Case Study
Patient Demographic: 7   Initial Intake: Age: 18 Gender: Female Sexual Orientation: Bisexual Ethnicity: African American Relationship Status: Single Counseling Setting: Agency Type of Counseling: Individual
Mental Status Exam: Millie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone
Presenting Problem: Diagnosis: Major Depressive Disorder, single episode, recurrent (F33), Anxiety disorder (F41.9) provisional
 

You are a mental health counselor with a community agency and have been referred a new client named Millie, an 18-year-old African American girl, for problems adjusting to life without her mother who has passed away nearly one year ago from illness. Millie’s father brought her to your agency after convincing her to see a counselor. The referral form filled out by her father says she has never spoken about her mother’s death and does not talk about it with anyone he knows. Millie has had medical problems that have been best explained by disruptions in her eating and sleeping habits, which started after her mother died. You learn several reports were made during her senior year in high school of her fighting with other girls, which Millie tells you were erroneous and “not her fault”. Millie also demonstrates a highly active social life, but primarily online with strangers as she exhibits strong social phobic behavior in public and around others in person. You recommend in-person counseling rather than Telehealth virtual sessions to support her improvement.
Other Contexts: llie was well groomed and presented as anxious with constricted affect as evidenced by shaking her leg and tapping her pen frequently. Millie made good eye contact and speech was coherent and rational, however tangential with increasingly rapid rate at times. Speech content is somewhat guarded, demonstrating preoccupation with social influences and deflection from discussion about losing her mother. Millie was surprisingly graphic with detail about self-starvation and purging food and did not show concern; presented with incongruent affect and smiling while she talked about it. Millie denied SI.

Family History and Living Situation:
Millie lived alone with her mother in a different state until last year when her mother died, and she moved to a new state to live with her father and his girlfriend. Their relationship had already been strained therefore Millie opted to live with her paternal grandparents who also lived locally, which is where she lives now. Millie comes and goes as she pleases and does not regard house rules. She reports most often staying in her room with the door locked while on the computer or phone.

Question: Millie agrees to enter your referred treatment program, a state-run facility that does not require her father's insurance as payment. Her father has left several voicemails for you, asking which program she is in and how to reach her. What is the most helpful response?
(A): Call the father back to apologize and explain why you cannot tell him.
(B): HIPAA prevents you from divulging this information, so you do not call back.
(C): Contact the treatment program and tell them to call Millie's father.
(D): You can tell him she is in detox within the state, but not the name of the facility.

Correct Answer: Contact the treatment program and tell them to call Millie's father.
Explanation: This is the most helpful option as Millie's counselor because, while HIPAA does not permit you to divulge the information to her father since she is 18 years old and did not sign the consent form you provided, you can help facilitate communication with the family by letting the facility know the family is trying to make contact. It will be up to her new facility to then work with Millie on signing a release form and communicating with her father. Calling the father back only to tell him you cannot help him is still violating the boundaries of HIPAA since Millie did not sign consent for you to communicate with him. Simply ignoring the voicemails altogether without further action as in answer a is neglectful of the family's needs, even if you are unable to influence the outcome of their contact. Therefore, the correct answer is (D)
Competency: professional practice and ethics