Running head: CLIENT ANALYSIS

Denisa Llangos
SW 4997
Bio-psychosocial Assessment
03/15/15
EY 8514
Integrative Paper # 2

Running Head: CLIENT ANALYSIS

Abstract
In this paper I am going to be explaining the Biopsychosocial assessment, the
interventions, values and ethical dilemmas and lastly my conclusion of a client I have and
facilitate at my field agency at West Village Academy. The Biopsychosocial assessment
contains the history of origin of the client, her medical conditions and her family
background. In addition, this document also includes a thorough list of intervention that
were developed for the client to better fulfill her needs and safety as a victim of domestic
violence. Following the interventions I will be explaining the values and ethical
dilemmas of this case, the client and the social worker.

Biopsychosocial Assessment
Jenny Wood (pseudonym) is a 12-year-old single Africa American female student
seeking help and treatment at her school for thoughts of suicide. Her friend referred her
to the school social worker. Jenny also reports a history of family abuse. Her friend was
concerned about Jenny because she had found a note in her locker stating, I want to die,
I want to die, and I hate my home. Jenny is scared to go to her house, claiming she has
been being abused for weeks. She and her stepfather do not get along, and her mother
does not help with their relationship. The client reports episodes of crying daily for two
weeks, signs of depression, difficulty focusing in school, not being able to finish her

Running Head: CLIENT ANALYSIS

homework, and an inability to communicate with others, such as friends and cousins,
both at and outside of home. Jenny suffers from low self-esteem, insomnia, and has
anxieties at times. She has difficulties with breathing when she experiences high levels of
stress.
A year ago, the client reported two previous episodes of depressive symptoms for
which she contacted her family therapist twice. She then never went back to therapy due
to transportation difficulties and lack of family support. She is a part of the dance team in
school to avoid going home where she lacks comfort and peace. When she was younger,
the court referred her to a social worker for coping with her parents' divorce. Jenny had
thoughts of suicide and has been stressed ever since. She has never been prescribed
medications for mental health issues.
Jenny reports having a slight case of asthma, headaches, and sometimes stomach
pain when experiencing high levels of stress. She reports bruises throughout her lower
body and feels pain in her back. She denies any major illnesses but has had leg surgery.
She does not see a doctor for regular checkups. The client reports consuming no serious
medications but takes pain relievers such as Tylenol or Advil and occasionally uses
inhalers for her asthma attacks prescribed from her doctor since she was age 4. Jenny
and her family avoid doctor and hospitals visits because of their low income. She does
not have a very healthy diet, as there are rarely fresh groceries at her house. Her meals
are sparse and often consist of dry meals such as cereal and canned soup. She claims that
she never takes lunch with her to school and is often hungry.
Jenny lives in an unsafe area of Detroit. Her parents divorced when she was five
years old, and she often overheard fights and disagreements. The divorce was very hard
for Jenny and her two younger siblings, Hannah, age 3, and John, age 2. After her father
moved out of the house, Jennys mother started using drugs, leading to a serious drug

Running Head: CLIENT ANALYSIS

addiction. She was barely making it to work and struggling to take care of her house and
children. Her mother also suffers from asthma due to her drug use, but the client reports
that her mother no longer uses any illicit drugs. Her mother remarried, and her new
husband moved into their home. This is new to the children, and they were not sure how
they felt about their stepfather. Her sister and brother do not suffer from any illnesses, but
the client reported that they have not seen a doctor for as long as she can remember,
possibly since birth. The client reports that she does not see her biological dad at all, and
does not know his medical history. She claims that her stepfather has a drug abuse
problem and experiences some type of bipolar disorder. Her stepfather is not interested in
seeking treatment for his bipolar disorder or drug abuse problem. Since they have been
living together, they are experiencing family problems and stress issues. The client
reports that her grandmother is her best friend. She often goes over to her grandmother's
house after school. Her grandma has confronted the family about the physical and mental
abuse of her grandchildren many times, but there has not been any change. Jenny reports
that her grandma encouraged her to report the abuse to the school if nothing changed.
The client was raised in a non-religious home but attended church with her
grandma every Sunday. She found comfort in after school activities such as dance and
basketball. She reports the inability to be involved with her family because of the abuse
she gets and pressure of being the oldest child. Often, there are many responsibilities and
chores she has to accomplish at home and babysitting her two siblings, putting her behind
in her academic work and causing trouble in school. Following the guidelines in their
student handbook, the school repeatedly contacted her parents, but her parents often
ignore the problem and are not taking care of the concerns. They often miss parent
teacher conferences and do not chaperon in the school at all.

Running Head: CLIENT ANALYSIS

The client is the oldest of three children. After they divorced, her parents
remained in the same town, and the children remain with their mother. Their father does
not remain much in the picture, and so the children do not see him very often. The client
reports feeling responsible for their divorce, believing she did not help enough around the
house, forcing her parents to be overworked and over-stressed because both worked
outside the home. Her mother had two jobs, waitressing and working in a clothing
factory. Her stepfather is a mechanic. The client often walks to her grandmas house
when she is being abused and stays there most of the time. Her grandma is very important
to her, and they experience a close relationship. Her grandma on her mother's side helps
Jenny with her with homework and comforts her when she is having a bad day. The client
is in seventh grade and occasionally misses school because she is too tired to get up in the
morning. The client has no history of legal involvement and no pending legal action.
The client always wears her school uniforms, but they are often not washed or
ironed and very cluttered. She is low-key, and there is no evidence of anything unusual
when in class or at events except her appearance and lack of communication. She is
moody at times and prefers to stay alone most of the time. Her speech is soft; her attitude
is not always positive, although she tries to appear happy because she would rather be at
school than home. She is in touch with reality but rarely pays attention in classes. She
never participates in class discussions and likes to work alone even when assigned to
work in groups. She is oriented to time and has a common sense. Jenny is not very
talkative, although she can be when she is having a good day. She appears to be
extremely sensitive to situations and other people.
Some short-term goals are to call the client's parents and inform them about the

Running Head: CLIENT ANALYSIS

information gathered and arrange a meeting with the family, principal, dean of students,
and client. After the meeting arrange, the social worker will develop further plans to help
improve the childs psychical and mental state. In addition, the social worker will contact
the school nurse and psychiatrist an request a checkup for the client. Then the social
worker will develop a behavioral intervention plan (BIP) to record Jennys behavior and
mental outcomes and create a plan for a one-on-one session and the specific topics
introduced. Along with the BIP, I would develop a safety plan in case thoughts of death
escalate to active suicide attempts. I would get client to engage in self-care plan. Lastly, I
would develop a treatment plan during next session and schedule a follow-up.
Client Strengths
Jenny Wood has many strengths. Despite her problems, Jenny was not afraid to
share her situation and the feelings that she is experiencing. She does not understand why
her mother does not do anything to avoid violence towards both her children and herself.
She understands that she deserves a normal life and a safe place to live. Jenny is afraid of
her stepfather and she understands her risks at home. Jenny is a very sweet young girl
that shows affection; she is not a troubled teen. She is enthusiastic, concerned, and
responsible. She desires to improve her academic level if she can and wishes she did not
have issues affecting her mind and body. The fact that Jenny was open and honest to the
school social worker is the first step to her calling for help and thinking about her
situation. She loves her family and siblings, so she is always trying to think positive.
Interventions
After interviewing Jenny and recording her information about her current
situation at home, the social worker and I concluded that the first intervention applicable
for the client should be in a group treatment. Through the creation and use of healing
rituals, blessings, poetry, art, and music, the girls in the group establish communities

Running Head: CLIENT ANALYSIS

and support each other in the work of self-reclamation and healing (Allen & Wozniak,
2014). After finding a group and attending the first three sessions, there was a major
change in Jennys inner state of mind. She began to make friends as the students shared
their stories about violence at home and negative thoughts. In dynamic cognitive
behavioral group therapy, functional analysis can be applied in three ways: to an
individuals behavior, to problematic behavior between an individual participant and the
group therapist, and in between two group members (Scharwachter, 2008). In group,
Jenny and the other girls are able to build strong relationships and bonds to share their
experiences. They are able to understand that they are not alone and that it is okay to
express their thoughts and feelings. These groups consist of frequent discussions among
others and 20 minutes of sharing and collaborating. After the freelance talks, we then do
activities that can help the clients engage as well as learn and boost their self-esteem over
time. Furthermore, group also makes Jenny and the others to eliminate shame. A victim
of domestic violence feels that they are worthless, bullied and feel like everyone is
looking at them with judgmental thoughts. For example, in session number 7 and 8 I
created a self-esteem activity called I am where the clients report all of their positive
characteristics and their abilities to keep reminding them how everyone is unique and
beautiful in their own way.
With the general based practice, I am able to learn how children cope and interact
with one another in school, but I must also consider and find out what kind of behavior
Jenny deals with at home. Children also have a different attitude at home. A home visit
would help me understand the case better and the client in a different environment. This
is the second method that I developed for Jenny. After having 10 sessions, Jenny, her

Running Head: CLIENT ANALYSIS

parents, and I agreed to have a home visit to see the differences in Jennys behavior and if
my therapies with her were effective and in place. Living with the abuser and
experiencing physical and psychological abuse everyday may cause trauma for the child
and potentially seriously harm the child and her siblings permanently. Children are
resilient, and being able to discuss and guide our children through a recovery process is
crucial to their success and often the first step towards healing (Joyful Heart
Foundation, 2015).
The third intervention is a meeting with the school psychologist every other week.
The majority of families in the general population who are affected by domestic violence
do not receive clinical services such as a psychologist (Thompson, 2012). Children
exposed to domestic violence have a greater risk of developing posttraumatic stress
disorder, which may further exaggerate developmental problems. Exposure to domestic
violence elevates stress feedback systems in the brain and heightens the childs
perception of danger (Thompson, 2012). Therefore, keeping an eye on the child from not
only the social worker but also the psychologist and the staff members in school will
reduce the symptoms that may lead to post traumatic stress disorder and other possible
disorders.
The fourth intervention that I used on Jenny was evidence based practice.
Evidence Based Practice is defined as conscientious, explicit, and judicious use of current
best evidence in making decisions about the individual. It requires an individual
assessment, a search for the best available external evidence related to the clients
concerns, and a consideration of the values and expectations of the client (Kessler, 2005).
Jenny and I were able to form a bond that helped her share her feelings and issues

Running Head: CLIENT ANALYSIS

bothering her. This helped me empower her to engage more and develop a self-care plan
and safety plan.
Values and Ethical Dilemmas
6.04 Social and Political Action section
Social workers should act to prevent and eliminate domination of, exploitation of, and
discrimination against any person, group, or class on the basis of race, ethnicity, national
origin, color, sex, sexual orientation, gender identity or expression, age, marital status,
political belief, religion, immigration status, or mental or physical disability (NASW
Code of Ethics, 2008).
There have been more than two sessions that when Jennys mother came to have a
meeting with me, she did not appear to take me seriously, asking me if I was a student
and telling me that I was as tall as her daughter. This made concentrating on Jennys
treatment difficult, as I was not treated like a professional social worker. I was afraid that
those thoughts were going to have an impact on Jennys treatment. I have to be prepared
for similar instances and come up with strategies that it will not affect the treatment of
my clients.
1.06 Conflicts of Interest
(a) Social workers should be alert to and avoid conflicts of interest that interfere
with the exercise of professional discretion and impartial judgment. Social workers
should inform clients when a real or potential conflict of interest arises and take
reasonable steps to resolve the issue in a manner that makes the clients interests primary
and protects clients interests to the greatest extent possible. In some cases, protecting
clients interests may require termination of the professional relationship with proper
referral of the client (NASW Code of Ethics, 2008).
Jenny found comfort in our sessions and talks. Every morning after the bus
dropped her off, she came to my office. She was not scheduled to be there and she knew
that, but she desired to stay with me and spend time to talk. Keeping the professional

Running Head: CLIENT ANALYSIS

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distance of setting appointments was difficult because she would start to open up, and I
did not want to risk her comfort in sharing.
1.14 Clients Who Lack Decision-Making Capacity
When social workers act on behalf of clients who lack the capacity to make
informed decisions, social workers should take reasonable steps to safeguard the interests
and rights of those clients (NASW Code of Ethics, 2008). Despite the problems that are
occurring with Jenny and her family, Jenny is still not capable of making any decisions
that wants. She keeps saying that she wants to move in with her grandma, but at this
point, that is not up to Jenny. Only Jennys guardians are able to make that decision. What
I could do in this case is help her be safe and find solutions to improve her self- esteem,
confidence, and academic level.
4.01 Competence
(c) Social workers should base practice on recognized knowledge, including empirically
based knowledge, relevant to social work and social work ethics. (NASW Code of Ethics,
2008). Competence, I would say was one of my personal dilemmas. As a social work
intern without any experience dealing with a case like this wasnt easy for me to take in.
It is different in a classroom setting and out it the real world. It required a lot of reading
and thought to make sure I am doing the right thing for my client at their worst.
Conclusion
According to Jennys biopshychosoical, the interventions, and overcoming ethical
dilemmas, Jenny Wood is a young 12-year-old female who is very strong and brave. No
one should ever be a victim of abuse in his or her own house. Jenny comes to group every
week, and if she misses a session, she makes it up by herself as an individual session. She

Running Head: CLIENT ANALYSIS

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appears to cope better with her situation and now knows how to care for herself and
watch over her brothers. She feels comfortable with my sessions and the techniques and
practice I have developed for her following depression, suicide, self-esteem, and
domestic violence. Jenny shows sings of improvement and is meeting her goals slowly.
She is completing her schoolwork, gained confidence and is more social. Her grandma
continues to care for her and check on her once a week. If the abuse at Jenny's home
appears to continue, the school will make a report to Child Protective Services.

References
Allen, K. N., & Wozniak, D. F. (2014). The integration of healing rituals in group
treatment for women survivors of domestic violence. Social Work in Mental
Health, 12(1), 52-68. doi:10.1080/15332985.2013.817369
Effects of Child Abuse and Neglect. (2014). Retrieved from
http://www.joyfulheartfoundation.org/learn/child-abuse-neglect/effects-childabuse-neglect

Running Head: CLIENT ANALYSIS

Kessler, M. L., Emmanuelle, G., & Poertner, G. (2005). Moving Best Practice to
Evidence-Based Practice in Child Welfare. Families in Society 86(2), 244-250.
Thompson, E. H., & Trice-Black, S. (2012). School-Based Group Interventions for
Children Exposed to Domestic Violence. Journal of Family Violence 27(3),
233-41.
Scharwchter, P. (2008). Three Applications of Functional Analysis with Group
Dynamic Cognitive Behavioral Group Therapy. International journal of group
psychotherapy 58(1), 55-76.

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