Running Header: EVALUTATION OF CLIENT SITUATION

EVALUATION OF CLIENT SITUATION
Jodie Annis
fi1274
Wayne State University
Lori Klein-Shapiro, LMSW

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Abstract
This report includes a biopsychosocial report of a client that presented to this
student during a Wayne State University field placement. In addition to the
biopsychosocial report, the client’s perspective of the problem and interventions are
included. Interventions included education on trauma response, self-care, and play
therapy. Peer-reviewed articles are referenced to explain why each intervention was
chosen. Ethical dilemmas that were encountered during treatment are also discussed.

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Susan Johnson is a 46 year old single, adoptive mother of six, referred by Child
Protective Services (CPS) to Post Adoption Resource Center (PARC) for Services.
After requesting her parental rights be terminated to her oldest son, an investigation
substantiated child abuse within the home. Ms. Johnson’s oldest son was placed into a
guardianship, allowing Ms. Johnson to maintain her parental rights without being
required to provide his daily care. Services were then put in place to aid Ms. Johnson in
gaining the needed skills to properly parent her five children that remained in the home.
Biological
Ms. Johnson sees a counselor bi-monthly to help her cope with the stressors of
parenting six emotionally challenged adopted children. She reported taking no
medications and having no history of mental health concerns or treatment. Ms.
Johnson reported that she is in good health and is currently taking no medications.
Ms. Johnson has two siblings, a younger sister, and older brother. She reported
that both of her siblings are in good health. She reported that her family has a history of
breast cancer, but at this time neither she nor her sister have any signs of this disease.
Ms. Johnson’s father was killed in a tragic accident. At the time of his death, he was
healthy with no known health concerns. Ms. Johnson reported her mother to be
physically healthy, but having emotional or mental concerns that go untreated.
Ms. Johnson reported that she began experimenting with alcohol when she was
approximately 17 years old, but never developed any alcohol dependence. She
reported that she currently drinks approximately one glass of wine monthly. Ms.

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Johnson reported that to her knowledge, no one in her extended family has ever had a
history of substance abuse.
Ms. Johnson reported that her children’s medical doctor has suspicions that three
of her adopted children may have Fetal Alcohol Spectrum Disorder (FAS). She stated
that their information processing and emotional maturity is not equivalent to that of their
peers. Ms. Johnson is currently in the process of having each of her children tested.
Ms. Johnson reported that five of her children are on medication for Attention
Deficit Disorder (ADD), and four are on additional medication to stabilize their mood.
She reported that these medications help them to function appropriately in school and
maintain good relationships with their family and peers. At this time, Ms. Johnson
reports their condition as stable.
Psychological
Ms. Johnson identified herself as an independent woman with poor self-care
skills. She reported that she has a high level of stress in her life due to her children
having high emotional needs and lacking a life partner. Her six adopted children are all
reported to be special needs, due to cognitive and emotional issues, as well as their age
at the time of their adoption.
Recently, after her oldest adopted son became increasingly violent and
threatened Ms. Johnson’s life, Ms. Johnson reported that her stress level was the
highest she had ever experienced. With the increased stress and lack of resources,
Ms. Johnson felt she could no longer meet her son’s needs, forcing her to pursue
alternative living arrangements for him. She contacted the PARC for assistance. She

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learned that the PARC can only assist with keeping families together not with
permanent separation from their families. This information brought on feelings of
desperation in Ms. Johnson. She began pursuing termination of her parental rights
through Child Protective Services.
Part of the termination process is a family assessment to determine if any
parental abuse is occurring in the home. During this investigation, it was discovered
that Ms. Johnson was in fact using inappropriate forms of corporal punishment.
Specifically, she had slapped her children in the face and pulled their hair. Ms. Johnson
reported these behaviors to Child Protective Services as unusual behaviors for her.
These behaviors seemed to be a reflection of the intense level of stress she was
enduring without any relief from supports in her life.
Ms. Johnson’s son was moved into a guardianship where he can remain until he
graduates from high school. Ms. Johnson reported that prior to her son leaving the
home, life felt hopeless. She stated that her children were all afraid of their brother and
that they were beginning to learn his behaviors. Since he was removed from the home,
all of the children’s behaviors have been returning to a calmer state. Ms. Johnson
reported that she is again feeling hopeful about life. She stated that her oldest son is
also thriving in his new home and is not acting out in the same ways he was with her.
Social
Ms. Johnson obtained her Bachelor’s degree in education. She currently works
as a fifth-grade teacher in a small rural community. She has been working within this
school system for fifteen years. Prior to this position she maintained steady

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employment within the educational system. She self-reported that her colleagues, at
her current place of employment, are a good support for her, and the staff is like family
to her.
Ms. Johnson lives in a modest, maintained home in a very rural community. Ms.
Johnson reported that her earnings are just enough to get by. She stated that although
her family’s basic needs are all met, it can be difficult to have any extras. Ms. Johnson’s
children are provided health insurance through state Medicaid. This is the only state
aid, besides adoption subsidy that the family receives. Due to Ms. Johnson’s single
income and large family, she may qualify for more services such as Food Assistance,
but chooses to not pursue these options.
Ms. Johnson is a single, heterosexual woman. She reported that she has never
been married. She is currently not in a romantic relationship. She stated that it had
been years since she was intimately involved with anyone. Ms. Johnson reported that
she is not currently seeking any romantic relationships.
Ms. Johnson grew up in a Baptist church. This was a positive experience for her
that she intends to pass on to her children. The Johnson family attends church
regularly. Ms. Johnson reported that her church community is a large support to her.
She stated that she gains comfort from attending church and reading the Bible.
The Johnson family is very actively involved in extracurricular activities within the
public school system. Ms. Johnson’s two oldest daughters play basketball and
volleyball, while the younger children are involved in intramural soccer and baseball. In
addition to these sports, all of the children take private piano lessons. Ms. Johnson

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reports that these activities are a priority for her. While she stated she enjoys attending
all of their events, she admits that it leaves her little time to tend to her own personal
needs.
Problem: Client Perspective
Although Ms. Johnson was required to receive some type of intensive services
by CPS, PARC only works with clients on a voluntary basis. Therefore, Ms. Johnson,
though mandated to participate, also personally desired to improve her stress
management and parenting skills making her participation voluntary.
Ms. Johnson displayed a positive attitude, yet her description of her problem did
not match that of CPS. Subsequently to Ms. Johnson’s request to terminate her
parental rights, CPS reported problems within the home. Specifically, the investigation
revealed that Ms. Johnson was using inappropriate discipline techniques such as
slapping her children in the face and pulling hair.
During the PARC intake, Ms. Johnson described that an angry friend had
reported her family to CPS stating false allegations of abuse. She stated that her oldest
son often angered her, and this would cause her to escalate verbally with all of her
children. She never self-disclosed the use of physical discipline to this student.
Ms. Johnson expressed that it was difficult to continue giving love to children that
never reciprocated these feelings. She reported that the lack of receiving love from her
children brought up hurts from her past that she had received from her mother. Ms.
Johnson reported that she had felt rejection from her mother as both a child and an
adult. In recent years, her mother had told her and her siblings that she needed a break

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from being their mother. Ms. Johnson reported that this is still a very painful memory
that has been stirred up by the lack of love displayed from her children.
Ms. Johnson’s oldest son has been removed from the home. Ms. Johnson
reported that this move was not traumatic to the other children, but the violence they
experienced and witnessed prior to the removal was. Therefore, Ms. Johnson
requested services to help the children better identify and express their feelings. Ms.
Johnson also identified that she needed help placing more importance on her own selfcare.
Interventions
Together with the client, this student set three goals to work on throughout an
eight week period. This student chose to use the family-centered model while settings
these goals and working with the client. The family-centered model according to King,
King, Rosenbaum, & Goffin, “involves ensuring that parents have ultimate control over
decision making, treating parents respectfully and supportively, and providing parents
with needed information” (1999, p. 1). Their research indicates that “services will have
the most benefits for parents when they address parent identified issues…” (King, King,
Rosenbaum, & Goffin, 1999, p. 11). Based on these findings Ms. Johnson was involved
in setting each goal.
The goals established included helping Ms. Johnson expand her knowledge on
parenting children that have experienced a traumatic past. As well as, working with the
whole family together on learning better communication techniques, and helping Ms.
Johnson to understand the need for and learn how to engage in improved self-care.

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The in-home services began with working on educating Ms. Johnson to better
understanding the effects of trauma on children. During the first meeting, this student
began by talking to Ms. Johnson about the trauma response as well as secondary
trauma. Ms. Johnson had some training on the effects of trauma, but was unaware of
secondary trauma.
Secondary trauma is described by Salloum, Kondrat, Johnco, & Olson, as “…the
experience of psychological distress and posttraumatic stress symptoms resulting from
helping clients who have been exposed to trauma” (2015, para. 3). While this study is
specifically researching the effects of secondary trauma on helping professionals, it
seems likely that individuals such as, adoptive parents, are impacted by secondary
trauma as well, due to the fact that they live with these children and the effects of their
trauma on a daily basis. In this same study, it was reported that, “trauma-informed care
is optimal for providers working with children exposed to trauma…” (Salloum, Kondrat,
Johnco, & Olson, 2015, sec. 5 para. 1). Due to the evidence on trauma education, this
student spent several meetings discussing trauma education with Ms. Johnson.
After working on trauma education with Ms. Johnson, this student moved on to
helping Ms. Johnson with self-care. The research finds that when self-care is
addressed the risk of experiencing secondary trauma is decreased. Katz reports that
parents that have the most success in adopting older children display the following
traits, “refusal to be objected by the child and ability to delay parental gratification, ability
to find happiness in small increments of improvement, parental role flexibility, a systems
view of the gamily, firm entitlement, caring intrusive and controlling qualities, humor and
self-care…” (1986, par. 1).

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With this research in mind, this student worked with Ms. Johnson on developing
a self-care plan. This plan included daily, weekly, and monthly goals. It was discovered
that Ms. Johnson had self-care in place in some areas and was completely lacking in
others. The changes that were implemented were things like spending time with friends
that provide support to her on at least a monthly basis. She also made a plan to change
her children’s bedtime to allow her increased personal time each evening. Ms. Johnson
felt positive about being able to continue implementing these changes as this student
closed this case.
The final area that this student worked on with this client was the family’s ability
to communicate about feelings. Ms. Johnson’s children ranged in age from six to
seventeen. The wide age range and differing cognitive abilities made group intervention
difficult, but the limited time that this student had to work with the clients made a group
activity necessary.
This student chose to use group play as a means of intervention. In an attempt
to work on identifying feelings, the game, Feelings Fun was played. According to
research by Bellinson, “Children do play structured games in their lives; it is their
preferred mode of play through most of their school years” (2013, para. 4). Bellinson
also reported that “Children use games during treatment to contain their uncomfortable
feelings and unacceptable behaviors” (2013, para. 2).
As this student played Feelings Fun with the Johnson family, the children were
able to share their feelings openly in a safe environment through discussion and play.
The older children had an easier time with the discussion portion of this game than the
younger children. This further supported Bellinson’s findings that “The language of

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childhood is action; they express themselves in behavior rather than words, particularly
when they are emotionally stimulated by anxiety or other complex feelings” (2013, para.
10). A more effective therapeutic intervention may have been to separate the children
and work with them in smaller more age appropriate groups.
Value/Ethical Dilemmas
When this student initially became aware of Ms. Johnson’s situation, this student
had conflict arise. Due to this student’s previous experience as a foster parent and
adoptive mother, this student had to acknowledge the impartial judgement that she felt.
This student discovered a tendency to put more trust in the adoptive parent’s words
than on the children. This issue is addressed in the NASW code of ethics 1.06(a)
stating, “Social workers should be alert to and avoid conflicts of interest that interfere
with the exercise of professional discretion and impartial judgment.”
The NASW code of ethics also states in code 2.01(b) that, “Social workers
should avoid unwarranted negative criticism of colleagues in communications with
clients or with other professionals.” When this student listened to conversation
discussing this case feelings of disbelief and anger rose up. This student had personal
experience living with and caring for foster and adoptive children. This first-hand
experience made this student feel like the social workers involved did not fully
understand the situation. These feelings brought forth an ethical dilemma.
When this student recognized these feelings of distrust and lack of confidence in
her colleagues, this student discussed it with her field placement supervisor. This was
in accordance with NASW code 1.06(a), “…take reasonable steps to resolve the issue

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in a manner that makes the clients’ interests primary and protects clients’ interests to
the greatest extent possible.” Regular supervision with this student’s field placement
supervisor helped this student to recognize that each case is unique, and judgement
about an adoptive parent or child cannot be made until all of the facts are gathered.
This situation resulted in the client’s needs being made priority.
Conclusion
This student followed this case from beginning to end. The initial evaluation
provided the background information needed to complete the biopsychosocial report.
From there, this student worked with the client to develop goals that she [client] desired
to achieve. These goals became the focus of all future meetings.
Ms. Johnson successfully achieved her goals. She was able to obtain the
needed knowledge to continue working on her parenting techniques while her children
remained in the home. When the client relationship was terminated, this student felt
confident that Ms. Johnson was ready to continue working on her self-care and
parenting skills independently.

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References
Bellinson, J. (2013). Games children play: Board games in psychodynamic
psychotherapy. Child And Adolescent Psychiatric Clinics Of North America, 22(2),
283-293. doi:10.1016/j.chc.2012.12.003
Finley, G. E., & Aguiar, L. J. (2002). The effects of children on parents: Adoptee genetic
dispositions and adoptive parent psychopathology. The Journal Of Genetic
Psychology: Research And Theory On Human Development, 163(4), 503-506.
doi:10.1080/00221320209598699
Katz, L. L. (1986). Parental stress and factors for success in older-child adoption. Child
Welfare: Journal Of Policy, Practice, And Program, 65(6), 569-578.
King, G., King, S., Rosenbaum, P., & Goffin, R. (1999). Family-centered caregiving and
well-being of parents of children with disabilities: Linking process with outcome.
Journal Of Pediatric Psychology, 24(1), 41-53. doi:10.1093/jpepsy/24.1.41
National Association of Social Workers, (2008). Code of ethics. Washington, DC: Author.
Retrieved from website: http://www.socialworkers.org/pubs/code/code.asp
Rubenstein, Franklin. Feelings Fun (15666). Play to learn dominos
Salloum, A., Kondrat, D. C., Johnco, C., & Olson, K. R. (2015). The role of self-care on
compassion satisfaction, burnout and secondary trauma among child welfare
workers. Children And Youth Services Review, 4954-61.
doi:10.1016/j.childyouth.2014.12.023