Bio-psycho-social assessment of Dalia, a fourteen-year-old female

Bio-Psycho-Social Assessment: A Case of Dalia Part A: Bio-Psycho-Social Assessment
The Presenting Issue and Demographic Information
The client is a 14-year-old female, Dalia, of mixed Irish and African-American origin, who presents for counseling following a referral from her school. She presents with behavioral issues that affect her relationships at both home and school. At school, Dalia displays truancy, verbal combativeness when confronted, irritable mood, poor concentration in class, physical altercations with peers, argumentative behavior with those in authority, disinterest in extracurricular activities, and sexualized behavior with male peers. At home, Dalia is extremely impulsive, highly irritable, physically threatening, and argumentative. She stays up most of the night and sleeps most of the day, and engages in alcohol consumption with friends in her parents’ home. Living Situation Dalia lives with her parents in a middle-class suburb and is the youngest of three children, two of whom reside out of the home. Her mother is an executive, spending long hours away at work, while her father works on a nontraditional schedule that has him working overnight and sleeping for the better part of the day. The family leads a comfortable life with no evidence of financial insufficiency.

Birth and Developmental History Dalia has had a difficult childhood, having been diagnosed with sickle cell anemia in early childhood, and spent most of her childhood in and out of hospital. However, her health seems to have stabilized over the last two years as she has not reported a serious episode since she was twelve.

School and Social Relationships Throughout elementary school, Dalia is described as a good-natured, easy-going youngster who shares strong relations with family and peers, and enjoys singing. Since joining middle school, however, Dalia has lost interest in extra-curricular activities, terming them boring and corny. Her family relationships are strained and although she still spends time with her peers, she reports taking alcohol and often engages in physical altercations, verbal combativeness, and sexualized behavior that weaken these relationships. Her performance at school has deteriorated and her teachers report a lack of concentration in class. However, the client has no demonstrated problems with alcohol and drug addiction.

Family Members and Relationships Dalia’s relationships with her family members are severely strained. She enjoys a good relationship with her eldest brother, but they rarely meet as he lives in a different state. Her relationship with her sister, a college sophomore, is, however, not as healthy as is that with her mother, who, being an executive, spends most of her time at work. The client believes that her mother has no time for her and is always trying to control her. Her dad, on the other hand, spends most of his day sleeping and often lets her do what she wants. Owing to their busy schedules, Dalia’s mother and father could not attend all the family meetings organized as part of the counseling process. The client describes her relationship with her family members as tense since her sister left for college.

Health and Medical Issues Dalia demonstrates psychological issues including irritability, impulsivity, and agitation leading to physical altercations with other children in school. She also demonstrates self-esteem issues brought about by teachers at school comparing her to her sister, who was more popular and an excellent student. Dalia experiences feelings of loneliness at home as a result of the communication breakdown with her mother. Her physical health is, however, stable, as she has not been hospitalized for attacks related to sickle-cell anemia for the last two years.

Spiritual Development; Social, Community and Recreational Activities There is no evidence of the client’s engagement in activities geared at increasing spiritual development. Further, the client does not take part in any social, recreation, or community activities before the intervention as she considers such activities ‘boring’. However, after the intervention, she takes up a position as a camp counselor in a local day camp.

Client Strengths, Capacities, and Resources The client exhibits several strengths. First, she currently enjoys stable health after a difficult childhood with sickle-cell that led to multiple hospitalizations. Moreover, she has hardworking parents who ensure that she and her siblings lead a comfortable life, and who take time off their busy schedules to attend family meetings. Further, the fact that she lives in a middle-class suburb implies that she has access to reliable and effective resources to aid her in realizing her goals such as proper community support programs that could facilitate behavioral change and rehabilitation. She also has an elder sister in college whom she can look up to as a source of inspiration and a role model. Also key is her resilience to complete middle school despite the psychological challenges that she was facing. Her fundamental capacities include the ability to sing like she did in elementary school and the ability to offer leadership as in the day camp. The client also enjoys several resources. First, the financial resources available in her family grant her access to proper support services such as rehabilitation programs and counseling to effectively deal with her behavioral issues.

Part B: Analysis of Assessment Client Challenges The client faces several challenges in her internal and external environment. First, she is alone most of the time and lacks someone to talk to at the family level. She is disconnected from her sister as well as her mother who she feels is controlling and does not have time for her; yet they are the people with whom she can share any issues that she could be facing as an adolescent girl. Although she is close to her elder brother, he lives in a different state, and may not really understand the issues that she is facing like her sister would. Another fundamental challenge is that she faces self-esteem issues as she feels that people view her as inferior compared to her elder sister, who is popular and an excellent student. The client is a victim of acculturation, forced to fit into both the Irish and African-American cultures, and lacking the time to discuss the same with her parents and obtain insights into how they dealt with the same while dating. Further, the client faces issues with alcohol use, which interferes with her sleep patterns and makes it difficult for her to concentrate in class. Finally, the client has difficulty controlling impulses in the company of peers, which leads her to drink more in social environments.

The Effect of Social Environment on the Client Hernandez and Blazer (2006) express that the social environment influences an individual’s behavior in two ways: social networks and social support. Social networks incorporate the structural elements of social relationships such as the size of the social network, density (the extent of members’ connectedness to each other), homogeneity (the extent of similarity among members of a network), the frequency of contact, duration of contact, and extent of reciprocity (Hernandez & Blazer, 2006). Social support, on the other hand, has to do with the assistance that people receive from their social networks (Hernandez & Blazer, 2006). It incorporates informational support, which is in the form of valuable information such as advice, and emotional support, which has to do with making an individual feel loved and cared for (Hernandez & Blazer, 2006). Individuals are more likely to be influenced by the social environment if their social networks are structurally strong and provide adequate informational and emotional support.
The presenting client’s social networks at the family level were weak because she was all alone and had no one to talk to (small size), there was a disconnect between the client and her mother/sister (low density), there was little similarity between family members – the client needs someone to talk to while the parents are too busy chasing their jobs (little homogeneity in objectives), and the client rarely met and had time to talk with her parents (low frequency and duration of contact). In this regard, the social environment at the family level had a weak influence on the individual’s behavior, which made it relatively easy for the client to fall victim to external peer networks, which had higher homogeneity levels, higher frequency of contact, and higher duration of contact. This way, the peer social network easily influenced the client into alcohol use, with the familial networks being unable to control the same. Further, the client’s parents had little time to offer informational support in the form of advice on wrong company and alcohol use, and emotional support when the client felt lonely and low on self-esteem. This worsened the clients’ at-risk behaviors and plunged them further to misguided peer influence. Application of Social Theory Bowlby’s Attachment Theory: the theory emphasizes the idea of relationships and bonds between people, such as between parents and their children (Goode, 2008). According to Bowlby, attachment is a lasting psychological connectedness between people that is a result of a dependency relationship between them. For instance, attachment between a child and a parent is a result of a feeding relationship - the parent feeds the child and provides nourishment, and the child, in turn, gets attached (Goode, 2008). Attachment leads to the development of clear motivation and behavioral patterns such that when a child is in an unfamiliar situation, they turn to their parent of caregiver for comfort and care (Goode, 2008). Based on the attachment theory, therefore, children are more likely to engage in negative behavior if their attachment to their families or caregivers is weak. For the presenting client, therefore, deviant tendencies were a result of the weak attachment between herself and her parents/siblings. As such, a potential strategy for the social worker is to devise ways of strengthening the trusting relationship and attachment between the client and her family.
Hirschi’s Social Control Theory: the theory postulates that deviance comes about when an individual’s ties to societal conventional order are either non-existent or weak (Goode, 2008). The underlying assumption is that humans are naturally inclined to commit crime, and need to be controlled by regulations, rules, and laws (Goode, 2008). Individuals are more likely to engage in deviant acts if they have a weak link to four types of bonds: belief, involvement, commitment, and attachment (Goode, 2008). Belief has to do with how much one believes in the values associated with positive behaviors. Attachment refers to the psychological effect that an individual has for pro-social institutions (Goode, 2008). Commitment has to do with the extent to which an individual values their social relationships and would not wish to jeopardize the same by engaging in deviant acts (Goode, 2008). Finally, involvement bond has to do with the extent of people’s involvement in the community and how the same restricts them from engaging in deviant acts (Goode, 2008). For the presenting client, deviant tendencies were a result of weakened bonds belief, attachment, and commitment bonds. In this regard, counseling needs to focus on empowering the individual to enhance the significance they attach to these bonds. Application of the Strength-Based Approach Strength-based assessment has to do with supporting the individual to recognize the resources at their disposal and how they could use the same to counteract the difficult situations that they are facing presently. There are several ways through which the social worker could incorporate the client’s strengths in their treatment plan. Two of the client’s greatest strengths are that i) she was able to make it to high school despite the challenges she was facing and ii) she managed to get over sickle-cell. The social worker could use these milestones to demonstrate the client’s resilience and show her that if she had the power to get over some life-threatening situations, then she could get over her current challenges. Further, the social worker could empower the client to view her elder sister, who has been identified as an excellent student, as a role model and someone to look up to, rather than as a competitor. The therapist could also empower the client to view her parents’ absence as an indication of their hardworking nature or as a means to achieving the desired end of providing a high-quality life for her and her siblings. This would address the misperceptions that the client holds about her parents and would help rebuild the trust relationship that has since been lost.