Mother reports that she and J.S’s father separated in October of 2015. She reports J.S wishes for her and his father to reunite and get back togethe

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Part 1: Comprehensive Client Family Assessment

Demographic information

J.S is an 8-year-old, African American/Caucasian, male.

 

Presenting problem

Mother reports that she and J.S’s father separated in October of 2015. She reports J.S wishes for her and his father to reunite and get back together. She believes that he could benefit from additional support with understanding the separation of his parents. Mother reports since separation J.S is “clingy” as evidenced by wanting to be with mother all the time (e.g., wanting to sleep with mother, wanting to be with mother in the house and not alone in his room). Mother reports J.S talks to her, but is uncertain if he has any suppressed thoughts or feelings. She shared that J.S’s father was recently on the phone with a women while he was visiting. Mother reports since this J.S has been having a lot of questions about whether his parents will be together again and whether they have other significant relationships. She shared that she wants J.S to understand the concept of his parents being apart.

 

History or present illness

Mother reports onset of Jayden’s behavior occurred in 2015 when her and Jayden’s father separated.

 

Past psychiatric history

Mother reports none

 

Medical history

Mother reports none.

 

Substance use history

Mother reports none.

 

Developmental history

Mother reports no delays.

 

Family psychiatric history

Mother reports anxiety and depression on both J. S’s paternal and maternal side of family. Father is struggling with addiction.

 

Psychosocial history

J.S reports having a lot of friends. He reports getting along with his friends.

 

History of abuse/trauma

Mother reports none.

 

Review of systems

 

Gen:  Denies weakness, fatigue, fever, chills, night sweats, heat intolerance.

Head: normocephalic; denies migraine headaches.

ENT: Denies visual changes, eye pain, hearing loss, tinnitus, vertigo, ear pain, ear discharge, epistaxis, nasal discharge, sinusitis, teeth problems, abnormal taste, sore throat, or speech difficulty

Neck: Denies neck swelling, pain, stiff neck, goiter, or masses, nodes. Cardiopulmonary: Denies cough, dyspnea, wheezing, hemoptysis, chest pain, palpitations, orthopnea, murmurs, edema, claudication, syncope, hypertension.

GI: Negative for decreased appetite. Neg for n/v, hematemesis, melena, dysphagia, heartburn, flatulence, abdominal pain, jaundice, change in bowel habits, diarrhea, constipation, hematochezia, or rectal pain.

GU: No dysuria, frequency, nocturia, hematuria, urgency incontinence or polyuria.

MS: Denies backache, joint pain, stiffness. Gait is normal and steady.

Heme/Skin: Denies bleeding, bruising, anemia. Denies changes, pruritis, rash, or changes in hair.

Neuro: Denies seizures, paralysis, muscle weakness, parasthesia, sensation changes.

Psych: Thought content: no SI/HI or psychotic symptoms; Associations: intact; Orientation: x 3; Mood and affect: euthymic and full and appropriate.

 

 

 

Physical assessment

Vital Signs:

47 Height: inches

Weight: 115lbs

Temp: 37 C.

RR: 16

BP: 110/62

Pulse: 82 BPM

Appearance: Slender bi-racial male, slightly tan, appearing younger than stated age in   distress, no acute distress, neatly dressed and groomed.

 

Mental status exam

 

J.S presents to the appointment with his mother. He alert and oriented x4. Neurologically intact. J.S. is neatly dressed. Polite mannerism and very social. Mood and affect is euthymic and appropriate. J.S. is comfortable interviewing with therapist while mother steps out. He seems to like talking to therapist and asks many questions about games, books, etc. that are present in the room. J.S. denies any SI/HI or A/V/H. Speech is coherent and clear. J.S. fidgets with his hands during interview and processed better after therapist offered Play-Dough to figet with instead.

 

 

Differential diagnosis

Z63.5 Disruption of family by separation and divorce

Diagnosis

 

Seperation and Anxiety Disorder

 

Case formulation

 

Mother reports that her and J.S’s father separated in October of 2015. Mother reports since separation J.S is “clingy” as evidenced by wanting to be with mother all the time (e.g., wanting to sleep with mother, wanting to be with mother in the house and not alone in his room).

 

J.S attended session with his mother. He completed a Basic Emotion Assessment indicating mixed emotions (sad, angry, happy, excited). J.S rated sadness as a 4 on a scale from 0-5 with 5 indicating very sad. Jayden explained, “I am sad that my dad does not live with me anymore.” He reported that he is happy and excited because he will be going to his grandmother’s home for the summer.

 

According to the American Psychological Association (2013), diagnosis assigned to individuals who have an unusually strong fear or anxiety to separating from people they feel a strong attachment to. The diagnosis is given only when the distress associated with the separation is unusual for an individual developmental level, is prolonged and severe. In accordance with J.S.’s intake assessment and individual therapy session, he fits the criteria for this diagnosis.

 

Treatment plan

 

Treatment Goals

J.S will acknowledge and accept the separation of his parents. He will begin a healthy grieving process and manage reactions experienced due to disruption of family by separation.

Estimated Completion: 3 Months

Objective #1

J.S will bring awareness to thoughts and feelings related to his parents’ separation as evidenced by (a) identifying and listing emotions surrounding two parents and two homes, (b) clarifying his relationship patterns with his custodial (mother) and noncustodial (father) parent, and (c) participating in expressive art activities or psychotherapy exercises to help express thoughts and feelings about parents’ separation. Progress will be measured per J.S’s report, parent report, and Therapist direct observation.

 

Treatment Strategy / Interventions: Supportive psychotherapy, integrating psychodynamic, cognitive-behavioral, and interpersonal conceptual models and techniques will be used to address and respond to J.S’s thoughts and feelings related to his parents’ separation.

Therapist will educate J.S on how relationships may begin and end. Therapist will elicit J.S’s exploration, description, and ventilation surrounding the disruption of family by separation. Therapist will assist him in developing vocabulary to express emotions. Psychoeducation, Psychotherapy Homework, Psychotherapy Worksheet, Expressive Arts Therapy will be used to help him identify, list, and bring awareness to his emotions and thoughts. Therapist will help Jayden learn how to rate his emotions using basic emotion assessments each session. Supportive Reflection, Interactive Feedback, Symptom Management, Relaxation/Deep Breathing will be used to foster a therapeutic environment and alliance where J.S is comfortable in sharing.

Estimated Completion: 3 Months

Objective #2

J.S will accept parents’ separation with consequent understanding and control of feelings and behavior as evidenced by (a) practicing emotion regulation skills (e.g., opposite actions, checking the facts, focusing on positive events, etc.), (b) developing and using relaxation techniques (e.g., deep breathing, mindfulness, drawing, coloring, etc.), and (c) learning and verbalizing the stages of loss and grief for children whose parents have separated. Progress will be measured per J.S’s report, parent report, and Therapist direct observation.

 

Treatment Strategy / Interventions: Therapist will gently explore, confront, and address J.S’s reactions to his parent’s separation. Using DBT and CBT approaches, J.S will be educated, taught, and modeled skills he can use to cope with strong negative emotions. Therapist will help J.S understand the stages of loss and grief experienced by children. Therapist will determine what stage of loss and grief he is in and help him move towards acceptance. J.S will be asked to identify and list the advantages and disadvantages of his parent’s separation. He will be encouraged to focus on positive experiences he has had since his parents’ separation to help him accept and embrace changes. Role-Play/Behavioral Rehearsal, Psycho-Education, Psychotherapy Worksheet, Supportive Reflection, Symptom Management, Interactive Feedback, Exploration of Coping Patterns, Exploration of Coping Patterns, Exploration of Emotions will be used.

Estimated Completion: 3 Months

 

Social Support system:

Mother, maternal grandmother.

 

Part 2: Family Genogram

Genogram includes J.S. maternal side of family. Mom reports no knowledge of paternal family members by name.

 

 

 

 

 

Grand

Father Ed

Grand

mother Judy

 

Jade

Father

Greg

Mother

Ashley

Great

grandfather

Tom

Great

grandmother

Ann

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Learning Objectives Students will:  •Assess clients presenting for psychotherapy • Develop genograms for clients presenting for psychotherapy 

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Learning Objectives Students will:  •Assess clients presenting for psychotherapy • Develop genograms for clients presenting for psychotherapy

To prepare: • Select a client whom you have observed or counseled at your practicum site. • Review pages 137–142 of the Wheeler text and the Hernandez Family Genogram video in this week’s Learning Resources. Reflect on elements of writing a Comprehensive Client Assessment and creating a genogram for the client you selected.

The Assignment

Part 1: Comprehensive Client Family Assessment With this client in mind, address the following in a Comprehensive ClientAssessment (without violating HIPAA regulations):  •Demographic information  •Presenting problem  •History or present illness  •Past psychiatric history   •Medical history • Substance use history  •Developmental history  •Family psychiatric history   •Psychosocial history  •History of abuse/trauma  •Review of systems   •Physical assessment  •Mental status exam  •Differential diagnosis  •Case formulation  •Treatment plan

Part 2: Family Genogram Prepare a genogram for the client you selected. The genogram should extend back by at least three generations (great grandparents, grandparents, and parents).

Required Readings:

(1) Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

ATTACHED WITH THIS HOMEWORK IS A SAMPLE OF THIS ASSIGNMENT AND REMEMBER IT HAS TWO  PARTS.

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This week you will submit the Literature Review section of your proposal. Each week you have been adding to your growing body of evidence to support your problem and proposed innovation to address the problem.

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By Week 4, Day 5, write a (5–6 pages) paper addressing the sections below of the research proposal.

This week you will submit the Literature Review section of your proposal. Each week you have been adding to your growing body of evidence to support your problem and proposed innovation to address the problem. The review of literature is a critical, analytical summary and synthesis of the current knowledge of your research topic. Thus it should compare and relate different theories, findings, etc., rather than just summarize them individually.

The following resources will help guide you (in addition to our course textbooks):

  • http://writing.wisc.edu/Handbook/ReviewofLiterature.html
  • http://www.duluth.umn.edu/~hrallis/guides/researching/litreview.html
  • http://writingcenter.unc.edu/handouts/literature-reviews/
  • Writing the Literature Review: Step-by-Step Tutorial for Graduate Students: http://www.youtube.com/watch?v=2IUZWZX4OGI
  • Writing the Literature Review (Part Two): Step-by-Step Tutorial for Graduate Students: http://www.youtube.com/watch?v=UoYpyY9n9YQ

Submit your assignment to the W4: Assignment 2 Dropbox by Week 4, Day 5.

Assignment 2 Grading CriteriaMaximum Points

Literature reviewed represents current scholarly literature.5

Literature reviewed represents a comprehensive review of the research topic.5

Review of the literature is a critical, analytical summary. 5

Review of the literature illustrates a synthesis of the current knowledge of research topic.10

Followed APA guidelines for writing style, spelling and grammar, and citation of sources.5

Total:30

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Hypertension in African Americans Research Proposal Draft

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Running Head: HYPERTENSION IN AFRICAN AMERICANS 1

HYPERTENSION IN AFRICAN AMERICAN 6

 

 

 

 

 

 

 

Hypertension in African Americans Research Proposal Draft

India Blandon

South University

 

 

 

 

 

 

 

 

Background

The racial differences in hypertension and the related complications for decades are recognized with African Americans having the highest risk compared to other ethnicities. Blood pressure readings have been consistently higher in African Americans with an early onset of hypertension. Despite awareness and treatment attempts, the problem of high blood pressure has continued to rise among the African American population. For this matter, various complications are associated with hypertension among this racial group (Allison, et al, 2014). Complications include end-stage renal failure, stroke, and congestive heart failure. In this case, research is focused and highly committed to determine factors associated with racial disparities in hypertension and addressing the essential need to the existing gaps. The purpose of this study, therefore, is to identify the high risk factors of hypertension and to determine if providing health education and developments of community programs are effective in reducing hypertension in the African American community.

Statement of problem and purpose

The major problem of discussion of this study is the high prevalence of hypertension in African Americans than other ethnicities. It is important to explore the norm, behavioral, and the disease control beliefs of the African American population in relationship to maintaining self-care behaviors that are essential in controlling and mitigating blood pressure and preventing hypertension. This would act as the first phase of studies aimed at developing clinical tools that can be utilized by the health professionals to design or develop more effective interventions aimed at reducing the disparities and prevalence of hypertension (Allison, et al, 2014).

Research question

This research is seeking to answer a specific research question concerning hypertension. In this case, the research questions would be, does the development of community programs and providing health education reduce disparities and factors associated with hypertension in predominately African American communities versus a more diverse community?

Hypothesis

The puzzle of the high risk of hypertension among African Americans has triggered various hypotheses both research and the null hypothesis. For instance, it is hypothesized that there are some genetically determined and modified physiologic differences that exist between the African Americans and whites. In this case, the Creatinine Kinase found in African American’s muscles has greater amounts than the Caucasians. Creatinine Kinase tends to influence blood pressure. It is also hypothesized that the environmental factors such as psychosocial and lifestyle factors are important in the development of hypertension. It is hypothesized that the African American individuals tend to have high rates of obesity. Body mass affects blood pressure and the anthropometric measurements as it relates to the risk of high blood pressure.

Study variables

Study variables are defined as those factors or things that have quantity or quality that varies or changes. In this case, there exist both dependent and independent study barriers. The variables of this study include salt sensitivity, environmental factors such as psychosocial, socioeconomic, and lifestyle factors, genetics, and the body mass index.

Operational definition of variables

Salt sensitivity

While salt sensitivity should affect blood pressure in many populations across the world, there are racial differences that exist in the intake as well as the handling of the sodium and potassium. While the prevalence of salt sensitivity in African Americans and the Caucasians remains similar, the degree of blood pressure increase and changes shows disparities (Allison, et al, 2014).

Body mass

The racial disparities in the body mass index have been recognized and suggestive of differences in blood pressure and the prevalent levels. In this case, African Americans have been associated with high chances of overweight and obesity in various age groups. However, this body mass affects blood pressure and hence the high disparities found in such individuals (Weaver et al, 2017).

Lifestyle

Hypertension can be categorized as a lifestyle disease. Research shows that African Americans, are not associated with high rates of exercise and hence they have high chances of hypertension. On the other hand, the whites take part in exercise and this helps to reduce the excessive fat in the body and hence prevention of atherosclerosis that may lead to increased blood pressure (Sessoms et al, 2015). Meeting guidelines by adhering to lifestyle modifications through the success of the DASH diet, alcohol consumption and weight loss helps to reduce hypertension in African Americans (Sessom et al, 2015).

Psychosocial factors

Research demonstrates that the psychosocial factors play a role in the development of hypertension. These factors may include occupational stress, personality, housing instability, sleep quality, and support and remain essential factors in the development of hypertension.

Socioeconomic

According to Weaver (2017), it was identified that socioeconomic factors also correlates with the blood pressure. Residential distance may be an indicator of systolic dysfunction in the African American community. Living closer to primary highways are associated with cardiac remodeling in an understudied African American population. Primary highways with limited access are typically busier and have more air pollution that can lead to heart failure. Those also closest to primary roads were found to have less education, lower socioeconomic and government assisted insurance (Weaver et al, 2017). African Americans who live in the United States usually suffer disproportionately high chances of hypertension when compared to other ethnic groups (Chor et al, 2015).

 

 

 

 

 

 

 

 

References

Allison, D. B., Edlen-Nezin, L., & Clay-Williams, G. (2014). „Obesity among African-American Women. Prevalence, Consequences, Causes, and Developing Research.“. Womens Health, 243-274.

Chor, D., Ribeiro, A. L. P., Carvalho, M. S., Duncan, B. B., Lotufo, P. A., Nobre, A. A., … & Barreto, S. M. (2015). Prevalence, awareness, treatment and influence of socioeconomic variables on control of high blood pressure: results of the ELSA-Brasil Study. PLOS one, 10(6), e0127382.

Sessoms, J., Reid, K., Williams, I., & Hinton, I. (2015). Provider Adherence to National Guidelines for Managing Hypertension in African Americans. International Journal Of Hypertension, 20151-7. doi:10.1155/2015/498074

Weaver, A. M., Wellenius, G. A., Wen-Chih, W., Hickson, D. A., Kamalesh, M., & Yi, W. (2017). Residential distance to major roadways and cardiac structure in African Americans: cross-sectional results from the Jackson Heart Study. Environmental Health: A Global Access Science Source, 161. doi:10.1186/s12940-017-0226-4

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