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CaseStudyTreatmentPlan.html

Case Study Treatment Plan

Introduction

For your course project, you will develop a treatment plan for one case study subject that you select from two possible candidates. These potential clients are ethnically diverse and are struggling with psychological disorders, which may require medication.

During the course of this project you will:

Evaluate client information.
Review possible assessment techniques.
Offer a diagnostic impression.
Review various behavioral and pharmacological treatments.
Discuss the legal and ethical ramifications of the disorder and proposed treatments.
Review the impact of diversity issues on various disorders and their treatments.
Develop a suggested treatment plan for the client.

You will select one of the case studies presented on the next page of this presentation as your client for this treatment plan project. Then you will use the Case Study Treatment Plan Template, provided in the Resources to complete your assignments for this project. Each section of the template includes a description of the type of information you will need to include. You should type your paper directly into this template, save it as a Word document with your name, and then submit it to the assignment area.

Stella's Case Study

Stella is a 38 year old biracial (African American and Native American) woman who has just been assigned to you as a client. You are currently working as a counselor for your county community mental health agency. You received the following information about her as background and history.

Stella is the only child of a Caucasian couple who are now deceased. She was adopted as an infant in a closed adoption, so that none of her birth parents' records are available. The only informal information that Stella remembers her parents telling her is that her mother was 16 years old at the time of Stella's birth and had been raped while at a high school football game.

Stella currently lives in a small city of 150,000 people where she is employed as a book-keeper for the local meat packing plant. She has worked there for 3 years. Her educational background includes an associate's degree in accounting and continuing education in tax preparation. Before working for this plant, she was employed as a tax preparer for a national company. She enjoys her work, saying that numbers are easier to get along with than people.

She has been married to her husband (Doug) for 18 years and has a 16 year old son (Tyrone), who is currently a junior in high school. Her son plays baseball on the school team and is a solid B student. Her husband is a long distance truck driver. He is often away from home for two weeks at a time. He is then at home for 3 to 4 days before he leaves on another trip. Stella reports that she stays at home and feels "blue" when her husband is on the road. Although there have been some problems in the marriage due to Stella's mental health concerns, the couple seems committed to each other and to staying in the marriage.

Stella reported that her problems began when she was in late adolescence. She started sleeping and eating excessively. She missed several days of school because she couldn't get out of bed and gained 15 pounds. Because of the weight gain she experienced, Stella obtained some methamphetamines from a friend of hers in school so she could lose the weight quickly. She was able to do so, but found that when she stopped taking the pills she felt even lower than before. She asked her friend for more pills, but her friend refused to provide them. Stella's mood continued to decline; she believed that she would never be successful at anything and stopped talking to her friends. She stated that she felt "blue" during this time, a word she frequently uses to describe her mood. This episode lasted about one month until school ended for the summer. She felt better because she had a summer job as a stocker at the local grocery store where her boyfriend was also working. The following year she once again became "blue" and this time she took 25 aspirins in a suicide attempt. She told her mother, who took her to the emergency room to have her stomach pumped. Stella did see a counselor briefly, but when she began to feel better, she stopped her counseling. She was not prescribed any medication at this time.

Stella was able to successfully graduate from high school and earn an associate's degree at the local community college. Her first full-time job was back at the grocery store, where she worked in the office preparing bank deposits and reconciling bank statements. She reported that she enjoyed this job "a lot". During this time she also married her high school boyfriend. However, after 3 years, she again experienced depression, this time more severely than ever before. "It felt like my 'blue' had taken over my whole world and I couldn't see anything else. I just wanted to die. That had to be better than how I was feeling." Her suicide attempt this time was more serious; she cut her wrist in the bathroom at work. A co-worker found her and called 911. She spent four days in the hospital and was referred to a psychiatrist for follow-up care. The psychiatrist prescribed an SSRI for the depression and referred Stella to her previous counselor.

Quickly, Stella began to feel much happier and elated. She began going out when her husband was out of town for work and soon began bringing other men home for sex. During the parties with the other men, she would drink excessively and smoke marijuana. She reported that these substances "took the edge off" of her excess energy. She also spent money on new clothes, until she had maxed out her credit cards and borrowed money from her parents. Her performance at work became erratic and her employer began to suspect that money was missing. He was unable to prove the missing money, but became so uncomfortable with Stella's change in behavior and her deteriorating performance that he let her go. When her husband returned home, he took her to her psychiatrist, who made adjustments to her medication regime, adding a mood stabilizer. Stella was not fully compliant with taking her medications and continued to smoke marijuana from time to time.

Since that time, Stella has had a series of jobs, most of which she was able to keep for several months and, on one occasion, for a year, until her mood changed. She feels very fortunate to have kept her current job for so long. She attributes this to a "kind boss," who has kept her employed through her highs and lows. Since this is a family company with a high level of commitment to their employees, and since she does not have access to any money, she is able to stay employed. Her boss has asked her to continue with treatment on a consistent basis. She had been in and out of counseling and on and off her medications before she got this job. When she stopped her medication, she would once again smoke marijuana in the evenings. Since being employed here, she has managed to stay on her medications. She had not been back in the hospital until this latest admission. Recently, though, her counselor closed his practice and moved to another city. Gradually, her behavior and mood became more and more unstable over time.

This most recent hospitalization came after she was found at her work desk, sobbing uncontrollably. She reported to her boss that she was "blue." This work site placed her on FMLA and asked her to get help for this current crisis. She admitted herself to the hospital, where she saw a new psychiatrist, who changed her medications. Stella is hopeful that she will be able to stay on the new medications.

Her husband and son are very supportive of her getting care and have met with both the new psychiatrist and your intake case worker. They want to know what they can do to help Stella re-stabilize, hopefully for good this time. They reported that her sister-in-law has volunteered to go walking with her each evening and that her son is willing to give Stella her medication each day. Her husband asked his employer for a change of route and was able to secure one that will take him away from home no more than 4 days at a time.

Upon discharge, Stella was referred to the community mental health agency where you are a counselor. After reviewing her hospital records and the intake report, you presented the case in a staffing. After listening to the other professionals' opinions, you are ready to develop a comprehensive treatment plan that will address, among other issues, medication and treatment compliance, and stabilization.

Oscar's Case Study

Oscar is a 19-year-old Hispanic male who is the oldest of 5 children. His family has been farming the same land for 4 generations. Currently they grow vegetables for the regional grocery chain's produce departments. They live in a rural area of the county. Three generations live in two separate houses on their land. They are fiercely independent and have little to do with people in town, although the family itself is extremely close knit.

Oscar is currently a freshman at the same college his father attended, majoring in agriculture. When he came home for spring break, his parents noticed significant changes in his appearance. He had lost weight, looked haggard, wasn't sleeping and seemed irritable and argumentative. He told his parents that he did not want to return to college after the break. He went on to say that his roommate had placed cameras in the room so he could record everything Oscar did while the roommate was absent. His grades were poor and he expressed that he believed his instructors were prejudiced against him. This poor performance was in stark contrast to his performance in high school, where he was in the top 10% of his class. Within days of coming home he had stopped showering and began wearing multiple layers of clothes (3 pairs of jeans and 4 t-shirts). He became essentially non-communicative, responding to questions with one-word answers and not initiating conversation. Oscar seemed unhappy or irritable whenever he encountered a member of his family and began spending all his time in his room. He even refused to talk with his youngest brother, with whom he had always been close. He did not take meals with his family, a long-standing tradition in his family, and left his room only in the middle of the night. He could then be heard opening drawers in the kitchen, going into his siblings' rooms and leaving the house for long periods of time.

The family (parents and grandparents) became very disturbed and consulted their priest. The priest recommended that the parents take Oscar to see a fellow parishioner who is also a counselor. This counselor was also disturbed with Oscar's presentation and recommended hospitalization. The family was very reluctant, but eventually agreed. By the time they got to the hospital, Oscar was essentially non-communicative, only nodding or shaking his head in response to direct questions.

The parents provided history that indicated Oscar had been a good student in high school and had participated in the school's FFA club. He has always wanted to carry on the family tradition of farming. He did not have many friends, but the family attributed that to their living in the country.

The psychiatrist diagnosed Oscar with major depressive disorder, single episode, severe with psychotic features and prescribed anti-depressants. He was released three weeks later, with some improvement. One week later he was readmitted, with the same presentation he had at the previous admission. This time, though, his father reported that he had found a cache of knives in the barn, some from the house, some from the grandparent's house and some from the barn itself. When he asked Oscar about them, Oscar responded that he needed them to protect himself from attacks. When his father asked from whom, Oscar responded that he had seen one of his college professors in the field of broccoli. That same day, Oscar's mother found notes stuffed between Oscar's mattress and box springs in Oscar's handwriting. The content of them was Oscar arguing with someone about killing his younger siblings. One side did not want to do it and begged to not have to; the other side ordered the killings, saying that was the only way to keep them safe. In light of these two events, both parents were afraid for Oscar to remain at the house. Oscar swore that he would never hurt any of his family and said that was why he had been keeping away from them. His parents could not be sure that no harm would come and were unable to watch Oscar day and night. Therefore, they readmitted him to the hospital.

During this admission, Oscar was more forthcoming with his treatment team. Once they had this additional information, the team realized that Oscar's initial diagnosis had been wrong. They began a re-assessment. Oscar acknowledged that the problems began about the time of the new semester. He was unable to complete his school work, as he was "consumed" with the need to follow instructions that were being given to him. These instructions actually began with a buzzing in his head, which quickly evolved into specific directions. When pressed, he acknowledged that he did not know who was giving him the directions, though he sometimes thought it might be Jesus. These instructions were for him to keep a log of every time he heard a door close on his hallway in the dorm. Oscar came to believe that doing this was the only way to keep his family safe from dark angels. Oscar tried to keep these voices quiet by smoking marijuana on a daily basis. While this helped in the short term, it also made it more difficult for him to complete any of his school work. By the time for spring break, the messages had begun to change. He was no longer able to keep his family safe by keeping a list; the voices told him he would have to kill them. Oscar knew that he did not want to kill his family. He could also not avoid going home for spring break. Therefore, he devised the plan to isolate himself.

Once the family recovered from their initial shock and as Oscar began to show some improvement with his new, anti-psychotic, medication, his parents and grandparents wanted to take him home to the farm. They believed that life on the farm, being outside and with hard, physical labor would cure Oscar. Finally, Oscar agreed to tell them what has been happening with him. At that point, the family agreed to residential treatment for Oscar. When asked if anyone else in the family has ever had symptoms like this, the grandfather acknowledged that he had a brother (Oscar's uncle) who had religious visions. This brother left the family and became a monk. Later the family heard that he had died under mysterious circumstances. One of the other monks at the monastery told Oscar's grandfather that his brother had died from engaging in a prolonged fast. The family is very lucky on two counts: 1) they have their medical insurance through the farmer's co-op and it includes coverage for residential treatment for up to a year, and 2) this hospital has a residential treatment unit for late adolescents and young adults. You are working as a counselor at the Residential Treatment facility where Oscar has been placed. He will be here for a minimum of 6 months and as long as one year. Professional staff at this facility includes 3 counselors, an addictions counselor, a social worker (currently on maternity leave), a psychologist, and 2 nurses on every shift. Oscar's psychiatrist is also on staff and will continue to follow his care.

The social worker usually coordinates clients' treatment plans; however she is currently away on maternity leave so you will be the lead therapist who is coordinating Oscar's treatment during the next 45 days. Once she returns, you will collaborate with her for developing Oscar's post-residential treatment and resources for him and his family.

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