Client Demographics

Client is a 52 year-old female. Client is a married and has four grown children. She is a retired firefighter and currently a paramedic. Client has a BFA and presently is enrolled in graduate school to become a mental health counselor. Client appears to be physically healthy and states she has no emotional, psychological, physical or spiritual issues at this time.

Using the symptoms check list, the client recalls feeling the following daily: overly sad, uncontrollable crying, easily irritated, difficulty concentrating and making decisions, loss of interest in things she once

When I first met this client, I thought to myself, “He does not want to be here, just like everybody else. What else is new?” When I first looked at his file, I realized that he was not a new resident at Alaris Health. He had been there multiple times throughout the years. As I noticed this, I quickly made the assumption that this client had not been taking care of himself.

The clinician reported the mother having an Hx of depression had been depressed for a couple of years no suicidality some anxiety making decisions-trouble sleeping wake up and ruminate-pressure due to husband

The client has a history of nine overdoses and suicide attempts. The client consistently talks about dying and I need to take every instance seriously.

When Samantha arrived on the unit, the first impression was that the client was a rich, privileged spoiled child in a 40-year-old body. The client was admitted post an overdose and driving into oncoming traffic. She was involuntary committed by law enforcement when cut wrists were also noted. The client was arrogant and very mean towards staff and peers. In the early part of the assessment, the client continued to be blunted, angry, and uncooperative. When the client was asked about allowed collateral calls about discharge planning, the client burst into tears. Totally changed the client begged for the mother not to be contacted. The client stated there was not a good relationship and in fact the mother was mentally ill also. The

The client requested that he speak to someone because he feels there might be something going on. He states that he doesn’t like alcohol or drugs, believes his depression and anger is because he is stupid, his mom doesn’t like his friends and he doesn’t need to eat.

On 3/5/2016, CM met with the client after the case was reassigned to this CM and developed with the client first initial ILP Review. In the meeting client appears to be cooperative, and friendly. Client reported she is a victim of domestic violence with her daughter’s father. She reported she has unresolved issues. Client reported one is domestic violence and the other one is securing permanent housing so that her only child can spend time with her. During the meeting session client was emotionally teary she reported being residing in the shelter is not easy and being away from her daughter is taking a toll on her.

The next client we visited was not as simple of a case. This client was a woman in her 90’s who lived with both of her adult daughters. The daughters were away to work for most of the day and she was left alone. Before coming to the home, it was reported in her file that she suffered from glaucoma and was legally blind, that she had anxiety, and that she often hoard items leaving her home cluttered with very narrow paths to walk. Upon arriving at her home she was very anxious for us to arrive and was alone. She home layout showed concern because of all of the clutter and steep staircases. Her bedroom and bathroom were on the second floor and had not grab bars or adaptive equipment. She had a walker and a commode that she kept in her room away from the bathroom. Although for 90 years old she was very mobile, she had a very high fall risk being legally blind, the homes set up, and the clutter. This woman also was clearly suffering from anxiety and depression and expressed that although she was not suicidal, she wished she would die soon. There were also no leisure activities for her to do while being left alone all day and the television was unplugged on the floor and the audio books she had did not work.

The client has children whose completion of college has been reported as her only hope. The client has also been resilient as evidenced by her ability to live with her symptoms for an extensive time. The client is also rearing children

The client’s family structure was disrupted by divorced when he was between the ages of 12 or 13. Prior to the divorce his mother did not work outside the home, his father was employed as a civil engineer. He describes his family as “not rich, but always had food on the table”. Client stated that “his family attended a Christian church when he was a child, but no longer attends church”. Client reported “his father was in foster care”, no other additional information was reported concerning his father’s growing up years, nor any information concerning the mother’s family or growing up years. The client describes his father as “harsh physical punishment-till he was “old enough to fight back”, but he did not consider the physical punishment as abusive. After the divorce, the client’s mother moved to California, the client resided with his father: the relationship between his parents varies from no contact with the mother to some contact with the father. The client reported that both parents are still living, but he is not close to his mother. His father lives closer and he contacts him for the holidays and talks to him once or twice per month by phone. The client had an uncle who committed suicide.

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My client initially talked about their relationship problems with their spouse. Once probing further, I was able to figure out that she had episodes for the last four years of being in slightly high moods as well as slightly low moods and her spouse was getting upset at how “moody” she has been. Immediately, I thought of Cyclothymic Disorder because of the persistent amount of time as well as the intensity of the episodes, but knew it could also be Bipolar I Disorder or Bipolar II Disorder if she met criteria for a manic or hypomanic episode. I began to probe more on her current mood, which she describes as feeling down for the past 2-3 months. I asked about other symptoms of major depressive episodes, such as diminished interest in activities, decreased or increased appetite, sleeping too much or too little, lack of energy, feeling guilty, as well as thoughts or plans of suicide. I was proud that I remembered to ask about all of those criteria and felt confidently doing so, but I did miss asking about diminished ability to concentrate or make decisions. In all of her answers to these questions, they either did not apply or were very insignificant. I discovered she felt slightly down, had a lack of energy and diminished interest in activities, but was still able to go to work and not be affected. The main issue was her husband being irritated that she would switch from feeling down and lying in bed more often to feeling more

Recommendations: (Identify the problem to be addressed, type of counseling [individual, family, group] frequency [50 minutes, once per week], and any recommendations for other services (i.e., couples therapy, medication evaluation).

There is a range of different customers such as new customers, returning customers, disabled, customers returning products etc. These customers usually all have different wants and needs and the store needs to know how to handle the different customers. For example, new customers are customers entering the store for the first time, returning customers are customers returning to the store after already using the business. Seasonality could affect the customer types of customers for example, if it is christmas and the store is selling christmas products then someone who doesn’t celebrate christmas for one reason or another won't want to shop at the store for the time being until the products change.