What intake information should be obtained and assessed to formulate a provisional DSM-5 diagnosis?
This week, you will be assessed on the use of diagnosis, assessment, and intervention in a multiple-choice final exam. This exam is modeled in the National Clinical Mental Health Counseling Exam (NCMHCE) format that is used in many states as their licensure exam and for the Certified Clinical Mental Health Counselor (CCMHC) national certification. As opposed to other exams where you are asked to recall specific facts, this exam is based on case scenarios where you will apply your clinical problem-solving ability to assess, diagnose, and treat crisis and trauma situations. You will focus on identifying “the best answer”—as opposed to the “correct” answer. This means that each question contains more than one correct answer, but only one answer is the best. As “best answer” exams require a great deal of discernment, be sure to read each question carefully, look for the correct answers, and then discern the “best” answer. Taking a comprehensive exam in this format will pay off in the end when you sit for the NCMHCE in the future. .
QUESTION 1
1. Case #1 – Jenna
Jenna is a six-year-old Caucasian female who currently resides with her foster parents, her older biological sister, and two foster brothers. Jenna and her siblings were taken from her biological parents because of suspected sexual abuse and neglect. It is reported that Jenna lived in a home without food, water, and utilities. Jenna’s foster parents report that her biological mother “may have some disabilities and has never had the financial means to take care of her children.” Jenna’s biological brother is in a separate foster home. He is suspected of sexually abusing both Jenna and her older sister. It has been reported that he sexually abused Jenna, while her sister was helplessly told to watch. Jenna has expressed this trauma with agitated behavior. The traumatic event is re-experienced by repetitive play where she stimulates herself on furniture. Jenna avoids the stimuli associated with the trauma by avoiding conversations associated with sexual abuse. Jenna avoids activities, places, and people associated with the trauma except for her sister who was also a victim. Jenna also has a sense of a foreshortened future. She frequently brings up death with her foster parents. Jenna has persistent symptoms of increased arousal that were not present before the trauma as indicated by irritability and outbursts of anger nearly every day with her biological sister and her foster father. Jenna is also hyper vigilant and does not want her foster father around. The disturbances have lasted for over a month and have caused clinically significant social impairment to the point she is unable to attend a full day of school due to emotional breakdowns.
1) What intake information should be obtained and assessed to formulate a provisional DSM-5 diagnosis? Select AS MANY as you consider essential.
a.
History of learning disabilities.
b.
Length of time problematic behaviors have persisted.
c.
Changes in sleeping patterns.
d.
Substance use.
e.
Attention problems.
f.
Details of sexual trauma.
g.
Hypervigilance or increased arousal.
2 points
QUESTION 2
1. What assessment tools might offer meaningful information on this client? Select the ONE most appropriate option. (Refer to Case #1)
a.
Beck Anxiety Inventory
b.
Attachment Questionnaire for Children (AQC)
c.
Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA)
d.
Child and Adolescent Needs and Strengths (CANS)
2 points
QUESTION 3
1. Based on the available information, what would appear to be the most appropriate provisional DSM-5 diagnosis? Select the ONEmost appropriate primary diagnosis. (Refer to Case #1)
a.
Disruptive Mood Dysregulation Disorder (296.99)
b.
Postttraumatic Stress Disorder (309.81)
c.
Acute Stress Disorder (308.3)
d.
Adjustment Disorder with Mixed Disturbance of Emotions and Conduct (309.4)
2 points
QUESTION 4
1. Based on the provisional diagnosis, what interventions might work best as you begin to work with this client? Select AS MANY as you consider indicated. (Refer to Case #1)
a.
Group Therapy
b.
Behavioral Rehearsal
c.
Grounding Techniques
d.
Play Therapy
e.
Flooding Techniques
f.
Medical Referral for Anxiety Medication
g.
Assertiveness Training
2 points
QUESTION 5
1. In developing a collaborative treatment plan with the client, identify immediate goals to be addressed. Select AS MANY as you consider correct and necessary. (Refer to Case #1)
a.
Reunification with Biological Family
b.
Addressing Sexualized Behaviors
c.
Increasing Emotional Regulation
d.
Preventing Revictimization
e.
Reenactment of Traumatic Events
2 points
QUESTION 6
1. Case #2 – Morgan
Morgan is staying at a local shelter after she experienced a natural disaster that destroyed her home three days ago. She is a 25-year-old lesbian female who was living with her partner. She has a flat affect and makes no eye contact as she talks about having to vacate her home in the middle of the night as the waters were filling her condo. Her partner did not make it out and drowned in the storm. She has not made contact with any of her other relatives who she says she has been distant from for “many years.” She mentions that before the storm she was taking “some meds to help with my moods” but is not sure of the medication name. Since she arrived at the shelter, she has laid in her cot, not taken any showers, eaten very little food, and avoided any contact with shelter workers or other families. She has a significant startle response when approached and has difficulty remembering basic information. She cries herself to sleep and has moments where she screams out at night after having “nightmares about drowning.”
What intake information should be obtained and assessed to formulate a provisional DSM-5 diagnosis? Select AS MANY as you consider important.
a.
Substance abuse history
b.
Medical history
c.
Educational history
d.
Military history
e.
Quality of family relationships
f.
Psychiatric history
g.
Employment history
h.
Threat to self or others
2 points
QUESTION 7
1. What assessment tools might offer meaningful information on this client? Select the ONE most appropriate option for your work while she is at the shelter. (Refer to Case #2)
a.
Beck Depression Inventory
b.
Inventory of Complicated Grief
c.
Triage Assessment Form
d.
The Behavioral Assessment Rating Scales
2 points
QUESTION 8
1. Based on the available information, what is the most appropriate provisional DSM-5 diagnosis? Select the ONE most appropriate primary diagnosis. (Refer to Case #2)
a.
Major Depressive Disorder, Single episode, Mild (296.21)
b.
Posttraumatic Stress Disorder (309.81)
c.
Generalized Anxiety Disorder (300.02)
d.
Acute Stress Disorder (308.3)
e.
Adjustment Disorder with Depressed Mood (309.3)
2 points
QUESTION 9
1. Based on the intake data, identify immediate potential issues to be addressed as a crisis counselor while the client is in the shelter. Select AS MANY as are correct and necessary. (Refer to Case #2)
a.
Hygiene
b.
Impulse Control
c.
Family Relationships
d.
Housing
e.
Suicidality
f.
Medication compliance
g.
Employment issues
h.
Stress management
2 points
QUESTION 10
1. Based on the provisional diagnosis, what theories or models will likely work best for the client? Select AS MANY as you consider correct and appropriate in working with the client while she is at the shelter. (Refer to Case #2)
a.
Group Therapy
b.
Psychological First Aid
c.
Existential Therapy
d.
Grief Therapy
e.
Maslow’s Hierarchy of Needs
2 points
QUESTION 11
1. Case #3 – Bob
Bob is a 45 year old African American man. He was recently medically discharged from the US Navy due to extensive injuries he sustained during his last time in combat. He is separated from his wife and has two teenage children. He has a prescription for an opioid pain medication and discloses that he has been engaging in daily marijuana use and drinks about 5-6 beers a day “to cope.” He has an extensive history of childhood physical and emotional trauma. His mother was alcoholic and his father was physically abusive to him and his siblings. He says that he is struggling over the past few months with “what could have been” if he was not so “damaged.” He sounds very agitated, stating that the pain is unbearable and he “can’t stand it anymore.” He mentions that he might be better off dead.
Based on the available information, what would appear to be the most appropriate provisional DSM-5 diagnosis? Select the ONEmost appropriate.
a.
Adjustment Disorder with Mixed Disturbance of Emotions and Conduct (309.4)
b.
Substance-Induced Anxiety Disorder (292.89)
c.
Posttraumatic Stress Disorder (309.81)
d.
Acute Stress Disorder (308.3)
e.
Generalized Anxiety Disorder (300.02)
2 points
QUESTION 12
1. To better determine the client’s current level of functioning and behavioral problems, what additional data may be helpful? Select AS MANY as are necessary. (Refer to Case #3)
a.
Collateral contact with the medical provider.
b.
Collateral contact with his spouse and children.
c.
Military record review.
d.
Substance abuse screening.
e.
Legal history review.
2 points
QUESTION 13
1. Which of the following risk factors are present in the case description? Select AS MANY as you consider indicated. (Refer to Case #3)
a.
History of previous attempts.
b.
Specific plan.
c.
History of drug and/or alcohol use.
d.
Cut off from others.
e.
Lack of belongingness.
f.
Feelings of helplessness.
g.
Financial loss.
h.
Access to firearms.
i.
Radical shifts in behaviors and mood.
2 points
QUESTION 14
1. Indicate the responses that would be most appropriate for addressing potential suicidal ideation. Select AS MANY as you consider correct. (Refer to Case#3)
a.
You say you are suicidal, but what’s really bothering you?
b.
You can tell me. I’m a professional and have been trained to be objective about these things.
c.
It seems like you’ve been suffering so much that hurting yourself seems like the only way you can make the pain go away.
d.
You have so much to live for, think about your wife and children.
e.
Tell me more about your suicidal feelings.
f.
You seem to be somewhat upset.
2 points
QUESTION 15
1. Based on the provisional diagnosis, what interventions and referrals might work best for the client? Select AS MANY as you consider indicated. (Refer to Case #3)
a.
Suicide Safety Plan
b.
Create a No Harm Contract
c.
Family Counseling
d.
Medication Review
e.
Cognitive Reframing
f.
Vocational / Job Training
