PRAC 6650 Walden University Comprehensive Client Family Assessment
Practicum – Assessing Client Families
Walden University
PRAC 6650: Psychotherapy with Groups and Families
July 5, 2020
Part 1: Comprehensive Client Family Assessment
Clients comprehensive assessment is a valuable treatment process necessary for identifying a client’s problems, strengths, and weakness (Center for substance abuse treatment (US), 2013). As a psychiatric mental health nurse practitioner, it is important to understanding client’s problems, strengths, and weaknesses to determine the right interventions and duration of treatment for the client. The purpose of this assignment is to select a client family and develop a comprehensive client assessment.
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Demographic information: Client is a 16 years old CJ from multicultural family. The mother is African American married to Nigerian.
Presenting problem “our 16-year-old CJ had become very defiant and disrespectful and recently ran away from their home to live with his friend.”
History or present illness: CJ who was a respectful little boy began exhibiting defiant behavior about 6 months ago, not doing his schoolwork, constantly playing video games, smokes marijuana, and had become very disrespectful. Since then, CJ and his parents had been into conflict because CJ had been lying about everything especially with completing his schoolwork. The parents became concern of his poor school performance and imposed stricter rules thinking that it may help CJ use of marijuana, limit the time he spends on playing video game and get him to focus on his schoolwork. CJ never disclosed what he was planning to do to his parents. About a week ago, CJ decided to leave the house and went to stay with one of his friends without notifying his parents. CJ reported he started experimenting with drugs about seven months ago when he started hanging out with his friends. CJ reported irritability, anger, sleep difficulty and restlessness if he does not use marijuana. Also reported feeling empty and lonely. Says this symptom will ease once he gets it and added that it helps him deal with his frustration of having to deal with his parents. CJ’s mother 41 years old SJ who was neglected and grew in foster care, then later engaged in an abusive relationship, and forced to use drugs by her ex-husband became too fearful of CJs life. CJs Dad, 48-year-old GJ on the other hand is from a very rigid controlling family where there is little freedom of self-expression especially of feelings by children. His father was respectful to his parents as a child and pride in education. He finds it difficult to comprehend his son’s drug use and the disrespectful behavior displayed by CJ’s towards her parents and his poor performance in school. CJ was referred for therapy by the school social worker after her recent meeting with CJ intended to address CJ’s school problems where CJ revealed that he smokes marijuana and he is addicted to video games. The couples are worried that CJ might associate with bad group of peers and continue to use drug use and get into trouble.
Past psychiatric history: CJ has no prior psychiatric history.
Medical history: CJ none
Substance use history. CJ: alcohol use, marijuana.
Developmental history: Normal developmental milestone.
Family psychiatric history.
CJ’s mother: Has history of drug abuse and PTSD. Father has no psychiatric history.
Maternal grandmother: history of anxiety
Maternal grand father has history of alcohol use disorder.
CJ’s Father: None
Paternal grandfather: PTSD (Veteran)
Paternal grandmother: None
Psychosocial history: Currently in 10th grade. Currently unemployed.
History of abuse and/or trauma: CJ none
Medications: Currently on no medication
Allergies: No known medication, foods or environmental allergies.
Review of systems
HEENT
Head. Denied headache
Eye: Denied eye problem. No itching, redness, drainage or visual disturbance, blurry vision.
Ear: Denied any ear problem, difficulty with hearing, pain, ringing in the ear, or itching. No redness or swelling noted.
Neck. No distended neck veins or swollen lymph nodes. Denied neck pain or stiffness.
Throat. Denied sore throat or itching.
Respiratory: No respiratory issues reported. Denied coughing, shortness of breath or pain on breathing. Lung sounds are clear with no abnormal breath sounds noted.
Gastrointestinal: Denied stomach problem including pain, diarrhea, constipation, or bloating. Abdomen is flat with normoactive bowel sounds present on all four quadrants.
Urinary: Denied difficulty urination, or pain on urination.
Musculoskeletal: No history of bone or muscle problem. Denied leg pain, muscle pain or stiffness.
Hematological: Denied any history of blood or clotting disorders.
Endocrine: Denied endocrine problem including diabetes or thyroid disease.
Neurology: Denied memory problems, headaches, history of seizures, syncope, or stroke. No evidence of confusion or disorientation
Integumentary: Denied history of skin problem. No wounds, rash, redness, or skin discoloration noted.
Cardiovascular. No history of heart problem reported. Pulse is normal, no swelling on the leg with adequate circulation. Denied chest pain, or tightness.
Physical assessment
General Appearance: Alert and oriented X3.Presents with a sad mood and a guarded affect.
Vital Signs: B/P 110/68, R 18, P, 78, T. 98.4
HEENT: Head: Eyes: Pupils are round equal and reactive to light and accommodation, extraocular motions full, gross visual conjunctiva and sclerae clear.
Nose: Septum is midline with no stuffy nose, discharge, nasal congestion, or runny nose.
Mouth: No mouth issues, oral mucosa moist, no cavities or missing tooth
Neck: No jugular vein distention, thyroid is not palpable with no mass or swelling.
Lymph nodes: No swollen lymph nodes.
Chest: Chest is symmetric. No chest congestion noted
Heart: No heart murmurs, normal heart rhythm, S1 S2 present with no S3 or S4 noted.
Lungs: Lung sounds are clear, with no wheezing crackles, rhonchi or any abnormal breath sounds noted.
Abdomen: Abdomen is soft, and Non-distended, bruit, pain, mass, or tenderness on palpation with normoactive bowel sounds present on all four quadrants
Mental status exam. Client is alert and oriented X3. No signs of confusion delusions or hallucination noted. Denied suicide /homicide ideations. Reported stress from school and at home from the strict rules set by his parents
Differential diagnosis:
Cannabis use disorder: Cannabis use disorderisthe use of cannabis in a manner that leads to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period (American Psychiatric Association., 2013). This client presenting issues and symptoms such as reports of marijuana use for up to seven months, giving up schoolwork, craving for marijuana may leads one to suggest cannabis use disorder. According to the DSM-5, to be diagnosed with cannabis use disorder, the individual must experience at least two of the following 12 symptoms; craving, recurrent use of cannabis resulting in a failure to fulfill major role obligations at work, school, or home, withdrawal, tolerance. lack of control, and negative effects on personal and professional responsibilities, giving up or reduce important social, occupational, or recreational activities for cannabis use, spending time in activities necessary to obtain cannabis, use it or recover from its effects (American Psychiatric Association., 2013). At least two to three of these symptoms are evidenced in this client. Therefore, it is fair to say that this client meets the criteria for diagnosis of mild cannabis use disorder.
Substance/medication-induced depressive disorder: This is depressive disorder that is related to substance use or withdrawal from the substance. It is characterized by a persistent disturbance in mood or depressed mood with diminished interest or pleasure in all, or most activities ((American Psychiatric Association., 2013). In CJ’s case for example, he had used marijuana and the related symptoms that would cause one to suggest depressive disorder are irritability, feeling of loneliness and lack of interest in accomplishing important social activities like his schoolwork,
Case Formulation
CJ is a 16-year-old male with no prior diagnosis of mental illness. He presents with symptoms that align with the criteria for mild substance use disorder. No psychosis or withdrawal symptoms noted. Six months history of conflict with parents, especially his father. CJ reports that family rules are too strict and stressful and thinks his parents are not supportive. For example, CJ thinks that by withholding financial and emotional support, and not allowing him TV time is more distressing to him and pushes him to go to his peers. His current issue of running away from home caused his father to be angrier at him. CJ had managed to stay out of delinquent behavior. However, he had continued to use marijuana which had affected his ability to maintain a good rapport with his parents. Issue of concern is that he continues to underperform in school and smoke marijuana which had caused him to be more irritable, anxious, sleep disturbane and depress mood. In this case, CJ will require therapy for his behavior and help build his relationship with his parents. He will also need medication to manage symptoms.
Treatment Plan
Brief strategic family therapy (BSFT): I choose brief strategic approach because BSFT model focus on addressing behavior problems for adolescents, such as drug and alcohol use. According to Horigian, V. E., Anderson, A. R., & Szapocznik, J. (2016). According to Nichols, M., & Davis, S. D. (2020), BSFT is an integrative model that combines structural and strategic family therapy techniques to address family interactions associated with adolescent behavior problem. Brief strategic family therapy is a short-term program typically implemented in 12–16 sessions, delivered once a week for 1–1½ hours per session for over four months (Horigian, V. E., Anderson, A. R., & Szapocznik, J. (2016). It is designed to treat issues of family functioning associated with adolescent drug use and behavior problems such as poor performance in school, oppositional defiance, and delinquency (Szapocznik, J., Zarate, M., Duff, J., & Muir, J., 2013). It is helpful in promoting engagement, identifying maladaptive interactions, and address negative beliefs and family interactions. It thus aims at changing family patterns of interactions by focusing on strengthening the adaptive family interaction that might affects the child’s behavior. For this family for instance, the maladaptive patterns of family interactions that may be targeted are, the father being too strict with CJ that could unconsciously influence CJ alliance with his peers and engaging in drug use. Client would also need to see psychiatrist for evaluation and treatment for depressive symptoms. And sleep disturbance.
Summary
Children behavior problems may sometimes result from parental control that may seem too stressful for them to bear. Treatment for such behavior problems will thus require a thorough assessment that may help reveal key issues and some maladaptive functioning in the family that may be related to a child’s behavior. Regardless of the issues, addressing behavior issues in children should aim at using treatment approaches that involve the family. Therefore, strategic family therapy my help address CJ’s behavior problems and also address family interactions associated with his behavior problems. PRAC 6650 Walden University Comprehensive Client Family Assessment
Part 2: Family Genogram
KEY
Female
Male death
Male alive
Female death
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Center for substance abuse treatment (US), 2013. Addressing the specific behavioral health needs of men. Rockville (MD): Substance abuse and mental health services Administration (US). Treatment improvement protocol (TIP) Series, No. 56.) 2, screening and assessment. available from: https://www.ncbi.nlm.nih.gov/books/NBK144289/
Horigian, V. E., Anderson, A. R., & Szapocznik, J. (2016). Taking Brief Strategic Family Therapy from Bench to Trench: Evidence Generation Across Translational Phases. Family Process, 55(3), 529–542. https://doi-org.ezp.waldenulibrary.org/10.1111/ famp.12233
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.
Szapocznik, J., Zarate, M., Duff, J., & Muir, J. (2013). Brief strategic family therapy: engaging drug using/problem behavior adolescents and their families in treatment. Social work in public health, 28(3-4), 206–223. https://doi.org/10.1080/19371918.2013.774666