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This assignment provides an opportunity for students to complete a thorough case review of a client (Lisa). Students will ass

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This assignment provides an opportunity for students to complete a thorough case review of a client (Lisa). Students will ass

This assignment provides an opportunity for students to complete a thorough case review of a client (Lisa). Students will assess Lisa’s case through a case study that provides several vignette’s regarding Lisa’s experience child welfare and substance usage. This case study illustrates the journey made by Lisa, a parent involved in the child welfare and addiction treatment systems. Students will follow Lisa through treatment program interviews and subsequent treatment, having to meet deadlines, and her recovery process with typical challenges and a relapse.

Lisa’s story illustrates clinical issues, observations and decisions made by child welfare and addiction professionals, confidentiality processes and procedures, and decision points related to her children and competing requirements.

Assignment #3: Case Review Paper

This paper will need to be typed, double-spaced with a cover page, font should be Times New Roman size 12, and inclusive of traditional (normal) one-inch margins. Any references you use need to be completed in APA formatting.

For this paper: (1) APA style must be used correctly, (2) All required relevant course readings and materials must be used, (3) At least 8 scholarly sources used (beyond course materials).The paper must be clear, well organized, and should be 10-15 pages not including the master treatment plan, biopsychosocial assessment, cover page, references and any other attachments

This assignment provides an opportunity for students to complete a thorough case review of a client (Lisa). Students will assess Lisa’s case through a case study that provides several vignette’s regarding Lisa’s experience child welfare and substance usage. This case study illustrates the journey made by Lisa, a parent involved in the child welfare and addiction treatment systems. Students will follow Lisa through treatment program interviews and subsequent treatment, having to meet deadlines, and her recovery process with typical challenges and a relapse.

Lisa’s story illustrates clinical issues, observations and decisions made by child welfare and addiction professionals, confidentiality processes and procedures, and decision points related to her children and competing requirements.

After reading Lisa’s Case Study, please adhere to the following guidelines:

· For this assignment, students will be expected to answer a series of questions that correspond to each stage of Lisa’s progress through the substance abuse child welfare system. These questions can be found at the bottom of every page of the case study.

· Please be sure that your answer for each section are supported with peer-reviewed resources or course literature.

· Also, please remember to integrate course material throughout your answers.

· Each paper should have an introduction/overview, section headings, and references.

· There must be a theoretical support section in which students must compare and contrast TWO theories and provide a through explanation and rationale for why one of the theories works best to support their work with the client. Please remember that you should specify the concepts and propositions from each theory that support, explain, and assist in your work with the client.

· Complete the biopsychosocial form and fill it out the best of your ability related to Lisa’s Case Study as if she was just entering into substance abuse treatment.

· Develop a Master Treatment Plan for Lisa and develop a primary diagnosis utilizing the DSM-V. Please provide a thorough rationale for your diagnosis.

· Develop a Prioritized Problem List. Please be sure to identify whether you are at the beginning, middle, or end of the treatment plan process. Remember, that your goals will be dependent upon where you are at in the treatment process with Lisa.

· Please remember to integrate at least 8 peer-reviewed resources (outside of course material) to support your assessment and treatment plan.

This paper will allow you to demonstrate how you would distinguish, appraise and integrate multiple sources of knowledge (including research –based knowledge and practice wisdom). Students will demonstrate their ability to apply Human Behaviors theories to guide basement and practice interventions, it is encouraged that you re-familiarize yourself with theories learned in Human Behaviors & Social Environment as well as Psychopathology courses (ex: Brief Solution Focused, Cognitive Behavioral Theory, Attachment Theory, Racial Identity Theory, Ego Psychology, Trauma Informed Theories).

,

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Case Study: The Treatment Process and Collaboration

Throughout this course the following case study will bring to life several important clinical and procedural issues. This case study is designed to illustrate real life issues that child welfare professionals encounter. It is designed to help you examine important issues, consider processes and procedures, review potential challenges, and explore effective solutions. Lisa’s Journey Through Treatment and Recovery

This case study illustrates the journey made by Lisa, a parent involved in the child welfare and addiction treatment systems. You can follow Lisa through treatment program interviews and subsequent treatment, having to meet deadlines, and her recovery process with typical challenges and a relapse. Lisa’s story illustrates clinical issues, observations and decisions made by child welfare and addiction professionals, confidentiality processes and procedures, and decision points related to her children and competing requirements.

Caseworker Molly’s Collaboration With Treatment Providers This part of the case study highlights the experiences of Molly, a county child welfare professional who is Lisa’s caseworker. You can follow Molly collaborating with Sarah, an addiction professional who works at the local substance abuse treatment program, about their shared client and her children. Molly and Sarah learn to work together to help Lisa deal with competing requirements; they observe and evaluate her progress, and influence agency procedures.

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Case Study: Lisa’s Initial Interview at the Treatment Agency

Lisa is a 42-year-old woman who was referred to treatment by Child Welfare Services (CWS). Her two adult daughters previously attempted an intervention because they felt that she was neglecting their two younger brothers, Ian age 6, and Ricky, age 5. Lisa refused substance abuse treatment evaluation when pressured by her daughters, who then called CWS for help. At present, Lisa’s two younger children are remaining at home but the CWS worker has made a referral to substance abuse treatment as part of Lisa’s service plan.

During her initial treatment interview, Sarah, the treatment counselor, conducts a biopsychosocial assessment and takes a substance use history from Lisa to gather information regarding the risk factors that influenced Lisa’s substance use. Sarah learns that Lisa married at 17 years old to “get away from” an alcoholic father. Lisa’s mother married Lisa’s father when she was 16 years old. While drinking, which was most evenings, Lisa’s father would become physically abusive with Lisa’s mother and verbally abusive to Lisa and her older brother.

In an attempt to remove herself from her home life, Lisa had several male relationships prior to her marriage at age 17. Her first husband was the father of her two older girls, who were born when Lisa was 18 and 20. Her husband was physically and emotionally violent toward Lisa and the girls, and the marriage ended in divorce when Lisa was 24. Following the divorce Lisa began smoking marijuana occasionally and drinking 3 or 4 beers a day to “feel better.” Lisa admits she uses methamphetamine but does not believe it is a big problem in her life and doesn’t think it affects her younger children.

At age 33 Lisa began a relationship with Dan, and while they never married, he is the father of her two younger boys. Dan is a methamphetamine user and was convicted for drug manufacturing and sales. He has just been released from prison. Before his arrest, Dan introduced Lisa to methamphetamine, which she began using to stay awake while working her job on the night shift at an all-night coffee shop.

Questions to Ask Yourself:

What roles do Lisa’s father and Dan play in her current substance use?

Who are Lisa’s supportive relationships?

What are Lisa’s strengths?

How urgent is the safety risk to Ian and Ricky with Lisa’s current substance use pattern?

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Case Study: Lisa’s Current Situation

When Lisa arrives for her initial interview at the day treatment program, the substance abuse counselor Sarah notes that she appears frail, underweight and unkempt, her skin is pale, her teeth are in poor condition and a front tooth appears to be chipped. Lisa chain-smokes throughout the entire interview. The probing questions of the seasoned counselor (a certified addiction counselor in recovery) help to uncover information about Lisa’s situation.

Sarah learns that Lisa’s housing situation is currently stable. However, Lisa feels that her night job interferes with her relationship with her boys

and is an unsafe environment for anyone trying to not use drugs. She has not seen a doctor since Ricky was born. She says that her night job is her only employment option and means of paying her rent. Lisa states that her only friends are the other waitresses at the coffee shop. They also use methamphetamine to stay awake on the job, and after work they have a few drinks before heading home. Sarah believes that Lisa is minimizing the amount of drugs she is using and that she does not clearly understand the adverse consequences of her drug use on her own health or on her children.

Lisa admits that Ian and Ricky have been absent from school 28 days this year, but she claims they haven’t been absent for the last 2 weeks. While she admits to using methamphetamine to get through her shifts and having “a couple drinks to wind down,” she feels her current substance use has no effect on her household. She states, “It is just hard for me, working evenings, and making sure the boys stay on track.”

When asked about her intentions in regard to her relationship with Dan (Ian and Ricky’s father) now that he has been released from prison, Lisa admits she doesn’t know what the relationship will be like now but that she is still in love with him. She also says that having another person around making money would help out a lot since now she’s barely making ends meet—barely being able to pay for food for the kids by the end of the month.

Questions to Ask Yourself:

Does Lisa meet criteria for substance abuse or dependence?

Which areas of life functioning are most urgent for Lisa to address?

What role does Lisa’s substance use play in Ian and Ricky school absences?

40

Case Study: Molly Calls Sarah the Addiction Counselor

Molly is a child welfare worker with the county department of human services. It is a typical day and she is frustrated. It seems that most of her cases involve parents who are abusing substances. While each of the situations are different, they share a common thread: it is difficult for Molly to know if the parents’ treatment is working, if they will be able to continue caring for their children, and if they will meet the court deadlines for making such a determination.

The child welfare agency and the treatment centers have signed agreements regarding the disclosure of information, which Molly feels is a step in the right

direction. But the information she receives from the treatment facilities is generally focused on the addicted parent. It does not provide a clear picture about the parents’ abilities to provide for their children’s safety and well-being.

Knowing that for one family – Lisa and her two children – an important review hearing is coming up, Molly picks up the phone. At the other end of the phone is Sarah, a substance abuse treatment counselor at the local day treatment facility where Lisa has been for the past month.

Molly: “Sarah, it’s Molly, the caseworker for Lisa’s children. I’m checking in to see how her treatment is progressing and I need a report for court.” Sarah: “Molly, glad you called. I’ve been so swamped with all these clients and paper work … Yes, I know Lisa’s hearing is coming up, and I’ve been gradually trying to help her get ready. She’s really committed to treatment once and for all … but it’s a hard road, recovery. You know what they say, “One day at a time, for the rest of your life!”

Questions to Ask Yourself:

With Molly’s concerns about Ian and Ricky’s safety, how do you think Molly feels when Sarah responds, “One day at a time?”

What information would you want from Sarah to justify Sarah’s statement that Lisa is committed to treatment?

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Case Study: Lisa’s Safety Assessment Home Visit

Lisa’s referral to the day treatment program resulted from initial observational screens conducted by CWS staff. Following Lisa’s daughters’ phone call to CWS, an investigator went out to Lisa’s home to conduct an in-home safety assessment. This was to determine if a case should be opened and whether or not the children were in immediate danger.

The investigator noticed that the family was living in complete disarray. The living room was cluttered with empty pizza boxes, soda and beer cans, and dirty dishes were piled high in the sink and on the stove in the kitchen. There was no milk, dairy products, fruit, vegetables, or meat in

the refrigerator. Clothes were strewn throughout the home’s two small bedrooms.

The caseworker noted that the two boys were dressed in clothes that they had outgrown and that were filthy and worn out. Both boys appeared to have upper respiratory infections, and they stated they had not eaten that day. During the visit, Lisa appeared anxious and jittery although there were no overt signs of drug use in the home such as drug paraphernalia. The CWS investigator asked Lisa direct questions about her substance use pattern and adverse consequences that resulted from her alcohol and drug use.

These observations and Lisa’s answers about feeling that she was using drugs more than she intended and was having problems stopping led the caseworker to believe that the children were being neglected and that Lisa might have a substance-related problem. The caseworker felt that a case needed to be opened and that Lisa should be referred to a local treatment program for a substance-related assessment. As part of her intake with CWS, Lisa signed release of information forms that allowed the caseworker to share the observations made at the in-home visit with the treatment counselor who would be conducting Lisa’s substance- related assessment.

At this point, the investigator determined that Lisa’s children were at a moderate level of risk and that immediate removal was not necessary. However, she opened a case, petitioned the court to require Lisa to participate in family maintenance services and referred Lisa’s family to Molly who would provide on-going in-home services to the family.

Questions to Ask Yourself:

Do you agree with the assessment that Ian and Ricky are at a moderate level of risk?

What questions should investigators ask about substance use?

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Case Study: Lisa Receives a Substance-Related Assessment

The release of information forms were signed at the first appointment with Lisa. This permits the information from the home visit to be shared with the treatment counselor Sarah, along with other information from the CWS case. This information includes: (1) the children have not been removed from the home but will be under court-ordered family maintenance; (2) the family will be receiving in-home services, Lisa will be required to complete parenting classes and weekly random drug tests; (3) there was no previous CWS involvement; and (4) Lisa has no criminal history, but the father of the two boys has recently been released from prison on drug-related charges.

With this information, Sarah is better prepared to conduct an in-depth assessment with Lisa. The immediate goal is for Sarah to be able to obtain as much information as possible, from Lisa and from other persons with knowledge about the family. This includes child welfare, other service providers and family members if appropriate. By gathering information from multiple sources, Sarah can get an accurate picture of Lisa’s needs and use this information to help increase Lisa’s motivation to actively engage in treatment.

During the assessment interview, Sarah uses her program’s standard assessment tool. It includes questions based on DSM-IV diagnostic criteria. After weighing the information that she has gathered regarding Lisa and her family, Sarah determines that Lisa has substance dependence and Lisa agrees to enter treatment. Sarah recommends to Lisa’s child welfare worker, Molly, that Lisa enter the intensive outpatient program for a minimum of 90 days with a planned transition to longer-term outpatient treatment. She will be attending 3 days per week for 5 hours, be required to randomly drug test each week and attend a minimum of 3 self-help groups each week.

Molly is pleased that Sarah has been able to conduct an informed assessment and supports her recommendation. However, she expresses concern about Lisa’s level of motivation and about child care arrangements for Ian and Ricky while Lisa is attending meetings and is at the treatment program. Molly will find after school child care options for the 3 days that Lisa is at the treatment program. Sarah and Molly agree to remain in close contact regarding Lisa’s progress in treatment and agree that their separate drug tests requirements will be coordinated so that Lisa does not have two drug testing requirements. Lisa enrolls in the program and is assigned a counselor and a family advocate. The advocate graduated from the program, was trained in motivational interviewing, and provides support services to Lisa and other women in the program.

Questions to Ask Yourself:

Do you agree with the substance abuse treatment plan?

What roles would you like to see the family advocate play in Lisa’s recovery?

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Case Study: Lisa Participates in Intensive Outpatient Treatment

During her first few weeks in the day treatment program, Lisa appeared to be increasingly engaged in the recovery process. She initially denied the impact of her substance use on her sons’ well-being. Since then, she admitted, first to her counselor and then in a group session, that her substance use may be affecting her ability to provide Ian and Ricky with a healthy home environment. She stated that her goals for Ian and Ricky are to be sure they don’t end up using drugs.

Lisa’s family advocate is able to help her understand that by focusing on her recovery, and the issues related to her substance use, she will be

better able to parent Ian and Ricky, and less likely to have them removed from her care.

Because of the supportive environment of the treatment program, and Lisa’s realization that she is surrounded by women who have had similar life experiences, she has a breakthrough. She admits for the first time that she was molested as a young girl by a neighbor. Within the safety of the treatment environment, Lisa is able to explore how childhood sexual abuse, her early home environment, parental substance abuse, and abuse by her first husband, all contributed to her substance use. She also recognizes that she did not have healthy role models to teach her how to effectively parent her children.

After Lisa’s initial 30 days in the intensive outpatient program, Ian and Ricky begin attending sessions with Lisa at the treatment program after school. Both boys are assessed using a variety of screening and developmentally appropriate tools.

Ian fits a typical profile of children of substance abusers who have serious behavioral problems. He is aggressive, manipulative, oppositional, and defiant. He is below grade level in most academic areas and has rapidly destroyed several toys and property belonging to other children at the program. Ricky, who was prenatally exposed to methamphetamine, has early signs of attention-deficit/hyperactivity disorder (ADHD) and other neuro-behavioral complications. He has difficulty following instructions, is easily frustrated, and has poor motor skills and frequent angry outbursts.

Questions to Ask Yourself:

How can Molly support Lisa’s goal to keep Ian and Ricky from using?

What role did Lisa’s childhood play in her substance use?

Do you think Lisa may have a co-occuring post-traumatic stress disorder?

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Case Study: Lisa Receives Motivational Enhancement

At the 30-day mark, Sarah, Lisa’s substance abuse counselor, calls Molly, Lisa’s child welfare worker, to inform her of Lisa’s progress. Molly is pleased to hear that Lisa is engaged in treatment and that she has had all clean drug tests since entering treatment. Sarah shares with Molly that introducing Ian and Ricky into the treatment plan has resulted in some stress for Lisa. For the first 30 days, Lisa’s attention had been focused on her recovery, and now the issues of parenting and her sons’ needs are being addressed.

Sarah and Molly strategize about how to use the children as a motivating force for Lisa. Sarah explains to Molly that threats about

losing her children in the future often don’t work with addicted women, particularly those who have been using methamphetamine, because they need more immediate incentives and sanctions based on their behavior. Molly understands that it will not be as effective to tell Lisa, “You better remain sober, or you will lose your kids” and that negative approaches will likely cause more stress, which could prompt a lapse or relapse.

Rather, Sarah and Molly decide to use a motivational enhancement approach with the message, “Your goals for your children include your being available to them to help them and to watch them grow up as their mom. You have worked hard. You have used several good strategies to get this far in recovery and you have done well. If you can’t continue with these strategies and to work on maintaining your recovery, you will not be able to be there for them as they need you to be.”

At Lisa’s next meeting with Molly, she approaches Lisa from a motivational enhancement perspective regarding her children rather than from a punitive one. She begins the session by saying, “I am here to work with you through this difficult time. What is your goal in this situation? How can I help you get to where you would like to be?” Molly elicits self-motivational statements of intent and commitment from Lisa in regard to improving her efforts to provide a safe home for Ian and Ricky. Molly learns that Lisa is worried about being able to support her children and to provide the mental health and medical care that they need. Lisa tells Molly that she feels overwhelmed with all the pressures of work, treatment, parenting and handling Ian who is beginning to act out more than he had in the past.

Molly assures Lisa that she will work with her about her concerns and tells her that she can use a benefits calculator that is available in a State-customized version from Wider Opportunities for Women, which checks possible eligibility for more than a dozen income- related benefits for a single mother with children. She determines that Lisa is eligible for child care assistance for her children as well as for low-cost health coverage for her children through the State’s Child Health Insurance Program (CHIP). Lisa begins to see Molly as less of a threat and more of a help to her and her children.

Questions to Ask Yourself:

What are the strengths that Lisa is demonstrating at this point in her recovery?

Why does Sarah think that Ian and Ricky are adding stress to Lisa’s recovery?

Do you think using a non-confrontational approach with Lisa is the right way for Molly to intervene?

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Case Study: Lisa Tests Positive for Methamphetamine

As a requirement of the treatment program, Lisa must submit to random drug testing 3 days per week. Shortly after her first 30 days in the program, Lisa tests positive for methamphetamine. The treatment program’s drug testing method provides instantaneous results at the time of testing, rather than sending each test to a lab. As a result of having the results immediately, Sarah is able to talk to Lisa in an individual session that afternoon. However, since Molly is also relying on those drug tests, she tells Lisa that she will be sending out the specimen for laboratory confirmation as required by the court.

During the counseling session, Lisa cries. She states that she had thought that she was holding it all together and was able to manage her treatment, her job, and her parenting classes. She says that although it had been tough to attend the treatment sessions and parenting classes, and work at night, she felt motivated to remain clean and kept pushing on.

She reveals to Sarah that the boys’ father, Dan Sr., had shown up last night right before she had to leave for her shift at the coffee shop. He was recently released from prison and was asking if he could move back in with her and the boys. Lisa said that she had to go to work and that they could talk about it later. When she got to work, she was exhausted and stressed out by Dan showing up, and one of her coworkers came over with some meth—”It was just too easy to give in, knowing that I wouldn’t be stressed and would get through my shift without falling asleep on my feet.”

Sarah and Lisa discussed the situation, with Sarah noting that Lisa has exhibited strong motivation for recovery by remaining clean and sober for more than 30 days, despite working in an environment where drugs are readily available. However, Sarah notes that with the increased stress of parenting classes, and with Dan returning, Lisa is not able to hold up against the temptation. They are able to discuss what this lapse means in regard to potential risks to Ian and Ricky.

Sarah uses Lisa’s lapse as a therapeutic tool, getting her to look at her current situation— stressors, protective factors, and motivation—and to determine what must change for Lisa to get back on track with her treatment. Together they plan to call Molly to let her know.

Questions to Ask Yourself:

Do you think Lisa/s drug use was a lapse or a relapse?

Are there strategies that Sarah and Molly could have used to help prevent Lisa’s drug use?

What should Molly do about the drug use?

How does Lisa’s drug use affect her prior safety assessment for Ian and Ricky?

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Case Study: Lisa Agrees to Attend Residential Treatment

During their discussion of Lisa’s lapse, Lisa explains to Sarah that she believes her job at the coffee shop is a risk to her recovery. She also feels that she doesn’t have any other job skills or employment options. Although she is unsure about her future with Dan, she wants him to be part of their sons’ lives—as long as he’s not using drugs. She says that she hopes that his prison-based drug treatment will help him stay clean now that he’s been released.

Sarah commends Lisa for recognizing that she cannot keep this job and maintain recovery. She suggests a higher level of treatment and recommends the agency’s 90-day residential treatment program. After initial resistance, Lisa agrees this may be the only way that she can achieve lasting recovery and be able to care for her sons. Sarah and Lisa develop a plan for Lisa to ask her oldest daughter if she and her husband can take the sons for the next 3 months while Lisa goes to the residential program. Sarah explains that Lisa may be eligible for temporary income assistance through TANF and can participate in the treatment program’s vocational services and job-training classes.

Sarah phones Lisa’s child welfare caseworker to inform her about Lisa’s drug use and arranges a meeting. At the meeting, Lisa and Sarah present to Molly an action plan for Lisa to go to residential treatment where she can get intensive substance abuse services and job training. Molly is pleased that Sarah and Lisa have come to her with a proactive approach to Lisa’s use. She explains that a visit to Lisa’s daughter and son-in-law’s home must be conducted. If it reveals that they are an appropriate kinship placement for the boys, the plan may work out fine. Molly explains that if Dan wishes to be involved with his sons, he will need to meet with her.

In a meeting with Molly, Dan expresses his desire to be a part of his sons’ lives. Molly explains that since his conviction was drug-related, he needs to be referred to a treatment program for assessment in order to have visitation with his sons. Dan agrees and is referred to a different program from the one Lisa has been attending. Molly learned from her treatment colleagues that couples should not be in the same program, and she also knows of a program that provides gender-specific treatment for fathers.

Questions to Ask Yourself:

What role did Lisa’s job play in her drug use?

Do you think residential care was needed at this point in Lisa’s recovery?

Do you think Dan needs to be in treatment?

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Case Study: Lisa Enters Residential Treatment

In her first few days in residential treatment, Lisa’s new counselor, Jill, explains what she can expect from the program. At successful completion, Lisa will be eligible to attend outpatient treatment and then aftercare. Visitation with her sons will be limited during the first 30-day period. While she has had 30 days in outpatient treatment already, with her relapse and increased level of treatment, Lisa needs to strongly focus on her own sobriety and recovery during this first stage.

After a successful 30-day period, a regular visitation schedule will be created with increasing levels of contact with her sons and decreased levels of supervision during those contacts. At 30 days, parenting classes will be introduced into Lisa’s program. At 60 days she will enter the job-training program. The job- training program, along with other support services, will continue during the outpatient and aftercare program.

Jill explains that the importance of Lisa focusing on her recovery at this stage and the progressive schedule of visitation and other services has been explained to and approved by Molly at child welfare.

Shortly after entering the residential program, Lisa has a child welfare court hearing. She is nervous about it because of her lapse in abstinence and the fact that she has gone into residential treatment. She worries that the judge might believe she couldn’t take care of her kids.

Questions to Ask Yourself:

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