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The Case of Anna

SOWK 613

Social Work Practice with Children and Families in Early and Middle Childhood

Background Information

Anna is a eight-year-old Caucasian female of low socioeconomic status. She lives in Pasadena, California with her paternal aunt and her aunt’s husband, who are Anna’s legal guardians. Also living with them are Anna’s five year old brother, their seven year old female cousin, and Anna’s paternal grandparents.

Anna was brought to counseling by her aunt, who was recommended to bring Anna to therapy by her pediatrician. Anna and her brother were removed from their biological parents’ home in 2014 due to severe neglect. Anna’s aunt also suspects that Anna was a victim of physical abuse by her biological parents. Since being removed from her biological parents’ home, Anna has expressed confusion about her living situation. Her main presenting issue, however, is her low self-esteem, anxiety and some irritability. This is Anna’s first time in therapy, with no prior psychiatric history or substance abuse concerns.

 

Anna has a family history significant for depression, anxiety, ADHD, alcoholism, substance abuse, domestic violence, and suicide. Anna’s biological mother has an 11-year-old son from a previous marriage who lived with Anna until she was removed from the home. Anna’s biological parents also have another daughter living with them who is one year old.

When Anna lived with her biological parents, she was exposed to domestic violence and drug use. She also witnessed her mother attempt suicide by slitting her wrists. On at least one occasion Anna’s parents were homeless with the children. Anna has been living with her aunt, uncle, cousin, and grandparents since her aunt and uncle gained legal custody of her and her brother in 2014. Anna’s aunt and uncle are caring and supportive.

 

 Anna was the product of a full term vaginal delivery. Her mother denied using substances during the pregnancy. Anna reached all developmental milestones on time. Anna is below average in social, language, and emotional development and average in physical and intellectual development.

 

Anna is in second grade, has never been held back, and has an IEP. She enjoys school and is a good student.

 

 Anna gets along well with other children and has at least one close friend. She is somewhat shy and reserved in large groups and with people she doesn’t know well.

 

Anna is relatively healthy but does suffer from a hearing impairment that requires the use of hearing aids. Past medical procedures include having tubes in her ears and her tonsils and adenoids removed. Anna also suffers from asthma and seasonal allergies.

Anna is a casually dressed and cooperative eight-year-old who appears her stated age.

She is alert and oriented to person, place, and time and makes minimal eye contact. Anna’s memory is intact and her attention and concentration are good. Her speech is normal in rate, rhythm, volume, and tone and her stream of thought is linear and logical. Anna reports her mood as “okay, sometimes.” Affect is congruent. She denies any current suicidal ideation or homicidal ideation and displays no evidence of delusions, hallucinations, obsessions, compulsions, or phobias. Anna’s insight and judgment are fair for her age and she seems to have control over her impulses. Anna has some trouble sleeping and tends to overeat. Her motor activity and energy level are normal.

 

In-Session Observations

Anna appears shy and guarded. She speaks in a soft voice and looks at you in a cautious and somewhat guarded manner. You decide to have her draw and offer her some markers and paper. You introduce her to a game of colors in which you have her identify a few colors and then link the colors to a specific feelings and emotions. She selects blue and says that it reminds her of feeling sad and the sky. She also selects red and says that red stands for nervous and scared.

Since she appears to have a good grasp of emotions, you decide to switch to storytelling and engage her in a conversation about a small cat who got lost and could not find his way home.  You ask her to continue the story and she says the following: “He turned red and then turned yellow and then nobody wanted him.”

 

The following assessment measures were administered:

Child Trauma Screening Questionnaire

Piers-Harris Self-Concept Scale

 

Anna’s scores are below.

 

Assessment Measure

Baseline

6-weeks

12-weeks

Child Trauma Screening Questionnaire

8

6

3

Piers-Harris Self-Concept Scale

39

47

57

 


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