PS450 Unit 3 Screening and Assessment Paper Example

A Score of Three and a Guitar Under the Bed: A PS450 Unit 3 Screening and Assessment Paper

[Student Name]

Purdue University Global

PS450: Case Management in Clinical Settings

Unit 3 Screening and Assessment Paper

[Instructor Name]

[Date]

The teen, his family and the program are composite; the screening test, protocol and study cited are real.

Why Tyler Was Screened

Tyler is the 15-year-old son of Brandi, a client in our outpatient recovery program in Huntington, West Virginia, which serves the county's family treatment court. Since child protective services removed Tyler and his six-year-old sister from Brandi's apartment last winter, they have lived with their grandmother. The family treatment court asks the program to screen children in the family for substance use and mental health needs, both because children of parents with substance use disorders face higher risk and because their needs affect reunification planning. A parent's substance use is one of the household problems that the Adverse Childhood Experiences study linked, in a graded way, to later smoking, drinking, drug use and depression in adulthood (Felitti et al., 1998).

As Brandi's case manager, I arranged Tyler's screening with his grandmother's consent and his own assent, and I sat in on the assessment that followed with the program's adolescent counselor. This paper describes the screening tool, the assessment and the strengths and needs we identified.

The Screening Tool

The CRAFFT is a brief screening test for substance use problems in adolescents. Its name is built from the first letters of key words in six yes-or-no questions about riding with an impaired driver, using to relax, using alone, forgetting, being told to cut down and getting into trouble. A teen scores one point for every yes.

Knight et al. (2002) tested the CRAFFT among adolescents aged 14 to 18 visiting a hospital-based adolescent clinic. Using a score of two or more as the cutoff, the test identified most adolescents who had a substance-related problem, disorder or dependence and correctly screened out most of those who did not, supporting its use in busy clinics.

Tyler answered yes to three questions. He said he smokes marijuana to relax, that he sometimes uses alone in the evening and that a friend had told him he smokes too much. He said no to the car, forgetting and trouble questions. A score of three is positive and means a fuller assessment is needed. It does not by itself indicate a disorder.

A CRAFFT score of three told us to look further; it did not tell us what we would find.

The Assessment

Federal guidance for adolescent programs, published as TIP 31, calls for a positive screen to lead into a broad assessment covering substance use history and severity, mental health, family, school, peers, legal involvement and strengths (Center for Substance Abuse Treatment, 1999). It stresses questions pitched to the teen's age, close attention to family, and information gathered from more than one person.

The counselor interviewed Tyler alone, then with his grandmother. Tyler began smoking marijuana at 14, shortly before the removal. He uses three or four evenings a week, alone in his room or with one friend, and says it helps him stop thinking about his mother. He has tried alcohol twice and no other drugs. His grades fell from Bs to Ds this year, and he missed eleven days of school in the fall. He reported trouble sleeping, frequent worry about his mother relapsing or going to jail and anger at her that he feels guilty about. He denied thoughts of self-harm.

His grandmother confirmed most of this and added that he spends hours in his room and has stopped seeing friends he used to visit. His school counselor, contacted with permission, reported that he had stopped turning in work but was polite and had never been in trouble.

The counselor's impression was a mild cannabis use disorder, with symptoms of anxiety tied to his family situation that warranted further assessment. She noted that his use followed and seemed to be a response to the stress of his mother's addiction and the removal.

Strengths

A strengths assessment asks what the young person and his environment bring. Tyler's strengths are real. He taught himself guitar from online videos and plays for hours, which his grandmother described as the only time he seems calm. He has a close relationship with his grandmother, who is consistent and firm. He is protective of his little sister and reads to her at night. He was honest during the assessment, which the counselor took as a sign of readiness. His school counselor likes him and is willing to help.

Needs

His needs follow from the assessment. He needs a way to manage stress and sleep that does not involve marijuana. He needs help with school, including a plan to recover credits. He needs a place to talk about his mother, his anger and his guilt, ideally with other teens in similar situations. He also needs to be included, at an appropriate level, in his family's reunification planning, since his anxiety centers on what will happen to his mother.

Recommendations

The counselor recommended an adolescent outpatient program using cognitive behavioral and family approaches, which our program offers weekly after school. She also recommended a support group for children of parents with addiction, a school meeting to create a credit recovery plan, and an invitation for Tyler to attend part of his mother's family sessions when she is ready. His guitar became part of the plan: the program has a music group on Thursdays.

Sharing the Results With His Mother

As Brandi's case manager, I had to decide with the counselor how much of Tyler's assessment to share with her. Tyler is a minor in his grandmother's care, and his consent covered sharing results with the court team in general terms. We agreed to tell Brandi that Tyler had screened positive for marijuana use and would join the adolescent program, without sharing what he said about his anger and guilt, which belonged to him to share when he was ready.

Brandi cried when she heard. Her first reaction was that she had done this to him. Her second, an hour later, was to ask whether she could pick him up from the Thursday music group once her visits were unsupervised. That question went into her own service plan as a goal, which tied her recovery and his more closely than any form could.

Conclusion

Tyler's assessment shows how screening and assessment work together. The CRAFFT flagged a problem quickly, the federal protocol shaped a fuller assessment from multiple sources, and the strengths inventory produced as many resources as concerns. A score of three became a plan built on a guitar, a grandmother and a teenager willing to be honest.

References

Center for Substance Abuse Treatment. (1999). Screening and assessing adolescents for substance use disorders (Treatment Improvement Protocol [TIP] Series No. 31, DHHS Publication No. SMA 99-3282). Substance Abuse and Mental Health Services Administration.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine, 156(6), 607-614. https://doi.org/10.1001/archpedi.156.6.607