Background Information
You are a clinical social work practitioner for a children’s mental health agency in a large metropolitan area in the Midwest. You have a meeting scheduled with Sue and Don regarding their 6-yearold daughter, Megan.
Intake Information
Sue, age 33, called to make the appointment due to her escalating concerns about Megan’s inability to attend school because of constant headaches and stomachaches. She told the intake worker that the pediatrician had seen Megan on three occasions in the past 8 weeks and could find no evidence of illness. The physician had given her a referral to the Child Guidance Center. The intake worker suggested that, if possible, Megan’s father, Don, should attend the initial interview along with Sue.
Initial Interview
You meet Sue and Don in the waiting room of the agency. Both look anxious and are sitting on the edges of their seats. When you introduce yourself, they both jump up immediately and hurriedly walk down the hall to your office with you. When they sit down in your office, they are still sitting on the edges of their seats, clutching the armrests of their chairs, and tapping their feet on the floor. You note their anxious expressions and behaviors as you begin the initial interview. “I’m glad you could make the appointment today. You both look like you might have a lot on your minds, but before we begin, let me tell you a little bit about the agency and what I do here. The Child Guidance Center is a nonprofit, United Way agency that runs on a sliding-scale fee system, which means that the fee you pay for the services we provide here is based on your income. There is someone here who will talk to you more about that when we are finished here today. We have several programs at this agency, and I’m involved with the Counseling Program. We also have a Big Brothers/ Big Sisters Program and a Domestic Violence Program. Do you have any questions so far?” Both Sue and Don shake their heads indicating “no.” “Great. I want to find out what brought you to the agency today, but first I want to explain to you that everything we talk about here is confidential. I will not share any of the information we discuss today with anyone other than my supervisor, with two exceptions: If you tell me you are going to hurt yourself, I have to tell someone about that; or if you tell me you are going to hurt anyone else, I have to report that also. If I need to talk with anyone else, like a physician or the school, I will get your permission to do that before moving forward. Is all of this information clear to both of you?” you ask. Sue and Don both say, “Yes.”
“Good. I understand that you have some concerns about your 6-year-old daughter, Megan. Can you tell me what’s been going on with her?” Sue begins, “Well, Megan is a very sweet child. She has always been our angel and has never caused any problems out of the ordinary for us. She is really very bright and has already learned the alphabet and is beginning to read a little, like easy reading books. She also is mesmerized by the computer and has learned her numbers and beginning addition with the computer games. She loved kindergarten last year. We sent her to our church kindergarten, and she really seemed to enjoy being with the other kids and learning new things. But this year has been a completely different story.” “What’s happened this year?” you ask. “She’s started first grade, I assume.” “Oh yes, she started in August, so it’s been about 3 months now, and she was doing fine the first week.” Sue rolls her eyes and rubs her forehead. “And then what happened?” you prompt. “Well, on the Monday morning of the second week of school, she woke up and said her stomach hurt. I suggested maybe she was hungry and would feel better after breakfast. She got up and ate breakfast, and the minute she finished she said her stomach hurt even more. I suggested she go get dressed for school and see if she didn’t feel better, and she burst into tears and said she had a stomachache and she felt terrible and she couldn’t get dressed. She threw a regular tantrum, and so I decided she must really be sick and told her that maybe she needed to get back in bed and stay home that day. She immediately stopped crying and went to her bedroom and climbed into bed. Since this just isn’t how she usually acts, I thought she must really not be feeling well.
So, she stayed in bed all morning and watched TV, and by lunch time she was feeling much better. She got up and helped me around the house and played all afternoon. Then she ate a good dinner. And I thought everything was okay. But the next
morning the same thing happened. She started complaining about her stomach hurting as soon as she got up and started screaming when I said I thought she’d be okay at school, although I told her if she wasn’t, she could have the teacher call me.” “She stayed home the second day?” you ask. “Yes, and the third day, and that’s when I made an appointment at the doctor’s office.” You ask Don what his thoughts and feelings were regarding Megan’s stomachaches. “Well, I didn’t know what to think. Maybe she was really sick. Maybe she got food poisoning or something. I agreed with Sue that Megan needed to go to the doctor, but the doctor said he couldn’t find anything wrong. The next day after seeing the doctor, we really pushed her to go to school. Sue was going to take her in the car, and Megan got as far as the front door of the school and began crying hysterically, saying she had a bad stomachache again. Sue didn’t have much choice but to take her home. But now things are out of control. Megan has been home for 8 weeks and to the doctor three times, and he says there’s nothing physically wrong with her. He says he thinks there is something psychological going on and we need to come here. I don’t know; maybe we need to take her to a specialist,” Don replies. You ask Sue if she agrees with her husband’s perspective on things. “Yes, he’s got it right except he’s not home when she suddenly gets better every afternoon and is ready to go outside and play. I’m so frustrated and confused by all of this I don’t know what to do anymore. And, in the meantime, she’s missing all this school.”
1. Write a short summary of the presenting problem.
Q