of the adequacy, appropriateness, and effectiveness of the services provided by the system. This calls for the establishment of bench marks from which the evaluation is based. It is also done through the measuring of the system's outcomes that helps in cost saving and determination of the quality of care given. This also ensures that the objectives and goals set by the organization remain realistic and fall within the mission of the organization. Client satisfaction is also one way that the organization uses to determine with their programs are effective or not. This can be determined through patient satisfaction questionnaires, patient's perceived quality of life, and client contract renewals.
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