Vignette 1

Isabella has a psychiatrist, individual therapist, rehab provider and case manager. She appears to be engaged with them and follows through on recommendations and making adaptations as recommended although she expressed frustration that her individual therapist continued to focus on her alcohol use which she does not consider an issue. Isabella has expressed possible interest in exploring the spiritual link between alcohol use and Buddhism with an alternative provider who is familiar with Buddhist teachings. She attends scheduled meetings irregularly due to transportation issues and her inability to develop and maintain a consistent schedule, such as when she is “upbeat” and has difficulty remembering her appointments or when she is feeling anxious and cannot “calm herself” sufficiently to attend appointments or when she is “down” and has limited energy to “get herself there”. Isabella benefited from previous IRTS services and felt the structure it provided was helpful in creating balance in her life.       

Isabella is currently being seen by a psychiatrist, individual therapist, rehab provider and case manager. She is non-compliant regarding taking medication and keeping appointments. Isabella fails to acknowledge that she has an alcohol dependence issue and this makes it difficult for her to fully benefit from services. She misses appointments frequently because of transportation issues and being manic and depressed. When she is anxious, she will not attend her meetings. Isabella cannot function without services and would rapidly decompensate if there was any decrease in number, type or intensity of services. She would need to be re-hospitalized if services are decreased.