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QUESTION

Feb 07, 2019

Section One:Choose one of the three Case Studies focusing on a family in crisis. Each member of the family has unique issues that you must address. You must also determine the primary problems (this m

Section One:

Choose one of the three Case Studies focusing on a family in crisis. Each member of the family has unique issues that you must address. You must also determine the primary problems (this may include diagnostic impressions but not formal diagnoses), intervention, prevention, and education required to assist the family. In your project, do the following:

Identify the client and the presenting problem or symptoms. Briefly explain if anyone else is involved and how they contribute to the problem. Explain if anyone other than the “identified client” also could be identified as a client. If so, describe who and why.
Briefly describe any underlying problems or potential mental health diagnoses contributing to the primary problem that should be noted as you proceed with the client.
Briefly describe the presenting problem from the family’s perspective and what theoretical perspective you will use to assess, analyze, and develop a treatment plan for this case.
Identify the unique needs of each individual in the family.
Briefly describe the culture of the family, societal expectations, gender roles, and cultural norms. Briefly explain how each of these might contribute to the problem.
Briefly explain the child and adolescent culture and at least one general contributing factor to the identified issue and explain how this may or may not impact the family dynamics.
Describe one intervention you might use for the identified client that would address the presenting problem and any related psychosocial factors.
Justify your intervention with evidence-based research to support the use of the interventions you have identified.
Briefly describe one preventative technique that you might use to reduce the likelihood of further crisis or the perpetuation of the current crisis.

Section Two:

Reflect on your journal entries throughout the course and consider what you may have learned about yourself as a future clinician working with children, adolescents, and families. Explain any areas of strength you have identified by completing this course that will assist you in working with children, adolescents, and families.

Explain any areas of strength you identified as you worked on this course that will assist you in working with children, adolescents, and families.
Explain any areas of knowledge you might want to further develop to become more effective as a clinician working with children, adolescents, and families.
Explain any insights you had or conclusions you drew as you worked on this course regarding your interest in becoming a clinician that works with children and adolescents.

Working With Children and Adolescents: The Case of Chase

Chase is a 12-year-old male who was brought in for services by his adoptive mother. He

is very small in stature, appearing to be only 8 years old. He also acts younger than his 12 years,

carrying around toy cars in his pockets, which he proudly displays and talks about in detail.

Chase was adopted at age 3 ½ from an orphanage in Russia. The adoptive parents are

upper middle class and have three biological children (ages 9, 7, and 5). Chase is reported to

often get upset with his siblings and hit or kick them. His mother stated that Chase has always

had issues with jealousy, and when her other children were younger, she had to closely monitor

him when he was around them. She reported several occasions when she found Chase attempting

to suffocate each of his younger siblings when they were babies.

The mother stated that Chase came to the United States without knowing any English.

She knows very little about his family of origin other than that he lived with his biological

parents until age 2 and then lived in the orphanage until he was adopted. She reported that the

plane ride from Russia was horrible and that Chase cried the entire flight and refused to sleep for

the first 2 days they had him.

The mother reported that Chase often hides food in his room and gorges himself when he

eats. She does not understand this behavior because he always has enough food, and she never

restricts his eating. In fact, because of his small size and weight, she often encourages him to eat

more. She also reported that Chase hates any type of transition and will get upset and have

temper tantrums if she does not prepare him for any changes in plans. He is reported to kick and

hit both parents, and they have had to restrain him at times to stop him from hurting himself and

others. The parents have never sought help before, but recently the school has been complaining

of his inability to focus and increasing disruptive behaviors. His teachers report that he -struggles

with school, has no friends, and often has “meltdowns” when he does not get his way. Prior to

our meeting, Chase had never had any testing for special education nor had he ever received any

counseling services.

During intake, I met briefly with Chase alone. He appeared anxious, had pressured

speech and facial tics, and was unable to keep his legs still. He chose to play a board game

during our time in the session and talked in detail about World War II and each of the boats in

the game. When asked how he knew all about warships, he stated that he often watched

television documentaries on the subject.

Plan:

Initially Chase’s parents were unsure what to do about their son’s behaviors. His mother

was the primary caretaker and his father thought she should handle any therapy or problems

related to school. His mother reported that she was “at the end of her rope” and was ready to give

her son up to foster care. She shared her frustration with her husband who “just did not

understand how hard it was.” It was concerning that Chase had never received any services prior

to our meeting and that the school had not properly referred him for testing to address his

behaviors and his academic struggles.

Both parents were asked to come in for sessions together to work as a united front in

addressing Chase’s behaviors and to be supportive of each other. The parents were taught

behavior modification, and they were successful in establishing a reward system that motivated

Chase to follow the rules in the home. In addition, the parents were provided with

psychoeducation regarding autism spectrum disorders, including how to parent a child with these

symptoms and how to advocate for Chase in the school system. The school complied with the

parents’ request for testing, and Chase was found to meet criteria for special education, and an

individual education plan (IEP) was established. In addition, a referral was made to psychiatry,

and medication was prescribed to help Chase with his outbursts, his tics, and with focus while at

school. Lastly, Chase was offered a socialization group with other children on the autism

spectrum, and he developed better skills in making friends and eye contact and self-soothing and

calming himself to avoid tantrums.

Reflection Questions

The social worker in this case answered these additional questions as follows.

1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation? Chase obviously had major developmental issues and issues related to socialization. Both parents were unaware of their rights and how to advocate for their son. In addition, the father was very traditional and thought that his wife was responsible for taking care of the children and that he did not need to be involved in parenting. It was necessary to get the father involved and for both parents to act as a unit. In addition, neither parent had demanded help for their son within the school system and they needed to be educated about their son’s educational rights and how to get his needs met. 2. Which theory or theories did you use to guide your practice? Theories used in working with Chase included structural family therapy, behavior modification, parenting, case management, and psychoeducation. The use of these interventions was very successful in getting Chase diagnosed and receiving needed services in the educational system. 3. What were the identified strengths of the client(s)? Chase was very bright and had a very loving family and two parents who were motivated to make parenting changes to keep Chase in their home. 4. What were the identified challenges faced by the client(s)? The most serious challenge for Chase was that he went undiagnosed for autism spectrum disorder (ASD) until he was seen by me at age 12. Early intervention may have been useful to help mediate his social challenges as well as his educational challenges.

5. What were the agreed-upon goals to be met to address the concern? Identified goals included the reduction of tantrums, an increased response to parents’ requests within three prompts, and an increase in age-appropriate socialization. 6. Did you have to address any issues around cultural competence? Did you have to learn about this population/group prior to beginning your work with this client system? If so, what type of research did you do to prepare? Chase was adopted from Russia, so research was done to understand challenges for children who were adopted from an orphanage as well as what type of support this family may receive from outside agencies to maintain placement. In addition, research was done to determine what option they had for relinquishment if the parents decided they could not continue to raise Chase. 7. What local, state, or federal policies could (or did) affect this case? Chase had an international adoption but it was filed within a specific state, which allowed him and his family to receive services so he could remain with his adopted family. In addition, state laws related to education affected Chase and aided his parents in requesting testing and special education services. Lastly, state laws related to child abandonment could have affected this family if they chose to relinquish custody to the Department of Family and Children Services (DFCS). 8. How would you advocate for social change to positively affect this case? Advocacy within the school system for early identification and testing of children like Chase would be helpful. 9. Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed? There was a possibility of legal/ethical issues related to the family’s frustration with Chase. If his parents had resorted to physical abuse, a CPS report would need to be filed. In addition, with a possible relinquishment of Chase, DFCS could decide to look at the children still in the home (Chase’s adopted siblings) and consider removing them as well.

Adapted from:

Working with children and adolescents: The case of Chase. (2014). In Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). Social work case studies: Concentration year (pp. 10–12, 97–99). Baltimore, MD: Laureate Publishing. [Vital Source e-reader]