Case Assessment: Mental Health Services

Thesis statement

According to the American Psychiatric Association, Attention Deficit Disorder is currently a rather common disorder occurring in 3-7% of school-age children (Barkley, 2014). Raising a child with Attention Deficit Disorder is a big challenge for parents and is typically associated with increased anger and frustration by child’s behavior as well as one’s poor learning results. However, timely measures on identifying the disease and care planning are able to demonstrate that symptoms and consequences of ADD are not the outcomes of poor parenting, but represent a medical condition that can be effectively treated with joint efforts of parties. In this regards, seeking assistance of mental health case management services is particularly helpful in formulating holistic treatment approach and reducing hospitalization necessities, as, for instance, in case of Jimmy and his family.

Identifying possible disorders, individual goals, needs and strengths

Jimmy. As a typical child with Attention deficit disorder, Jimmy experiences difficulties in concentrating his thoughts and, in connection with this, cannot always cope with study assignments. He exhibits excessive mobility, commits many unnecessary actions, instead of focusing on a particular task. This behavior creates problems both in school and at home. Having low academic performance and considered disobedient, Jimmy not only makes family and teacher concerned about his health but is also “terrorizing” his family members with regularly occurring and long-lasting temper tantrums. Despite being described by parents as a very loving child, Jimmy is not capable of controlling his emotions and regularly becomes violent, selfish, cruel and excessively demanding in treating his loved ones. At the same time, children with a form of Attention deficit hyperactivity disorder also suffer from low self-esteem which makes it difficult for them to make friends and demonstrate social adaptation skills overall.

Therefore, it is possible to diagnose a combined type of Attention deficit hyperactivity disorder with a predominance of inattention and impulsivity. However, the child should also be carefully examined by a doctor to exclude other diseases that can also cause these symptoms. In particular, possible associated disorders for Jimmy may include (Brown, 2013; Barkley, 2014):

• An evocative opposition disorder manifesting itself as deliberate disobedience, hostility and sometimes violent behavior;

• Anxiety disorders common for children traumatized by divorce;

• Developing tics like prolonged sniffing or twitching of the head;

• Delay in psycho-speech development or mental development;

• Depression and suicidal ideation.

Linda. Jimmy’s biological mother is reportedly suffering from substance abuse. In Linda’s case, cocaine is often used in combination with alcohol which typically serves for reducing the irritability experienced in abuser by taking high doses of cocaine. In this way, cocaine and alcohol addiction develop alongside, where simultaneous intake of these substances results in cocaine’s interesterification into cocaethylene, a metabolite strong in its ability to block the re-uptake of dopamine (Kelly & White, 2010). Overall, even with a single use of cocaine, irreversible changes occur in the human brain, which only increase when used repeatedly for many years as in Linda’s case. The longer a person uses cocaine, the greater are the sense of fear, satiety, and depression (Kelly & White, 2010). Currently Linda experiences moody states, apathy, low activity, decrease in working capacity and self-esteem, hindering her from getting a regular job and inclusion into Jimmy’s up-bringing. In addition, Linda tends to avoid responsibilities and to establish abusive relationships with men. Therefore, comorbid conditions may involve post-traumatic stress syndrome, victim syndrome, and depression.

Warren, Sammi and Cara. Generally demonstrating healthy and caring behavior toward Jimmy and Linda, other family members are confused and frustrated with recent developments and occurring crises. The strong side of their mentality is the clear understanding of the necessity to turn for external medical and psychological help. Indentified by Jimmy as parents, Warren and Sammi cannot be blamed for the lack of attempts to fix Jimmy’s conditions. At the same time, the increasing conflicts regarding the effectiveness of treatments and approaches create tense atmosphere in their home.

Basing on case overview, the individual needs and goals of the family member include:

  Needs Goals
Jimmy Attention and love from all family members   Support and positive assessment   Understanding of his conditions   Social inclusion   Stable family climate   Prevention of trigger factors   Identifying comorbid states   Accept current condition as temporary   Learn to cope with hyperactivity episodes   Avoid violence and anger tantrums   Improve concentration skills, self-esteem and learning results overall   Establish healthy relations with mother, forgiving parents for divorce  
Linda Abstinence and adequate evaluation of life events   Social inclusion   Stable family climate   Identifying comorbid states and their traumatic causes   Financial independence   Overcome substance addition   Restore activity levels and working capacity   Quit abusive relations   Establish healthy relations with her son   Find regular job
Warren and Sammi Understanding of Jimmy’s conditions   Controllability of Jimmy’s tantrums   Stable family climate   Certainty and predictability in Jimmy-Linda relations   Learn useful coping strategies for Jimmy’s state   Create clear and regular daily routines, hobbies and spare time activities for the family members   Establish healthy relations with Linda
Cara Attention and support from parents   Understanding of Jimmy’s conditions   Controllability of Jimmy’s tantrums   Stable family climate Learn useful coping strategies for Jimmy’s state  

The established goals serve as a route map for further care planning.

Care planning and implementation

Jimmy. The basis of ADD development mechanism is the deficit of dopamine and norepinephrine in some areas of the brain (Brown, 2013). These data underscore the fact that Attention deficit disorder is a disease that requires appropriate diagnosis and proper treatment, and here, combined treatment demonstrates higher efficiency. As Jongsma and Peterson (2014) claim, studies of school-age children suggest the best outcomes develop from integrated treatment approaches that involve educating patients about their condition, maintaining their self-esteem, suggesting behavioral changes through behavioral, cognitive and family therapy, and medication. These approaches can successfully be planned and implemented in primary care:

  1. Education and training. Helping children recognize that their disease is a manageable problem contributes to the development of a sense of control in them (Jongsma & Peterson, 2014; Barkley, 2014). Jimmy can be helped to recognize triggers for impulsive behaviour, and then learn healthy responses to these triggers (evaluating a situation, waiting before acting, etc.). Education can be facilitated by reading illustrated materials provided by the local support center.
  2. Self-esteem. Techniques for enhancing child’s self-esteem include acknowledging even small accomplishments and changes they made, challenging negative thoughts about themselves and replacing them with positive ones, avoiding situations of possible failure and setting attainable learning goals (Jongsma & Peterson, 2014; Barkley, 2014). Self-esteem work should be accomplished in joint attempts of family, teachers and assigned psychotherapist.
  3. Behavior therapy. Social skills training is able to teach patients how to access reinforcers and alter the relationship between undesired behaviors and their consequences (Barkley, 2014). For instance, shaping and graded task assignments technique could be applied in Jimmy’s case. This technique is used when a person feels life’s tasks appear to be overwhelming, and therefore, the complex behavior patterns to be learned should be broken down into simple steps. By developing daily routines with short-term and attainable goals, a therapist is able to create a sense of accomplishment in patient. The ultimate goal of behavior therapy is to increase the frequency of desirable behavior by rising child’s interest towards pleasing parents and by supplying positive consequences to actions (Jongsma & Peterson, 2014; Barkley, 2014).
  4. Group therapy, including art therapy. Play and dance therapy options are effective for both redirecting child’s energy and improving socialization skills, while music therapy demonstrates good results in developing concentration (Barkley, 2014). Art therapy groups might be both after school options or weekend recreational activity at the local art center.
  5. Medication. The ineffectiveness of the previously prescribed medication might be a sign that the symptoms of ADHD occur as a result of another disease. In this case, the effective treatment requires a thorough examination of the child by specialists in various fields. Overall, ADD management relies on two groups of drugs: stimulants (such as methylphenidate or dexamphetamine), and antidepressants (such as buproprion, tricyclics, and selective norepinephrine reuptake inhibitors) (Jongsma & Peterson, 2014; Brown, 2013).

Linda. The main task in the treatment of substance dependence is not so much to stop using the drug, but help the patient resist the urge to return to its compulsive use. Indeed, there is currently a great interest in finding medications that could help in the rehabilitation of people with cocaine and alcohol addiction, but according to reports, programs including individual and group psychotherapy and methods of behavior therapy are now crucial factors in improving the effectiveness of treatment (Kelly & White, 2010). In Linda’s case, management tasks include:

  1. Behavioral treatments. One of the most effective forms of behavioral therapy in people with cocaine addiction is contingency management program using prize-based system that rewards patients who abstain. Contingency management may be particularly functional at the beginning for helping Linda achieve initial abstinence from cocaine. Furthermore, cognitive-behavioral therapists could be consulted for preventing relapse (Kelly & White, 2010).
  2. Joining therapeutic communities. Communities in which patients in recovery share experiences and help each other to change their behaviors can be found for Linda locally. Therapeutic communities may require a 6-12-month stay and thus include the functions of control, change of social circle, and supportive services that are focused on further successful reintegration into society (Kelly & White, 2010).
  3. Addressing PTSD. As a victim of home violence and regular abuse for her partner, Linda requires appropriate post-traumatic stress management therapy. Methods may involve psychoanalysis, analytical therapy, Adlerian therapy, client-centered therapy, and gestalt therapy (van der Kolk & McFarlane, 2006).
  4. Career counseling. Aftercare serves should be aimed at reinforcing positive ambitions in the patient and addressing problems that increase one’s vulnerability to relapse. For instance, Linda’s declining self-efficacy should be restored to normal level by motivation to find a workplace she would be valued at.

Family and school interventions. Given the mechanism of complex interaction between biological, cognitive and social factors as well as comorbid conditions, treatment of ADHD begins with a comprehensive family and classroom work directed at the cause of the disorder. Here, management is focused on (Jongsma & Peterson, 2014; Barkley, 2014):

  1. Parent education and skills training. Educating parents on possible behaviour management strategies, treatment options and comorbid problems is crucial for their effective participation in patient support. During skills training courses, Jimmy’s parents are required to learn how to prepare reminder and goal lists that reduce symptoms, organize Jimmy’s daily routines, avoid triggers, and use the techniques of operant conditioning. Techniques include, i.e. not only effective punishments or revocation of privileges for poor behavior, but also the consistent application of rewards for meeting goals and desired behavior. Specialized ADHD coaches can provide services and strategies for parents to improve time management or organizational skills.
  2. Consultation with teachers and school social workers. Involvement of school environment in Jimmy’s treatment is essential for facilitating the sustained approach to the management of his condition. Classroom management is generally similar to parent management training and involves training the educators on techniques of increased structuring of classroom activities, daily feеdback, and tokеn economy. The focus of treatment consists in providing the child with positive consequences for behaving in desired ways. The frequency of desired behavior is effectively increased by providing rewards for accomplishments, rather than punishment for failures.
  3. Family therapy sessions. Family therapy conducted by the assigned therapists contributes to establishing healthy reaction and attitudes towards the behaviors of family members, increasing understanding of inner fears and concerns of others and learning to readapt. Thus, during session parents need learn how to talk to both of their children to provide them with the sufficient amount of attention (discuss topics children are interested in, finding out what they thinks, asking open-ended questions).
  4. Establishing clear rules, duties and routines. The presence of a specific schedule helps anxious children know when and what they need to do and feel calmer as a result. Social workers need to ensure that the daily work at school and home is performed same time of the day: meals are scheduled, assigned tasks are not postponed, the number of distractions is limited, spare family time is organized, important matters are kept in a list, and children are taught to plan their day on their own.

In this regards, a case manager is required to arrange and coordinate the services of specialists in various fields; individual, group and family therapists; therapeutic communities,school teachers, social workers, and career counseling service. Scheduled and planned rationally throughout the year, these services should be accessible and understable for the family in order to bring prompt results. 

Progress monitoring and re-assessment

Undertreated ADD may later exhibit in adolescence and adulthood as the lack of rational time planning, poor memory, low academic achievement and, as a result, low level of professional achievements (Barkley, 2014). According to Brown (2013) survey, adults diagnosed with Attention deficit hyperactivity disorder in childhood are accompanied by a feeling of impatience and restlessness, impulsiveness, social inadequacy, and a feeling of low self-esteem throughout their whole life. There are reports of a greater frequency of accidents, divorces, changes in jobs for this group of people. Adults with ADHD may also suffer from substance addiction and depression, especially given their family history. Meanwhile, according to research, nearly 25% of substances abusers relapse to the weekly use of cocaine or alcohol or both within the first year following treatment (Kelly & White, 2010). Besides, treatment dropout is one of the major problems among traumatized patients (van der Kolk & McFarlane, 2006). Therefore, regular monitoring of family’s progress is required:

  1. Monitoring the dynamics of Jimmy’s temper tantrums, their frequency and duration.
  2. Monthly control of family schedule keeping;
  3. Monthly consultation with school teachers;
  4. Regular medical testing to control medication effects;
  5. Controlling therapy attendance plan for Jimmy, his parents and Linda

The results of monitoring may lead to the necessity to revise certain care planning option in case of progress or regress, for instance medication dosage and therapy frequency should be adjusted appropriately. Thus, therapeutic sessions, diagnostic and educational testing, individual evaluation plans, conferences with teachers, arranging tutors, disciplinary meetings, appointments with physicians with regard  to medication, and appointments on interventions with family conflict should be rescheduled by the case manager.

Generally, individual progress of treatment occurs at various rates, so there is no predetermined duration of treatment. For instance, both inpatient or outpatient drug addiction treatment lasting for less than 3 month shows limited effectiveness (Kelly & White, 2010), and thus a significantly longer plan of treatment and monitoring should be proposed. Besides, substance addiction is chronic in its nature and is often recurring. By viewing Linda’s addiction as a chronic state and thus offering a continuing care and long-term monitoring, program has more chances to succeed, but this also means the possibility of multiple readmitting of the patient. In addition, the negative impact of relapse possibility in Linda’s case should be taken into account in calculating risk factors for triggers affecting Jimmy’s progress.

Similarly, health professionals view Attention deficit hyperactivity disorder as a chronic disease that lasts for years, and sometimes stays for a lifetime (Jongsma & Peterson, 2014). Therefore, medications for Attention deficit disorder are intended to be taken for long periods of time, however, they still do not have proven long-term outcomes exceeding drugs’ active period of reducing symptoms (Brown, 2013). Unlike medication, psychotherapy is limited in time and is applied only until the patient is learning new strategies and skills (Jongsma & Peterson, 2014). In most cases, patients are successfully treated in under a year period (Barkley, 2014). In its turn, parent training typically takes even less and consists of up to16 weekly sessions (Jongsma & Peterson, 2014). Overall, with the effective treatment and proper involvement of all parties, it is possible to normalize child’s behavior in school and at home fully, increase child’s self-esteem, facilitate social interaction with other children and adults, and thus, help to open potential and return to a full life. Analysis of the results of studies indicates that up to 50% of children outgrow the syndrome as adults (Barkley, 2014).

The final report on the case is the analysis of goals achieved as compared to goals planned.

References:

Barkley, R.A. (2014). Attention-Deficit Hyperactivity Disorder, Fourth Edition: A Handbook for Diagnosis and Treatment. 4th ed. The Guilford Press.

Brown, T.E. (2013). A New Understanding of ADHD in Children and Adults: Executive Function Impairments. Routledge.

Jongsma, A.E.Jr. , & Peterson, L.M. (2014). The Child Psychotherapy Treatment Planner: Includes DSM-5 Updates. 5th ed. Wiley.

Kelly, J.F., & White, W.L. (2010). Addiction Recovery Management: Theory, Research and Practice. Humana Press.

van der Kolk, B.A., & McFarlane, A.C. (2006). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. The Guilford Press.

The terms offer and acceptance. (2016, May 17). Retrieved from

[Accessed: November 26, 2021]

"The terms offer and acceptance." freeessays.club, 17 May 2016.

[Accessed: November 26, 2021]

freeessays.club (2016) The terms offer and acceptance [Online].
Available at:

[Accessed: November 26, 2021]

"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: November 26, 2021]

"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: November 26, 2021]

"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: November 26, 2021]

"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: November 26, 2021]
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