Behavioral Theory: Behavior Plan

Resources: University of Phoenix Material: Individual Case Studies, University of Phoenix Material: Behavior Plan Template, and the “Effective Treatment for Addicted Criminal Justice Clients” article located on the National Criminal Justice Reference Service website.Use the “Effective Treatment for Addicted Criminal Justice Clients” article as a sample for how to write a behavior plan. The “Case Study” section near the end of the article provides a good example of a behavior plan.Choose one behavioral theory from your course textbook.Choose one of the following case studies from the University of Phoenix Material: Individual Case Studies:Case One: VioletCase Two: MaxCase Three: OnurComplete the University of Phoenix Material: Behavior Plan Template based on your selected behavioral theory for your selected case-study patient—Violet, Max, or Onur.Incorporate one peer-reviewed research study as justification for the theory you used in your plan.Format your plan consistent with APA guidelines.
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Behavior Plan Template
CJHS/400 Version 2
University of Phoenix Material
Behavior Plan Template
Use this template to create behavioral plans for assignments in Weeks Two and Three. Fill in each
section and provide additional information as needed.
Client Identifying Information
List all pertinent and known identifying information.
Name
Age
Gender
Religion
History
Describe all pertinent and known history.
Medical
Family
Substance Abuse
Developmental and
Social
Course of Treatment
List two target behaviors and two interventions.
Target Behaviors
Frequency and
Duration of Target
Behaviors
Severity and
Number of
Relapses
Interventions
Goals and Objectives
List two long-term goals, two short-term goals, and one objective to work towards each goal.
Long-Term Goal
Short-Term Goal
Objectives
Discharge and Termination Plans
Describe the discharge and termination plan for the client.
Discharge Plan
Termination Plan
Copyright © 2016 by University of Phoenix. All rights reserved.
1
Individual Case Studies
CJHS/400 Version 2
University of Phoenix Material
Individual Case Studies
Case One: Violet
Violet is a 20-year-old woman with a history of difficult relationships. She was in foster care from 12 to 18
years old. She attended a career college and is employed as a dental assistant. This is her first real job.
She was referred to you after a patient at her dental office had a stalking complaint. She apparently
began dating a young man (John) after meeting him at the dentist’s office.
When she arrives for her appointment with you, she is dressed provocatively in a low-cut blouse and tight
pants. She has heavy eye makeup on and seems to be very needy, becoming tearful several times during
the session.
At the start of the interview, she states that this thing would not be a problem if those “idiots” in the office
were not jealous. She reports feeling like they were talking about her and feeling like they were out to get
her. When asked why they would want to get her, she states that all girls are like that. She reports early
sexual abuse in her home by an uncle. She also reports conflict with her mother. Apparently she had
been in an incestuous relationship and had gained favor from her uncle. She would receive cash and get
to go out to eat with her uncle, who was abusing her. She stills denies any abuse and claims that he was
only 12 years older than she was at the time of the abuse. After some reluctance, she admits that she
was 12 and he was 24 when the abuse started.
When asked about depression, she stated that she has a hard time knowing what she is feeling. She
says that she needs to have a man to feel safe and secure. She reports that she has been in a number of
relationships with men and several with women. She usually becomes sexual early on in the relationship.
She has used self-harm in an attempt to regulate her emotions.
After some conversation, she stated that she met John at her office while she was helping the dentist
prepare for a filling. She said that she always flirts with the customers and that John asked her out on a
date. She agreed and reports a short fling. They met for dinner, and she ended up going to his apartment
where they had sex. She reports that they saw each other every day for about 3 weeks, which often
ended in sex. She states that he said he needed more space and asked that they not see each other any
more. She then reported trying to get him back and calling him up to 20 times a day. He asked for a
restraining order and phoned the dentist’s office asking for a referral to another dentist—he no longer felt
comfortable coming into that office. Violet has had five other restraining orders in the past.
Case Two: Max
You are completing your graduate work at a local university by participating in an internship at a private
mental health clinic. As a part of your internship, you were asked to cofacilitate a group for men and
women with relationship difficulties.
While cofacilitating the group, you meet Max, who was court ordered to participate as a result of
allegations of assault. After a careful review, you find that he has six past charges of assault. Max is an
attractive man in his mid-thirties. He is charming with both the males and female in the group. Although it
is clear that he does not feel he should be in the group, you find that he adds dimension to it.
After some time, Max discloses that he has been involved in multiple sexual relationships and says he
“can get in any woman’s pants.” He also brags that he is smarter than anyone in the group, regardless of
the fact that one person has a PhD in physics. When you challenge him, he reminds the group that he
has been on television (in a commercial for a local car dealership) and is just waiting for a contract from a
major television network. He says, “Anyone can go to college, but how many of you have been on TV?”
Copyright © 2016 by University of Phoenix. All rights reserved.
1
Individual Case Studies
CJHS/400 Version 2
He also states that he has a unique ability to be the center of attention and that people are drawn to him.
He has been a successful salesman, but is not able to maintain a job for more than about 1 to 2 years. He
brags about his sexual conquests almost nonstop. After several group sessions, he does acknowledge
some history of depression.
One day, you hear him discussing a “great investment opportunity” with the other group members prior to
the start of the session. You ask him to stop his discussion and he agrees. However, after concluding the
session, he asks you if you would like to invest in his Internet company. He says that he knows you told
him to stop because you were interested in joining him at the beginning and watching it grow. After you
tell him no again, he cusses at you and leaves the group.
Case Three: Onur
You have been asked to evaluate a 25-year-old man named Onur who is presented before the court
following charges of embezzlement. An evaluation is requested pending investigation. He had been
working at a savings and loan company. During the past 2.5 years, a number of older adults in nursing
homes had unexplained transfers made to an off-shore bank.
There are significant indications that Onur was directly involved in the missing funds. There is, however,
little physical evidence to tie him to the crime. He has agreed to resign and participate in therapy in lieu of
charges.
After several sessions, he asks specific questions about confidentiality and reminds you that you cannot
report past crimes. You agree, and he brags about his ability to move money. While he is not specific, it is
clear that he has no remorse for stealing more than 3 million dollars.
According to collateral information and past records, Onur has been involved in crime for many years. At
the age of 15, he was charged with theft. He also was reported as a runaway three times. He is reported
to have stolen items and cash from his parents and grandparents. He was also charged with under-aged
drinking. He has a unique ability to be very convincing and brags about being able to get away with
anything.
Copyright © 2016 by University of Phoenix. All rights reserved.
2
Effective Treatment for Addicted
Criminal Justice Clients
Harvey Weiner, DSW
Arlin Silberman, DO
Peter Glowacki, MD
W. Charles Folks, MSW
ABSTRACT. Addicted criminal justice clients present unique challenges because of the
complex biopsychosocial problems which frequently accompany their addiction. An
overview of the current understanding of addictive disease is presented, including the
important distinction between abstinence and sobriety.
In the Eagleville Recovery Program, each client’s medical, psychosocial, educational,
vocational and psychiatric assessments are used to develop an individualized treatment
plan. Group therapy is the primary treatment modality, supplemented by individual and
family therapy, a unique Adult Basic Education component, work therapy, and active
involvement in the 12-step programs. Group therapy is important because these clients
often reject suggestions from professionals but are willing to accept feedback from peers.
Even minor successful accomplishments in the educational program enhance clients’ selfesteem and reinforce other areas of growth and change, while work therapy provides an
opportunity to learn how to relate to a supervisor and “straight” co-workers.
A case study is presented to illustrate the course of treatment for a typical client. [Article
copies available for a fee from The Haworth Document Delivery Service. 1-800-3429678. E-mail address: getinfo@haworth.com]
______________________________________________________________________________
Harvey Weiner, Arlin Silberman, Peter Glowacki, and W. Charles Folks are affiliated with
Eagleville Hospital, 100 Eagleville Road, Eagleville, PA 19403-1800.
Alcoholism Treatment Quarterly, Vol. 15(4) 1997
1997 by The Haworth Press, Inc. All rights reserved.
1
Substance abuse has been called the nation’s number one health problem (Robert Wood
Johnson Foundation, 1993), and the impact of drugs on America has been summarized by Joseph
Califano (1995) as follows:
For 30 years, America has tried to curb crime with more judges, tougher punishments and
bigger prisons. We have tried to rein in health costs by manipulating payments to doctors
and hospitals. We’ve fought poverty with welfare systems that offer little incentive to work.
All the while, we have undermined these efforts with our personal and national denial about
the sinister dimension drug abuse and addiction has added to our society.
Providing effective treatment to addicted criminal justice clients presents special challenges
because of the complexity and severity of the biopsychosocial problems which frequently
accompany their addiction. The purpose of this paper is to describe the Eagleville Recovery
Program, a residential program which has been very effective in treating these clients of particular
interest is the program’s structure, its multidisciplinary treatment team, and its unique adult basic
education and work therapy components.
To provide a framework for understanding the program’s treatment philosophy, the paper will
begin with an overview of the current understanding of addictive disease. This will be followed
by a detailed description of the program, and a case study.
THE CURRENT UNDERSTANDING OF ADDICTIVE DISEASE
The American Society of Addiction Medicine (Morse and Flavin, 1992) defined alcoholism as
follows:
Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental
factors influencing its development and manifestations. The disease is often progressive and
fatal. It is characterized by continuous or periodic: impaired control over drinking,
preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and
distortions in thinking, most notably denial.
In general, the same definition can be used for addiction to drugs other than alcohol. The
Greek historian Plutarch said, “Drunkards beget drunkards” (Burton, 1906), and it has long been
recognized that addiction, like other chronic diseases, runs in families. Chronic diseases are, by
definition, incurable. Examples of chronic diseases include diabetes, high blood pressure, heart
disease,
asthma,
schizophrenia,
and
bipolar
manic-depressive
disorder.
2
Characteristics common to all chronic diseases include the following:
1. Treatment is effective, but there is no cure.
2. These diseases are progressive and often fatal.
3. There is a lifelong risk for relapse. Rarely does a single episode
of treatment result in lifelong remission. To avoid a relapse, the
individual must assume personal responsibility for the ongoing
management of the disease.
Addicted individuals need to be educated about their disease, and the fact that they will have
it for life. Also, they need to understand that abstinence from all psychoactive substances is the
only way to guarantee continued sobriety.
To understand the dynamics of addiction, it is important to recognize the difference between
abstinence and sobriety. The failure of the current policy of incarcerating addicted offenders
without treatment relates to a misconception which equates abstinence and sobriety. The
disease of addiction is the continuing desire to use, and it has long been recognized that specific
“people, places and things” can cause an intense craving to return, even after years of abstinence
(Weiner et al., 1990). Abstinence is simply an absence of, a void, while sobriety means that
something has been found to fill the void. Offenders who are incarcerated may be abstinent
much of the time (only the myopic clue to the belief that prisons are totally drug and alcohol
free; Knopf, 1993), but even prisoners who are abstinent for years may find themselves suddenly
overwhelmed with craving if they are not prepared to cope with the temptations and
environmental cues they will face upon release. Unless addicted offenders receive treatment
during their incarceration, or immediately thereafter, “picking up” (resuming use) is very
common. Since the use of drugs or alcohol stimulates the desire to use more in vulnerable
individuals, metaphorically awakening sleeping demons, relapse can proceed very rapidly.
Furthermore, the readdiction process is telescoped, and it happens much more quickly than the
onset of the original addiction.
While sobriety includes abstinence, it is much broader in scope.
therapist Edward Foley (1993),
As noted by veteran
Abstinence as a goal is a negative. It focuses on suppression, repression and restraint, effort
is directed to not doing certain things. People expend much energy in avoiding substances
rather than looking to areas or issues needing change or growth. This behavior is known in
self-help groups as “white knuckle” sobriety. Given the insidious nature of addiction there
is a greater danger of relapse when the focus is so narrow.
Sobriety is an open, wide avenue. While a primary ingredient of sobriety is abstinence, the
goal is change and growth: to make progress in living a healthy life free of the dominance of
substances. In sobriety, people aim to improve the quality of life.
3
Treatment for addicted offenders is an educational and habilitation/rehabilitation process:
clients learn about themselves and they learn about addiction as a chronic disease. They also
learn that recovering from a chronic disease is a journey, not a destination, and that they must be
willing to assume responsibility for lifestyle changes to maintain sobriety.
William James (1986) wrote:
The greatest revolution in our generation is the discovery that human beings, by changing
the inner attitudes of their minds, can change the outer aspect of their lives.
Treatment Population
Addicted criminal justice clients often have significant medical, psychological and social
problems associated with their addiction (see Table1), and effective treatment must address
these problems simultaneously, not sequentially (Wallen & Weiner, 1988, 1989).
Typically, addicted criminal justice clients are from urban areas and almost all are
socioeconomically disadvantaged. Most evidenced behavioral problems in school, became
involved with the juvenile justice system during adolescence, and experienced early use of
mood-altering substances. Many were placed in foster care facilities and dropped out of school
before attaining a high school diploma. They have little or no job experience, and few
marketable job skills. Their relationships with women tend to be markedly impaired and many
have several children but no involvement in parenting. Their children are growing up fatherless,
repeating the pattern of their own lives.
Clients often come from a family where parents or siblings are abusing drugs or alcohol.
Physical and/or sexual abuse, and abandonment, are also prevalent. Lacking positive role models
at home, they identified with antisocial peers in the community. Nurturance during adolescence
was often supplied by an organized gang and the individual would participate in the group’s
activities (including alcohol and drug use) to gain acceptance. Given this background, most
clients struggle in treatment to develop self-control, accept limits, and learn to trust others. For
many the process is not one of rehabilitation but rather of habilitation, in that they need to learn
coping skills and social behaviors which were never developed because of their addiction.
4
TABLE 1. Problems Frequently Associated with Addiction in Criminal Justice Clients
MEDICAL
PSYCHOLOGICAL
SOCIAL
HIV+
Depression
Unstable Relationships
TB
Impulsivity
Unstable Living Arrangements
Sexually Transmitted Diseases
History of Violence
Alienated From Family
Hepatitis
Antisocial Personality Traits
Poverty
History of Childhood Neglect
and/or Abuse
Incomplete Education
Pervasive Sense of Despair
Helplessness, and
Hopelessness
Few Marketable Job Skills
Teenage Parenthood
Present vs. Future Orientation
(immediate gratification vs.
sacrifice for long term goals)
Multigenerational Addiction
Friends Who Drink/Use Drugs
THE EAGLEVILLE RECOVERY PROGRAM
The Recovery Program, which is part of Eagleville Hospital, is a 90-day, 30-bed forensic
program for males age 18 and older. Approximately one-hundred and fifty clients are admitted
each year, with 60% successfully completing treatment. This is a significant completion rate given
the fact that many of the clients initially seek treatment to avoid incarceration.
The program’s staffing pattern is as follows:
•
•
•
•
•
•
•
Director (Master’s level Social Worker)
Assistant Director (Master’s level Social Worker)
Psychiatrist (part-time)
Teacher/Vocational Counselor (Bachelor’s level)
Vocational Psychologist (Master’s level)
Social Worker (Bachelor’s level)
Three Therapists (2 Master’s level, I Certified Addictions Counselor)
5
Referrals to the program are made by attorneys, public defenders, prison counselors, parole
and probation officers, and other treatment programs. There are no involuntary commitments,
although clients may be given the choice of entering the program or being incarcerated. The types
of legal involvement range from driving under the influence (repeat offenders) through parolees
who have been in state prison for a number of years.
Generally, the client’s criminal activity has been directly related to the addiction. Individuals
with a history of violent crimes against persons usually are not accepted for admission, unless the
violent act occurred as a result of intoxication. Most of the clients have abused a variety of
mood-altering substances, with alcohol, cocaine, heroin and marijuana being the most prevalent.
The average age of clients is currently 30 years, and 60% are African-American, 35%
Caucasian, and 5% Hispanic. In addition to their addiction diagnosis, four out of five clients are
typically diagnosed as having a personality disorder, with the majority being. Antisocial
Personality Disorder. Major affective disorders are seen in approximately 5% of the clients.
Other diagnostic categories include: Conduct Disorder, Intermittent Explosive Disorder, and
Anxiety Disorder.
Although only 5% of the treatment population are given a formal affective diagnosis, many
clients suffer minor depression which is short-lived. Symptoms include feeling “blue,” guilt over
past deeds, and sleep disturbances. Most clients are initially anxious over being in, a treatment
setting and fearful of what will be required of them. Distrust of authority is also a prominent
feature, as evidenced by prevarication and passively resisting instructions. Intimidation of peers
often occurs early in treatment, and this behavior is especially prevalent in clients just released
from incarceration. In prison this served as a protective defense as well as a survival technique.
In the Recovery Program intimidation can ran …
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