Running head: EVALUATION OF CLIENT

Evaluation of Client
Mary Glass
Wayne State University

EVALUATION OF CLIENT

2
Abstract

This paper will offer detailed information about a female youth who is aging out of the foster
care system. First, a biopsychosocial assessment is provided. The topics covered in the
assessment are her identifying information, family of origin, family history of physical and
mental illnesses, placement history, physical health, mental health, education, and social
development. Second, theories will be presented to describe how the youth has responded to her
traumatic life. She spent eleven years in an abusive and neglectful environment with her
biological parents and seven years in several foster care placements administered by various
caseworkers. Third, interventions will be introduced to help the youth address her needs and
work toward her goals. Finally, ethical dilemmas will be discussed which could affect how
services are afforded to the youth.

EVALUATION OF CLIENT

3
Evaluation of Client

Every person is unique. Each person has other people who will enter their lives which may
affect their perspective. A person may have eventful situations which can affect their
psychological and social decisions. When a child enters the foster care system due to physical
abuse or neglect, they often suffer from some type of trauma induced mental illness (Lehmann,
Havik, Havik, & Heiervang, 2013). The foster care system can sometimes even increase the
trauma and cause life lasting effects.
Identifying Information
Beth Gally (pseudonym) is an 18 years old Caucasian single female with light brown hair
and hazel eyes. She is 55 tall and 187 pounds. Beth wears prescription glasses. She does not
identify with any specific religion. Beth is a high school student who lives in a youth residential
group home. She has never obtain employment. The client has no children. Beth entered the
foster care system in 2008 due to her parents substantiated abuse and neglect charges. Her father
released parental rights on December 3, 2008 and her mothers parental rights were terminated
on July 24, 2009. In addition to the legal, medical, psychiatric, and social services provided to
Beth, she began meeting with the Foster Care Review Board for a semiannual review of her case
plan. Even though Beth knows she struggles with living outside a structured environment, she
would like to live with her maternal aunt in a home environment. She is also interested in
visiting with her siblings again. Educationally, she would like to obtain a high school certificate.
Family of Origin
The clients mother was 21 years old and the father was 23 years old at the time of her
birth and were married. Her mother, Susan (pseudonym), earned her high school diploma. The
father, Bill (pseudonym), has completed 10th grade. Susan has worked as a waitress. Bill has

EVALUATION OF CLIENT

worked as a builder. Beths parents divorced when she was 6 years old. A no contact order was
put in place for Bill because of the chronic environment of conflict, animosity, and chaos
between the parents. Beth has not had contact with her parents since 2009 when the parental
rights were ended.
The client has 3 siblings, two younger sisters who shared the same biological parents and
one younger brother who has a different father. All of the children were removed from their
mothers home in 2008. One of Beths sister, Jamie (pseudonym), is one year younger than her.
According to the last case plan before Jamie was adopted, she was living with the youngest
sister, Fran (pseudonym), in a licensed foster home which was interested in adopting the girls.
Jamie was a student in a Mildly Cognitive Impaired Special Education program. She had some
incidences of self-harm and destructive behavior. Fran is 3 years younger than Beth. According
to Frans case plan prior to her adoption, she was a student receiving additional support in
reading, spelling, and writing. She exhibited some negative behaviors. Jamie and Fran were both
attending counseling and were adopted by the same adoptive parents. Kyle (pseudonym), Beths
maternal half-brother, is ten years younger than her. He lives with different adoptive parent than
his half-sisters. According to his last case plan before his adoption was finalized, he was
developing appropriately for his age and attaching well to his adoptive parents.
Beth did visit her siblings frequently when they initially entered the foster care system.
However, the sibling visits were cancelled in 2011 because Beths mental state would decrease
significantly after each visit. The Permanency Resource Manager suggested the visitation stop
until Beth could psychological handle visiting her siblings.

EVALUATION OF CLIENT

Family History of Physical and Mental Illnesses

Prior to the termination of parental rights, the father suffered from substance abuse and
conduct disorder. He was also charged with sexually molesting Beth, Jamie, and Fran. Her
mother battled severe depression and Crohns disease. Neither parent was equipped with
adequate parenting skills. Services including psychological evaluations, individual counseling,
parenting classes, and anger management were offered to the mother and father; however, they
chose not to participate.
Prior to the adoption of Jamie, she was taking medication for depression, Attention
Deficit/ Hyperactivity Disorder (ADHD), and bipolar disorder. She was also participating in
counseling individually and with her foster mother. Fran was diagnosed with conduct disorder,
but was not prescribed any medication. Fran was meeting with a therapist bi-monthly. Kyle was
not diagnosed with any physical or mental illnesses.
Placement History
Beth has had 15 placements since entering foster care system. Beth was initially put in
Kids First, an emergency shelter, upon removal from her biological home. She was then placed
in four unrelated licensed foster homes, three residential group homes, four psychiatric hospitals,
one relative placement, one detention facility, all prior to being placed at her current residential
group home.
The client has struggled with mental instability since she entered the foster care system.
Her removal from the initial licensed foster home placements were due to the foster parents
inability to prevent her from self-harm and control her outbursts. Beth was placed in a
psychiatric hospital in 2009 after removing two of her own teeth during an explosive tantrum.
After hospitalization, Beth entered Kids First again until the caseworker could find a suitable

EVALUATION OF CLIENT

placement for her. Beth went from one residential group home to another with frequent stops at
a psychiatric hospital in between. She would not willingly participate in any program and had to
be watched consistently so she would not harm herself or others.
In April 2011, Beth was placed with her paternal aunt, Sue Marks (pseudonym), after
years of personal visits and phone contact while she resided at the residential group homes.
Beths behavior started to improve as her relationship with her Aunt Sue strengthened. Sadly,
once Beth was placed in her home, Ms. Marks was unable to constantly meet her needs. Beth
had frequent visits to the psychiatric hospital after extreme defiant behavior. Ms. Marks even
called the police one time when Beth threatened to physically harm her. Beth was detained and
placed in a juvenile detention facility. By December 2011, Beth was placed at another
residential group home. After extensive psychiatric services were provided, Ms. Marks tried to
care for Beth in her home again in September 2013. By April 2014, Beth was taken to a
psychiatric hospital because she was verbally threatening to kill her aunt and there was a
suspicion of self-harm. In May 2014, Beth was place in her current placement, a residential
group home.
Physical Health
Beths physical health information for the first nine years of her life are unavailable
because records we not kept prior to her entering the foster care system. Since 2008, Beth has
been current with her medical, vision, and dental. She is up to date with her immunizations.
Beth was diagnosed with Borderline Diabetes in 2011 and continues to take Melformin to
manage her blood sugar levels and Gemifibrozil to help her body metabolize fats. The client was
given her first Depo Provera injection to prevent pregnancy in 2012 and has been receiving the
injection every three months since then. In April 2012, she was diagnosed with mild obstructive

EVALUATION OF CLIENT

sleep apnea and fitted for a mouth guard. In 2012, it was discovered she has high cholesterol.
The cholesterol is being monitored and she has not been prescribed any medication. She started
taking Synthroid, a prescription medication, to improve her underactive thyroid. She also began
wearing a back brace to treat Scoliosis. Beth started receiving B-12 injections after it was
determined she is Vitamin B deficient.
Since January 2014, Beth has lost 50 pounds. She is more active and eating healthier.
The extreme weight loss caused the back brace to be too large. The doctor was able to adjust the
straps and informed Beth her back is improving and she will likely not need back surgery. In July
2014, Beth attended a seminar which explained puberty and ways to prevent dating violence.
Mental Health
The client has a long history of mental health issues. She was sexual molested by her
biological father and her parents physical abused each other in front of Beth and her siblings
prior to entering care. In 2008, Beth was diagnosed with Disruptive Behavior Disorder and Mild
Mental Retardation. She acted sexually inappropriately toward men and exhibited frequent
physical outbursts. Her mental and physical actions caused her to be removed from a licensed
foster home and be placed in a residential group home. At the residential group home, she was
monitored all the time. When she demonstrated disruptive behavior, it often resulted in her
being restrained or put in seclusion until she would calm down. By 2011, Beths mental health
diagnosis were updated to Conduct Disorder, Oppositional Defiant Disorder, Mood Disorder and
Cognitive Impairment. She was prescribed Levothyroxine, Seroquel, Lamictal, and Sertaline. In
2012, Beth was admitted to the hospital emergency room for allegedly self-mutilating her
vaginal area. She confessed to stabbing the area with a pen. At the time Beth was fifteen years
old, but she was only considered to be seven years old emotionally. Beths 2012 psychological

EVALUATION OF CLIENT

evaluation diagnosis was updated to Reactive Attachment Disorder, Mood Disorder, and
Posttraumatic Stress Disorder. Her medications were changed to Eskalith, Topomax, Latuda,
and Welbutrin to stabilize her mood.
Beth continues to receive mental health treatment. Her most recent psychiatric diagnosis
are Reactive Attachment Disorder, Mood Disorder, and ADHD. Her psychiatrist changed her
medication to Wellbutrin, an anti-depressant, Lithium Carbonate, a mood/aggression stabilizer,
Abilify to help with her mood, Naltrexone to help with symptoms of self-abuse and overeating.
According to her caseworker and psychiatrist, she is benefiting from the medication. Beths
psychiatrist reviews her medications monthly. During Beths weekly visit with her therapist,
behavior focused Talk Therapy is utilized. Beth also participates in individual and group Art
Therapy which allows her to artistically express herself. Beth has not exhibited any alcohol or
medication dependency issues.
Education
Beths education prior to entering care in 2009 is unknown. In 2009, Beth, 12 years old,
was placed into the 6th grade. She spent most of her school day in a cognitively impaired
classroom. The next school year, she was promoted to the 7th grade with special education and
cognitive impairment assistance; however, her Individualized Educational Plan (IEP), revealed
Beths academic performance is at a 1st or 2nd grade level. In 8th grade, Beth continued to remain
in the cognitively self-contained classroom. She was able to write her name in cursive and
complete basic addition problems. She was promoted to the 9th grade, although her IQ was 48.
She received 1:1 tutoring four days a week and participated in educational field trips on Friday.
Beths IQ was retest in 10th grade. The results increased to 63. The client remained in the
cognitive impaired classroom with students of similar impairments.

EVALUATION OF CLIENT

Beth is currently classified as an 11th grade high school student and she enjoys school.
She is able to follow instructions with help and has not exhibited behavioral problems this school
year. The results of her IEP in 2014 allow her to continue to receive special education classes
due to her cognitive impairment. Even though she is technically in the 11th grade, a recent
standardized test placed Beth in a 1st grade level in reading comprehension and a 2nd grade level
in math and writing. The clients current placement provides Beth with additional tutoring
services three days a week for 45 minutes each day. Beth is eligible to receive special education
services until she is 26 years old and she could obtain a certificate of completion according to her
caseworker.
Social Development
Beth initially had severe struggles with developing social relationships. The trauma she
has experienced limited her emotional coping skills which have resulted in outbursts until she is
physical restrained. At fifteen years old, it was documented she behaved like a twelve year old
and her mental functioning was similar to a seven year old. Her social development improved
greatly when Ms. Marks, her aunt, started visiting her. Beth has made significant improvements
in her ability to utilize people skills to make friends. The client has the ability to improve her
behavior with help and when she understands the goal. She achieved a 5 step behavioral
program which initially allowed her to move in with her aunt. Ms. Marks was unable to provide
the structure a group home can afford for Beth, so the clients behavior decrease rapidly while in
her home. Since being in her current placement, Beth discovered writing in her journal, listening
to music, or calling her aunt can help her calm down if she becomes frustrated. She enjoys
participating in outings to bowling alleys, roller skating rinks, and other recreational places in the
area with the friends she has made at the group home.

EVALUATION OF CLIENT

10

Beths independent living skills have improved over the years. She has participated in a
summer independent living skills training in 2014. Beth can maintain personal hygiene, write
and balance a checkbook, and cook small meals for herself. Although, to complete these tasks
consistently she needs constant reminders. Since Beth may be unable to completely care for
herself, she will receive financial assistance through Social Security Insurance (SSI).
Beths professional services from the foster care system have frequently not met a quality
standard of care. The issue of constant staff changes at the residential group homes have not
helped Beths mental state. She has attended numerous schools as she moved from one
placement to another. The client has been assigned ten different caseworkers in the seven years
she has been in care. The only professional Beth has been afforded services on a consistent basis
is the LGAL. Thankfully, the LGAL cares passionately about the well-being of Beth and has
advocated for her on many occasions.
Theoretical Framework
The three different theories which can be applied to Beths assessment are the social
exchange theory, cognitive theory, and systems theory. An important aspect of the social
exchange theory is the ability to form and develop healthy relationships with others (Paat, 2013).
During Beths early formative years, her family did not provide her with an environment suitable
to create wholesome relationships. Her fathers substance abuse problem often resulted in
physical altercations with her mother. Her father was also convicted of sexually molesting her.
Her constant mental issues prevented her from forming healthy relationship with her sisters. The
only family member Beth has been able to form a partial healthy relationship with is her aunt,
Ms. Marks. However, due to Beths mental instability, the relationship is not consistently strong.

EVALUATION OF CLIENT

11

Cognitive theory explains a person will define their experience in the environment by the
way that person processes the world around them. (Reid-Cunningham & Fleming, 2009).
Throughout Beths assessment, it was noted she was cognitively impaired. Beth did not develop
a healthy mental state properly due to the hostile environment she was born in and then the years
she has continued to spend in the foster care system without achieving permanency. She is
approximately 9-10 years behind educationally and emotionally she exhibits behavior similar to
someone half her age.
System theory attempts to explain human behavior through diverse systems (ReidCunningham & Fleming, 2009). Since Beth entered the foster care system, she has had difficulty
controlling her physical and mental behavior when she interacted with others. The foster care
system made efforts to keep Beth in a household like setting with foster parents; however, the
environment was not structured enough for her. The client was move to a residential group
home setting and she will likely have to live in that type of location her whole life due to her
mental state. Beth enjoys participating in activities within her community.
Intervention
Beths goals are living with her aunt, visiting with her siblings again, and obtaining a
high school certificate. The caseworker is aware that Beth would like to move in with her aunt
again; however, the aunt is unwillingly to allow Beth to move in due to the Beths previous
behavior in her home. Since the clients current placement is over two hours away from the
aunts home, she would like Beth moved to a residential group home closer to her so she can
visit more frequently.
Beth has shared the desire to see her siblings. The siblings adoptive homes are in closer
proximity to the aunts home. The aunt has their contact information and is willing to arrange the

EVALUATION OF CLIENT

12

visit once the caseworker informs her to do so. Beths behavior has been more stable recently, so
she may be able to emotionally handle a visit with her siblings. If an adult group home can be
located near the aunt, the caseworker and aunt can arrange a visit with the siblings.
A foster childs sibling can be a necessary source of emotional support in their lives
(James, Monn, Palinkas, & Leslie, 2008). At a Foster Care Review Board meeting, the
caseworker is asked if the foster child has any siblings and if so, when does the child visit with
them because child welfare laws and policies require the organization to collect data on sibling
placement and visitation information. At Beths review meeting, she was able to share with the
review board members how much she misses her siblings and how important it is to her to see
them again.
While the caseworker searches for an adult foster care home, she must also consider the
education availability for Beth. The clients current school will provide her with a certificate.
However, if Beth moves near her aunts home, a school will need to be identified that will
provide Beth with a certificate. For Beth to earn the high school certificate, she needs to be in a
program with teachers trained in special education. The program will also need to give her more
time to complete the educational material. Schools with special education programs should offer
effective professional development for their teachers (Stephenson, Carter, & Arthur-Kelly,
2011). At the review board meeting, a board member informed the caseworker about a school
located near the aunts residence which will provide similar education services as the school
Beth currently attends. The caseworker will be inquiring about the resource.
Research shows that youth aging out of the foster care system with various mental health
issue can have negative outcomes. Homelessness may be an issue because many aged out youth
are burdened with challenges and support services are essential to their survival (Gardner, 2008).

EVALUATION OF CLIENT

13

Realizing the importance of human relationships, the caseworker is looking for an appropriate
adult foster care home near the aunts home. An additional organization will be utilized in the
transition to provide wraparound services. Wraparound services insure the client receives all the
services he/she needs in a situation. Even though, Beth has a history of physical outbursts and
other mental health issues, the caseworker needs to consider her dignity and worth as she
diligently searches for a place suitable for Beth to live throughout her adulthood. Case
management will be provided to Beth in the adult foster care home and Beths aunt can be
named as her guardian to handle financial matters.
Ethical Dilemmas
Beths mental health history leaves her more vulnerable to situations in her life becoming
ethical dilemmas. As stated before, Beth has been restrained due to her physical outbursts on
several occasions. The restraining occurs to stop Beth from harming herself or others. The
dilemma is how long should she be restrained and what are the specific reasons that make
restraining her justified. Is there a specific protocol to follow in a youth or adult residential group
home? Who makes the decision to restrain her? When trying to prevent her from committing
self-harm, it would be unethical for her to be harmed.
Another potential ethical dilemma could arise while the caseworker searches for a new
placement for Beth. If caseworker makes arrangements for Beth to move to an adult foster care
owned by a personal friend because the caseworker is assured that the facility will meet all of
Beths needs. Then the caseworker is informed a month after Beths transition to this place by
the aunt that Beth is not receiving the services she needs at the adult foster care home. Due to the
relationship with the owner, the caseworker may have difficulty addressing Beths needs
efficiently.

EVALUATION OF CLIENT

14

There are many youth in the foster care system who have stories similar to Beths life. It
is important for social workers and other professionals to strive to achieve social justice for these
children who have experienced numerous placements by several caseworkers. Every child
deserves to be in a permanent, loving environment whether it is through reunification with their
biological parents or through adoptive parents. However, some children have been so
traumatized their mental health issues will keep them institutionalized their entire life.

EVALUATION OF CLIENT

15
References

Gardner, D. (2008). Youth Aging Out of Foster Care: Identifying Strageties and Best Practices.
National Association of Counties-The Voice of America's Counties, 3-8.
James, S., Monn, A., Palinkas, L., & Leslie, L. (2008). Maintaining sibling relationships for
children in foster and adoptive placements. Children and Youth Services Review, 90-106.
Lehmann, S., Havik, O., Havik, T., & Heiervang, E. (2013). Mental Disorders in Foster
Children: A Study of Prevalence, Comorbidity and Risk Factors. Child and Adolescent
Psychiatry and Mental Health, 1-12.
National Association of Social Workers. (2008). Code of Ethics of The National Association of
Social Workers. Retrieved from Social Work:
http://www.socialworkers.org/pubs/code/code.asp
Paat, Y.-F. (2013). Relationship Dynamics and Healthy Exchange across the Family Life Cycle:
Implications for Practice. Journal of Human Behavior in the Social Environment, 938953.
Reid-Cunningham, A. R., & Fleming, V. (2009). Theories of Disability: Findings From an
Analysis of Textbooks on Human Behavior and the Social Environment. Journal of
Human Behavior in the Social Environment, 10-25.
Stephenson, J., Carter, M., & Arthur-Kelly, M. (2011). Professional Learning for Teachers
Without Special Education Qualifications Working With Students With Severe
Disabilities. Teacher Education and Special Education, 7-20.