Please keep the following tips in mind, as you complete your case studies this semester. 1.Using the Gray conceptualization helps to construct a competency based assessment, which is different than the diagnosis. You don’t need to write out these factors using a Venn Diagram (as shown in the text) or in paragraph form. A listing of factors under each heading is easiest to do and to use. 2.Determining DSM diagnoses is a skill; and skills need practice, practice and more practice. We will review many case studies in this course to get that practice. It is essential that you use the symptoms to support the diagnosis you select. You should be able to make your “clinical reasoning” clear as to why you have selected the diagnosis you have. 3.Always use both the number code and the diagnostic label from DSM 5. 4.Try your best and learn from each case study in the course. 5.Ask a question if you have one! Sally Sally has been referred to you for an assessment by the school guidance counselor. Sally is about to turn 18 years old and is a junior in high school. Over the course of the last 8 months several of her teachers have complained of her negative demeanor and her quick reaction of being annoyed by any request. Her teachers want her to be successful, but Sally rejects any of their overtures for help or assistance in the classroom. There is growing concern that Sally may not be able to graduate. She has already failed a grade in high school (9th grade) and there is the possibility that she may fail this year as well if she doesn’t bring up her grades. When the guidance counselor approached her to discuss her status, Sally erupted in anger accusing the guidance counselor of always being negative and never having confidence that Sally can succeed. Recently, Sally had a verbal altercation with her English teacher during class. The teacher had returned the midterm and Sally had failed the test. Sally became irate, accusing the teacher of intentionally making the test so difficult that students could not pass it. She tore up her test paper, and stormed out of the room. Sally had a similar argument with the teacher 3 months ago. Sally maintained that her English teacher is “stupid” and that she asks them to read “ridiculous” books. She stood up in class and told the English teacher her choice of books was “moronic” and refused to read an assigned book. Sally often slept during class when it was discussed. If Sally does not pass English she will likely not pass this year. Sally arrives to the appointment with you dressed neatly in jeans and a t-shirt. You notice her full sleeve tattoo and multiple piercings in her ears. She says hello, but avoids your gaze. She is accompanied by her father, Eli. Eli relates that in addition to the school concerns, he has issues with Sally at home. “She thinks she knows best about everything! You can’t tell her anything!” Eli states that he and his wife, Sally’s step-mother, have repeatedly tried to reason with her. But she continues to question their parenting and refuses to comply with the family rules. Sally rarely meets curfew and at times doesn’t even explain where she has been. Often, she is out until 2 or 3am even though she is expected home at 10pm on school nights. He is aware that Sally has been meeting older men online. And he fears for her safety. He explains that no matter what he asks Sally to do, she blows up, stomps out of the room, and there is no further discussion. Eli also notes that on three occasions now, money has come up missing from his wife’s purse. They have asked Sally directly if she took the money. Sally chimes in, “It’s a total of $30 bucks – she probably spent it and doesn’t even know it”. Recently, Eli gave Sally a ride to a friend’s party. When she got out of the car, she slammed the car door hard and yelled back over her shoulder “tonight I’m going to try pot!” He believes that she did this to intentionally upset him as he fears that she is using drugs. Sally giggles in session and assures you that she is not using any drugs. “I just know that it freaks him out.” Sally has 3 younger half siblings from the marriage of Eli and his wife. “She’s a role model for her younger siblings, this has got to stop!” Sally’s father tells you that Sally historically was a “really good kid, kind and helpful around the house.” She got good grades until she started high school. She was a cheer leader in elementary school and her coach thought she had great potential. Her behavior has changed in the last year and he doesn’t understand why. He notes that the problem behaviors seem to be escalating. Every week he is getting a call from the school or his wife about something Sally has done. Her step mother has stopped interacting with Sally, hoping that if her father initiates the interaction, Sally will be more receptive. But this has not worked. As her father relates this to you, Sally laughs. “Yeah right, I’m going to listen to you more if she stops talking to me!” You ask Sally to share her story with you. Sally becomes agitated; she glares at her father and demands that he leave the room. “You don’t have to tell me, I’ll go!” And he abruptly leaves the session. Sally smiles, “it’s so easy to piss him off”. She shares with you that there is no point in her being here. No matter what she does, the English teacher is not going to pass her. “She will never give me a break.” And she has no intention of getting along with her father. “He and his wife don’t care about me ~ they just want someone to agree with their rules.” She laments that the only person who cares about her is her grandmother. She says what she really needs is your help with something else. Since her parent’s divorce when Sally was 5, she has had minimal contact with her biological mother. But Sally ran in to her mother 18 months ago at the opening of the new casino downtown. Sally had gone to the casino to meet a man she had met online. Sally was thrilled to see her mother and they have been in contact ever since. Sally has been frequenting the casino in order to see her mother over the course of the last year. She has a fake ID, and accesses the casino regularly now. Sally enjoys that she looks older than her stated age and that she is fooling the security personnel. She also enjoys the attention she gets from the older men at the casino. Sally started playing slots as a way to pass the time until her mother had a break from her shift. “It’s a great stress reliever – after that stupid English teacher flunked me, I went straight to the casino and dropped some coins!” She lowers her head and tells you that she didn’t win that day. “But I’m sure that I will make it up soon!” Sally has been asking her friends if she can borrow money in order to continue trying to win back money. She assures you that once she wins again, she will pay them back. “This is just a bad streak, it will change soon. I may be in the hole, but that will turn around any day now.” Sally asks you to please not share this with her father. “He wouldn’t want me to be talking with my mother.” When Sally was 5 her mother took off with another man. Her parents eventually divorced, and Sally was raised by her father and his mother. Sally remains very close to her grandmother. She’s the only one who sees the good in me. “My mom’s different now – she wants to get to know me and be a part of my life.” Sally and her mother have talked about the past, and Sally has forgiven her mother for leaving. Sally tells you that her father and step mother “have everything” and that she wants the same for her mother. Sally hopes that if she can just win, she can move out and go to live with her mother. Sally explains to you that she doesn’t have time for English class, or to read stupid books, when she needs to be trying to move out. Her mother is working double shifts and is very tired. Her mother does not know that Sally is playing the slot machines, and Sally knows that she wouldn’t approve. “But she’ll be proud of me when I tell her I have enough money for my own place.” “So I really need your help, can you loan me $500? I promise I will pay you back soon”.
Please select one of the two case studies posted on the Moodle site. Carefully read the case and respond to the following questions in a narrative format. Be sure to respond completely to all questions. This assignment should be between 5 and 10 pages, double spaced, in length and referenced according to APA style. If you refer to works other than the DSM (for example, when talking about a screening tool), please cite your source appropriately. You are expected to work independently on this assignment.
Please provide a response to each of the following prompts. Note that some prompts include multiple questions.
1. Draw the competency-based assessment model diagram as shown on page 15 of Gray & Zide. Fill in each of the biological/psychological/social circles appropriately for this client. Include your assessment of competence (strengths and resources) as shown on the diagram. (You can use a table rather than the overlapping circles shown in the diagram.) Describe how the strengths and resources of this client can be used in assessing this client (rather than in providing treatment).
2. List the diagnosis or diagnoses for the client using DSM-5 diagnostic categories. Use DSM-5 terms and code numbers. Include and describe all appropriate specifiers.
A. Provide your reasoning for each diagnosis. Use critical thinking skills to support your reasoning. Describe your diagnostic process. Specifically address the DSM criteria that were used in making your diagnosis.
B. List the diagnoses you considered but eliminated and describe your evidence for eliminating each one.
3. What screening tool(s) would you use in your assessment? Explore screening instruments used by practitioners that might be helpful in assessing this particular client. Please be specific and provide your rationale.
4. What other questions would you ask? What other areas would you explore with the client? What else are you curious about to formulate a complete assessment?
5. Create a problem list for this client and include problems not captured by the mental health diagnosis or diagnoses you have assigned to the client.
6. Please reflect upon your personal reaction to this client. What are the potential barriers to your engagement with this client? What do you think might ease the process of engagement for you with this client?
7. How competent do you feel in your assessment with this client? Please indicate your response by selecting a number on the scale below.
0 1 2 3 4 5_______
Incompetent Competent Very Competent
A. What do you need to continue to strengthen your diagnostic skills in this area?