Sample Case Study: Client Scenarios

Our client is an intermediate care facility for developmentally disabled individuals under the age of twenty-two years. The campus consists of several residential, educational and administrative buildings and recreational areas on twenty-six acres of land.

Meeting is arranged for Tuesday, September 20, 2016. Client continues to report not even her coordinator she gave him a copy of her psychosocial and psychiatric evaluation. She also mentions that her coordinator is requesting for client to be removed from his

CM was out on vacation for the period of 5/2/2016 to 5/9/2016. On 5/19/2016, CM met with the client to update Assessment and to complete Other ILP Review. In the meeting client appears to be friendly and cooperative. She appears to have some cognitive impairment. Client reported WECARE/Wellness referred the client to see Dr. Larissa Lempert/Neurology. Next upcoming appointment is scheduled for 5/26/2016. During the meeting session, client was dressed appropriately for the weather and had good hygiene. She ambulates with a cane due to leg problem. Client affect was flat. Client denied suicidal or homicidal ideation.

The client which I worked with, R.C. was brought in by staff at her group home with the knowledge and agreement of her brother. The client in question began having an exacerbation of her psychotic symptoms which was observed by staff at the group home where she lived as well as her visiting nurse. The behavior which was of concern included increasing self-neglect by the client who was notably not performing hygiene activities. The client was also reported to have struck her visiting nurse and to have been smearing fecal matter. The client is in her mid-sixties, divorced, and has a son, three grandchildren, and two brothers. The client 's brothers act as her guardians and are involved in her care. The client 's guardian reports that the client has struggled with mental illness throughout her life. Past medical history for the client indicates a number of past hospitalizations in a few different institutions and a diagnosis of schizoaffective disorder years prior. The client has had recent increasing difficulties with health problems not concerned with her mental illness. In addition to her diagnosis of schizoaffective disorder, the client also takes medication for hypertension, hypercholesterolemia, and asthma. The client also has a history of type two diabetes, renal insufficiency, pancreatitis, and fatty liver deposits. The patient 's chart

Client was scheduled for a Mental Health Assessment at Woodhull Hospital on 8/9/2016. Client reported she didn’t go because she doesn’t need. Client continues to report if the Mental Health Counselor at Woodhull Hospital need to contact her and tell her why she need to be seeing and to show documents. CM explain to the client since she saw the onsite psychiatrist doctor, that the doctor referred her for mental health counseling. Client agreed and another appointment is scheduled for

My client is a 3-year-old boy that has a diagnosis of Autism Spectrum Disorder. Occupation-based problems typically seen in toddlers with a diagnosis of Autism Spectrum Disorder includes difficulty with dressing, toileting, bathing, self-feeding, socialization, interacting, and make eye contact with adults and other children.

D- Client arrived on time with his appointment. When asked by the writer about his morning thus far, he reported his morning is going well. The client appeared to be pleased to meet with his new assigned clinician. During the course of the one hour session, the client was aware about completing his first initial TX plan, at which he was open to discuss and complete. This writer asked the client about his drug of choice and the length of time of his use. The client reported that his only drug of choice is heroin and his length of time is about a year. When asked by the writer about how he was introduced, the client mentioned his significant other, who is also a client at the clinic. His significant other name is Lucy Dannelley. The client mentioned his relationship will not hinder his recovery process because according to the client, he and his significant other want to recover from illicit drugs.

Patient is a 75 year old female who presented to the ED with depressive symptoms and suicidal ideation. Patient reports for the past 3 months she has been treating a UTI. She expressed that she has been complaint with medications, however has been to the hospital 4 to 5 times within the last 2 months for the same. Patient reports since been diagnosed with the shingles last year everything has been going downhill. The patient has been treated for the shingles since. The patient reports multiple stressor including: medical conditions, inability to care for herself, financial concerns, and poor familial support.

The “Client Scenario” video reflects the main character as a client that currently has several needs based on the fact that she has went through a divorce, has one child to provide for, and is in need of financial assistance to pay monthly bills and provide food for herself and her child. The client appears frustrated, overwhelmed, stressed, hostile, and entitled throughout the video. These are often common feelings that are displayed by clients when clients and social workers are meeting for the first time. The client is seeking services due to the needs of her family caused by unforeseen events that recently occurred, which can be a very stressful time for clients. The social worker revealed concern, empathy, and a willingness to assist the client as the social welfare policies

The patient is a 48 year old male who presented to the ED with acute psychosis. Leo brought the patient to the ED. The patient denies suicidal ideation and homicidal ideation. The patient states, " I hear and see things, but I don't want to harm myself or anything like that." At the time of assessment, patient denies suicidal and homicidal ideation. Patient reports psychosis and issues with his brother's group home residents as the primary factor that was contributing to his distress. When confronted about psychosis to the nursing staff and to this clinician, patient stated "earlier I was repeating what the voices were saying to me." Patient reports he thinks his medication is the issue. Patient outpatient provider is DayMark. The patient denies a history of self harm or hospitalization for the same. Patient does not appear to be exhibiting signs of agitation, aggression, or responding to internal stimuli. The patient does appear guarded. He

On 7/15/2015, CM conducted a search via Security to locate client. Client was found sitting in the Cafeteria. Client was asked by Security to come upstairs to meet with her assigned CM met with the client and completed Bi-Weekly ILP Review update information concerning NY Psychotherapy Mental Counseling referrals. In the meeting client appears to be space out and worry. CM inquires was going on. Client replies; she need to secure permanent housing because this place is worn in her out. CM also mentioned to the client yesterday CM did a visual and client was located in the Cafeteria, CM asked client to come upstairs to Social Service Office to signed housing package, but client was no show. Client replies “she probably had a minor seizures attack because she doesn’t remember speaking with CM.” CM also inquires about the numerous referrals to NY Psychotherapy Mental Counseling for individual session to address client depression. Client reported she couldn’t attend the first scheduled appointment on 7/14/2015 because she had a HRA appointment scheduled the same day. (Client

Chronic pain is best acknowledged by understanding the person and how they live. Client A (as he will be known) lives with pain on a daily basis, as do thousands of people. Currently, Client A is trying to deal with high stress levels and this is affecting his work and personal relationships, as well as life in general. So what is happening to Client A from a biological, physiological and social aspect and how can these changes affect the musculoskeletal system enough to create pain? Client A did not wake up one morning and his pain began. His pain journey is a process of ………changes. began developed needs to begin with confirmation that his pain is real and what he is experiencing is normal but his actual journey is unique to him. As a therapist, it is about recognising specific mechanisms and understanding how they

On 2/19/18 met Mr. Revis, both guardians and also the internal case manager from Rainbow at the appointment with Dr. Geffard. This was a meeting because at the last appointment which Brian only attended with the internal case manager he asked Dr. Geffard about regaining his own guardianship. Dr. Geffard wanted to speak with the co-guardians so this was today. Brian is still acting out with other clients. He also had an incident of taking pictures in the home where he stays and calling adult protective services. He claimed that it was not clean and the staff was using toxic chemicals. The home was visited and he was interviewed but nothing was found. His primary goal is to get out of Rainbow and get his guardianship taken back. He continues to be very impulsive. He continues to not be on any medications. At this point, Dr. Geffard said he needs to have some Neuropsychology testing done to go over what is TBI and what is just Brian’s normal behavior. Dr. Geffard said that yes we already know he makes bad choices by his past behaviors but that doesn't mean he has to be housed in a facility. That he may be at the point he can make his own choices even if we do not agree with them. Dr. Geffard's office will be setting up the testing then we will decide where to go from there.

On 1/20/2016, CM met with the client to complete Bi-Weekly ILP Review. In the meeting client was dressed in full black attire. She was well groomed. Client walks with a cane due to chronic back problems. In the meeting client was hostile, rude, uncooperative and disrespectful. . It has been this writers observations that client displays signs of narcissism behavior. She often dictates to staff what she will do as opposed to working with staff. At times she reports knowledgeable of DHS Rules and Regulation and she constantly personalized staff as she quote” You guys are trying to make me a mental client.” During the meeting session client was loud and hostile with this writer that the Social Service Supervisor intervenes and join the meeting. However, client continues to display uncooperative, disrespectful behavior. Client talked over the Social Service Supervisor displaying sign of narcissism. In the meeting she constantly personalized staff of as she quote “I not supposed to be here in this shelter. This shelter is for people with mental illness. I do not have a mental diagnosed. My psychiatrist wrote a letter stating I do not have a mental diagnosis, and you people are trying to put a mental diagnosed on me”. She continues to report she will not participate in the psychosocial because she was informed by the previous shelter that the psychosocial evaluation is optional. She also continues to mention she was punished by DHS for reporting DHS to the Coalition,

The client is a 51-year-old African American male who was cooperative during the assessment. The client was given the diagnosis of Major Depressive Disorder, Mild while hospitalized during the 1980’s. The client is unable to remember the name of the hospital. The client has been prescribed the following medications: Clonidine Patch, Albuterol, Clarithromycin, Metformin, Loratadine, Carafate, Hydralazine, Triamterene, Clopidogrel, Tartrate, Lisinopril, Atorvastatin, Buproban, Pantoprazole, Amlodipine Besylate, Nitroglycerin, Lingual Spray.