Treatment Planning Case Study
CYMH 5331 Treatment Plan: Diagnosis of Client by Physician/Psychiatrist.
Clinical impression by therapist
Client Diagnosis (Gary): Gary’s diagnosis is insufficient sleep resulting in a circadian rhythm sleep-wake disorder. In addition, Gary’s situation means that he is suffering from other factors that may need clinical attention. Certain environment and psychology events because he living in a single-parent family where the sole parent works night shift and is absent for the majority of Gary’s waking time. This negative effect on Gary’s functioning are associated with the way that Emily and Gary interact (lack of communication, little connection, and adult neglect), resulting in a parent-child relational problem.
Client (Gary) Rationale …show more content…
and Clinical Impression
Gary is 13 years old, and his actions are what have brought mom to seek help from mental health services. Gary lacks a father figure and his mother depends on him to help raise his little sister. Gary is acting resentful for having to babysit and his roughhousing with Grace has recently resulted in a broken arm. There are no reports of Gary acting aggressively or inappropriately at school. Gary is the primary caregiver of his 4-year old sister during the evening and night period when his mom, Emily, is working. Unfortunately, this the same time when Grace is the most alert due to her sleep schedule. This means that Gary is likely impacted by a sleep restriction (SR) condition (that is, 6.5 hr in bed per night) rather than a healthy sleep duration (HS) condition (that is, 10 hr in bed per night). The mood of adolescents who face SR conditions become tense/anxious, angry/hostile, confused, and fatigued. When sleep deprived, Gary likely exhibits oppositionality/irritability and poorer emotional regulation (Baum, Desai, Field, Miller, Rausch, and Beebe, 2014). In addition to gaining a healthy sleep condition, Gary would benefit from having a supportive father figure or community of men in his life. Boys with absent fathers are more likely to be violent and get into trouble (Biddulph, 2008; Sax, 2016). Although his mom may be doing the best she can as a single mom, the importance of a father-figure cannot be forgotten.
Diagnosis (Grace):
Grace’s diagnosis is also circadian rhythm sleep-wake disorder. In addition, Grace’s symptoms fall into the category of global development delays as she shows multiple delayed developmental milestones (that is, speech delays, bladder control, etc.) and has not been adequately evaluated. Further investigation may prove Grace suffers from reactive attachment disorder due to insufficient caregiving and parental neglect. She is clingy, insists on being carried, and exhibits stunted growth bed wetting, and speech delays. These symptoms should be reviewed to accurately determine Grace’s diagnosis and resulting support measures.
Rationale and Clinical Impression (Grace)
Although Gary is the focus of the treatment plan, any plan needs to involve and consider the complex factors of his home life. In fact, Emily should be encouraged to engage in a treatment plan that moves the focus to supporting Grace. Although Emily does not feel there is anything amiss with Grace, there are some critical concerns that arise through this case.
Grace is four years old, wets her bed, wants to be carried, and has delayed language abilities. She presents characteristics of a much younger child and is not meeting the developmental milestones normally seen by a four-year-old (McGoey, McCobin, & Venesky, 2016). Because her mother fails to see this lag in development as a need for concern, a lack of support for treatment options exists, posing an additional barrier to treatment. Grace lives in a single-parent home, meaning that there is only one adult supporting her development. To support Grace, Emily would benefit from greater understanding and knowledge around the growth and development stages of children.
During the interview, the mother described Grace’s need for constant attention and the family’s combined efforts to schedule care for Grace. Grace’s sleep schedule follows mom’s (that is, sleeping during the day) and Gary is responsible for her care during the night hours. Unfortunately, these night hours are when Grace is most alert, thereby contributing to Gary’s sleep restriction condition. Grace’s atypical sleep pattern provide a contributing factor to her lack of development. Grace’s care during her waking hours has been left to her brother. As a 13-year-old boy, Gary the lacks maturity and the ability to foster the needed support for a developing child (McGoey, McCobin, & Venesky, 2016)..
Diagnosis (Emily):
The DSM-5 diagnosis for Emily is circadian rhythm sleep disorder of the shift work type (American Psychiatric Association, 2013). In addition, she should be reviewed for mood disorder as she is single-parent, with no reported significant other to share the burden of raising the children. Given the number of stressors that Emily faces in her situation, she may be developing depression, anxiety, and other behaviourial symptoms related to adjustment disorder.
Rationale and Clinical Impression (Emily)
During the interview, Emily does not share any information regarding her own health and wellness other than to state that she is forced to work night shifts and has no other family supports (like a husband, grandparent, etc.) to help her raise the two children.
It is likely that she is unable afford daycare for Grace, and that is the reason that she keeps Grace at home with her during the day even though Emily should be sleeping. Financial limitations are likely the reason behind the need for Gary to take care of Grace when Emily is working. Emily does not recognize that her work schedule contributes greatly to the problems associated with Gary’s behaviour and Grace’s delayed development. In moving forward, Emily would benefit from identifying and accessing community supports that can mitigate the negatives of shift work. She must also monitor her own health to ensure she does not succumb to long term circadian rhythm sleep disorders (DMS-5). Her personal health and wellness is key to the successful treatment of her …show more content…
children.
Although Emily’s employment means that she needs to sleep during the day, multiple problems that have resulted by having allowing Grace to sleep during the day. Grace's waking hours coincide to Gary's sleeping hours, resulting in sleep deprivation for Gary as well as lack of developmental support for Grace. To avoid getting a circadian rhythm sleep disorder, Grace requires a regular sleep schedule suited for the growth and development her age. She also would benefit from having age-appropriate experiences during her waking hours, time for outside play, and other learning experiences provided by an attentive caregiver.
Motivation
Gary has been referred to treatment by his mother Emily.
No information has been shared about Gary’s opinion or attitude about this referral but is likely that Gary could be resistant to treatment. His mom, Emily is motivated to improve Gary’s situation (that is, to minimize his aggressive behaviours), but she does not realize the extent to which Grace’s caregiver and developmental needs contribute to Gary problems.
Financial
Gary is 13 years old and does not have a job. His mom, Emily, is a single parent raising two children. She works full time, night shift. It is likely that there exists a lack of disposable income within this family.
Transportation
No information provided. Due to Gary’s age, he would be limited to public transportation or walking to get from place to place.
Lack of caregiver availability
Gary is at school during the day and responsible for looking after his sister, Grace at night. Emily works night and both Emily and Grace’s sleep during the day as a way to reduce the need for child care during the day.
Other
Emily does not indicate any other family members are involved.
Custody
Emily - The children have different fathers but neither fathers are involved in their care. Emily has
sole-custody.
Child protection
No abuse noted in this case however, Gary is just 13 years old and solely is responsible for a four-year-old child for a long period of time. Under BC law, there is no defined age limit for leaving a child alone nor is there a legal age defined for babysitting. That being, each case needs to be taken in context and courts may determine if this case represents a case of no/inadequate care provision for Grace.
School
Unidentified but Gary’s teachers and/or school counsellor may have information to share about Gary’s mood and ability to manage emotions. These details can be shared with the clinician if there are appropriate sharing agreements in place.
Community
Unidentified: Potentially supports maybe available to provide Gary with a supportive male or community of men to fill the void left by an absent father. Supports for single parents and/or shift workers may exist and should be explored.
Other
Clinical impression by therapist
Client Diagnosis (Gary): Gary’s diagnosis is insufficient sleep resulting in a circadian rhythm sleep-wake disorder. In addition, Gary’s situation means that he is suffering from other factors that may need clinical attention. Certain environment and psychology events because he living in a single-parent family where the sole parent works night shift and is absent for the majority of Gary’s waking time. This negative effect on Gary’s functioning are associated with the way that Emily and Gary interact (lack of communication, little connection, and adult neglect), resulting in a parent-child relational problem.
Client (Gary) Rationale …show more content…
and Clinical Impression
Gary is 13 years old, and his actions are what have brought mom to seek help from mental health services. Gary lacks a father figure and his mother depends on him to help raise his little sister. Gary is acting resentful for having to babysit and his roughhousing with Grace has recently resulted in a broken arm. There are no reports of Gary acting aggressively or inappropriately at school. Gary is the primary caregiver of his 4-year old sister during the evening and night period when his mom, Emily, is working. Unfortunately, this the same time when Grace is the most alert due to her sleep schedule. This means that Gary is likely impacted by a sleep restriction (SR) condition (that is, 6.5 hr in bed per night) rather than a healthy sleep duration (HS) condition (that is, 10 hr in bed per night). The mood of adolescents who face SR conditions become tense/anxious, angry/hostile, confused, and fatigued. When sleep deprived, Gary likely exhibits oppositionality/irritability and poorer emotional regulation (Baum, Desai, Field, Miller, Rausch, and Beebe, 2014). In addition to gaining a healthy sleep condition, Gary would benefit from having a supportive father figure or community of men in his life. Boys with absent fathers are more likely to be violent and get into trouble (Biddulph, 2008; Sax, 2016). Although his mom may be doing the best she can as a single mom, the importance of a father-figure cannot be forgotten.
Diagnosis (Grace):
Grace’s diagnosis is also circadian rhythm sleep-wake disorder. In addition, Grace’s symptoms fall into the category of global development delays as she shows multiple delayed developmental milestones (that is, speech delays, bladder control, etc.) and has not been adequately evaluated. Further investigation may prove Grace suffers from reactive attachment disorder due to insufficient caregiving and parental neglect. She is clingy, insists on being carried, and exhibits stunted growth bed wetting, and speech delays. These symptoms should be reviewed to accurately determine Grace’s diagnosis and resulting support measures.
Rationale and Clinical Impression (Grace)
Although Gary is the focus of the treatment plan, any plan needs to involve and consider the complex factors of his home life. In fact, Emily should be encouraged to engage in a treatment plan that moves the focus to supporting Grace. Although Emily does not feel there is anything amiss with Grace, there are some critical concerns that arise through this case.
Grace is four years old, wets her bed, wants to be carried, and has delayed language abilities. She presents characteristics of a much younger child and is not meeting the developmental milestones normally seen by a four-year-old (McGoey, McCobin, & Venesky, 2016). Because her mother fails to see this lag in development as a need for concern, a lack of support for treatment options exists, posing an additional barrier to treatment. Grace lives in a single-parent home, meaning that there is only one adult supporting her development. To support Grace, Emily would benefit from greater understanding and knowledge around the growth and development stages of children.
During the interview, the mother described Grace’s need for constant attention and the family’s combined efforts to schedule care for Grace. Grace’s sleep schedule follows mom’s (that is, sleeping during the day) and Gary is responsible for her care during the night hours. Unfortunately, these night hours are when Grace is most alert, thereby contributing to Gary’s sleep restriction condition. Grace’s atypical sleep pattern provide a contributing factor to her lack of development. Grace’s care during her waking hours has been left to her brother. As a 13-year-old boy, Gary the lacks maturity and the ability to foster the needed support for a developing child (McGoey, McCobin, & Venesky, 2016)..
Diagnosis (Emily):
The DSM-5 diagnosis for Emily is circadian rhythm sleep disorder of the shift work type (American Psychiatric Association, 2013). In addition, she should be reviewed for mood disorder as she is single-parent, with no reported significant other to share the burden of raising the children. Given the number of stressors that Emily faces in her situation, she may be developing depression, anxiety, and other behaviourial symptoms related to adjustment disorder.
Rationale and Clinical Impression (Emily)
During the interview, Emily does not share any information regarding her own health and wellness other than to state that she is forced to work night shifts and has no other family supports (like a husband, grandparent, etc.) to help her raise the two children.
It is likely that she is unable afford daycare for Grace, and that is the reason that she keeps Grace at home with her during the day even though Emily should be sleeping. Financial limitations are likely the reason behind the need for Gary to take care of Grace when Emily is working. Emily does not recognize that her work schedule contributes greatly to the problems associated with Gary’s behaviour and Grace’s delayed development. In moving forward, Emily would benefit from identifying and accessing community supports that can mitigate the negatives of shift work. She must also monitor her own health to ensure she does not succumb to long term circadian rhythm sleep disorders (DMS-5). Her personal health and wellness is key to the successful treatment of her …show more content…
children.
Although Emily’s employment means that she needs to sleep during the day, multiple problems that have resulted by having allowing Grace to sleep during the day. Grace's waking hours coincide to Gary's sleeping hours, resulting in sleep deprivation for Gary as well as lack of developmental support for Grace. To avoid getting a circadian rhythm sleep disorder, Grace requires a regular sleep schedule suited for the growth and development her age. She also would benefit from having age-appropriate experiences during her waking hours, time for outside play, and other learning experiences provided by an attentive caregiver.
Motivation
Gary has been referred to treatment by his mother Emily.
No information has been shared about Gary’s opinion or attitude about this referral but is likely that Gary could be resistant to treatment. His mom, Emily is motivated to improve Gary’s situation (that is, to minimize his aggressive behaviours), but she does not realize the extent to which Grace’s caregiver and developmental needs contribute to Gary problems.
Financial
Gary is 13 years old and does not have a job. His mom, Emily, is a single parent raising two children. She works full time, night shift. It is likely that there exists a lack of disposable income within this family.
Transportation
No information provided. Due to Gary’s age, he would be limited to public transportation or walking to get from place to place.
Lack of caregiver availability
Gary is at school during the day and responsible for looking after his sister, Grace at night. Emily works night and both Emily and Grace’s sleep during the day as a way to reduce the need for child care during the day.
Other
Emily does not indicate any other family members are involved.
Custody
Emily - The children have different fathers but neither fathers are involved in their care. Emily has
sole-custody.
Child protection
No abuse noted in this case however, Gary is just 13 years old and solely is responsible for a four-year-old child for a long period of time. Under BC law, there is no defined age limit for leaving a child alone nor is there a legal age defined for babysitting. That being, each case needs to be taken in context and courts may determine if this case represents a case of no/inadequate care provision for Grace.
School
Unidentified but Gary’s teachers and/or school counsellor may have information to share about Gary’s mood and ability to manage emotions. These details can be shared with the clinician if there are appropriate sharing agreements in place.
Community
Unidentified: Potentially supports maybe available to provide Gary with a supportive male or community of men to fill the void left by an absent father. Supports for single parents and/or shift workers may exist and should be explored.
Other