SWRK-CAFT 630 Risk and Resililence Framework 2021

ADULT MENTAL HEALTH Risk and Resilience and Treatment Planning Framework You will utilize this framework in assessing cases presented in class; this will also be the basis for short paper assignments throughout the semester. You may or may not be able to complete all of these elements for all cases; and, there may be elements missing from this grid that you may want to add. Student’s Name: Atousa Saadati Date: February 2024 Case Study Name: Maria Diagnostic Category: Major Depressive Disorder (MDD), with Comorbid Alcohol Use Disorder (AUD) Clinical summary and initial diagnostic formulation with respect to DSM-5 criteria, including (refer to case and to the DSM-5): a. What symptoms does the service user exhibit and/or describe? 1- Depressed Mood: Maria reports feeling "low" for several years, which worsened after her divorce. She expresses sadness, exhaustion, and low motivation. 2-Maria experiences decreased pleasure or interest in activities she used to enjoy, such as cooking and caring for the house. 3-Sleep Disturbance: Maria Maria has difficulty falling asleep, frequently wakes up during the night, and sleeps during the day, indicating disrupted sleep patterns. 4- Appetite Changes: She has little appetite and tends to eat “junk food” 5- Feeling of Guilt and worthlessness: Maria feels guilty about her children's decision to live with their father and may harbor feelings of worthlessness due to the changes in her family dynamic. 6-Experience Irritability: Maria has been described as often being irritable, which may contribute to her interpersonal conflicts, especially with her ex-husband and children. 7-Alcohol Use: Maria”s alcohol consumption has increased significantly over the past few months. She uses alcohol as a copig mechanism, experiences hangovers, and has had incidents of driving while intoxicated. Her alcohol use contributes to mood disturbances, disrupts her sleep, and affects her ability to function during the day. 8- Suicidal Ideation: Maria has expressed thoughts of wanting to die, indicating suicidal ideation, though she has not made any past suicide attempts or formulated a plan. 9- Social Withdrawal: Maria has withdrawn from socializing and has not been feeling up to social interactions since the divorce. 10- Financial Stress: Maria is experiencing financial problems, including a large credit card debt and reduced income due to being on sick leave from work, contributing to her overall stress and anxiety. 11- Totally based on the information provided in the vignette there are indications of impulsivity in Marias behavior, especially concerning her alcohol use and risky Behaviors like: -Alcohol Use as her alcohol consumption has escalated over the past few months. She engages in heavy drinking episodes, often consuming multiple drinks in one sitting, both at home and when visiting the casino. This pattern of drinking suggests impulsivity in her decision-making regarding alcohol consumption, as she may not consider the consequences or moderation. -Gambling: Maria visits the casino for fun and engages in gambling activities, such as playing slots or blackjack. While gambling itself may not always indicate impulsivity, her heavy drinking while at the casino and the associated financial losses suggest impulsive behavior. -Driving while Intoxicated: Maria admits to driving home from the casino while intoxicated on multiple occasions. This behavior is highly risky and demonstrates

ADULT MENTAL HEALTH Risk and Resilience and Treatment Planning Framework You will utilize this framework in assessing cases presented in class; this will also be the basis for short paper assignments throughout the semester. You may or may not be able to complete all of these elements for all cases; and, there may be elements missing from this grid that you may want to add. impulsivity, as she prioritizes getting home quickly over the safety of herself and others on the road. -Financial Management: Maria has accrued a large credit card debt and is struggling financially, yet she continues to engage in activities like gambling and heavy drinking. This suggests impulsivity in her financial decision-making, as she may prioritize immediate gratification over long-term financial stability. 12- Maria’s disturbances encompass various aspects of her life, including her relationships, emotions, coping mechanisms, self-care, and thoughts of self-harm. Addressing these disturbances comprehensively is essential for her well-being and recovery. b. What additional symptoms do family members describe, if any? Maria's children and ex-husband, describe additional symptoms related to Maria's behavior and emotional state. Here are the additional symptoms described by family members: 1- Concern’s about alcohol use: Maria's children and ex-husband have expressed concerns and criticisms about her alcohol use. They have noticed her drinking behavior, especially before they decided to live full-time with their father. They find her apartment messy and worry about her overall emotional state, which suggests that they perceive her alcohol use as problematic and affecting her ability to care for herself and manage daily life. 2- Impact of family dynamic: Maria's children have chosen to live full-time with their father, indicating that they feel more comfortable and supported in his household. This decision may be influenced by Maria's behavior, including her irritability, neglect of household chores and cooking, and emotional distress. Her children's reluctance to visit her and their concerns about her well-being suggest that Maria's behavior has impacted their relationship and family dynamics. 3- Expressed concerns and criticism: Maria's ex-husband, Michael, has expressed concerns and criticisms about her alcohol use and behavior. He has blamed the breakdown of their marriage on Maria's alleged emotional detachment and the need for her to seek help. Michael's concerns and criticisms indicate that he perceives Maria's behavior as problematic and affecting their family life. c. Is the symptom pattern consistent with a DSM-5 diagnostic category? If so, justify your position. If not, explain why. I believe that Marias symptoms correspond with DSM-5 diagnostic Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD). 1- According to DSM-5 criteria, a diagnosis of MDD requires the presence of five or more symptoms during the same 2-week period, representing a change from previous functioning. These symptoms include depressed mood most of the day, markedly diminished interest or pleasure in activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicidal ideation. Also, Maria exhibits several of these symptoms, including depressed mood, diminished interest in activities, insomnia, fatigue, feelings of guilt, and suicidal ideation, suggesting a diagnosis of MDD. 2- DSM-5 outlines 11 criteria for diagnosing AUD, including problematic patterns of alcohol use leading to clinically significant impairment or distress. These criteria encompass aspects such as tolerance, withdrawal, unsuccessful attempts to cut down or control use, spending a great deal of time obtaining or using alcohol, and continued use despite social or interpersonal problems caused or exacerbated by alcohol . Maria meets several of these criteria, such as unsuccessful attempts to cut down on drinking, continued use despite adverse consequences (e.g., hangovers, strained relationships), and using alcohol as a coping mechanism for distress

ADULT MENTAL HEALTH Risk and Resilience and Treatment Planning Framework You will utilize this framework in assessing cases presented in class; this will also be the basis for short paper assignments throughout the semester. You may or may not be able to complete all of these elements for all cases; and, there may be elements missing from this grid that you may want to add. Adapted from Corcoran & Walsh (2014) and Petrovich & Garcia (2016) Risk Factors (for onset and course of disorder) Resilience Factors (for onset and course of disorder) a. Goals for Intervention b. Intervention or Treatment 1. Biological · Heritability · Temperament · Intelligence · Physical Health · Developmental Stage - Her mother had a history of undiagnosed mental health concerns & mood swings so Maria may be genetically predisposed to mental health issues, increasing her risk for depression or other mood disorders - Parents' immigration, her father's death, and her recent divorce - Excessive alcohol consumption and irregular sleep patterns - Ability to recognize and seek help for her struggles, as evidenced by her willingness to engage with a SW & explore her alcohol use. - Maintaining employment and seeking support from her sister and medical professionals. - to identify potential solutions to her challenges, such as finding a new job to improve her financial situation & seeking counseling for her mental concerns. - Seeking medical help and counseling - Adjusting to her children living with their father and rebuilding her life after divorce . Goals - Stabilize alcohol use -Improve sleep quality -Adress genetic vulnerabilities Intervention/Tx - Offer evidence- based interventions such as cognitive- behavioral therapy for substance use disorder s (CBT- SUD) - Provide education on sleep hygiene practices, relaxation techniques, and cognitive- behavioral therapy for insomnia (CBT- I) to help Maria achieve better sleep quality 2. Psychological · Self-efficacy and self-esteem · Self-regulation and emotion regulation · Stress & Coping style/strategies · Cognitions · beliefs - Her self-esteem appears to be low, especially after the divorce. She feels guilty about her children's decision to live with their father and is frustrated by her inability to meet their needs. - ability to regulate her emotions seems impaired, as she resorts to alcohol as a coping mechanism, experiencing temporary relief but worsening mood the following day. - financial difficulties, strained relationships with her children and ex-husband, and the recent divorce. Her coping strategies, such as alcohol use and gambling, are maladaptive and exacerbate her problems rather than alleviating them. - Maria exhibits negative thought patterns, feeling - Supportive sister who actively checks in on her and tries to help (social support). - Maria has been referred to a crisis support unit for short-term counseling and other services. - Despite her ambivalence toward medication & initial dismissal of concerns about her alcohol use, Maria is beginning to acknowledge the need for help. - She is starting to question her alcohol use and its impact on her life. Her self-awareness is a crucial first step toward initiating change & seeking help for her substance abuse issues. - Improve emotion regulation & coping skills -Reduce alcohol misuse -Enhance self- esteem & self- efficacy - Provide Maria with cognitive- behavioral therapy (CBT) or dialectical behavior therapy (DBT) techniques to enhance her emotion regulation skills and develop healthy coping strategies. - Offer Maria access to substance abuse treatment

ADULT MENTAL HEALTH Risk and Resilience and Treatment Planning Framework You will utilize this framework in assessing cases presented in class; this will also be the basis for short paper assignments throughout the semester. You may or may not be able to complete all of these elements for all cases; and, there may be elements missing from this grid that you may want to add. overwhelmed, guilty, and hopeless. Her belief that alcohol helps her cope may perpetuate her reliance on it despite its negative consequence. programs, such as counseling or support groups Provide psychoeducation on the effects of alcohol misuse 3. Trauma · Attachment-related · Traumatic event(s) across the lifespan · Chronic trauma · Intergenerational trauma · Racial/Indigenous trauma - Experienced the loss of both her parents at different stages of her life. The death of her father when she was fourteen likely resulted in significant emotional distress and disrupted attachment bonds. - The deaths of her parents, her parents' divorce, and her recent divorce from her husband of 21 years. These events have likely contributed to her feelings of sadness, grief, and loss. - ongoing marital conflict, financial struggles, and substance misuse are some forms of chronic trauma. -Intergenerational trauma: undiagnosed mental illness in her mother and potentially problematic drinking behavior in her father - supportive sister who provided emotional support in her difficult time. - her access to crisis supports services and has been referred for short-term counseling - She identifies as Italian-Canadian and Catholic, and used to go to church, which may provide her with a sense of cultural & spiritual connection that can serve as a source of resilience and support. - Awareness and insight regarding her struggles with alcohol use and emotional distress, as she had willingness to question her drinking behavior and engage in discussions about her mental health with SW. - Process &heal from traumatic loss -Improve attachment and relation dynamic - Address chronic trauma &stress management - Offer her grief counseling or therapy involving exploring her feelings of sadness, anger, and guilt, & working through unresolved emotions related to her parents' deaths. -Techniques such as narrative therapy, expressive arts therapy, or EMDR (Eye Movement Desensitization & Reprocessing - Provide Maria with family therapy or interpersonal therapy 4. Family Systems · Life Cycle Events/Development · Nature and quality of family relationships · Expressed Emotion (For further elements, scroll down for a wide array of other factors to consider here; insert any/all that may apply) - Maria's recent divorce from her husband Michael after 21 years of marriage is a significant life event that can cause emotional distress and disrupt family dynamics. - Maria experienced the loss of both parents at different stages of her life, which may have impacted her emotional well-being and family relationship. - Clients emotional state is characterized by anger, frustration, sadness, and guilt. - Conflicts with her ex-husband and concerns - Supportive sister who plays an important role in her life and provides emotional support and helping to mitigate the impact of expressed emotion, despite her busy schedule. - Improve communication and coping skills - Reestablish healthy boundaries and roles - Address substance use and gambling issues - Family therapy sessions - Individual therapy for Maria to explore her emotions, develop healthier coping mechanisms - Establish clear boundaries between

ADULT MENTAL HEALTH Risk and Resilience and Treatment Planning Framework You will utilize this framework in assessing cases presented in class; this will also be the basis for short paper assignments throughout the semester. You may or may not be able to complete all of these elements for all cases; and, there may be elements missing from this grid that you may want to add. 5b. Social · Friendship network/nature and quality of relationships · Affiliation/access to formal networks and organizations · Affiliation/access to informal networks and organizations - Clt.'s social network appears to be limited, she is living alone & experiencing difficulties in maintaining relationships with her children &ex-husband - Limited affiliation/access to informal network and organization - Clt. 's current employment situation & recent sick leave may limit her access to formal networks & organizations, such as workplace social circles or professional association. - Clt. 's reliance on alcohol & gambling as coping mechanisms may isolate her further from informal support networks, as these behaviors can strain relationships & lead to social withdrawal. - Clt. has a supportive sister, Carmella, who has demonstrated concern for her well-being. - Clt. 's upcoming return to work presents an opportunity for her to re-engage with formal networks & organizations within her workplace - Clt. 's interest in exploring her career options and pursuing new employment opportunities could expose her to informal networks and social circles. - Expand &strengthen social support network like increase Maria's social connections & improve the quality of her relationships -Enhance access to formal networks & organizations like help her to establish connections with formal networks and organizations to access resources - Facilitate participation in support groups or therapy sessions. - Provide information & resources about employee assistance programs, counseling services, or support groups 5c. Safety · Suicide Risk Assessment · Interpersonal violence (victim/perpetrator) · Other safety concerns - Client expressed feelings of exhaustion and thoughts of wanting to die, indicating a potential risk of suicide. - Clt. 's excessive alcohol consumption, particularly when driving home from the casino while intoxicated. - Clt. 's overall emotional state, characterized by anger, frustration, guilt, and low motivation, may impair her judgment and decision-making - Client was referred to a brief crisis support unit following her visit to the emergency department, indicating access to immediate mental health support& intervention - Clt. 's willingness to explore her alcohol use with the SW shows a degree of insight & openness to addressing her substance - Suicide risk assessment - Address alcohol misuse & substance use concern - Conduct a comprehensive suicide risk assessment - Connect clt. with ongoing mental health support, such as individual therapy or support groups - Develop a safety plan collaboratively with Maria, which includes identifying triggers, coping strategies, social support networks, & emergency contacts. 6a. Structural Factors · Immigration status - Clt. 's family immigrated from Italy, which might contribute to feelings of dislocation or - Clt. 's ability to hold a job and seek help for her mental health concerns demonstrate her resilience and - Explore structural barriers & enhance - Conduct a cultural assessment

ADULT MENTAL HEALTH Risk and Resilience and Treatment Planning Framework You will utilize this framework in assessing cases presented in class; this will also be the basis for short paper assignments throughout the semester. You may or may not be able to complete all of these elements for all cases; and, there may be elements missing from this grid that you may want to add. · Intersectionalities (ethnicity/race, sexual/gender identity, socio-economic status, disability) · Historical cultural stigmatization, marginalization, racialization cultural adjustment challenges. - Clt. identifies as Italian-Canadian, which may influence her experiences of marginalization or discrimination based on ethnicity. - Being a divorced woman, Clt. might face socio- economic challenges & stigma related to her marital status. - Clt. 's family history includes instances of undiagnosed mental health concerns and stigmatization willingness to address challenges. - Clt. has social support cultural competence - Mitigate intersectional challenges& promote equity - Collaborate with community organizations or cultural groups that specialize in providing support services to individuals from immigrant backgrounds or specific ethnic communities - Provide psychoeducation on the intersectionality of various identities (e.g., ethnicity, gender, socio- economic status) 6b. Neighborhood · Physical environment · Access to resources - Clt. may face to challenges accessing essential resources such as affordable healthcare services, mental health support, and community centers - Clt. 's sister e efforts to accompany Maria to the emergency department when she expressed suicidal thoughts demonstrate a strong support system within the family. - Living in a suburban area like Laval may offer access to recreational facilities 7. Spiritual / Cultural · Personal / Family/ Cultural nature of connection with faith/religion/sense of meaning and purpose, sense of hope Cultural · Connection/lack of with culture/cultural group, acculturation processes Culture-specific definitions of strength & well- being