Case Study

RECTH 4330

Caitlyn Belcher

April 27th, 2022

 Introduction
This Case Study focuses on a resident at the Copper Hills Youth Center in West Jordan, Utah.
The Copper Hills Youth Center (CHYC) offers individualized therapeutic treatment to male and
female adolescents between the ages of 12 and 17 years old. Currently, there are 119 residents at
CHYC. The facility offers a variety of recreational and therapeutic areas such as a gymnasium,
indoor and outdoor ropes course, outdoor courtyard area, and group rooms for all units. The
mission statement of the CHYC is “To provide a structured and therapeutic environment with
individualized treatment to encourage progress, growth and healing.”
The Recreation Therapy program at CHYC is the program that I worked within. This
program includes 8 Recreational therapists; however, they work in conjunction with 3 other
therapists at the facility. My clinical rotation supervisor, Allysa Beers, has been a TRS in
the state of Utah for 14 years and worked within the Recreational Therapy department at
CHYC for 11 years.
Alana, a 14-year-old female diagnosed with Bipolar I disorder is the resident discussed in
this case study was admitted on March 8 th, 2022 and is expected to stay for 3 months to
start. Her time as a resident may increase to accommodate the completion of her goals and
objectives. The patient has a co-occurring condition of generalized anxiety disorder. Alana
is on the Moonstones unit, which is a girls unit with residents ages 12-17. The resident is
of Native American descent and is the oldest of 5 children in her family.
 Assessment and Interview

There are three different assessments that the Recreational Therapists use at Copper Hills Youth
Center (CHYC). The RASP assessment measures the patient’s resiliency, the RT LWB
assessment measures the patient’s well-being, and the Animal Assisted Therapy assessment
makes sure that the patients are safe to be around the animals. A copy of each assessment is
posted at the bottom of this document.
For the patient represented in this Intervention Protocol Report and Case Study, I was present for
the assessment and was able to observe her RT LWB assessment and Animal Assisted Therapy
assessment. The patient was highly conversational and thoughtful in her responses to the RASP
assessment. She was able to identify areas of recreation and leisure that she enjoyed and where
she wanted to learn more. She was also able to identify specific qualities about herself that her
friends like about her, and that she likes about herself. Some of these things included: “I am a
loyal friend,” “I am supportive, but I also tell them the truth,” and “I like that I am close to my
family.” The patient has a hard time with self-image and pinpointing ways to work on herself
and her own goals. This is a presenting problem that will be addressed in the Intervention
Protocol Report.
The patient scored well on the Animal Assisted Therapy assessment and was cleared to have
access to the Animal Assisted Therapy at CHYC.
Presenting problems for the patient after the interview assessment are: low self-esteem, low self-
efficacy, social insecurities, and anxious tendencies.
 Diagnostic Protocol

Diagnostic Grouping
Bipolar Disorder

Specific Diagnosis
Bipolar I Disorder

Etiologies
Exact causes of Bipolar I Disorder are not known; however, both biological differences and
genetic factors have been shown to impact the prevalence of bipolar disorders in individuals.
Individuals with bipolar disorders experience physical changes in their brains that other
individuals do not experience. They also are more likely to develop a bipolar disorder if they
have a first-degree relative (sibling or parent) with the disorder.

Demographic Information
The patient observed for this Diagnostic Protocol is a 14-year-old female of Native American
decent.

Stages/Levels of disorder
There are three different conditions of bipolar disorder; however, they do not always progress
from one to the others. The categories are: Bipolar I, Bipolar II, and Cyclothymic disorder.
Bipolar I can exist with or without psychotic episodes, Bipolar II has both manic and depressive
episodes that are typically not very severe, and Cyclothymic disorder is a cyclical disorder that
includes manic and depressive episodes.
Client Problems to be Addressed
 Lack of emotional regulation
 Low self-esteem and self-confidence
 Lack of appropriate coping skills
 Goals and Objectives

Client Demographics
Age: 14 years old
Gender: female
Diagnosis: Bipolar I disorder
Co-occurring conditions: Generalized Anxiety Disorder
Presenting Problems:
 lack of emotional regulation
 low self-esteem and self-acceptance
 low social confidence
 lack of appropriate coping skills
Identified Strengths:
 personal emotional awareness
 loves to participate in sports
 values family and activities with her family
 enjoys trying new things
 good at engaging with younger siblings

Emotional Regulation
Goal: To identify emotions and appropriately communicate them in order to improve emotional
regulation
 During RT groups, recreational therapist will work with resident to verbally
identify emotions, verbalize what she is feeling, and determine a coping skill to
help her regulate impulsive and angry emotions once per week in an RT session.
 During RT groups, recreational therapist will work with the resident to verbally
identify emotions and use assertive communication to express how she is feeling
and what she needs to do to calm down at least once per week in an RT session.
  During RT groups, recreational therapist will check in with the resident so she can
verbally identify her mood and describe her needs according to how she is
feeling.

Self-Concept
Goal: To increase self-worth and self-confidence
 During RT groups, recreational therapist will work with the resident to verbally
identify the emotions related to self-worth at least once per week in an RT
session.
 During RT groups, recreational therapist will work with the resident to write
down three positive statements related to her self-worth and self-competency.
 During RT groups, recreational therapist will work with the resident to identify 3
things that help her feel more confident in herself at least once per week in an RT
session.

Healthy Coping Skills

Goal: To identify and implement specific healthy coping skills
 During RT groups, recreational therapist will work with the resident to identify
moods and emotions, verbalize those feelings, and determine coping skills to help
regulate the emotions.
 During R.T. resident will check in with appropriate/accurate mood/S.O.S. and use
group participation as a coping skill to build emotion regulation at the beginning
of each RT group.
 While in recreational therapy groups, resident will use appropriate coping skill(s)
when challenged or overwhelmed in each RT group and write it down in their
journal.
 Intervention Protocol and Report

Introduction: This assignment is meant to outline the specific intervention used with our case
study patient that we have been observing throughout the semester. The Intervention Protocols
for specific interventions are meant to provide specific ways that a service can be provided to
patients. The following Intervention Protocol Report outlines the patient being observed in my
Case Study in a specific observed intervention at my clinical site. The Report is done through a
SOAP note and an evaluation of the intervention used and will also include an overview of the
interview questions used to assess the patient. The patient observed participated in the first
session of an 8-week Workout Program, the first week being a fitness test and goal-setting time.

Program Title: Workout Fitness Program

General Program Purpose: The purpose of this program is to provide patients with the
opportunity to engage in fitness activities and workouts. This program is designed to help
participants increase self-efficacy and goal setting, while providing a program that is self-
oriented rather than others-oriented.

Program Description: This program will be facilitated by an RT once a week for 8 weeks.
Patients will write down a specific, realistic, and attainable fitness goal or personal goal for the
program. Each session will consist of a short workout focusing on different muscle groups and
exercise styles. Patients will be participating in individual exercises together and are encouraged
to verbally support one another throughout each group. If an individual participates in all
exercises in a single session, they will receive a healthy treat. Individuals who complete all 8
weeks of the program will receive a “Fitness Party” at the end of the program. The first session
and last session will consist of a simple fitness test (pushups, sit-ups, wall sit, sprint, plank);
patients will be able to record their own results both times in order to see improvement
throughout the program. This program is designed to give patients the opportunity to create goals
for themselves, see individual improvement, and learn ways to workout various muscle groups in
different ways.
  Specific Client Population:
o Diagnosis: Bipolar I
o Age: 14 years old
o Gender: female
 Program Setup:
o Group-based

Program Outcomes:
1. Increase self-efficacy
2. Develop goal-setting skills
3. Increase focus on self instead of others

Client Problems:
 Low self-esteem and self-acceptance
 Struggles to focus on herself and is critical of others

Activity Intervention: Week 1 Fitness Test

 Supplies and Equipment
o Yoga mats
o Journals
o Fitness Program Calendar
o Cones
o Stopwatch
o Pens
o Pullup bar
o Workout/muscle group charts for journals
o Water bottles
o Healthy snack (individually packaged)

 Implementation Instructions
o Line up yoga mats along the wall of the gym or large open room. On each yoga
mat, place the patients journal and pen along with their Fitness Program Calendar.
o Instruct participants to find the mat with their journal and write down their
personal fitness goal for the program. RT will help in goal-setting to ensure that
goals are realistic, related to the program, and attainable.
o Goals can be related to fitness (i.e., “I will be able to plank for 30 seconds”) or
related to the program as a whole (i.e., “I will attend all 8 weeks of the Fitness
Program”).
o RT will explain the 8-week fitness program to participants and explain the fitness
testing that will take place in this session as well as the last, and outline the
exercises to be completed: pushups, sit-ups, wall sit, sprint, plank
o Each exercise will be conducted as follows:
 Pushups – number of pushups in 60 second time limit
 Sit-ups – number of sit-ups in 60 second time limit
 Wall sit – time recorded of first drop
 Plank – time recorded of first drop
 Sprint – time recorded from start distance to end distance
o After each exercise, participant will write down their personal results for each
individual exercise under Week 1 Fitness Test. For example, they might write that
they did 20 pushups in 60 seconds.
o Individuals will out their Calendar with their goals in their journal at the end of
the Week 1 Fitness Test
o RT will process individual goals with the group for 5 minutes. Examples of
processing questions:
 What goals did you record for the next 8 weeks?
 How is this goal achievable?
 How might achieving this goal increase your self-efficacy?
o RT will award participants with healthy snack before cleaning up supplies
 Participant Response to Intervention
Subjective: “Okay but do we really have to sprint?”
Objective: The patient was not fully engaged for the Week 1 fitness test. The patient was not
focused on herself, but rather was talking with the girls next to her and was making fun of
another participant. The patient was able to write an attainable goal for the workout program.
Assessment: The patient can improve upon her goal of focusing on herself rather than others.
The patient also can work on her listening skills and engagement in exercises. Additionally, the
patient would benefit from being reminded of her goals before each following session.
Plan: Patient should continue working on her goal to attend all 8 sessions in the program and
engaging in exercises during the program.

Evaluation of Intervention
The patient responded in an expected way to this intervention. She initially was able to identify
goals that she can accomplish throughout the Workout Program; however, she continued to
struggle with focusing on her own goals rather than making fun of others. Additionally, I believe
that if the patient is able to complete the 8-week program and accomplish her set goal, this will
help to increase her self-efficacy and self-esteem. The patient’s personal goal for this workout
program was to be able to complete all 8 weeks of the program and to be able to hold a plank for
30 seconds. This goal-setting exercise within the program will, I believe, help the patient to focus
more on her own accomplishments, and it will serve as a good reminder for when she is
distracted by her own self-criticism or her criticism of others. The act of setting goals for herself
during this Week 1 Fitness Test was beneficial to the patient because she was able to focus on
herself for the goal-setting time, and was able to assess her own strengths as well as areas where
she desires to improve.

C. Belcher, TRS, CTRS (RT Student), April 27th, 2022

 References

About us: UT youth behavioral therapy: Copperhillsyouthcenter.com: Copper Hills Youth

Center. Copper Hills Youth Center | Official Website. (2021, June 1). Retrieved April 27,
2022, from https://copperhillsyouthcenter.com/about-us/