Case Study
Patient Demographic: Client Age: 13 Sex Assigned at Birth: Male Gender: Transgender; Gender Nonconforming (TGNC) Ethnicity: Caucasian Counseling Setting: Child and Family Agency, School-Based Services Type of Counseling: Individual and Family Presenting Problem: Truancy; Gender Dysphoria Diagnosis: Gender Dysphoria, Provisional (F64.1); Social Exclusion or Rejection V62.4 (Z60.4)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing. They wear eye makeup and chipped black fingernail polish, and they have bitten most fingernails down to the quick. The client’s mood is irritable, and they are quick to show anger toward their mother when misgendered. Their thoughts are coherent, and they deny audio/visual hallucinations. The client acknowledges feeling sad and hopeless but denies suicidal ideation. They attribute increased levels of anxiety at school to bullying, particularly with select peers. They explain that a select group of students threaten the client and call them offensive and derogatory names. Family History and History of th
Presenting Problem: You are a school-based mental health counselor in a public middle school. Your client is a 13-year-old Caucasian 7th grader who presents for the initial intake with their mother. The mother says that the client has had several unexcused absences from school because “he is confused about his gender.” The client adamantly denies being confused and explains that they self-identify as transgender. The client’s preferred pronouns are “they/them.” The client further states that they have had a strong desire to be a different gender since early childhood, and this desire and their distress have recently intensified. The mother reports that the client is chronically irritable, spends a lot of time alone, and has “basically shut everyone out.”The client reports experiencingbullying—both verbal and physical—in school “nearly every day.” In addition to the bullying, the client says that certain teachers refuse to allow them to use the bathroom aligned with their identified gender. To prevent this conflict, the client does not eat breakfast or lunch at school.
Other Contexts: The client arrives for the session without her husband. Her affect is flat, and she presents as more subdued. The client explains that she has been in bed for the last 4 days, which has caused escalated conflict and tension with her husband. She says that her husband believes that they are at an impasse and threatened to leave during their fight last night. When processing the details of their altercation, the client states that her fear of being alone has become unbearable. She denies any suicidal plans but says she feels hopeless and void of purpose and is in significant levels of physical pain due to intractable migraines. You conduct a suicide risk assessment to determine the client’s level of safety

Question: The National Action Alliance for Suicide Prevention (2018) evidence-based standard care for people with suicide risk includes all of the following elements EXCEPT:
(A): Supervision
(B): Caring contacts
(C): Safety planning
(D): Means reduction

Correct Answer: Supervision
Explanation: The National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group’sRecommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe(2018) contains recommendations for treating suicidality. All of the elements (safety planning, means reduction, and caring contacts) except supervision are included in the recommended standard care. EBPs for outpatient behavioral health include conducting a safety plan intervention during sessions when the concern for suicide risk is high. Safety planning includes frequently assessing suicidal risk and updating the safety plan during each visit until the risk subsides. Means reduction involves assessing for lethal means and arranging for their removal or reduction. Caring contacts is another evidence-based standard and practice. Caring contacts are staff members or other individuals who provide brief support to clients during high-risk periods, such as transitioning from hospitalization to a lower level of care or for missed appointments. Contacts are made via phone, texts, or letters to help prevent isolation and reduce the risk for suicide. Therefore, the correct answer is (C)
Competency: professional practice and ethics