Running head: EVALUATION OF CLIENT SITUATION

Evaluation of Client Situation

Kelly Talbert
Wayne State University
SW 4997

Professor Klein-Shapiro
June 14, 2015

Abstract
The purpose of this paper is to evaluate a twenty-three years old homeless woman suffering from
mental and physical disabilities. She is currently a client that receives help from South Oakland
Citizens for the Homeless. It will include a bio-psycho-social assessment detailing her life filled
with traumatic events. This paper will also provide information on how the client views her
problems. Ethical dilemmas and intervention will be addressed in regard to the client with a
focus on her mental and physical health. Author will provide peer reviewed journals to support
the information for this client.

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Evaluation of Client Situation

Presenting Problems
Felicity (pseudonym) is a twenty-three year old Caucasian female, who is currently
homeless in Oakland County. She was brought to South Oakland Citizens of the Homeless
shelter by members of Common Ground, a crisis center in Oakland County. Felicity has mental
and physical health issues including Aspergers, bipolar, and motor apraxia. She has a history of
physical, mental, sexual and verbal abuse, foster care, and she is a parent. She was recently

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abandoned by her boyfriend. She is in need of resources that South Oakland Citizens for the

Homeless (SOCH) can hopefully provide.

Family and Personal Information
Felicity was raised by her foster parents John and Sue (pseudonym) on their farm in
Oxford, MI. Felicity biological parents rights were terminated and she was given to this family
at birth. She has a foster sister named Blake (pseudonym) that is five years older than her. Blake
and Felicity do not have a close relationship. Felicity stated that her foster parents were very
mean people. They would make Felicity sleep in the barn with the animals when they felt her
behavior was bad, this occurred weekly. She was verbally and physically abused by her foster
father. This contributed to her adoptive behavior to run away from home. Abuse is defined as any
action that intentionally harms or injures another person. Abuse also encompasses inappropriate
use of any substance, especially those that alter consciousness (e.g., alcohol, cocaine,
methamphetamines) (Mosbys Medical Dictionary, n.d.). She became pregnant at the age of
seventeen, by her boyfriend that is twenty years her senior. Felicity does not have custody of her
daughter; the fraternal aunt was awarded custody, because Felicity was unfit. Felicity is currently
homeless and in need of shelter, job training, mental health services, continued medical services,
and permanent housing.
Felicity stated that she was born full term pregnancy weighing seven pounds and six
ounces. No significant issues at birth. However, she reported significant developmental delays in
walking, talking, potty training, etc.
Religion
Felicity stated that she was not a very religious person. She stated that yes; they had
attended church as a family unit in her youth, but that eventually she stopped attending. She felt

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that she was a hypocrite for having questions that lead in the direction of religion not helping her
with her circumstances. She stated that her parents still attend and she did not understand why.
She stated, they are mean and hateful. How can they attend church? She stated she listened to
the pastor, but felt that the values were lost in her family structure.
Felicity began nursery school at the age of four. As she aged her issues with motor
apraxia and Aspergers did not go unnoticed. She struggled academically in school. The other
children would tease her. Since there was an age gap between her and her sister Blake
(pseudonym), they were not in the same schools together. She felt that she was alone. She stated
every time she made friends they would discontinue the friendship without reason or
explanation. This presented a problem, which was displayed by becoming disruptive in the
classroom.
Medical and Mental Health Concerns
Felicity was reportedly healthy at birth; childhood illness included Measles and Chicken
Pox. No significant family illnesses to report. Her first menses was at the age of fourteen. She
was diagnosed with Aspergers and Motor Apraxia at age two. The spectrum approach to autism
owes a lot to the recognition of Aspergers Syndrome and higher functioning autism. Han
Asperger identified a group of children who displayed pronounced autistic traits but also welldeveloped language and at least average intelligence. Autism is not a mental illness; they may
also have difficulty accessing mental health services. However, mental health problems
particularly anxiety and depression, are relatively common in adults with Autism spectrum
conditions ASCs (Pierson&Thomas,2010). Motor apraxia is the inability to follow through with
planned movements or handle small objects. The condition results from a legion in the premotor
frontal cortex on the opposite side of affected limb (Mosby Medical Dictionary,nd.). These issues

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posed as a great challenge for Felicity. She expressed how she feels pain and sadness almost

every day. She stated that it is often unbearable; she feels that it is such a struggle.
Felicity was diagnosed with Bipolar disorder at the age of eight. Bipolar disorder defined
in psychiatry as a psychosis, involving the experience of extreme moods and emotions and
formerly referred to as manic depression (Pierson&Thomas,2010). Some signs displayed in
school were, experiencing extreme highs and lows in her emotional state. She would be
disruptive in the classroom. Felicitys counselor suggested that her foster parents have her
evaluated by a therapist. After the diagnosis she was to receive behavioral therapy and cognitive
therapy. This was ongoing throughout her childhood and teen years. There is extensive literature
on the efficacy of Cognitive Behavioral Theory (CBT) for depressive and anxiety disorders.
Promising work on CBT for bipolar disorder was conducted in the mid-1980s, but it wasn't until
the late 1990s that its potential value for Bipolar Disorder (BPD) was recognized. Some of these
protocols were "component approaches" that focused on one specific aspect of disease
management. Others were more broad-based, comprehensive approaches. Of the more
comprehensive treatment approaches, Scott, Garland, & Moorhead randomized 42 patients with
bipolar disorder to either CBT or a treatment as usual wait-list condition. CBT consisted of
psychoeducation, training in medication adherence, stress management, cognitive restructuring,
and regulation of activities and sleep. At a six-month follow-up, patients who received CBT had
significantly greater improvements in depression symptoms and global functioning than patients
in the wait-list condition. Furthermore, a follow-up of 29 patients who were given the CBT after
initially receiving treatment as usual revealed a 60% reduction in relapse over the 18 months
after starting the therapy (Medscape.org). Felicity spoke of the mistreatment that she was

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experiencing at home and in school. As she got older she began to run away, because she was

being abused. She stated that if she ran away she felt like she was free from the abuse.
Felicity takes medication for her medical and mental issues. Unfortunately she has not
followed up with her providers since becoming homeless. She does not know how she will get
the medications she needs if she cannot pay for them, when she does get the opportunity to get
and new provider.
Mental Status Assessment
The initial meeting with Felicity showed a sad, hurt, distraught, and scared young
women. She did not make eye contact. She was nervous and crying uncontrollably. She shared
how she felt no one cared about her and she had no place to go. Her boyfriend abandoned her at
a local motel. She was without identification or vital documents; she stated that these items were
in the boyfriend possession. She appeared to be on the verge of a nervous breakdown. She was
upset that she only had the clothes on her back and that it is very cold.
The interventions that were put into place for Felicity were to promote emotional wellbeing. This will help with her trust issues and how she expresses herself. A behavioral
intervention will be put into place for her bipolar disorder and Aspergers. This will promote the
importance of her sessions with the social worker and medical providers. She will need
occupational therapy intervention for her motor apraxia.
Intervention Plan
The intervention for Felicitys well-being was going to allow for her to help herself and
for others to help her. She was so emotional at times that this was a major concern. With this put
into place it could promote more positive energy, which is certainly needed when you are
homeless and face many obstacles.

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The behavioral intervention is an asset for her bipolar disorder and Aspergers. Our

ability to constantly adapt to our dynamic environments is the basis for preserving psychological
and physiological health. When confronted with adversity, it is particularly important to
assemble resources to most effectively negotiate the difficult circumstance. This adaption and
accommodation to the challenges of our ever-changing environments is the basis of coping, a
method of self-preservation that is defined as, any response to external life strains that serves to
prevent, avoid or control emotional distress ( Pearlin &Schooler, 1976) (Appleby, Colon, &
Hamilton,2011). Evidence abounds that counseling clients on how to develop coping skills in
response to medical conditions can help them to identify those situations that are stressful for
them, to know when they are experiencing stress, to know how to evaluate their reactions to
stressful situations and to know how to make rational decisions about whether or not they need to
do something to change their reaction, frustration, or anger (Williams, 2008) (Appleby, Colon,
&Hamilton, 2011).

Treatment Readiness
Felicity was referred to South Oakland Citizens for the Homeless (SOCH) by Common
Ground because of the resources they felt could be better provided by SOCH. She is in need of
housing, medical and mental health benefits, new medical providers, job training, and vital
documents. All of her needs are a priority; her medications are an immediate need. She appears
to be suffering with her mental and physical health currently. Felicity is open to receiving
treatment.
Treatment Sessions and Goals

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The goals that have been put in place for Felicity are: 1) make sure that she is able to see
a social worker to receive counseling. These sessions will allow for continued needs to be met
and for progress updates. 2) Schedule her appointment with a new provider to evaluate her
mental and physical health and provide needed medication. 3) Help fill out the needed
paperwork to attain vital documents. This will help when the process begins for find her
permanent housing.
With these goals set in place, Felicity should be able to feel like she can depend on a
reliable source for help needed. She will hopefully feel safe and not so alone. Also, she will have
a social worker readily available whether her days are good or bad to help her maintain a positive
environment.
Felicity was a scared young lady when I first met her. The sessions were a means for her
to be able to speak freely, but she cried mostly. She eventually, started to talk about her boyfriend
and his mother. She talked about how his mother does not like her and she is not welcomed at her
home. She addressed the issue that her boyfriend had been married before and has other children.
She spoke of the way he has mistreated her in the past and present. Felicity stated that she knows
that it is not good to continue a relationship with him, but she felt he was all she had. The fact
that they have a child together also came up in the sessions. Felicity shared that the child is living
with the fraternal aunt. She admitted to not having seen the child in several months.
Felicity stated that she wants to gain her independence. She was tired of being hurt and
feeling like she cannot trust anyone. She wanted to be able to be helpful to others and not taken
for granted. As the sessions progressed Felicity was more upbeat and happier. She displayed that
she was feeling better about herself and she felt that her issues were being addressed.
Social Work Values and Ethics

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The values related to service of delivery were; service, the provision of help, resources,
and benefits so that people may achieve their maximum potential. Dignity and worth of the
person, holding people in high esteem and appreciating individual value.1.01 Commitment to
Clients cautions that there are times when other obligations such as those to the larger society or
specific legal obligations will supersede loyalty to clients, 1.02 Self-Determination, is each
individuals right to make his or her own decisions, 1.03 Informed Consent, worker clearly
informs client of all the facts, risks, and alternatives involved, 1.04 Competence, social worker
should be competent, 1.07 Privacy and Confidentiality, practitioners should uphold client privacy
and confidentiality (Kirst-Ashman & Hull, 2013).
It was important that Felicity be treated with the values and ethics stated, her
circumstances were challenging and needed to be addressed individually and thoroughly. She
had low self-esteem and she felt abandoned. As a social worker practitioner it is important that
the well-being of the client is first and foremost when considering service. The client needs to
have hope and possibility of issues being successfully dealt with. This provides the dignity they
deserve and shows their worth. A social worker want to build on the issues to attempt to solve a
clients issue, knowledge of this profession is important in regard to client well-being this shows
the competency on their behalf. Privacy is extremely important as this allows the social worker
to establish trust from the client.
Ethical Dilemmas
The ethical dilemmas presented in this case were the abuse that she endured, from her
foster parents and her classmates during her childhood and the current disadvantage of being
homeless. They were very pivotal to her upbringing. She needed to have a since of belonging and
trust to help her along the way. In the end she had no choice because when she turned eighteen

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the foster parents put her out. She was dealing with the boyfriend and his families distain for her.
She has lived in cars, motels, abandon building, and couch surfed. Through the sessions the
dilemmas were addressed and she has gained coping skills. The needs are being met due to the
use of extensive resources available and the social worker acting as advocate for the client also
helped to gain productive progress through difficult road blocks. As a strong advocate for the
client, the author was faced with an ethical dilemma when speaking with perspective landlords
with hopes of securing permanent housing for Felicity. Although the author was very focused on
securing housing and wanted to provide enough information to the landlords in an effort to
persuade them to rent to Felicity however, had to maintain a level of confidentiality as required
by social workers according to the NASW Code of Ethics (Kirst-Ashman, 2013).
Conclusion
In conclusion Felicity was dealt a challenging deck of cards in her lifetime thus far. Her
case was full of psychodynamics. Sigmund Freud, a physician and neurologist, developed the
first major theory of personality during the late nineteenth century. He became interested in
patients with mental health problems and encouraged his clients to explore their childhood
experiences. Freud believed that early experiences were possibly the most important factor in the
formation of adult personality and psychopathology. His contributions to psychology are perhaps
unmatched in terms of their overall influence (Schultz& Schultz, 1999; Viney & King, 2002)
(Asford& Lecroy, 2011). It is disheartening to know that someone could go through life, with so
many obstacles. Felicity has been adjusting well to the help given. Her boyfriend is trying to
communicate with her, but she is currently rejecting his advances, stating that she feels showing
restraint for someone that will do harm is not a route she continues to travel.

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Felicity is an individual case that is in a high risk environment. The everyday challenges
will arise, but she is motivated to accept those challenges for her well-being. Aspergers, motor
apraxia, and bipolar disorder in this case are being acknowledged and treated. Her fears are
finally subsiding. She has an established provider for her mental and physical health. The shelter
was able to provide transportation to and from destinations for Felicity. She is active in the
chores assigned to the clients at SOCH. She was provided additional clothing.
Felicity stated how this shelter was very beneficial to the homeless population and she
was happy that she was referred here. Although, SOCH is a seasonal shelter she felt they did
more for her in a few months than the help she has tried to receive for years. She was now
actively interacting with other client/guest of the shelter.

References
Abuse. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved May 31 2015 from
http://medical-dictionary.thefreedictionary.com/abuse medical-0
dictionary.thefreedictionary.com/abuse
Appleby, G.A, Colon, E., Hamilton, J. (2011).Diversity, oppression, and social functioning:
Person-in-environment assessment and intervention.(3rd edition).Boston, MA:Pearson Inc
Ashford, J., Lecroy, C( 2011). Human Behavior in the social environment: A multidimensional
perspective.(5th edition). Belmont CA: Brooks/ Cole.

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th
Kirst-Ashman, K. & Hull,G. (2013). Understanding Generalist Practice. (6 ed.). Mason, OH:
Brooks/Cole.
Pierson, J.&Thomas, M(2010). Dictionary of social work; The definitive A to Z of social work
and social care. New York, NY:McGraw-Hill
Psychosocial Interventions for Bipolar Disorder: A Review of the Literature: Empirical Support
for Adjunctive Psychosocial Interventions in Preventing Relapse and Sustaining 0
Remission. Retrieved June 14, 2015 http://www.medscape.org/viewarticle/570219_4
Motor apraxia. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved June 14 2015
from http://medical-dictionary.thefreedictionary.com/motor+apraxia