|Mark: A Case Study
Mark, a 13 year old Caucasian male, was originally referred for mental health services by his parents. Mark lived with his biological parents in a suburban community and had been attending seventh grade in a local middle school. When Mark was seven years old he was diagnosed with Attention Deficit Hyperactivity Disorder and prescribed Ritalan by the familys physician. According to his parents, Mark had been failing classes in school, refusing to do chores and homework, abusing substances, breaking curfew, and being oppositional at home. Mark admitted to presenting many behavioral problems at home and school. However, he also described instances where his father became physically abusive and would push, shove, slap, and bite Mark. In light of these allegations, Child Protective Services were contacted and became involved with Mark and his family.
Mark had been suspended from school for 15 days on Friday for cigarette smoking. Rather than go home and face his parents, Mark spent the evening with a friend and then was picked up by the police on Saturday afternoon. When the parents came to pick Mark up at the police station, they had a loud altercation and Marks father threatened to kill him. Because there was concern that he had been abusing drugs, Mark was placed in a detoxication center. While he was at the center, Mark was caught huffing deodorant with another youth, making threatening and physical gestures to the staff, and experiencing suicidal ideations. Mark was then sent to a residential treatment center for a 60-day evaluation.
In an effort to summarize Marks strengths and identify areas for improvement, the BERS was completed by his primary therapist at the treatment center. It was anticipated that the information would be beneficial in the assessment of Marks functioning as well as for discharge and transition planning back to his home environment and school setting. Marks scores on the BERS across the five subscales appear below.
Mark was rated very high on the Intrapersonal Strength subscale which reflected the positive feelings he held about himself. Specific items that were scored high included his ability to identify personal strengths, his popularity with peers, his ability to enjoy a hobby, and his sense of humor. The other area in which Mark evidenced skill was in the Affective Strength subscale. It was noted that he demonstrated a willingness to talk with others about his problems, acknowledge painful feelings, ask for help, and show concern for the feelings of others. On the Interpersonal Strength subscale Mark was rated below average. His score reflected some of the difficulties he has had with identifying the consequences of his behavior, reacting to disappointments, and managing his anger. Mark was also judged low on Family Involvement which reflected the tensions and conflicts in the family system. For School Functioning Mark was rated as demonstrating limited strength. His score showed that Mark had considerable difficulty with paying attention, completing tasks on time, and studying for tests.
On the open-ended questions, Marks therapist learned that his favorite activities and hobbies were roller blading, biking, and playing the trumpet for the school band, he enjoyed playing soccer and baseball, he had a history of involvement with a church youth group, and an important person in his life was Mr. Karl Quinn, the youth pastor from his church.
Marks 60 day evaluation period at the residential center was ending. A transition team was assembled consisting of Mark, his parents, the primary therapist at the center, a child protective case worker, a school counselor, the familys outpatient community therapist, and the youth pastor. The transition team members reviewed the psychological report and the BERS to identify services and support strategies that could enhance Marks transition to his home, school, and community. Working from a strength-based orientation, the transition team developed a series of recommended goals, activities and services. A summary of the recommendations appears below:
1. Increase Marks awareness of the relationship between behavior and consequences by helping Mark set small concrete goals and determine actions needed to achieve those goals.
2. Structure after school time and supervised social situations with same age peers through participation in community sports programs such as soccer and baseball.
1. Provide support to parents in developing and maintaining behavior management skills through in-home family preservation services.
2. Increase family communication by scheduling evening meals together at least three times per week.
3. Hold family meetings at least once every week with the youth pastor being present.
1. Support Marks positive interests by enrolling him in the school band or in organized sports clubs.
2. Schedule times when Mark can invite friends to the house or participate in a supervised community activity with friends.
1. Schedule follow-up medical care to monitor effects of Marks use of Ritalan.
2. Hire tutors to assist Mark in math and study skills.
3. Teach Mark how to maintain an organizational notebook to track daily and weekly homework assignments.
1. Schedule Mark to meet with a counselor on a weekly basis to discuss concerns or difficulties.
2. Identify a community program (e.g., child care center) where Mark can demonstrate his ability to care for others.
3. Plan with Mark to reenter the church youth group.Next Section
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