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D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

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Page 1: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

D.T.’s CaseChris Carey, Megan Holloway, Beatty Kelly, Taylor

Normand, Karie Snyder, Brandon Walker

Page 2: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

D. T.’s Story

15-year-old freshman at Byrd that lives with his mom, younger sister, and stepfather

D. T. and his father had a close relationship, often going on fishing trips together

Father was an alcoholic, drank early in the day and was inebriated by the evening

When drunk, he was verbally and physically abusive towards D. T.

When D. T. was 10 years old, he and his father were arguing about his father’s driving after a fishing trip, and his father gave D. T. a black eye. When D. T.’s mom confronted his father, he stormed out in rage and never returned home.

Mom remarried when D. T. was 12, simultaneously, D. T.’s troubled behavior at school worsened

Page 3: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

D. T.’s Behavior

Blames himself for the breakup of his family but won’t admit it

Appeared to accept disappearance of his father

Spent most of his time alone, either playing video games or skateboarding around the neighborhood

Sneaks out at night without his parents knowing

Suspended many times for skipping class and talking back to teachers

Diagnosed with ADHD but his mom does not let him take medicine because she is worried about the side effects

Page 4: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Troubled behaviorWhen his mom asked D. T. to take out the trash, an

argument ensued and D. T. angrily did the chore

D.T. began to use his slingshot to shoot out the window

When his stepdad came out to confront him, D. T. aimed it at him, screaming at cursing

His mom called the police and D. T. was arrested

At the police station, he tested positive for methamphetamines and cannabis

Transferred to Brentwood Hospital for a 30-day inpatient substance abuse program

Page 5: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

D. T.’s Medical Report

Diagnosed with polysubstance abuse, ADHD, and truancy with a poor academic performance Bipolar Disorder ruled out

“The police think I have a problem with anger and drugs, so they sent me here.” –D.T.’s chief complaint

D.T. stated he snorted ¼ gram of meth at a party, came home at 2AM and smoked 2 joints of marijuana to sleep

Felt ‘very strung out’ when mom asked him to take out the trash

Perceived stepfather’s confrontation as threatening physical violence; he pointed slingshot in defense; his mom overreacted

Page 6: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Maladaptive Strategies

D. T. stated feeling depressed and worthless for a long time

Scored a 33 on the Beck Depression Inventory (severe depression)

Verbalized suicide ideation with no intent or plan

Problems with school and parents make depression worse

Long, thin scars on upper abdomen from D. T. cutting his torso with a razor to relieve dissociative feelings “I feel like I am not real, like this is all a really bad dream

and I get scared so I have to cut myself to get relief”

Page 7: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Social History

Repeated 2nd grade due to academic behavior problems

Currently in 9th grade

Admitted skipping classes and forging excuses

Stated having few male friends, and a girlfriend of whom he denied sexual activity with

Relationship with parents is “stressful” because they expect too much from him, academically

D.T. explained discipline involves yelling and being grounded, but his parents will usually forget about his grades within a few days

Page 8: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Occupational Adaptation

Adaptive Response MechanismAdaptive Response Behavior- Hyper-mobileAdaptive Energy- PrimaryAdaptive Response Mode – Existing

Adaptation Gestalt

Page 9: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Current Treatment

Buproprion (100mg 3x/day)Antidepressant

Trazodone (50mg before bed)Antidepressant, anti-anxiety, sleep-inducingCan help prevent suicidal thoughts

Suicide precautions, inpatient activities, meals on unit only, no day pass, OT eval and treat

Page 10: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Drinking and Drug Abuse Questionnaire

Page 11: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Social Worker Note

1st drink at 3-4 years old from dad’s beer when they were on a fishing trip

At 7 years old, he drank up to 10oz of beer with his dad Now drinks alcohol when opportunity arises

At 12 years old, he smoked his first joint, and said that it helped him relax and easily interact with friends Now smokes 1-2x a week, usually before class

At 14, used meth (1/4g) and said it gave him a euphoric feeling and he felt like he was normal Now smokes 1-2x a week when he has money for it

At 14, had first sexual experience, has had a number of partners (all while under the influence) Stated being sexually exclusive with his current girlfriend

Page 12: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Drug Withdrawal Symptoms

30-90 days can pass after the last drug use before the user has any sign of withdrawal

Depression, loss of energy, anhedonia, craving, suicidal,

Painful and difficult, 93% people using methamphetamines will relapse

Page 13: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

OT Initial Note

“Leave me alone, I just want to sleep”

Given Adolescent Role Assessment and Magazine collage test

Page 14: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Adolescent Role Assessment

Positive – most childhood play (rules, interactions, interests); peers/community; fantasy with future work

Neutral – role models during childhood; family responsibility and economics; choice of occupation, and future work goals

Negative – family interactions; school consistency, responsibilities, and activities; peer activity

Page 15: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Magazine Collage Task

Minimal insight for reasoning of drug addiction

Moderate insight for personal responsibilities for actions

Themes Drug use, escape to rural setting, feelings of anger

and frustration

Able to think abstractly

Stated he had poor motivation for drug abstinence and did not want to ID consequences of past drug usage

Page 16: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Motivation

D. T. is in pre-contemplative stage according to trans-theoretical model of behavior change

Benefit from structured OT groups that increase motivation and interpersonal communication skills to avoid relapse

D. T. identified family emotional strain as a trigger for relapse, so family involvement in OT and counseling groups is necessary

Client will participate in OT psycho-educational group 1x/week and OT skills group 3x/week for 4 weeks

Page 17: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

FOR: Cognitive Behavioral

D. T. can benefit from CBT because he presents with cognitive errors, irrational thoughts, and poor executive functioning.

He becomes overwhelmed when triggers are presented, causing him to have a negative view of his environment.

Treatment with this FOR will focus on helping D. T. react to triggers in a healthier way.

Page 18: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Goal 1

D.T. will identify triggers and develop strategies for coping and preventing relapse by the end of acute treatment.

Page 19: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Interventions for Goal 1

REBT Self-Help Form (CBT)D.T. will complete REBT self-help form to identify

stressors for determining triggers that lead to drug usage.

D.T. will collaborate with the OT on adaptive strategies to assist in preventing relapse

Coping Strategy Practice with Role PlayingTherapist plays roles of both an authority figure and

a peerTherapist first challenges/provokes D.T. to better ID

triggers, and can then come up with coping strategies specific to D.T.’s triggers

Page 20: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Goal 2

D.T. will improve self-efficacy as measured by receiving a score of at least a 29/40 on the general self-efficacy scale (OA)

Page 21: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Intervention for Goal 2

Improve self-efficacy by attending psychosocial group therapy for 50 minutes 2x/week

Maintain a log of activities requiring 5 points of positive feedback and 2 points of constructive criticism

Page 22: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Occupational Adaptation

Occupational readiness Journal/Daily log

Occupational activityPsychosocial group

Occupational readiness

Occupational activities

Relative Mastery

Page 23: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

Generating an Adaptive Response

Adaptive Response MechanismAdaptive Response Behavior- StableAdaptive Energy- SecondaryAdaptive Response Mode – New

Page 24: D.T.’s Case Chris Carey, Megan Holloway, Beatty Kelly, Taylor Normand, Karie Snyder, Brandon Walker

References Botvin, G. (2000). Preventing drug abuse in schools: Social and competence

enhancement approaches targeting individual- etiologic factors. Addictive Behaviors, 25(6), 887-897.

Custer, V., Wassink, K. (1990). Occupational therapy intervention for an adult with depression and suicidal tendencies. American Journal of Occupational Therapy, 45(9), 845-848

Kursurkar, R. (2013). Critical synthesis package: General self-efficacy scale. Mededportal, doi:9576

Hogarty, S. S. (1987). A suicide precautions policy for the general hospital. Journal of Nursing Administration (17)10. 37-42.

Schultz, S., & Schkade, J.K. (1992). Occupational adaptation: toward a holistic approach for contemporary practice, part 2. American Journal of Occupational Therapy, 46(10), 917-925.

Stoffel, V.C., & Moyers, P.A. (2004). An evidence-based and occupational perspective of interventions for persons with substance-use disorders. American Journal of Occupational Therapy, 58, 570-586.

Weaver, W. (n.d.). Retrieved from http://brentwoodbehavioral.com