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Psychosocial Case
"The Road to Adoption":
The Case of Lilly.
*Disclaimer All Identifying information in this presentation is fabricated for confidentiality purposes*
Lilly Frazier
13 Years Old
African American Female
Not Married
Resides in Hampton, Virginia with foster Mother D.
Client is under: Hampton Department Social Services Foster Care and Adoption Unit
(Emergency Removal Order)
Presenting Problem:
Lilly was placed into Foster Care after great aunt caused physical harm.
- Great Aunt does not want Lilly back in the home and is not willing to work with CPS with conducting home visit, not willing to learn other forms of discipline
- Relative Information Form was completed, relatives have not contacted the department back or been consistent
Stressors: Non Productive Behavior Problems:
Physical Abuse Defiance, Lying, Sexual Acts, School Issues
Abandonment
Referral Source:
CPS was contacted by Lilly's teacher,
-Visible Indications of physical abuse (facial bruises and bleeding)
Precipitating Event:
Lilly defiance and getting into trouble at school
Lilly was victim of physical abuse by mother
(1) Founded Level II Newport News Social Services . . . case was transferred to Ongoing Services . . . Mother declined services
(2) Founded Level II victim of physical harm
Great Aunt agreed to take custody
Lilly stated that she feels angry towards her family because no one wants her and there was no structure .
Lilly has admitted to partaking in substance misuse because of the environment that she was in.
Lilly has been struggling focusing in school.
Lilly's psychological status was assessed there was no indication of sexual trauma, severe mental issues, developmental delay suicide, or lethality, the client is currently on no medications besides vitamins.
Due to client's history of physical harm, and current family issues, PTSD and Depression and Anxiety are possibilities.
Oriented To: Client is fully aware of time, objected, other people, places, and persons, she is very aware of her situation and the details it involves
Clothing: Neat/Clean, Situation Appropriate
Grooming: Well-groomed
Mood: Normal
Affect: Appropriate
Eye Contact: Avoided (Embarrassed)
Motor Activity: Unremarkable
Posture: Normal
Attention: Unremarkable
Emotional Status
Concentration: Normal
Judgment/Insight: Appropriate
Memory: Normal
Speech: Normal
Thought Content: Mood/Situation Appropriate
Thought Processes: Circumstantial
Hallucinations: None
Estimate of intelligence: Average
Social Functioning: Impulsive
None
7th Grade Virtual Learning
Dependent on Foster Mother, Does recive $10 week allowance
None
No diversity within the foster home , minimal diversity in the community.
No identified oppression.
Tech Savy
No Certification
Resilient
Confident
Proud
Creative
Assertive
Brave
Optimistic
Strong
Client did not state that she has a significant other but does have sexual relations
Family is not making an effort to attend visitation regularly to see the client.
Mother and Father was contacted with no response.
Due to COVID-19 client is involved in minimal community organizations.
Aware of Christianity, does not attend church but believes in God.
Professional Conclusions:
- Due to the negative energy flow and non compliance from the client's mother an other family members, the client is at rick of depression, anxiety, and PTSD.
- Due to Lilly being a victim of physical abuse on three documented occasions, she is vulnerable to other forms of abuse.
What does this client need?
-Trauma counseling with Center for Child and Family Services
- A tutor to hold her accountable to completing school work
- A mentor
-Opportunities to be involved in the community
What is the client seeking?
-Permanency (Desires to stay in the foster home)
-Stability
-Love
Explanation of observations
What meaning does the client ascribe to the problem?
- Lilly is optimistic that a family member will contact the department but she does desire to stay with her Foster Mother
- The client is aware that she has an issue with running off, lying, stealing, and is participating in sexual acts, does not seem to have a 'true' desire to fix the problems.
DSM-5
- High risk for Depressive Disorder, Anxiety, and PTSD
Explanation of Evidence
What practice skills did I use?
-Empathy
-Active Listening
-Cultural Competence
-Patience
-Critical Thinking
-Boundary Setting
-Information Gathering
What treatment model should be used?
-Cognitive Behavioral Therapy
-Narrative Therapy
What theories did I integrate?
-Systems Theory
-Rational Choice Theory
-Empowerment Theory
Explanation of evidence based support
Leila Morsy and Richard Rothstein
“Stress” is a commonplace term for hormonal changes that occur in response to frightening or threatening events or conditions. When severe, these changes are termed “toxic” stress and can impede children’s behavior, cognitive capacity, and emotional and physical health.
Social class and childhood stress. Beginning in infancy, lower social class children are more likely to have strong, frequent, or prolonged exposure to major traumatic events, the frightening or threatening conditions that induce a stress response.
Income and childhood stress. The lowest-income children are more likely to be exposed to frightening or threatening experiences than other children.
Race and childhood stress. Black children are more likely than white children to be exposed to frightening or threatening experiences.
Childhood stress and depressed outcomes. Independent of other characteristics, children exposed to more frightening and threatening events are more likely to suffer from academic problems, behavioral problems, and health problems.
Policy Recommendations
Main Resources
Trauma Counseling
Together Lives Change Program (TLC)
-Mentoring
-Family Healing & Reunification Services
-Day Treatment
-Independent Living Coach Trainings
The UP Center
Outpatient Therapist
Gaps In Resources
Many resources are catered to individuals with psychological
issues and are on medication
Agency Mission Statement
Our mission is to create a collaborative system of services and funding that is child-centered, family-focused, community-based and cost-effective when addressing the strengths and needs of troubled and at-risk youths and their families in the commonwealth.
The department works to ensure that all Hampton families are able to become healthy and self-sufficient.
Goals include:
Empowering families and children to escape the long-term effects of poverty
Protecting abused or neglected children and adults
Supporting families for healthy development
Social Justice Issue: Intentionality
No Social Policy Issues
Congruence Level
High. HDSS is committed to permanency and strengthening the family. HDSS is aware of possible social justice and policy issues and combats them.
Value Challenge:
-Being non-biased
-Open mindedness
Ethical Dilemma
-Other Social Workers in the office conversations about the case
-The client asking for my phone number
Managing conflict
-Unsuccessfully being able to get in touch with Lilly's family members
-Lilly's defiant behavior
Application of the NASW Code of Ethics
Dignity and Worth of a Person
This client needs to feel worth!
Processional Growth
-Solidified the population I desire to work with
-Note taking skills on home visit
-Actual client interaction
C. (n.d.). National Association of Social Workers (NASW). Retrieved November 8, 2020, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
Poulin, J., Matis, S., & Witt, H. (2019). The Social Work Field Placement: A competency-based
approach. New York, New York: Springer Publishing Company, LLC.
doi:10.1891/9780826175533
Human Services (Social Services). (n.d.). Retrieved November 8, 2020, from https://hampton.gov/269/Human-Services
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Publisher.
Morsy, L., & Rothstein, R. (2019, May 1). Toxic stress and children's outcomes: African American children growing up poor are at greater risk of disrupted physiological functioning and depressed academic achievement. Retrieved November 8, 2020, from https://www.epi.org/publication/toxic-stress-and-childrens-outcomes-african-american-children-growing-up-poor-are-at-greater-risk-of-disrupted-physiological-functioning-and-depressed-academic-achievement/