Case Study
Patient Demographic:  Initial Intake: Age: 14 Gender: Female Sexual Orientation: Heterosexual Ethnicity: Hawaiian American Relationship Status: Single Counseling Setting: School-based mental health counseling Type of Counseling: Individual
Mental Status Exam: Malik presents as well groomed, good hygiene and behavior within normal limits. She is highly anxious, evidenced by limited eye contact, tense expressions and fidgeting with her hands. Malik admits to having suicidal thoughts and has self-harmed by cutting herself in the past. She reluctantly shares that she had a traumatic event in Hawaii right before leaving but is unwilling to discuss it and begins crying. She then changes the subject and tells you moving out of Hawaii has been painful because “everything is different here, including how they do school and how people talk about each other.” She adds that she experiences at least one nightmare a week since moving.
Presenting Problem: Diagnosis: Major depressive disorder, single episode, unspecified (F32.9), Anxiety disorder, unspecified (F41.9)
 

Malik, a 14-year-old girl entering High School is referred to you for mental health counseling by her school counselor for reports of her leaving the classroom in tears and because of calls received by her mother stating that she has crying spells at home. After speaking with Malik’s mother, you learn her mother, stepfather and sisters have recently moved with her to the mainland states from the Hawaiian Islands and that she has been missing her father, friends, school, and other family members left behind. Malik spends most of her time in her room, appears depressed often, gets upset easily and is constantly on her phone. Her mother asks that you meet with her during school hours and help her understand what is going on. She says Malik has been crying since just before leaving Hawaii.
Other Contexts: Family History:
Malik’s parents divorced while she was young but had always lived in Hawaii, making it easy for her to see both sides of her family at will. Malik has several siblings, cousins, and all her grandparents are still alive. Malik has a strained relationship with her father and stepmother and feels heavily influenced by her father’s opinion of her, stating “he just wants what is best for me, but he’s really harsh about it and it sometimes hurts my feelings and stresses me out.” She is struggling to connect with her mother now because she is working full-time, and she feels “doesn’t have time for her anymore.” Malik is also forced to do most of the household chores and care for her younger siblings on top of managing her schoolwork. All of this has made her feel overwhelmed.

Question: Now that Malik is reporting no suicidal thoughts, how should you update her treatment plan?
(A): Add "codependency" to her treatment plan goals.
(B): Resolve SI treatment plan goal and add "monitor SI" as an objective under depression goal.
(C): Mark SI treatment plan goal as "resolved" and focus more on other goals.
(D): Continue to monitor SI using C-SSRS for the remaining duration of the SI treatment plan.

Correct Answer: Continue to monitor SI using C-SSRS for the remaining duration of the SI treatment plan.
Explanation: You must continue to monitor for suicidal thoughts using a Suicidal Ideation specific treatment plan goal for its minimum duration required as defined by your agency or state laws. Following that period, if SI has been evidenced to be "low risk" or "very low risk" it would then be appropriate to mark the goal as "resolved" and add an SI monitoring goal underneath a depression goal as answer c states. Answer b is not correct as the client had a temporary change in affect for 1-2 weeks and she may still be suicidal. Answer d is a great option for this client but it is best practice to discuss the goal with your client first and ensure they understand it prior to adding it to their treatment plan. Most agencies and state laws also require that a parent sign a consent form for any major updates or changes to their child's treatment plan. Therefore, the correct answer is (A)
Competency: treatment planning