The Final Project is a descriptive narrative divided in two sections. Section One requires you to analyze a case study of a family in crisis, to include a child, an adolescent, and a set of parents. Section Two is a self-reflection of your abilities to be an effective clinician who works with children, adolescents, and families.
This Final Project is a 6- to 8-page paper and will be due Day 3 of Week 11. Include the following sections in your Final Project:
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.
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.
Although the Final Project is not to be submitted until Day 3 of Week 11, you should become familiar with the project requirements and have them in mind as you proceed through the course. Many of the Discussions and Assignments relate to and can be of use to your Final Project.
The Final Project will be evaluated according to all four indicators in the Final Project Rubric located in the Course Information area. Be sure that the Final Project is written using APA format.
Information on scholarly writing may be found in the APA Publication Manual and at the Walden Writing Center website. Also, see the Walden University Policies and Information, in Guidelines and Policies, under “Policies on Academic Honesty.”
Final Project Case Study Working With Families: The Case of the Cooper Family The Cooper family consists of Susan (age 42), Matthew (age 41), Savannah (age 16), and Milton (age 9). Susan works in the computer division of a telephone company. Matthew is a graphic artist who runs a private business out of their home. There are a number of issues that precipitated a family crisis and led them to consult with you for counseling. Susan and Matthew are experiencing marital problems. Susan is a strong and achievement-oriented woman who works very long days and makes approximately four times the salary of Matthew. Although Matthew takes care of the family home and most of the children’s daily needs, he is chronically oversensitive and edgy about his place in the family hierarchy. Both Susan and Matthew are somewhat perfectionistic. This style has clearly affected Savannah. Savannah is a straight-A student who has never even been close to having even the most minor school-related behavioral problem. She loves to feel in control. Unfortunately, she has begun obsessing not only about her academic performance but also about calorie counting. She has begun compulsively exercising and weighing herself several times a day. Both Susan and Matthew have observed Savannah’s hyper-concern about her weight but are at a complete loss as to how to deal with this problem. Milton is the opposite of Savannah. He is slightly overweight, will eat consistently, and does not seem to understand the word “No.” Matthew gets calls about his misbehavior at school almost daily. The problems often are trivial, and Matthew has let the school know this, but Milton continues to get into trouble for slapping other students, not completing his homework, not paying attention, calling the teacher a sexist Nazi, and carving his initials into the bus seat. Susan and Matthew also struggle with Milton’s behavior at home: They cannot get him to stop playing violent video and computer games, and Milton is always into something, whether it is pestering the family dog or the next-door neighbors. The final incident prompting counseling occurred about a week ago. Savannah had a large school project due on a Friday and came home from band practice to find that Milton had destroyed her project. After a series of wailing screams, Savannah proceeded to the privacy of her bedroom and began cutting on her left arm with a pair of scissors. The cuts were small and not dangerous, but the incident made Susan and Matthew panic and become desperate to “make things right again” in their family.
Working With Families: The Case of Brady Brady is a 15-year-old, Caucasian male referred to me by his previous social worker for a second evaluation. Brady’s father, Steve, reports that his son is irritable, impulsive, and often in trouble at school; has difficulty concentrating on work (both at home and in school); and uses foul language. He also informed me that his wife, Diane, passed away 3 years ago, although he denies any relationship between Brady’s behavior and the death of his mother. Brady presented as immature and exhibited below-average intelligence and emotional functioning. He reported feelings of low self-esteem, fear of his father, and no desire to attend school. Steve presented as emotionally deregulated and also emotionally immature. He appeared very nervous and guarded in the sessions with Brady. He verbalized frustration with Brady and feeling overwhelmed trying to take care of his son’s needs. Brady attended four sessions with me, including both individual and family work. I also met with Steve alone to discuss the state of his own mental health and parenting support needs. In the initial evaluation session I suggested that Brady be tested for learning and emotional disabilities. I provided a referral to a psychiatrist, and I encouraged Steve to have Brady evaluated by the child study team at his school. Steve unequivocally told me he would not follow up with these referrals, telling me, “There is nothing wrong with him. He just doesn’t listen, and he is disrespectful.” After the initial session, I met individually with Brady and completed a genogram and asked him to discuss each member of his family. He described his father as angry and mean and reported feeling afraid of him. When I inquired what he was afraid of, Brady did not go into detail, simply saying, “getting in trouble.” In the next follow-up session with both Steve and Brady present, Steve immediately told me about an incident Brady had at school. Steve was clearly frustrated and angry and began to call Brady hurtful names. I asked Steve about his behavior and the words used toward Brady. Brady interjected and told his dad that being PRACTICE 31 called these names made him feel afraid of him and further caused him to feel badly about himself. Steve then began to discuss the effects of his wife’s death on him and Brady and verbalized feelings of hopelessness. I suggested that Steve follow up with my previous recommendations and, further, that he should strongly consider meeting with a social worker to address his own feelings of grief. Steve agreed to take the referral for the psychiatrist and said he would follow up with the school about an evaluation for Brady, but he denied that he needed treatment. In the third session, I met initially with Brady to complete his genogram, when he said, “I want to tell you what happens sometimes when I get in trouble.” Brady reported that there had been physical altercations between him and his father. I called Steve in and told him what Brady had discussed in the session. Brady confronted his father, telling him how he felt when they fight. He also told Steve that he had become “meaner” after “mommy died.” Steve admitted to physical altercations in the home and an increase in his irritability since the death of his wife. Steve and Brady then hugged. I told them it was my legal obligation to report the accusations of abuse to Child Protective Services (CPS), which would assist with services such as behavior modification and parenting skills. Steve asked to speak to me alone and became angry, accusing me of calling him a child abuser. I explained the role of CPS and that the intent of the call was to help put services into place. After our session, I called CPS and reported the incident. At our next session, after the report was made, Steve was again angry and asked me what his legal rights were as a parent. He then told me that he was seeking legal counsel to file a lawsuit against me. I explained my legal obligations as a clinical social worker and mandated reporter. Steve asked me very clearly, “Do you think I am abusing my son?” My answer was, “I cannot be the one to make that determination. I am obligated by law to report.” Steve sighed, rolled his eyes, and called me some names under his breath. Brady’s case was opened as a child welfare case rather than a child protective case (which would have required his removal SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR 32 from the home). CPS initiated behavior modification, parenting skills classes, and a school evaluation. Steve was ordered by the court to seek mental health counseling. One year after I closed this case, Brady called me to thank me, asking that I not let his father know that he called. Brady reported that they continued to be involved with child welfare and that he and his father had not had any physical altercations since the report. SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR 108 5. What were the agreed-upon goals to be met to address the concern? The goal was to find solutions to alleviate their frustrations and the discord in their relationship. 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? I was aware and sensitive to the fact that they were a gay couple. I was cognizant of the possible biased reactions they might have received from administrators at Jackson’s school and their surrounding community. I inquired into their interactions with the adoption agency and the school to get a sense of any negative interactions that might have impeded service delivery. I also suggested a support group for lesbian and gay couples who adopt. 7. How would you advocate for social change to positively affect this case? I would advocate for better education for foster and adoptive parents on the resources they may be eligible to receive. 8. How can evidence-based practice be integrated into this situation? Using weekly scaling questions would be one way in which evidence-based practice could be implemented. Working With Families: The Case of Brady 1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation? I used structural family therapy, particularly the use of a genogram. I addressed issues of grief and loss and child development. Finally, I used education to help them learn about services available and crisis intervention. 2. Which theory or theories did you use to guide your practice? I used structural family therapy. 3. What were the identified strengths of the client(s)? Brady’s bravery in disclosing the altercations between himself and his father showed great motivation and strength. APPENDIX 109 4. What were the identified challenges faced by the client(s)? Steve was resistant to his own mental health needs and the effect on his relationship with Brady. Brady was not receiving proper evaluation and intervention for his presentation of developmental delays/disabilities. Brady and Steve were clearly dealing with unresolved grief due to the death of Brady’s mother. 5. What were the agreed-upon goals to be met to address the concern? The goal was to obtain a second evaluation and then provide suggestions of services to improve Brady’s behavior in the home and at school. 6. What local, state, or federal policies could (or did) affect this situation? The child abuse reporting laws were relevant to this case. 7. How would you advocate for social change to positively affect this case? I would advocate for more education and support for children with developmental disabilities and their parents. It was clear that Brady had an intellectual disability that had not been previously acknowledged nor properly addressed. 8. Were there any legal/ethical issues present in the case? If so, what were they and how were they addressed? While the reporting laws and ethics for clinicians are very clear in a case like Brady’s, there is always the concern that a parent might file a lawsuit against the social worker for making the report. These are cases in which the clinician’s documentation of the sessions needs to be accurate and thorough to justify the CPS report. 9. Describe any additional personal reflections about this case. I am often asked by students, “Do you find it difficult to make calls to Child Protective Services and does it get any easier?” My answer to that question is no, I do not find it hard to make calls to CPS because those institutions are there to help. However, I do continue to find it hard to hear stories of abuse from children. That will never get easier. I have learned a great amount of humility in these cases. If a child (or adult) finds my office space SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR 110 safe enough and is able to disclose such complex issues as these to me, I feel honored. It is because a client trusts me enough to tell me these things that I feel responsible to do my job. Working With Families: The Case of Carol and Joseph 1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation? This case required extensive use of active and passive listening and patience to enable the client to become sufficiently comfortable with me and to arrive at a point where she could work on her issues. Initially she was very angry, hostile, resistant, and very much in denial. 2. Which theory or theories did you use to guide your practice? I work with people in their homes, which is their territory, not mine. I think it is very important to be aware of how I would feel if I were in their shoes. The person-in-environment perspective and Carl Rogers’ person-centered approach are crucial here. 3. What were the identified strengths of the client(s)? She was smart and had a good support system in her husband and mother, who were very supportive during her treatment. 4. What were the identified challenges faced by the client(s)? Carol was a severe alcoholic and had a drug problem to a lesser extent. She had psychological issues as well, including low selfesteem, depression, and anxiety. She also had transportation and legal problems as a result of losing her driver’s license after the DUI. 5. What were the agreed-upon goals to be met to address the concern? The primary goal was to protect her child by keeping Carol sober and finding the intervention method that would be most appropriate for her to do that. This took time due to the resistance to treatment. 6. How would you advocate for social change to positively affect this case? Treatment options and access to them need to be improved in rural areas. There were not many choices for this client.
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 Working With Children and Adolescents: The Case of Chase / Page 2 of 4 © 2016 Laureate Education, Inc. 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 Working With Children and Adolescents: The Case of Chase / Page 3 of 4 © 2016 Laureate Education, Inc. 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. Working With Children and Adolescents: The Case of Chase / Page 4 of 4 © 2016 Laureate Education, Inc. 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.
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