Teenager's Troubles: Marion's Troublesome Path of Crime - Essay Sample

Introduction

Marion is a 15-year old African American male. His behaviors started when he was 14 years old. Marion and his friend attacked a peer and robbed him. He received probation from DJJ for this incident. Marion was arrested and charged on 12/15/2018 (age 14) for burglary of a home. He was arrested again on 3/4/19 (age 14) and charged with Burglary 1st degree and Burglary and Criminal Damage to Property 2nd degree for breaking into a vending machine at a gas station. On 7/1/19, Marion and his friend were selling drugs at a local convenience store when they were robbed. Marion witnessed his friend being shot and killed. He reported the following symptoms: flashbacks 2-3 times a week, nightmares 2-3 times a week, persistent state of anger, unable to feel happy, irritability, and difficulty sleeping. On 12/3/19, Marion was arrested for possession of Marijuana with an attempt to sell; a large quantity of Marijuana was found in his room. DJJ committed Marion for two-years, and he was ordered for treatment in a maximum oversight program.

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Marion reported a history of smoking marijuana, "A few times a week." When asked to clarify, he restated the same thing. Marion reported participating in outpatient counseling at Viewpoint Health after witnessing the murder of his friend. He reported positive results; however, he still has ongoing symptoms. His symptoms interfere with his daily functioning and sleep pattern. Marion's developmental history is unknown. Marion reported being in the 10th grade and is on grade level. He reported one incident of in-school suspension because he did not report to detention. He denied having frequent absences, being retained, or taking special education classes.

Marion reported participating in outpatient counseling after the murder of his friend on 7/1/2019. He was not prescribed psychotropic medication. Marion denied a history of abuse. He denied history a family history of substance abuse; however, records revealed that his biological father has a history of alcohol dependence. Marion's appearance was unremarkable. He was oriented on four spheres. His insight and judgment were observed to be a poor insight into his responses and statements about his behavior. Marion reported difficulty falling or staying asleep at night. He reported having nightmares or flashbacks about the murder of his friend. He reported a normal appetite. He appears his stated age. Marion's affect was flat, and he spoke in a monotone voice. He reported the following depressive-like symptoms: sadness, irritability, withdrawal. Marion's attitude was resistant, AEB his short yes/no responses. He was unwilling to provide clarification or details when asked. Marion has a history of Asthma. He denied any current issues. He denied a family history of medical issues.

Marion’s Trauma-Informed Assessment

Trauma-informed assessment is necessary to determine the past history of trauma and the presence of trauma-related symptoms (Center for Substance Abuse Treatment, 2014). The screening behavior examples mentioned giving the counselor a clearer picture as they determine which clients should continue through to assessment. Marion has not disclosed any traumatic history in his past, but substance abuse is a qualification for assessment. Trauma-Informed Assessments helps to define the client’s struggles and helps both the counselor to determine a treatment plan and make a fully informed and agreed upon decision on treatment placement with the client (Center for Substance Abuse Treatment, 2014).

Assessment Tools

Assessments use many tools to obtain the full picture before creating the treatment plan and placement, including possible multiple sessions, applicable information from families, necessary clinical information such as medical records, interviews with other mental health professionals and agencies. Assessor Qualifications include. Assessments require proper qualifications to conduct assessments and interviews. Screening, due to its “yes or no” nature, can be completed with an administrator or a student without assessment or in Marion’s case, trauma assessment training. For Marion, it is important that a properly trained trauma assessor conduct his assessment to ensure Marion receives the care he needs in the timely manner necessary in his case.

Application of Core Concept in Identification of Immediate Treatment Issues

Trauma occurs within a broad context that includes children’s personal characteristics, life experiences, and a current circumstance is the chosen concept. He also has lost the ability to experience positive emotions and goes from appearing tired and despondent with a low voice and flat affect too anxious and tearful (NCTSN, 2012). He is also isolating and dissociating himself from going to class and has stopped driving because he is too fearful of hitting someone else or being hit by someone else. The only support person involved is his school roommate, and the only person on his care team is the campus physician (NCTSN, 2012). There has been no mention of the family in the case study. These are all indicators of crisis and increase suicide risk for Marion greatly (American Psychological Association, 2013).

Marion’s Immediate Needs

The immediate need is to contact a supervisor or agency who work with clients demonstrating self-harming, self-destructive, or suicidal homicidal ideation, intent or behavior and either refer Marion out or seek specialized supervision to ensure the counselor fully understands Marion’s “I don’t deserve to live” comment and intent and his substance abuse behavior along with his despondent attitude and dissociative nature from school and from social life (Center for Substance Abuse, 2014). Once the client is understood to not be a suicide threat, the self-harm comment "I do not deserve to live" needs to be addressed, then the isolation and dissociation from school, social life, family need to be addressed. It is important to distinguish self-harm that is suicidal from self-harm that is not and explain to the client to assess and manage each of these feelings as seriously dangerous behaviors that always need to be addressed without delay.

Efforts Made in Addressing Ambivalence/Resistance Effectively

Timing and Setting. Trauma-informed counselors begin educating clients on the process of trauma-informed screening and assessment on the first contact, typically the first phone call. In Marion’s circumstances, there was a delay, so this adds responsibility to the counselor to educate Marion of the process, but to do this at Marion’s pace to avoid becoming overwhelmed and for him to know that he is in control of this process. The initial assessment contact and how the assessment is conducted needs to be done, asking general questions, and being attentive to move at Marion’s pace. The counselor must come prepared, referencing notes from the initial phone contact, setting up the appointment over the phone, and conducting a screening interview at that time.

Summary of the Treatment Interventions

Cognitive Processing Theory

Cognitive Processing Therapy looks at faulty belief systems and thinking processes that allow posttraumatic stress disorder symptoms to continue. This treatment approach also includes an exposure component that gradually exposes a person to the full experience of the traumatic event. This technique helps to break the emotional hold of the event over a person’s daily life experiences (DeAngeles, 2008).

Those battling PTSD in cases like Marion feel that the world is no longer a safe place. Some people may actually blame themselves or view themselves as weak or incompetent for letting the event happen. This is matching Marion’s comments of “I am so stupid!” and his worries about being hit by another car or hitting someone in their car if he was to begin driving again.

Trauma-Focused Cognitive Behavioral Therapy

Trauma-Focused Cognitive-Behavioral Therapy is a direct approach exposure therapy that works with clients to gradually expose them to elements of their trauma such as their attached feelings, thoughts, and emotions until they no longer have a negative response to anything related to the trauma. It is in one therapeutic environment where the client learns to replace PTSD thoughts and emotions with a healthier, balanced place for the trauma in their life.

Identification of Next Steps Based on the Trauma Treatment Framework

Marion’s Family, Friends, and Peers Contacted

Marion is still underage at 14 years, and according to the Jed Foundation, a non-profit helping colleges and universities address mental health issues, the family will be contacted if they are admitted on a college campus for the following reasons (Jed Foundation, 2019):

Under 19. Marion is under 19-yrs. - Marion’s is 14 and considered underage. He will be contacted by the counselor, myself, Student Life Services on campus, the auto insurance claims adjuster, the police department issuing the citation.

Self-Harm Concern. They feel a student is suicidal or homicidal - It is understandable that there has been a great focus on this one comment "I don't deserve to live"; however, it is too much of a risk if Marion has ever had more thoughts than he was sharing and it is not worth the risk for this counselor if Marion is as serious as he has been behaving.

Substance Abuse Issues. Parents of students under 21 years know of any drug or alcohol violations.

References

American Psychiatric Association (APA). (2013). Trauma and stressor-related disorders. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington, VA: American Psychiatric Pub.

Center for Substance Abuse Treatment (US). (2014). Trauma-informed care in behavioral health services; chapter 4, screening and assessment (Treatment Improvement Protocol (TIP) Series No. 57). https://www.ncbi.nlm.nih.gov/books/NBK207188/

DeAngelis, T. (2008). PTSD treatments grow in evidence, effectiveness. PsycEXTRA Dataset, 39(1), 40. doi:10.1037/e722952007-025

Jed Foundation. (2019). For colleges & universities. https://www.jedfoundation.org/what-we-do/colleges/

NCTSN Core Curriculum on Childhood Trauma Task Force (2012). The 12 core concepts: Core curriculum on childhood trauma. Los Angeles, CA, and Durham, NC: UCLA-Duke University National Center for Child Traumatic Stress. file:///C:/Users/my%20pic/Downloads/the_12_core_concepts_9814%20(1).pdf