Caseload Case Studies

Disruptive Behavior Disorders. Oppositional defiant disorder (ODD), conduct disorder (CD), and attention deficit hyperactivity disorder (ADHD) form a cluster of childhood disorders considered to be “disruptive behavior disorders” (American Psychiatric Association, 2004). Although most violent adolescents have more than one mental disorder and they may have internalizing disorders, for example depression or substance abuse, there appear to be increasingly higher rates of physical aggression found in these adolescents who experience disruptive behavior disorders than for those with other mental disorders. The fact that violent juvenile offenders are more likely to have these diagnoses is not surprising, because impulsive and/or aggressive behaviors are part of their diagnostic criteria. Additionally, there is relatively high co-morbidity with substance abuse disorders, which are also associated with juvenile violence (Moeller, 2001). Individuals with conduct disorder have the following features but this list is not inclusive for example they may have little empathy and little concern for the feelings, wishes, and wellbeing of others, respond with aggression, may be callous and lack appropriate feelings of guilt re remorse, self-esteem may be low despite a projected

Presenting Problem: She has a hx of multiple failed placements and relates being placed in the programs for her substance abuse, anger and aggression. She has 2 past suicide attempmts one from an attempted hanging and the other from attempting to jump off a building. She reported feeling homicidal 7-8 times against her stepfather. Rhonda reported physical and emotional abuse from maternal uncle and incidents of sexual assault btwn the ages of 6 and 12.

I presented Esteban’s case during case consultation because I noticed that I had countertransference when doing his intake. My expectation when presenting this case was to receive feedback that would help me to provide effective treatment to Esteban without my countertransference affecting his treatment. This section of the paper will talk about the feedback I received about my countertransference and how to support Esteban.

The victim was court ordered to be admitted at the Specialized Treatment Facility by Harrison County Youth Court on 04/27/16; he will be admitted for six months and the expected discharge date is 10/27/16. The reporter stated John was has been diagnosed with bipolar disorder, ADHD, marijuana abuse, mood disorder, severe mood swings, disruptive behavior, border line dyslectual disorder, basic personality disorder, mental incompetance; John is unable to function on his age level and has a very low IQ; John is unable to read, write, and count. Mr. Young stated John will never be able to live on his own and will always need assistance. During a session with John on 04/28/16, he disclosed that his father punched him in the face but that the details

Presenting Problem: Dejon has a diagnosis of ADHD- CT, Disruptive Mood Dysregulation Disorder, and R/o Learning Disorder. He has presented with being verbally and physically aggressive towards his siblings and mother, and he requires constant adult supervision. He is impulsive and he lacks the skills needed to be trusted in the community. De’jon’s poor judgment leads him to be put in situations where he is either harming others or setting himself up to be injured. He was involved in a shooting of a 7 year old child in the head with bb gun in Marcy 2016. He intentionally obtained the bb gun. He also threatened bodily harm to school staff and was involved with shoving a teacher this past school year. He has poor coping skills and he becomes explosive and dangerous to others when he is in frustrating situations.

Per report from mother pt have demonstrated erratic behaviors and unstable emotions since the change in living arrangments. Per report from mother the Pt have been demonstrated violent behaviors (e.g. kicking, hitting, spitting, throwing items) towards mother and (13) sister. Per report from mother pt have been demonstrating self injurious behaviors (hitting self in the head, pulling hair out). Per report from ther pt have been demonstrated property destruction in the home where she has thrown items and taken them apart. Per report from mother pt does not have any triggers for maldaptive behaviors or mood swings. Pt reports her anger

Javon was placed in therapeutic foster by order of the court on October 2, 2015. His previous guardian, Ms. Terrell had sought psychological testing for Javon on numerous occasions, but never felt she was able to access the community resources and after-care appropriate help for Javon’s diagnoses. She reports not being able to obtain SSI benefits for Javon that would allow for additional treatment and supervision in the community. There is no prior involvement with the Department of Social Services or Child Protective Services.

Presenting Problem: He has 2 Kempsville Acute visits, endorses anger and thoughts of suicides. Reported hx of Neurodevelopmental problems most recently as consistent with Autistic Spectrum Symptoms. He reported having intense anger toeards his parents but denies homicidal thoughts, acknowledges suicidal thinking. On May 27, 215 he pulled a knife on his mother, no injury occurred. Mother states he has been increasingly agitated. He has been posturing at his mother yeling clinching his fist at her as well as sneaking out and lying. Mother states he obtained the knife from his room and threatene her life. He states his mother swas chasing him around with a broom which is why he grabbed the kife. He states he is depressed all the time. He a Hx of suspensions for fighting while in school and he was the aggressor.

Pt is a 15 y/o African American male presented at NNBHC with a dx of PTSD, ODD, ADHD, Bipolar Disorder, and Depression, who have been demonstate emotional instability and aggressive episodes in the home. Pt discussed that he have been having difficulty controlling his anger when triggered for getting trouble. Pt stated that he god in troubled for hiding soiled clothes in his drawer, where his mother found them. Pt stated he became upset and demonstrated verbal aggression which includes threats and foul language. Pt states that he black outs and have mind/body experiences where he lose control over his actions. Pt states that during his anger outburst typically one of his parents have to tell him what he has done. Pt states he is easily trigger by being called “fat” or discussion of his bed wetting. Pt discussed he frequently have phobias in new places due to believing he may be sexually assaulted again which intensify his nighmares and nocturnal enuereis.

According to the CMSA (Case Management Society of America) and several others organizations that case management alone means that it is a collective system that helps the patient and their family needs through the communication, available resources of promoted quality, and cost-effective outcomes.

Anilda Rodriguez, adoptive mother/grand aunt, reported that her 14 year old, adoptive son Anthony Rodriguez, is disrespectful towards authority figures, failing all of his classes, multiple suspension from school and does not take ownership of his ungoverned behavior. According to Ms. Rodriguez she has been taking care of Anthony since he was 1 ½ year old. Ms. Rodriguez reported that Anthony is diagnose with ADHD and has an IEP. Ms. Rodriguez reported that the child has engaged in mental health services since the age of 5. Ms. Rodriguez reported that the child received appropriate mental health services and psychotropic medication (Focalin XR 25mg) prescribed by psychiatrist George Alvarado (718) 283-8215 (once a month) at Maimonides’s Mental

D.D. is a 50-year-old, African American male presenting with a number of anxiety and depressive symptoms. The client reports that he came to counseling for “extra support and someone to talk to.” D.D. has been struggling with mental health issues since he was young. Since the age of 15 he has been hospitalized on and off for “hearing voices.” In the early 1980’s he was diagnosed with schizophrenia and prescribed Risperdal to treat the symptoms. Since then, D.D. has been in a variety of mental health settings, including hospitals, day programs, and outpatient treatment. The client has an extensive alcohol and drug use history that he believes impacted his Schizophrenia. In the early 1980’s the client would use alcohol every day “to avoid the voices,” drinking “anything he could get his hands on.” He was also heavily involved with drugs at that time and regularly used marijuana, PCP, cocaine, and heroine. In 2000, the client was sentenced to eight years in jail for four bank robberies. While in jail, D.D. received mental health treatment and alcohol and drug treatment, which was greatly beneficial. When the client was released from jail in 2008, he was drug and alcohol free and was taken off of Risperdal.

Twelve months before attending the agency the client began to demonstrate increasing levels of anxiety. This anxiety commenced with significant difficulties being separated from his mother or father at home, to go to school, stay with family and play with friends. The parents said the client’s behaviours included clinging on to them and chasing after them as they were leaving the house or school. He would also check their location in the house to confirm that they were still there. On occasion his behaviour deteriorated into tantrums, although this only happened at home. The parents also expressed concern that the boy’s teacher noticed he was refusing to eat at school. The parents also reported their child was unable to get to sleep without their presence. He would awaken with nightmares at least three times a week saying he was frightened something bad was happening to them. The parents stated that it was becoming increasingly difficult for them to manage their son’s behaviour.

Acute external workloads of approximately 120-210 deliveries/wk lead to the lowest injury risk (4%) which affirms previous research that deduces 123-188 deliveries/wk produce the least number of injuries. The training stress balance did not provide significant difference in the week of measurement, however in subsequent weeks a negative external and internal training stress balance (acute >chronic) lead to a greater number of injuries (63% and 57% of all injuries respectively).

In reading the first article Coach Knight: The Will to Win, I found the article found Coach Knight to be very offensive and mean to his players. Coach Knight did not display good leadership skills. According to the article, Coach Knight’s drive and passion for excellence was not always received as well as his record of wins and losses Snook, Per low, Delacey, 2005).