Client Name: Sarah Cisneros
Age: 7 years old
Ethnicity: Hispanic
Educational Level: Second grade
Sarah Cisneros is a 7-year-old Hispanic female who has just started the second grade at Hutto
Elementary School. She is a friendly and engaging child, although she has had numerous
problems at school. Last year, the teacher reported that Sarah had difficulty following
directions and staying in her seat and talked incessantly. She often got into disagreements with
other children on the playground when she couldn’t seem to follow the rules of a game they
were playing. Her teacher also stated that she had difficulty learning the alphabet and writing
letters and numbers. Sarah often reversed words, saying “tac” instead of “cat” and “kool”
instead of “look.” Although she had a difficult time in first grade, her teacher felt that Sarah was
just an active child who would “settle down” when she entered second grade.
At the beginning of second grade, Sarah’s parents separated. Sarah stayed with her mother,
Regina, age 27. Regina moved back to Sarah’s grandmother’s home and went to work as an
administrative assistant at a law firm in town. Sarah’s father, Don, age 32, moved in with a
girlfriend he had been seeing for several months prior to the separation. Don travels extensively
in his job as an international computer sales representative. He is often out of the country for
3–4 weeks at a time. Sarah told her grandmother, “My heart won’t hurt anymore when my
daddy comes back to live with me.” Regina and Don have told Sarah that they are just living in
separate places for a little while.
When Regina discovered that Don was seeing another woman, she became very angry and de-
pressed. She began working overtime, sometimes 12 hours a day, as a way of coping with the
upheaval in her marriage. Sarah often sees her mother only early in the morning when Sarah is
getting ready for school. Sarah’s grandmother takes care of her after school. She complains to
Regina that Sarah is “headstrong” and “can’t seem to follow directions.” She also tells Regina
that if Sarah were given a good spanking she would “straighten up.”
Regina just doesn’t feel she has the energy to deal with Sarah’s behavior and told her mother,
“I just can’t deal with everything, Mom. You need to help me with the discipline. I can’t be
mother and father, hold down a job, and deal with Don. It’s just too much for me right now.”
Regina’s mother told Sarah that if she didn’t follow directions, she would get a spanking. Sarah
screamed, “If my Daddy was here, he’d give you a spanking,” and ran to her room, slamming
the door.
Regina decided to enroll Sarah in Brownie Scouts for one afternoon a week after school. The
Brownie Scout leader is a friend of Regina’s who lives down the street and said she’d bring
Sarah home after the Scout meeting. Although Sarah was very excited about being a Brownie,
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she had difficulty getting along with the other girls. She couldn’t sit quietly and work on
projects; she often interrupted the leader with silly outbursts; she got bored easily and began
running around the room; and she disrupted the meetings with her constant chatter.
After several weeks, the Brownie leader called Regina and told her that perhaps Sarah needs
another year before she’s mature enough to be in Brownie Scouts. Regina was so frustrated
that when she got home from work, she screamed at Sarah, gave her a spanking, and sent her
to her room. Sarah slammed her door and began throwing all her toys off the shelves. She
screamed for 2 hours until she was so exhausted that she lay down on the floor and went to
sleep.
After this incident, Regina, feeling very guilty, sought the advice of the counselor at school. The
counselor suggested that Sarah may need an out- let for all her energy—something that
involves physical activity. Regina decided to enroll Sarah in a ballet class on Saturday
mornings at the local dance company. Once again, Sarah was very excited about being in the
ballet class. She went shopping with Regina and bought a pink leotard with matching ballet
slippers. Sarah danced around the house all day in her leotard in anticipation of the class.
Unfortunately, when Sarah began the dance lessons, the ballet teacher had the same
complaints the Brownie leader had about Sarah’s inability to follow directions and pay
attention in the class. Regina felt at her wit’s end about what to do next. She called Don and
told him the problems she has been having with Sarah, and he told her, “You just let her get
away with murder. When I was that age and I didn’t obey my parents, I got a whipping and it
never happened again. I’ll take her for a weekend and teach her a lesson or two.”
Regina angrily told him, “Don’t bother,” and hung up the phone.
Initial Interview with Regina (Client’s Mother)
Late one night shortly after this altercation with her husband, Regina was sitting by herself in
the living room of the dark house watching the news on television. During a public
announcement commercial for a Fun Run, she noticed that one of the sponsors was the Family
Mental Health Center, a private nonprofit organization. Regina wrote down the phone number,
and the next day at work, she made an appointment to go talk to a counselor about Sarah. The
intake worker told Regina that the counselor would like to talk to Regina at the first
appointment before she brought Sarah to the agency.
The counselor introduces herself as Peggy Ross, a clinical social work practitioner who works
with children and families. Peggy tells Regina about the agency and what her role as a
counselor is. Regina tells Peggy about the problems she has been having with Sarah since her
separation from her husband. She states that she just can’t do anything with Sarah anymore
and she just doesn’t know what to do. She states that it is difficult living with her mother;
however, her mother does provide child-care so that Regina can work.
Peggy asks Regina whether the behaviors that Sarah has been displaying are new behaviors or
ones that were present before the separation. “Come to think of it,” says Regina, “Sarah has
had trouble ever since she started school. Even in kindergarten, she didn’t seem to listen to the
teacher. She’s not a dumb child. In fact, I think she’s very smart, above average. But when it
comes to completing her homework, she’s a mess. She loses things she needs for
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assignments. She seems completely disorganized; she spreads all her stuff around and then
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can’t find anything. She’s always excited when she starts projects, but then it’s like pulling
teeth to get her to finish.”
Peggy asks Regina about her and Don’s child- hood experiences. Although Regina doesn’t
know why that’s important, she tells Peggy that she had no problems in school and, in fact,
excelled in all her classes. “I was a classic good little girl. I knew if I wasn’t, I’d get in big
trouble at home,” Regina told the counselor.
Peggy asked about Don’s childhood experiences. Regina stated that Don’s experience was
very different. He was constantly getting into trouble and was very active as a little boy. He
once told Regina that he was considered the “class clown” all through elementary school.
Although he at- tempted a variety of sports, he was never very good at anything except soccer.
He said he could run longer than most kids his age. He was a skinny, high-strung child. Regina
tells the counselor that Don recently told her that he got whipped all the time for his bad
behavior. She says that she doesn’t really think spanking helps Sarah. She relates the incident
of the night she spanked Sarah out of frustration and the tantrum that Sarah threw afterward.
After obtaining information about Regina, Don, and Sarah’s present difficulties, Peggy
suggests that Regina bring Sarah with her for the next interview. She states that she has some
ideas about what is going on with Sarah but would like to talk with her before making any
assessment. In the mean- time, she gives Regina a form to fill out on Sarah’s behavior as she
observes it over the next week. She also asks her to sign a form giving Peggy permission to
talk to Sarah’s teacher at school. The following week, Regina brings Sarah to the agency to
talk with Peggy.
Interview with Sarah (Client)
Peggy meets Sarah in the waiting room of the agency. She readily goes with Peggy to her
office. Peggy gives Sarah a few choices of some things they can do together while they talk,
including drawing, puppets, and a board game. Sarah has a hard time deciding what to do and
after making a choice, she quickly grows bored with drawing a picture and wants to do
something else.
When Peggy suggests they can do something else once they have finished their pictures,
Sarah gets irritable and keeps jumping up from the table and wandering around the room. She
says that she has lots of friends at school. She likes recreation time the best because she likes
to jump rope. She also tells Peggy that she doesn’t like her teacher, who is always mean to
her. When Peggy asks her why she is mean, Sarah states, “She makes me sit in my chair and
do my letters over and over again. It’s boring.”
While Sarah is easy to engage, she talks constantly and has difficulty focusing her attention on
any one task. She wants to play with all the items on Peggy’s desk, and when Peggy says she
can’t play with those things, Sarah stomps her feet and says, “If my daddy were here, he’d let
me.” Peggy feels very tired after 30 minutes with Sarah.
Peggy invites Don to come in for an interview, but Don states that he has to be out of town for
a month and thinks that the problem is simply Regina’s problem with lack of discipline with
Sarah. Peggy tells Don that she’ll call him when he
1.How would you describe the presenting problem? Identify specific “symptoms” (or
signs/markers that indicate a problem in behavior).
2.What are some of the psychosocial issues facing Sarah?
3.What resources might be available to help Sarah and her family (e.g., counseling
options)?
4.What diagnosis would you give Sarah? Choose between one of the following:
Intellectual Disability, Attention-Deficit/Hyperactivity Disorder (ADHD), or Autism
Spectrum Disorder. Explain your choice.
5. What are some of the strengths of this family
6List the cultural factors that you would take into consideration when working with this
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