Case Study
Patient Demographic: Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)
Mental Status Exam: Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f
Presenting Problem: You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.
Other Contexts: Since the start of counseling and services with the local government mental health agency, the client has maintained sobriety from fentanyl and has been moved into stable housing via assistance from the agency. The client reports that the management of his anxiety has been better, but that he often feels lonely and unengaged. The client states that he is not sleeping well and thinks it is because he does not do much during the day. He continues to participate in Narcotics Anonymous daily in order to have interactions with other people. The client says that he tried to reach out to his children but they would not answer his phone call. You empathize with the client regarding his difficulty reaching out to his children. You and the client use this session in order to review progress and identify new goals

Question: Which of the following would be an appropriate goal to focus on based on this session?
(A): Explore reentering the workforce
(B): Focus on improving hygiene and daily living skills
(C): Continue the current focus
(D): Reconnect with family

Correct Answer: Explore reentering the workforce
Explanation: The client is showing signs that he is prepared to explore reentering the workforce. The client has accomplished 10 weeks of sobriety, consistent participation in all services with the local government agency, and maintained housing for 7 weeks. Engaging in work can provide the client with a sense of purpose, meet some social needs for the client, and is part of adult life that the client will need in order to maintain consistent housing and meet his additional financial needs and desires. The client’s family does not appear to be ready to reengage with him at this point because they do not respond to phone calls. The client’s daily living skills were not mentioned in the session note and are therefore not indicated as an immediate or current need. The current focus of therapy should not be continued because the client’s situation has improved significantly and he has maintained progress. Therefore, the correct answer is (B)
Competency: treatment planning