Chloe McGovern was referred to the pediatric headache clinic at a children’s hospital in a metropolitan area. Chloe was a 13-year-old, eighth-grade student with tension headaches of moderate intensity. The headaches began approximately 18 months ago and have gradually worsened, especially over the past 6 months. These headaches occurred approximately three times per week, with a duration of approximately one to three hours each. Over-the-counter medications (e.g., acetaminophen, ibuprofen) are generally effective in shortening their duration, but Chloe’s parents are worried given the headaches’ increasing frequency and severity.
A neurological examination revealed no apparent structural or functional abnormalities of Chloe’s nervous system. She appeared to be perfect except for her headaches. Consequently, Chloe and her family were referred to a pediatric psychologist at the clinic to explore psychosocial causes for her problem.
The psychologist, Dr. Witten, learned that the onset of Chloe’s headaches coincided with her transition to middle school. Chloe’s mother explained, “Chloe’s always been a perfectionist. She was in accelerated programs throughout elementary school: math, language arts, music. When she started middle school, she tested into the gifted program, meaning that she could skip seventh-grade classes and begin immediately to eighth-grade work for most subjects.” Her father added, “And she’s also a very good musician. They asked her to play for both the seventh- and eighth-grade orchestras. She plays the oboe, which is somewhat rare. Both orchestras needed her.”
Dr. Witten looked up from her notes, “And is all this work hard to manage, Chloe? I mean, you essentially skipped the seventh grade.”
Chloe answered, “Not really.” Then crossed her arms and remained silent.
Chloe’s mother elaborated, “Chloe’s a really hard worker. I drive her to school each morning a little early because she’s on the student council. She tries to do as much homework as possible during study hall. Then, after school, she has orchestra or archery practice. She also takes private oboe lessons twice a week.”
“That seems like a busy schedule,” commented Dr. Witten. Chloe remained silent.
Later, Dr. Witten interviewed Chloe privately. She said, “ Chloe, I know that you’re a good musician. I wonder if you’re a good artist, too. I want you to draw me a picture of yourself just when your headache is about to begin. Draw how you feel.” Reluctantly, Chloe sketched the image of a teenage girl with taut shoulders, stiff neck, bulging forehead and eyes, and a worried expression on her face. Dr. Witten responded, “That’s a really good picture. The girl looks so tense! I wonder what’s going through her mind right now.” Dr. Witten drew a bubble above the image of the girl and then asked, “Write some words that describe what she’s thinking.”
Chloe hesitated, reached for the pencil, paused again and then began writing. The words flowed from her, like water breaking through an old dam that was no longer able to bear the strain: math test, language arts presentation, student council service project, science fair, string ensemble, dad’s cholesterol, mom’s work schedule, friends, another headache, getting enough sleep, grandma’s sick . . .
“Do you think about these things before you have a headache?” asked Dr. Witten.
Chloe looked up from the paper, then answered, “I think about these things all of the time. There’s always something going on in my life, something to worry about. I tell myself, ‘Relax. Nobody else worries about things like you do.’ But it doesn’t do any good. I feel tense all the time. I can’t control it. It’s the worst at night before I fall asleep. All the things I need to do and should have done come to my mind and they don’t stop.”
Dr. Witten responded, “All the things that you’re good at, like school and music?”
“Right,” Chloe sighed. As a tear trickled down her cheek, she added, “That’s just it. I think that if I didn’t worry so much, you know—make sure I’ve planned for everything, I might not get good grades, or do well in my ensembles, or let my parents down.”
Pointing to her head, Dr. Witten replied, “You carry all this pressure up here.” Your problem is not the headaches, though—it’s that you think too much! I’d like to work with you to find a way to stop all that worrying. Would you like that?”
For the first time in a long time, Chloe smiled.
- What DSM-5 anxiety (or associated) disorder best describes Chloe’s behavior?
- How does Chloe meet DSM-5 criteria for this disorder?
- When do problems with worrying tend to emerge? Is Chloe’s age on onset developmentally atypical?
- Chloe seems to worry about mundane things: school, extracurricular activities, family. How does the worrying of children with anxiety disorders differ from the worrying of typically developing children?
- Chloe seems to be a high-achieving girl who is rather mature for her age. Is this typical of children with anxiety disorders?
- Based on the results of longitudinal studies, what disorder is Chloe at particular risk for developing as she enters later adolescence and early adulthood?
- How can cognitive avoidance theory be used to explain Chloe’s problem with chronic worrying?
- If you were Chloe’s clinician, what evidence-based psychotherapies or pharmacological interventions might you recommend? Discuss the Child/Adolescent Anxiety Multimodal Study. Discuss medication management for anxiety in children and adolescents. You must use the Klykylo book to discuss medications. Outside sources not acceptable.
Presentation This paper will think of some as parts of client and carer cooperation in principle and practice in connection to the instance of a seventy multi year elderly person named Harold. Distinctive Levels of Service User Participation Administration client investment is a basic piece of social work practice and comes from the idea of the strengthening of administration users. This reaches from meeting on an individual level… to client control and administration of administrations (Carr, 2005, p.14). Administration client support is a rule that is regularly hard to try, albeit new activities, for example, Direct Payments which permit benefit clients to pick and pay for the administrations they need go some approach to lightening this, on account of a man, for example, Harold, who has complex needs, this isn't constantly clear. There are control suggestions in the connection between administration clients and social work experts, and this makes it hard for administration clients to know whether their worries are being taken seriously. This is significantly more risky in circumstances where the individual concerned does not seem to have any enthusiasm for the end result for them and this is talked about without reference to the administration client as has all the earmarks of being occurring with Harold. Harold has told his children that he can't be tried to get washed or cook a dinner… The children have as of late talked with the day focus supervisor about their worries in regards to their dad… he is investing the vast majority of his energy in bed, and he isn't eating routinely… he now and again is by all accounts marginally confounded and inaccessible. It is hard to evaluate how far client cooperation may apply to Harold under these conditions he never again needs to go to the day focus and isn't taking care of himself so it is hard to know whether he would have the capacity to be required at any genuine level in an appraisal of his needs. This case provides a situation for social laborers from one perspective they have an obligation of consideration, and furthermore as far as moral practice, to consider what the administration client really needs for him/herself. Administration client interest regularly happens in gatherings with the goal that the administration client does not feel overpowered by expert contribution, but rather this does not appear to be an alternative for Harold's situation. He in some cases gets befuddled and he likewise likes to be alone. On the off chance that, then again, the day focus supervisor and alternate experts (social laborer, a Physiotherapist, Occupational Therapist, and a Community Psychiatric Nurse) required with Harold take excessively notice of the children then they could be tending to their necessities instead of Harold's and it is hard to perceive what level of administration client support would be relevant for Harold's situation. An Approach to Service User Empowerment Harold does not protest individuals going to the house and maybe client cooperation for Harold may best be accomplished through the administrations of a supporter who could show Harold's perspectives in the best light. As a gathering more established individuals can be distraught and usually overlooked that they are individuals who are as qualified for be treated with deference and thought as are different gatherings. Since the 1960s there has been a developing development in Britain which has come to be known as backing. Support includes talking for the benefit of somebody, it is an endeavor to empower and engage individuals who may some way or another be impeded. A backer is there to advance the interests and perspectives of the individual they are representing. Dunning (2005) keeps up that there are various stages in individuals' lives (especially those of more seasoned individuals) when support ought to be a necessity, and particularly if there is: ..a decrease in physical and emotional wellness, tactile weakness and the requirement for wellbeing and social administrations (Dunning, 2005, p.10). This is a reasonable portrayal of how things are for Harold's situation, he loses his way around the nearby shops and his GP has as of late analyzed that Harold has Parkinson's Disease. Harold is winding up progressively separated from reality he goes about just as his dead spouse is still in the house with him and is uninformed of the expert concern and thought about association for his situation. Under these conditions it would appear to be certain that Harold need somebody who will act to his greatest advantage and talk for his sake in the event that he is to have any authority over his own future. A backer would, ideally, have the capacity to set up what Harold ought to request and what he may be qualified for regarding administrations and support. Regardless of whether Harold would be enabled by recognizing what is on offer is hard to survey as a result of his inclination to wind up confounded, yet a promoter could put forth a defense for the way that Harold needs to remain in his own home and this would reduce any apprehensions he has of private consideration. Quinn (2003) is of the supposition that data and promotion are themselves benefits and can be the building squares of … empowering more established individuals to get the administrations they require (Quinn, 2003, p.3). The group made reference to above have every single got referral for Harold, a promoter would attempt to inspire what Harold extremely needed and pass on this to the group with the goal that his desires are made referred to, and quite far, cooked for. Along these lines a backer would give Harold a voice and in this way engage him. Variables that Promote and Limit Service User Involvement in Decision Making Continuous discussion on the necessities and privileges of more established individuals feature the way that while there has been a move to guarantee person's rights to uniformity of administration, more seasoned individuals may even now confront segregation. Under these conditions it is imperative that components identifying with power awkward nature between administration clients and experts be recognized. It is just with this affirmation that the gatherings would then be able to cooperate to at any rate decrease those variables that add to the underestimation and rejection of some administration clients (Carr, 2004). These variables may incorporate an inclination of a few experts to disregard benefit clients sees or to in any event confuse them so that as opposed to being empowered administration client interest can result in administration clients feeling further impaired. Institutional boundaries should be survived, as completes a proceeding with utilization of expert language which can likewise serve to avoid benefit clients from the basic leadership process. Carr's (2004) look into found that administration clients frequently refered to dialect holes as a weakening and exclusionary factor, notwithstanding, when this was uncovered most experts were glad to attempt to change their dialect with the end goal to empower more prominent administration client cooperation. Research has a tendency to recommend, and Harold's circumstance is a for example, that more prominent and more powerful administration client support can't be accomplished unitarily. There is a requirement for various models and levels of cooperation relying upon the administration client's conditions. Some administration clients will be so enabled by investment that they will proceed to be engaged with how benefits are conveyed, still others are not ready to be really required at any unmistakable level without the intercession of a third individual. Along these lines promotion is an essential component of lower levels of administration client investment. A backer can enable individuals in Harold's circumstance since administration clients will then have somebody who is fair-minded, who can educate them with respect to what is accessible as far as administrations and support and who will advance their best advantages among different experts and ensure that their desires are made known. Harold, for instance wishes to stay in his very own home, he wouldn't like to go to multi day focus, neither does he need to go into private consideration. Carr (2004) takes note of that the administration client development has been instrumental in advancing the privileges of individuals' qualification to as conventional lifestyle as is conceivable. Working with Service Users and Carers in an Ethical and Anti-Oppressive Manner Society frequently sees elderly individuals starting at little utilize in light of the fact that they never again add to society similarly as when they were more youthful and in the meantime they are more prominent customers of wellbeing and welfare administrations (Moore, 2002). Unmistakably it isn't in every case simple working with more established individuals since they may have various and complex needs, in any case under the 1998 Human Rights Act, they are qualified for be treated with nobility and nearby specialists have an obligation to submit to the prerequisites of this Act. Any move to constrain a man like Harold to go to multi day focus when he unmistakably does not have any desire to is apparently not great practice. With the end goal to manage a man like Harold in a moral and hostile to harsh way it is essential that he is tuned in to. On the off chance that his disarray makes this troublesome of course, this is the place the administrations of a supporter could assume an indispensable job. A backer would have the capacity to see that Harold's voice was heard they would likewise have the capacity to express the worries of his family. Harold may not know how concerned his children are, he should be educated of their worries however this does not imply that their anxiety for him should overshadow his own longing not to go to day focuses or to go into private consideration. The experts required with Harold ought not be convinced by the contentions of his family since this could result in harsh practice. Hostile to severe and moral practice needs to consider the rights and needs of the administration client as preceding the worries of those near him. Moral and viable social work ought to include an intensive appraisal of Harold's needs and a consideration bundle that considers his wellbeing and his desires. It ought to be custom-made to suit his individual needs and there ought to be space for changes and modifications if the consideration bundle isn't to wind up an inconvenience (Kerr et al, 2005). Where a man isn't completely cognisant of what is going on then enemy of abusive practice ought to include the utilization of an altogether free supporter. This would be advisable.>GET ANSWER