Course 4997: Intgv.

Seminar
Part 2 of 3: Evaluation of Client Situation
15 March 2015
Oliviah Marshall

EVALUATION OF CLIENT SITUATION

This paper is the second part of three total documents included in the integrative
paper assignment. Throughout this paper, I will carefully discuss and analyze the
presented client through an evaluation of situation. Parts of this paper will include a biopsycho social, description of interventions and a report on the empirical basis of
interventions. Ethical dilemmas and values related to the service delivery and chosen
interventions with the client will also be addressed. To support interventions in this paper,
chosen peer reviewed articles will be referenced as they relate to evidence based practice
and theory in the client situation.

EVALUATION OF CLIENT SITUATION

Bow Soardie (pseudonym) is an eleven year old Caucasian male. Bow is the only
child in his family. His parents are married, and the family lives together in Southfield,
Michigan. Bow Soardie is enrolled in mainstream classes at Maple Grove Elementary in
Southfield and is currently in the 6th grade. Recently, a 504 plan, as well as a behavior
plan for educational assistance in school has been implemented with the request of Bows
parents. Bow struggles with social relationships and maintaining friendships, often
resulting in feelings of hopelessness and action seeking behaviors, commonly seen while
at school. Bows parents suspect their child of having Autism Spectrum Disorder, and
have scheduled a psychiatric evaluation to be done at U of M in April of 2015. Bow
exhibits signs of anxiety and depression, along with traits of ADHD. For these reasons, it
is assessed that Bow would benefit with therapy. Bow attends weekly, individualized
therapy with a LMSW at the Judson Center Autism Connections in Royal Oak, Michigan.
A positive and comfortable rapport has been established thus far between the therapist
and Bow.
Aside from spontaneous visitation or impromptu sessions with the school social
worker at Maple Grove Elementary, Bow has seen other therapists in the past. Bows
parents begin treatment for their son and then report abruptly terminating services
because no one listens to them. Bows mother, Kerstin, reports his last therapist only
played games and Kerstin does not view that as a rewarding or therapeutic experience she
believes her son needs. The parents have signed documents with the social worker at
Judson Center Autism Connections to release and exchange information regarding Bows
case with his primary care provider, school and mental health clinician.

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Work history, legal history, or sexual histories are not applicable to assess at this
time in Bow Soardies personal case file.
Bows parents are strictly against medicinal treatment; Bow is not currently
prescribed or taking any medications. Client and his parents do not believe there are
present medical concerns to assess. Bow has not endured any serious mental or physical
health concerns. Bow has reported having headaches after prolonged use of a computer or
playing a video game. He reports his eyes feel tired while attending school. Bow does
not wear optical lenses, and says he can see clearly. There is not a concern of dependency
and or substance addiction within the immediate family to report at this time. Bow has a
typical, age appropriate appearance for an eleven year old male. However, it is assessed
Bow is slightly overweight and appears to wear sweat pants frequently. The social worker
has also noted that Bow walks on the back of his shoes, instead of properly putting them
on the back of his feet and tying them. There are no presenting issues with Bows hygiene
or grooming habits. Bows social affect is appropriate to the conversation, and word
fluency, as well as topic of conversational interest is age appropriate. During therapy,
Bow is willing to participate and engaged during his therapy sessions. Bow is orientated
to time, place and person and does not struggle with proper use of pronouns and ability to
view opposing perspectives.
Kerstin Soardie and Kevin Soardie (parents) have been married for 15 years. They
moved from Louisiana to Michigan in 2000. Bow is Kerstin and Kevins only child, and
it has not been assessed if the couple wanted or tried for more children, they report Bow
being spoiled. Kerstin reports that there were no complications with her pregnancy or
delivery with Bow. She reports a gestational period of 40.5 weeks and a vaginal delivery.

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Bow was over 8 pounds at birth, with no medical concerns presented. Kerstin Soardie
was born and raised in Louisiana. She reports having a tough life and many of her
family members have been medically diagnosed with disorders such a bi-polar disorder,
schizophrenia, depression and her sister committed suicide at the age of 33. Kerstin
appears to have presenting emotional issues due to the lifestyle she had as a child, and the
social worker believes she is projecting her feelings onto Bow. Kevin Soardie appears
very guarded and reports possible feelings depression. The couple has disclosed to the
social worker that they argue frequently, and do not have similar parenting styles. It has
been observed that the couple arrive to Bows therapy sessions in different vehicles, and
sit alone in the waiting area of the agency. Kerstin and Kevin are actively involved in
counseling together at Judson Center to assess and implement therapeutic treatment for
their presenting marital and parental issues. Mr. & Mrs. Soardie are actively involved in
Bows treatment. Mr. and Mrs. Soardie have participated in the development of treatment
goals and openly communicate with the therapist.
Bow does not identify himself with any religious affiliation, and does not attend
church. Bows parents have not addressed their religious background with the social
worker; however, Kerstin identified herself as Christian while completing the Judson
Center intake packet. Kevin and Kerstin own their home, and report in the agencies
intake packet of having an annual income of approximately 50,000 dollars or above.
Bows grandmother, (name not disclosed) frequently cares for him. Bow has
reported his grandmother as one of his favorite people and often stays at her house. Bow
discusses with his social worker that his grandmother plays board games with him and
they watch movies together. During breaks from school, Bow spends that time at his

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grandmothers house instead of at home. Bow states that he has friends, but only from his
previous neighborhood and that none from school. During unstructured play with his
friend, Bow states they engage in video game competitions together and riding bikes. It
has been assessed that Bow feels his friend does not have reciprocal feelings of towards
him or his accomplishments. For example, Bow has discussed with the social worker that
his friend does not want to participate in activities or games Bow initiates. Once when the
friend unlocked a challenging level in a video game, Bow provided him with praise and
positive reinforcement, however, when Bow unlocked the same level, the friend brushed
off the issue instead of acknowledging the situation. Bow has reported that his
grandmother praises him, and makes him feel important, resulting in his want to be with
her. Aside from video games, Bow has said to have an interest in Legos, riding his bike,
and Minecraft. When the social worker asked what qualities does Bow have to be a good
friend, he replied I am trustworthy, a good listener and like to have fun.
Bow reports episodes of feeling bored and reports that he does not like school.
He admits to the social worker that he hates his teachers and they never are on his side
or provide him with praise when he does a good job. In therapy, Bow stated that he had
plans to burn the school down. The therapist actively listened as Bow proceeded to
discuss his plan. He reported that he learned how to start a fire with a toilet paper roll in
boy scouts and will use the same technique to burn the school. Bow stated that no one
would be hurt because he would walk to the school alone on a weekend when no one was
there and hide in the playground as it was burning. When the social worker asked what
would happen if he got caught, Bow stated he would run and hide from the police. The
social worker provided a crisis intervention with Bow, where it was assessed Bow had

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plans to burn the school down because he did not like homework or his teachers. After
providing crisis intervention, the social worker at Judson Center Autism Connections
filed an incident report and followed up with Bows designated social worker at Maple
Grove Elementary.
Bow denies any suicidal or homicidal ideations. Bow does not have any history of
physical aggression. It is assessed that Bow is a low risk of harm to self or others. Merely
wanting to provide extinction of homework and school attendance, Bow believed his
school having no physical building would result in no school for the rest of his life. He
did not implement or carry out burning down the school. No further crisis interventions
have been reported.
Bow also expresses feeling bored at home, resulting in prolonged video game
usage (average of 5-7 hours daily). Bow states that his parents do not make him do chores
and there is no family plan at home (eating dinner together, chores, homework etc). Bow
disclosed to the social worker that he witnesses his parents fighting a lot and his mom
cries every day. He said that seeing his parents behave negatively make him feel sad.
Bow explains to the social worker that he has created a worry box for his family to use.
Bow reported that at any point in the day, a family member could write down their worry
and place it in the box. Every Friday night, the worry box would be opened and together
the family would present and discuss their worries. When the social worker followed up
with how the worry box was working at home, Bow stated that his parents did not place a
worry in the box for that week and they forgot to open it the past Friday night.
Bow discloses with the social worker that he would like to make progress in areas
of his life such as improved social relationships, time spent at school and general anxiety

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or feelings of depression. It is assessed that Bow has shown improvement in these areas
from being involved in individual and family therapy addressing emotional stability,
social and family relations, and emotional regulation. It is assessed that Bow enjoys
communicating with his peers; however Bow losses focus when interacting with others
and struggles to initiate communication. Bow and the therapist have created action steps
to work towards his goal of improving his overall area of communication. The action
steps are recorded in his initial assessment plan as, identifying three ways to initiate a
conversation and to learn three active listening skills. Bow cooperates in therapy and is
open and honest about his feelings, however, he appears to struggle with feelings of
anxiety or depression at home or school. Bow has discussed with his social worker the
goal of demonstrating emotional regulation to manage these feelings. To address his
behavior goals, the presented action steps are to learn and identify coping skills when
feeling anxious/depressed and to recognize the trigger feelings to feeling
anxious/depressed. Bow appears to maintain focus for short periods of time on topics that
are of interest to him. Often in therapy, though Bow is engaged, his body is either fidgety
or carried with a flat affect. Bow can become easily distracted and required redirection to
maintain focus, which is a common behavior reported being observed in him at school.
To assess Bows goal of increasing his focus and attention (especially in areas of
disinterest) Bow will learn and identify three ways to maintain focus, and three triggers to
becoming distracted.
This therapist currently provides Bow therapeutic interventions such as psychoeducation, cognitive behavior therapy, modeling, praise and reinforcement. The therapist
reports feedback, areas of concern and areas of improvement to Bows parents, Kerstin

EVALUATION OF CLIENT SITUATION

and Kevin Soardie. During therapy, the social worker may present activities of
mindfulness, choice of perspective and implements the use of open ended questions while
using active listening skills and consistent engagement with nonverbal communication.
After committing and staying actively involved with individual therapy, it has been
assessed that Bow would benefit from using additional services at the Judson Center such
as Kids Night In and Social Zone. These groups have a recreational theme and provide a
forum for our participants to gather together in a social environment. Social interaction
skills are addressed but through in-the moment (incidental) teaching opportunities as they
naturally occur in interactions. Overall, these groups aim to give our participants a fun
and comfortable environment where they can make connections with their peers (IDG
Solutions Corporation, 2015). The presented programs will further strengthen Bows
social skills, as well as assist him with emotional regulation especially focusing on
compromise and friendly relationships with other peers in the group. Once Bow becomes
of age, he can join Gamers Group to interact with other peers having similar gaming
interests as he does.
This therapist implements session with a person-centered intervention focus.
The clients right to autonomy and self-management are supported not only by this
therapist, but by the mission of Judson Center, as well. Though Bow is a minor, he is very
active in his treatment plan, and this therapist is open as well as operates session with a
strength based perspective. This therapist practices psychotherapy, relying heavily on
cognitive behavior therapy (CBT). Psychotherapy, also known as talk therapy, is when
a person speaks with a trained therapist in a safe and confidential environment to explore
and understand feelings and behaviors and gain coping skillsStudies have found

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individual psychotherapy to be effective at improving symptoms in a wide array of
mental illnesses, making it both a popular and versatile treatment (NAMI, 2015). This
intervention is appropriate in treatment relating to Bows depression and anxiety
regulation. With Bow working towards his treatment goals through objective action steps
that teach him to assess and understand the negative trigger before his unwanted
behavior, this is using cognitive behavioral therapy. Individuals who undergo CBT show
changes in brain activity, suggesting that this therapy actually improves your brain
functioning as well. Cognitive behavioral therapy has a considerable amount of scientific
data supporting its use and many mental health care professionals have training in CBT,
making it both effective and accessible (NAMI, 2015). In therapy, the social worker has
also used techniques of mindfulness. In a previous session, Bow was asked to draw
anything he wanted on a piece of blank paper. After a few minutes, Bow was asked to
look deeply into the picture, then close his eyes and visualize with each sense what was
interpreted from the picture. This form of therapy was to help Bow focus on the now,
while relaxing and using detail to express himself not only with though, but every part of
his body. Two important aspects of mindfulness become valuable in the treatment of
mental disorders and substance abuse: First, exercises in purposeful awareness can build
capacity in dealing with the ruminative thought-affect cycles which tend to exacerbate
depression and anxiety for those with mental illness; and second, having the skill to
recognize thoughts, feelings, and body sensations through mindfulness may serve as an
early warning system of an impending depressive or vulnerable episode (Segal, 2001 as
cited in Hanfling, 2010). While in therapy, this social worker provides Bow with skills of
active listening, follow up questions and praise. Since Bow struggles with emotional

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regulation, this therapist believes providing additional praise will help Bow to recognize
the positive in him. Allowing the use of open ended questions gives Bow the opportunity
to speak exactly what is on his mind, with trusting that his thoughts and feelings are kept
confidential. These therapeutic interventions also assist Bow with communication skills,
emotional and social regulation.
When providing services and interventions, social workers have been criticized
in a number of areas and are not always viewed in a positive light. Social workers are
often thought to be untrained, uncaring and disruptive in the lives of clients. In a recent
report in 2007 by Peter Beresford on client feedback, it was found that clients frequently
complain that little social support is provided by social workers and prevention services
are rarely available. Clients continue to feel stigmatized and looked down upon after
working with a social worker. There remains a need for continued efforts to improve and
strengthen the role of social workers as they intervene in the lives of those with whom
they work (Bresford, 2007 as cited in Humphry, 2010). The stigma towards this
consideration does not provide a social worker with a positive reputation. It can
negatively impact opinions of social work clientele as well as violates many codes of
ethics relating to the NASW. Ethical principles such as service, social justice, dignity and
worth of the person are falsely treated by the social worker related to this consideration.
As a social work therapist at Judson Center Autism Connections, ethical dilemmas are
constantly endured. In the situation of Bows parents strictly being against the use of
medicinal treatment, the presenting social worker may find it difficult for a
breakthrough with therapy alone. Bows behaviors could be affected and treated
differently should a prescription for presenting symptoms be prescribed. In this case, if

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there is only partial or no progress made towards the assessed goals with merely
psychotherapy, the social worker may have to terminate the case and refer Bow to a
higher mental health provider. This social worker believes medical intervention is a
positive treatment when combined with the use of therapy. The social worker is presented
with the ethical dilemma of further discussion regarding medical treatment for Bows
behaviors when Kirsten and Kevin have made it clear multiple times they do not want
their son to have a prescription diagnosis for his presenting behaviors. Should Bow be
prescribed an anti-depressant medication, his body would naturally go through changes to
adapt to the drug. It often takes two to four weeks to begin having an effect, and an
additional six to 12 weeks for antidepressants to have their full effect. (NAMI, 2015).
During this time, the social worker can monitor with Bow and his parents the behavioral
changes, as well as assess or suggest different medications or dosage amounts. Though
research demonstrates that a combination of medication and psychotherapy is often the
most effective treatment for depression (NAMI, 2015), Bows parents seek only the
implementation of psychotherapy for their son. In this situation, to not violate the clients
values, the Judson Center Autism Connections, as well Bows social worker will need to
respect Kirsten and Kevins view of medicinal treatment. This therapist must continue to
be professional to the clients choice related to the situation, and place additional focus on
areas such as client-in-environment, cognitive behavioral therapy and mindfulness to
treat Bow.
After Bow undergoes scheduled psychiatric evaluation in April of 2015, resulting
in proper diagnosis, further treatment will be properly discussed. A thorough examination
of Bows presenting needs and behavior concerns relating to his diagnosis will be

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updated as well as assessed. At that time, a new treatment plan will be implemented for
therapy, and should medical intervention be introduced, the parents will be provided with
resources and furthering therapy for their concerns. It is assessed that Bow will continue
to benefit with continued therapy at Judson Center.

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This paper assessed the description of interventions presented in Judson Center
therapy with eleven year old client, Bow Soardie. His presented behaviors were analyzed
and presented onto a treatment plan, with relation to the clients views of his current
reported problems. Included in this document was a bio-psycho social for Bow Soardie. A
report on empirical basis of interventions such as psychotherapy, focusing on CBT and
usage of mindfulness was discussed. Other therapeutic techniques such as active
listening, praise, engagement, open ended questions and nonverbal communication were
also reported. Values of ethical dilemmas related to Bows case were correlated to the
NASW code of ethics, and service delivery was also assessed. Peer reviewed entries were
documented as they were used in text.

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Beresford, P. (2007). The Roles and Tasks of Social Workers.

Humphrey, F. A. (2015). What is Social Work Intervention. (Demand Media) Retrieved
from eHow: http://www.ehow.com/about_5410009_social-work-intervention.html
Hutchinson, L. (2010, November 30). Biospychosocial Assessment Example. Retrieved
2015, from Blogspot. Social Work Exam Review: Test Prep ASWB LCSW
Exams. Case Studies: http://socialworkexamreview.blogspot.com/2010/11/24biopsychosocial-assessment-example.html
IDG Solutions Corporation. (2015). Social Skills Groups. Retrieved from Judson Center:
http://www.judsoncenter.org/autism-connections/programs/social-skills-groups
Mallory Hanfling, M. (n.d.). Mindfulness as an Adjunct Intervention With Dually
Diagnosed Individuals. Retrieved 2015, from Social Work Today :
http://www.socialworktoday.com/archive/exc_052511.shtml
NAMI. (2015). Psychotherapy. Retrieved from National Alliance Mental Illness:
http://www.nami.org/Learn-More/Treatment/Psychotherapy
NAMI. (n.d.). Depression. Retrieved from NAMI. National Association Mental Illness:
http://www2.nami.org/Template.cfm?
Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&Cont
entID=88858
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2001). Mindfulness-based cognitive
therapy for depression: A new approach to preventing relapse. New York:
Guilford Press.
Workers, N. A. (2008). NASW Code of Ethics (Guide to the Everyday Professional
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Conduct of Social Workers). Washington, DC: NASW.

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