Case Study
Patient Demographic: Client Age: 30 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Agency Type of Counseling: Outpatient Presenting Problem: Recent Hospital Discharge Diagnosis: Borderline Personality Disorder (BPD) 301.83 (F60.3)
Mental Status Exam: Mental Status Exam: The client is wearing a low-cut blouse and short shorts. Her affect and mood are labile, and her speech is pressured. She is fidgety at times and sits with her arms crossed. The client states that she has had three previous suicide attempts and has been cutting since her late twenties. Her last suicide attempt was an overdose, which resulted in her recent hospitalization. She stated that this was the result of her last boyfriend “ghosting” her. The client denies audiovisual hallucinations but states that she often feels that others are conspiring against her. She says that she continues to have suicidal thoughts but denies having a current plan. Fam
Presenting Problem: You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i.e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).”
Other Contexts:   You are a mental health counselor in an outpatient setting. Your client is a 30-year-old white female who was released from the hospital 48 hours ago. The client presents today for a postdischarge follow-up appointment. The hospital clinician diagnosed the client with borderline personality disorder(BPD) and substance use disorder. The client has a history of suicidality, impulsivity, and relational instability. She explains that she has a “quick temper,” which occurs when she is feeling rejected. She explains that she has a long history of being treated poorly by others, including her last boyfriend, former employers, and family members. During these times, the client admits to substance misuse and self-mutilation (i\. e., cutting). She states that there are times when she drinks to black out and that she is more inclined to do so when her feelings become intolerable. The client has had multiple hospital admissions and has been in the care of several counselors. She questions your credentials and your ability to “work with someone like (her).” ily and Work History: The client attended 3 years of college and reports dropping out due to “depression, anxiety, and anger issues.” She has worked off and on as a server at several restaurants and says she usually quits after coworkers or employers “reject or betray her.” The client’s mother was a teenager when the client was born. Her mother is diagnosed with bipolar disorder, which first appeared after childbirth. She reports moving back and forth between caretakers when she was younger. Her maternal grandmother eventually became her legal guardian and died when the client was in her early twenties. The client reports that she constantly fears abandonment and has “never been successful in a relationship.” She has limited contact with her mother, and the identity of her father is unknown.  To help improve your clinical judgment, your supervisor suggests that you first rule out a substance use disorder diagnosis by using a standardized instrument

Question: To help improve your clinical judgment, your supervisor suggests that you first rule out a substance use disorder diagnosis by using a standardized instrument. Which instrument provides a screening component followed by an assessment for those who screen positive?
(A): TAPS (Tobacco, Alcohol, Prescription Medication, and other Substance use) tool
(B): CRAFFT (car, relax, alone, forget, friends, trouble) screening test
(C): MAST (Michigan Alcohol Screening Test)
(D): CAGE (cut down, annoyed, guilty, and eye-opener) questionnaire

Correct Answer: TAPS (Tobacco, Alcohol, Prescription Medication, and other Substance use) tool
Explanation: The TAPS tool has a screening component followed by a short assessment. The first component (TAP-1) screens for tobacco, alcohol, prescription medication, and other substance use. If the individual has a positive screen, it can be followed by a brief substance-specific assessment (TAPS-2). The CRAFFT screening test is used with adolescents aged 12-21 to screen for risk factors associated with substance use. The CAGE is a brief (ie, four-question) screening instrument for alcohol use. Finally, the MAST is a screening instrument used to determine symptoms of alcohol dependency. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis