Reference no: EM133226174

Michael was a 10-year-old African-American male. Michael lived with one younger brother, age 8, and an older brother, age 17, who was in and out of the home due to educational problems at the nearby University. Two additional older siblings did not live in the home: one brother, 23, and one sister, 26, who also just had a baby of her own. Michael and his family lived in middle-class suburban community. Michael was a fourth-grade student at the local city magnet elementary school. He was referred to the school-based mental health provider by the assistant principal. Michael was becoming increasingly defiant and unwilling to comply with the rules and regulations of the school. Michael experienced drastic mood and behavioral swings from day to day. He would be a model leader one day, and then the next refuse to follow any directions and be a distraction to the entire class. Michael argued with his teachers and refused to complete assignments. During class, Michael would beat pencils on the table, attempt to talk to anyone around him, or try to engage the entire class. At times, he became physically and verbally aggressive with peers. Michael would be intentionally annoying to others and spent more than 50% of the school day in the office 2 to 3 times a week. Michael had not received mental health services before being referred, and it took several months to foster buy-in from Michael's mother. Michael's home life had always been chaotic, with many moves and instabilities. Michael did not know his biological father growing up, but he did have a stepfather in the home until he was 9 years old, when his stepfather died from an opioid overdose. After this, the family moved closer to Michael's mother's family at this time, and Michael's biological father began to reach out © 2019 Laureate Education, Inc. 2 for a relationship. Before his stepfather died, there were several instances of domestic violence in the home. Michael's mom always believed that the children never saw any of the violence, but they lived in the same home and heard the fights and arguing. Before Michael's stepfather died and the family was forced to move, Michael was a "model" son and student in previous schools, according to his mom, school staff, and by self-report. He was a leader in his class and was on the A/B honor roll. Since starting at his new school, Michael was emotionally dysregulated and outraged. He was no longer able to focus and became easily irritated. Michael still wanted to be a leader, but his erratic moods and aggressive behaviors hinder his ability to do so. Michael has also watched his brother go through student court, dean's review, and eventually be expelled from his educational program due to getting caught drinking while underage. After the move, the family struggled to find stability and security. Michael's mom had a difficult time finding a job, and because of this, after 6 months in the area, the family found themselves in a situation where their house was being foreclosed on and they had to move in with extended family. This move put the family in the middle of one of the most rural parts of the area. Michael's level of insight into his behaviors and thinking patterns was very high. He was able to process cognitively appropriate and inappropriate responses to situations when he is in a calm state of mind. Michael was an intelligent young man and was able to use that intelligence to connect his thoughts and his feelings. He wanted to be a good role model to younger kids and was helpful in working with kindergarteners in the mornings at school. The recommended treatment was outpatient therapy within the © 2019 Laureate Education, Inc. 3 school, as well as family sessions to address the stressors in the home setting. Michael's goals for treatment were to increase his ability to maintain appropriate interpersonal relationships and regulate his emotions as evidenced by participating in cognitive-behavioral therapy, identifying 5 contributing factors to his "bad attitude"; complying with adults 4 out of 5 times on the first prompt; processing past traumatic events; learning, practicing, and implementing 5 emotional regulation skills; and learning self-regulation. Therapeutic rapport building was the first step I took with Michael and his family. The family needed support to be able to process events and talk about emotions. Michael responded to the positive attention, but his mother remained guarded and unwilling to participate actively. Cognitive-behavioral therapy (CBT) was the modality of choice. Michael was able to connect to the thinking strategies and identify how thoughts and feelings are linked to each other. Michael and his family struggled to open up about personal emotions and the history of violence and abuse within the household. I spent a lot of time during family therapy sessions discussing appropriate and inappropriate ways of communication. Just a few months after Michael began services, the family moved away. To find a job, mom moved the family out of state with a month left in school. The family did not engage in any mental health services while living in another state. At the beginning of the new school year, the family had moved back and intro a lower income neighborhood and reentered mental health services in the school. The family's new neighborhood was not as chaotic, but was a home to one of the city's major gangs. Upon Michael's return, his symptoms were more severe, including becoming more © 2019 Laureate Education, Inc. 4 physically aggressive with peers. Therapeutic rapport had to be reestablished, and my consistency and follow-through became an important factor in that development. After returning to services, Michael's mom refused to acknowledge that there were any concerns at home and be directly involved in treatment. The interventions at this point were directly focused on Michael individually, but I still attempted to call his mom every other week to engage her in Michael's progress and discuss any concerns from home. Michael was engaged during therapy sessions, initially learning selfregulation activities such as blowing up balloons to practice deep breathing, muscle relaxation through trying to move walls, and coloring Mandalas. After engaging in the self-regulation activities, Michael and I began to focus on CBT techniques. Michael learned to process a situation and identify how automatic thoughts affected his feelings and behaviors when separated from the situation and in a calm state of mind. Michael was able to identify some of his automatic negative thoughts. He was unable to talk specifically about traumatic personal events or any related feelings, but did engage in discussions about trauma and trauma responses as well as the effects of trauma on thoughts and feelings. I showed Michael how trauma can affect the brain using the diagram of our brain as a fist with our fingers being cognitive processing, our thumb as the trigger to fight, flight, or freeze, and our palm as the survival part of the brain. Michael related to this demonstration and was able to identify being in the survival part of his brain when he is angry and that he is unable to access the cognitive part of his brain. Michael was unable to meet his goals, and his behaviors in the school setting continued to be out of control. Michael was unable to identify and acknowledge any © 2019 Laureate Education, Inc. 5 trauma experiences in his past. He will continue working toward his goals and being able to transfer the strategies he has learned to times when he feels out of control. Michael's family will be the biggest challenge moving forward, and getting their involvement is a crucial factor in the success of treatment. It would be beneficial for the family to become involved in a higher level of care, such as intensive in-home or possibly multi-systemic therapy.

Webb, N. B. (2019). Social work practice with children (4th ed.). New York, NY: The Guilford Press.

• Chapter 9, "School-Based Interventions"

D'Agostino, C. (2013). Collaboration as an essential school social work skill. Children & Schools, 35(4), 248-251. Quinn-Lee, L. (2014). School social work with grieving children. Children & Schools, 36(2), 93-103.

• Define the problem.
• Formulate a theory-based treatment plan including short- and long-term goals for the couples and/or families.
• Describe two theory-based interventions you would use and justify your selection.
• Explain one anticipated outcome of each.