Shaneka Wilks is the 21-year-old wife of Army Specialist (SPC) James Wilks, who is a member of the South Carolina National Guard. SPC Wilks was severely injured in Iraq in December 2008, when an improvised explosive device (IED) blew up the mine-resistant, ambush protected (MRAP) vehicle in which he was a passenger. He lost most of his left leg and about half of his right leg in the blast. SPC Wilks’s lower back and groin were also injured. His physicians believe that he may also have a mild to moderate traumatic brain injury (TBI). He is currently on the physical rehab unit at Walter Reed Army Medical Center in Washington, DC; he has been there for three months. Shaneka’s and James’s grandmothers have both been staying with him for most of his hospital time. Shaneka and James do not have any children. They are from Charleston, South Carolina.

                      You are a medical social worker who provides case management services to military members and their families at Walter Reed Army Medical Center. One of James’s doctors has requested your assistance in helping James and his family begin to prepare for his eventual discharge from the hospital. The doctor has recommended that James be discharged to a long-term Veterans Affairs (VA) rehab hospital near Charleston. However, James’s family reportedly does not believe that the VA hospital will take adequate care of him: a family member died at that facility several years ago.  The doctor is also concerned about how Shaneka is managing James’s injuries. Some of the staff have commented on how they think she pushes James too hard during some of his physical therapy sessions. Staff members have told you they have heard Shaneka argue with his grandmother over how much exercise they think he can do.

After reviewing James’s medical chart, discussing his needs with the hospital’s discharge planning group, and meeting with James, you decide to interview Shaneka in your office. She tells you that she is very worried about taking James home. She does not feel equipped to manage his care at their house. Shaneka is thankful for James’s grandmother’s help, but she is concerned that she will “try to control everything in their home.” She confesses to you that she sometimes secretly dreams of leaving James because of how overwhelmed she feels. Shaneka states that she feels very guilty about these thoughts and prays that “God will take them away.” She tells you that she loves James very much, but that his personality seems so different after the blast, and that he sometimes even forgets her name. James and Shaneka were very involved in their church back in Charleston. In fact, they met through their involvement in the church youth group.

• What are the highlighted and explicit common service-related issues that this client may be experiencing?
• What other potential service-related injury would you assess for and why?
• What modalities of treatment might you recommend for this service member and why based upon your assessment.
• What additional referrals or information would you give to the family?
• What strengths does the Wilks family have to draw on as they transition out of the military? 

Reference

• Social Work with Military Populations (Advancing Core Competencies) 1st Edition – ISBN-13: 9780137413607 – by Diane Scott ,James Whitworth, Joseph Herzog