Sally S. is a client with bipolar disorder and addictions to opiates, amphetamines, and alcohol who overdosed and had to be resuscitated. The therapist contacted emergency services, Sally's doctor, sponsor, and other support systems to ensure her safety and proper care. Sally was hospitalized initially and then transferred to an inpatient treatment program. After treatment, she received disability benefits and began an outpatient program along with vocational rehabilitation to find stable housing and employment.

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Decision Tree Portfolio
Jody Marvin
PSY 410
September 2, 2013
Dr. Kristi Huff

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Decision Tree Portfolio
Sally S. is a client working on an assessment to qualify for Disability with the Social
Security Administration. Sally is Bipolar and addicted to opiates (barbiturates, oxytocin,
Adderall) and amphetamines. Misdiagnosed with Attention Deficit Hyperactivity Disorder
and Chronic Pain, Sally began self-medicating before her teens. Fifteen years later
Sally is an alcoholic and drug addict. As a therapist boundaries must be understood,
sometimes unspoken, including physical and emotional limits of the relationship.
Additionally unless the client objects, the therapist may release health information
about the client to a friend or family member involved in medical and mental care. With
written consent information may be given to someone who helps pay for the case. The
therapist may tell the family, sponsor, or friends the condition you are experiencing, and
that you are in a hospital. In addition, in case of an emergency (ICE), we may disclose
health information about you. For public and safety purposes as allowed or required by
law, incidence such as the day you wondered into my office unannounced and four
hours late for your scheduled appointment you were delusional, paranoid, and
extremely drug-induced. Before you began to speak you leaned toward me and past out
in my arms.
Sally’s breathing became extremely shallow and CRP was necessary. I began CPR
as I dialed 911. The operator informed me services would be there within 30 thirty
minutes. Immediately, the Crisis Team at Sea Mar Behavioral Health was notified. Greg
Arnold is the Mental Health Lead. He is at 5007 Claremont Way, Seattle, Washington.
His e- mail address is gregoryarnold@seamarchc Within minutes Greg walked in, and
took over CPR, so I could continue accessing immediate help. I called Lt. Tim Tullis,

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King County Fire District #5: Cell Phone (425-359-6512); email is T-TULLID@King5.org.
Tim is also an EMT-I (at 304 Alder Street, Seattle, Washington). The paramedics
arrived in seven minutes.
The concern was whether Sally would be taken to a hospital or jail facility. I
contacted her doctor, Bill Lawson, AARP at Harbor Valley General Hospital. Hospitals in
King County and surrounding counties do not have psychiatric facilities for suicide
victims at the present time. You must go first to be interviewed to determine the severity
of your suicidal tendencies, and you are put on a waiting list. Suicide attempts revived
are incarcerated and charged with attempting to harm you. Inmates receive no
medication and are kept in isolation, naked, in a four by six block wall room, naked until
proven he or she will not harm herself.
Greg was successfully reviving Sally, and she was totally disoriented. I contacted Sgt.
Ed Swainson with the Washington State Patrol. Ed is at 900 W. Main St. Seattle,
Washington (360-654-1204). He immediately responded to assist in the proper
placement of Sally. Next I called Kelly W. (425-609-6170) (Seattle Area GSR at
alcoholicsanonymousforhope.org.), Sally’s Alcoholics Anonymous’ Sponsor. A sponsor
can have a huge impact on an individual’s life and decision if a relationship of trust and
hope has been established.
Sea Mar Behavioral Health Crisis Team – substance abuse and medical arrived
within minutes, located at 17707 W. Main Street, Seattle, Wasgington 98272 – 360-2823886. Eventually 911 supports arrived and were informed the situation was under
control. Sgt. Swainson was in charge of disposition depending on my recommendation
and a safe and healthy location was established. Sally was taken to Harborview

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General Hospital to have her stomach pumped. Sgt. Swainson and Kelly, Sally’s
sponsor provided transportation and support. Several hours later, my recommendation
was for in-patient (21 days) at Swedish Medical Center. My diagnosis specified
Substance Abuse (prescription drugs and alcohol) and a dual diagnosis with Bipolar
Disorder with rapid cycling. Following her 21 days Sally would begin her two-year
program with out-patient treatment through Sea Mar Outpatient for co-occurring
psychiatric and substance disorders.
I begin my follow-up contacting Pat Simpson, MS, Vocational Rehabilitation Lead
Counselor with the Dept. of Social and Health Services. Pat is at 840 N. Broadway, Ste
500, Seattle, WA 98201 (425-339-1724). We assisted Sally in acquiring her disability
status and within five months she was established with Social Security Supplemental
Income (SSI and SSD). For the first time in 17 years Sally had found hope, established
healthy relationships through AA and NA, and had a small income with medical
coverage for her existing disorders. The medical team at Swedish Hospital initiated a
complete physical examination and began a medication regime for her bipolar disorder.
After three weeks Sally located her necessary seeds for Hope and began developing
coping skills.
DVR established a Community Rehabilitation Program (CRP). CRP will locate,
secure, and place Sally in a Residential Half-way House under the conditions she would
continue her medications and out-patient program. In addition, Sally will be placed in a
paid employment setting, or other realistic work setting with the provision of needed job
supports and training to learn preference for a vocational environment. Sally must
complete her out-patient program; attend three AA meetings a week, continue regular

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follow-ups with her therapist, a psychiatrist who will monitor her medications, and fully
participate in and complete the Community-Based assessment as mutually agreed by
Sally, VRC, and CRP.
My counseling and guidance is provided through a one-on0one relationship between
a Vocational rehabilitation, myself, and Sally. Her counselor will review assessment
information, explain the VR process, help her make good decisions, and support her
progress throughout the process. Because Sally will receive public benefit, such as SSI
and SSID, her counselor will explain the impact of working and refer her to a Benefit
Planner for a more comprehensive consultation. Sally will learn independent living
services to help her manage disability issues, such as following a schedule, managing a
daily routine, and learning how to get around in the community using public
transportation.
Sally needs the safety of women’s groups to explore her issues, such as the little
sexual experience without the use of chemicals and believes she cannot enjoy sexual
activity with them. Other common issues that often go unaddressed or under addressed
are family violence, parenting, relationship, and sexual addiction, Aid’s, and eating
disorders, all of which are potential relapse factors for women. Sally is learning she is
not responsible for predisposition to substance disorders and bipolar disorder of the
brain. A person is responsible for participating in appropriate treatment and complying
with a recovery plan. Recovery is simple but not easy because change can be difficult,
requiring effort and patience with more effort and patience. Finding a balance in
physical health, mental health, an educational journey, relationships, and spirituality is
Sally’s daily goal.

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