Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts:    age.” Family History: As part of the Karen community in Southeast Asia, the client and his family lived in a refugee camp near the Thai-Burma border before coming to the United States. His family fled to an internal displacement camp (IDC) to escape ethnic violence and torture. The family arrived in the refugee camp when the client was two years old and stayed for nearly a decade before coming to the United States. He reports that his parents do not drink or use drugs; however, he states that drugs and alcohol were prevalent in the IDC. His family is Christian and is involved with a local church that sponsors individuals from the Karen community and helps with resettlement.  You would like to use a screening instrument to determine the severity of your client’s depression and anxiety

Question: You would like to use a screening instrument to determine the severity of your client’s depression and anxiety. Which one of the following screening instruments has a standardized modification for adolescents?
(A): Cut down, annoyed, guilty, and eye-opener (CAGE)
(B): EQ-5D
(C): Alcohol Use Disorders Identification Test (AUDIT)
(D): Patient Health Questionnaire (PHQ-9)

Correct Answer: Patient Health Questionnaire (PHQ-9)
Explanation: PHQ-9 is a 9-item, self-administered screening instrument used to measure depression and anxiety. PHQ-9: Modified for Teens is adapted for use with adolescents. CAGE is a four-item screening instrument measuring an individual’s problematic alcohol use related to cutting down, others’ annoyance with one’s alcohol use, personal guilt over use, and alcohol use first thing in the morning. EQ-5D measures health-related quality of life across five dimensions, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-Y can be used with children and adolescents. Although measures are included for anxiety and depression, the instrument is not designed for the sole use of determining the severity of anxiety and depression. Finally, AUDIT is used to help identify alcohol consumption, alcohol-related health problems, and drinking behaviors. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis