Each tab explores one clinical case in depth — read through all three to continue.

Alex (29)

Jana (35)

Peter (42)

Case 1:Alex

Alcohol Use, Liver Disease, Trauma, Minority Stress

Alex is 29 years old.

History of domestic violence in adolescence

Period of incarceration

Periods of street homelessness

Alcohol dependence

Early-stage liver disease

Avoids structured services

Additional context:

Identifies as bisexual

Previously experienced discrimination in a shelter

Uses alcohol to manage anxiety and social discomfort

Recently discharged from hospital after elevated liver enzymes

He has missed two follow-up appointments.

Step 1 – Identify Layered Vulnerability

What do you see?

Trauma history

Institutional mistrust

Substance dependence

Minority stress

Emerging chronic physical illness

Housing instability

This is not a single-axis addiction case.

Step 2 – Apply IHSC Principles

P1 · Whole-Person Integrated Care

Does care include addiction, liver monitoring, mental health, and safe housing — or are services fragmented?

P2 · Low-Barrier and Equitable Access

Is the service environment safe for LGBTIQ+ individuals? Are appointments flexible? Is follow-up proactive?

P3 · Trust-Based and Trauma-Informed Practice

Instead of "You are damaging your liver," MI: "What worries you most about your health right now?"

Instead of confrontation: "It sounds like alcohol helps with anxiety — but you've also noticed it affects your body."

P4 · Health and Housing as Rights – System Responsibility

Is discharge coordinated? Is discrimination addressed structurally? Is housing treated as part of health stabilisation?

Step 3 – Support Intensity

ICM or ACT?

Consider:

Liver disease progression

Alcohol dependence severity

Trauma history

Appointment avoidance

If instability escalates, ACT-level intervention may be appropriate.

Case 2:Jana

Parenting, Depression, SGBV Survivor, Hypertension

Jana is 35 years old.

Mother of a two-year-old child

History of intimate partner violence

Recently evicted

Chronic depression

Untreated hypertension

Missed recent primary care appointment

She appears withdrawn during consultations and avoids discussing her past. She expresses fear that services might "take her child away."

Step 1 – Identify Layered Vulnerability

What do you see?

Parenting under instability

Chronic physical illness

Trauma from SGBV

Housing insecurity

Mental health disorder

Fear of institutional authority

Her avoidance may reflect trauma, not resistance.

Step 2 – Apply IHSC Principles

P1 · Whole-Person Integrated Care

Care must include mental health treatment, blood pressure management, housing stabilisation, parenting support, and trauma-informed counselling — housing stability becomes child protection.

P2 · Low-Barrier and Equitable Access

Can appointments accommodate childcare? Is the environment emotionally safe? Are services coordinated to reduce repeated retelling of trauma?

P3 · Trust-Based and Trauma-Informed Practice

Instead of "You need to manage your blood pressure," say: "I want to make sure we look at your health in a way that feels safe and manageable for you."

Explore fear gently: "What worries you most when you come to appointments?"

P4 · Health and Housing as Rights – System Responsibility

Is the system protecting the mother-child relationship? Are services preventing retraumatisation? Are child welfare interactions collaborative rather than punitive?

Step 3 – Ethical Tension

Balancing:

Safeguarding responsibilities

Respect for autonomy

Trauma sensitivity

Non-maleficence

Integrated care requires coordinated, non-punitive safeguarding.

Case 3:Peter

PTSD, Chronic Pain, Opioid Use

Peter is 42 years old.

Survived armed conflict

Diagnosed PTSD

Chronic musculoskeletal injury

Opioid dependence

Recurrent emergency department visits

He is frequently labelled as "drug-seeking." He reports severe pain and insomnia.

Step 1 – Identify Layered Vulnerability

What do you see?

Trauma

Stigma

Chronic pain

Institutional mistrust

Addiction

Housing instability

Pain and addiction may be intertwined.

Step 2 – Apply IHSC Principles

P1 · Whole-Person Integrated Care

Does care integrate pain management, PTSD treatment, opioid substitution therapy, and housing stability — or are these treated separately?

P2 · Low-Barrier and Equitable Access

Are crisis responses immediate? Is opioid substitution accessible? Are follow-ups proactive?

P3 · Trust-Based and Trauma-Informed Practice

Instead of "You're misusing medication," try: "It sounds like the pain feels unbearable. Let's explore what options we have."

Use scaling: "On a scale from 0 to 10, how manageable is your pain today?"

P4 · Health and Housing as Rights – System Responsibility

Is emergency department cycling a personal failure or a coordination failure? Is there structured discharge planning, and is housing integrated into treatment planning?